Intravenous drug use is a major risk factor for infection with the human immunodeficiency virus (HIV), which is the etiological agent for the acquired immune deficiency syndrome (AIDS). In addition, intravenous drug users (IVDUS) are involved in the majority of cases of perinatal or heterosexual HIV transmission. The purpose of this project is to establish a Drug Abuse Treatment Research Unit (TRU) that will conduct multifaceted clinical research aimed at improving treatments for intravenous drug abuse and at reducing the spread of HIV infection and AIDS. A collaborative program of research involving the Department of Psychiatry, the Department of Medicine, and the Department of Obstetrics and Gynecology will be pursued. The TRU will serve as a central resource for developing and enhancing drug abuse treatment, drug abuse research, and drug abuse education and training capabilities throughout the institution. The focus of TRU research activity will be on the behavioral pharmacology and clinical pharmacology of drug abuse treatment. The TRU will consist of a core component and four scientific components: (1) a new 150-census multimodality outpatient drug abuse treatment research clinic; (2) a 6-bed residential treatment research laboratory; (3) a 2-bed medical inpatient trealmetit research unit-, and (4) an HIV service component for HIV risk assessment and behavior change interventions. Additionally, it will be supported by a variety of specialized medical will behavioral/psychiatric services directed toward the unique needs of the drug abuse patient population. 'Me TRU components will function as central shared resources that will be utilized by a variety of investigators. Specific domains of proposed treatment research include: behavioral and pharmacological treatment of cocaine abuse; buprenorphine treatment of opioid abuse; contingency management to reduce IV drug use; treatment of drug abusers with concurrent psychiatric disorders; HIV testing, counseling and education of male and female drug abusers and of their sexual partners; and pa- ient-treatment matching. Rigorous, well-controlled experimental designs and procedures will be used, involving randomization and double-blinding where appropriate. Studies wiU include controlled laboratory experiments as well as clinical trials and longitudinal outcome assessment. The TRU will be established on the campus of the Francis Scott Key Medical Center/Johns Hopkins Medical School in Baltimore, where it will be adjacent to a large and productive complement of faculty dedicated to drug abuse treatment and to clinical research on drug abuse treatment issues, including a behavioral pharmacology research unit, a clinical pharmacology unit for drug development research, a postdoctoral research training program, and inpatient and outpatient treatment programs. These facilities and resources provide a unique breadth of scientific and clinical opportunities and will enhance the scientific, clinical, and training productivity of the TRU. The TRU will offer an integrated program of services, research, education, and training that will be truly outstanding, and that will allow the program to address multiple aspects of the complex drug abuse problems faced by individual patients and by society, with the bottom line being reduction of IV drug use and reduction of HIV transmission.
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