of the herbal products being used and the ability to acquire an IND for them, and then to contemplate an interaction to them, is a great challenge.

So, it is hard work, but again, I think the right people now are invested. The open-minded skeptics are asking, “what have we got here in each of these studies?”

My hope is that my colleagues will assure that the science is done well, so we don’t assume prematurely that we have the answers before we actually have them.

PARTICIPANT: I was wondering, David, if you would comment on some policy that we have evolved at the Center for Substance Abuse Treatment, of the Substance Abuse and Mental Health Services Administration, that suggests the notion for the need for randomized clinical trial results, and may actually shed some light on your question of which should come first.

That is, starting in about 1994 and 1995 with a program called the Rural, Remote, and Culturally Distinct Populations Program, populations were funded for comprehensive culturally appropriate substance abuse treatments.

Community interventions were implemented, such as a program in Hawaii funded to include traditional Hawaiian healing practices, and several programs serving Native American communities were funded to include sweat lodges. There were also programs funded to include acupuncture.

What they had in common was that they were high demand, low cost, safe, but non-evidence-based treatments that were allowed to be included in a comprehensive treatment setting.

That program has become more operationalized. What we are working on at the Center for Substance Abuse Treatment is developing guidelines on acupuncture incorporation into addiction treatment programs, and we are doing a treatment improvement protocol on that.

Admittedly, the evidence for acupuncture being efficacious in addiction treatment is somewhat lacking. I find it promising but not conclusive.

At the same time, this is used by several hundred different programs. In substance abuse treatment programs in particular, we noticed that time and treatment of almost any sort has a significant improvement on the long-term outcome.

If we have a treatment, such as acupuncture or a sweat lodge, that brings people into the treatment setting, as long as it is comprehensive, then that may improve outcome, if not through efficacy, perhaps through increased utilization or compliance with treatment.

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