1. Collaborative Addiction Research in Asian Populations Home and Abroad Gavin Bart, MD PhD FACP FASAM Director, Division of Addiction Medicine Department of Medicine Hennepin County Medical Center Associate Professor of Medicine University of Minnesota bartx005@umn.edu International Conference on Global Health: Prevention and Treatment of Substance Use Disorders and HIV Taipei, Taiwan April 18, 2013

3. Hmong and opiate dependence Validate the assessment tool –MINI versus SSADDA Prevalence –Laos ~ 10% –Thailand ~15% –US ~3% Mode –Smoking opium –Smoking heroin Malison 2011; Westermeyer 1981, 1995; Wiewel 2005

4. Hmong entering treatment Westermeyer and Chitasombat 1996

5. Methadone maintained Hmong: psychiatric comorbidity Bart 2013

6. Hmong treatment outcome Behavioral only ~90% relapse Methadone ~80% retention –Hmong 49.0 mg (17.4) –Non-Hmong 77.1 mg (25.1) Bart 2012

7. Hmong: a pocket of people Listman et al, 2007 and unpublished data

8. Hmong genotype v. phenotype Straka et al. 2006

9. R-methadone population pharmacokinetics: Hmong and non-Hmong Bart 2013

10. More questions Why are the Hmong different? –Diet –Transporter function –Genetics Can we predict methadone dose requirements? Does this happen with other medications?

11. Why Research? To find cures to disease and illness Describe the situation –Epidemiology –Cohort studies Compare approaches –Outcome –Quality of life / Satisfaction –Cost-effective To inform policy

12. Research resources

14. Thank You NIDA K23 DA024663 SAMHSA PEPFAR USAID CDC Vietnam VAAC FHI360 Yih-Ing Hser Betty Tai NIDA R13DA035084