Featured News: Need for Multiple Naloxone Doses on the Rise
The percentage of people treated for a drug overdose who need more than one dose of the opioid overdose antidote naloxone is on the rise, a new study suggests.
White House drug czar Gil Kerlikowske's thinking about drug addiction has moved from disdain to enlightenment over the past decade, but the former police chief views drug legalization as a “non-starter” and is urging law-enforcement officials to speak out against the idea.
A new Justice Department policy directive not to prosecute legitimate medical-marijuana programs in states that allow medical use of the drug has sparked concerns in some precincts that the Obama administration is laying the groundwork for legalizing the drug — or at least blurring the distinction between legal and illegal drugs.
However, in an Oct. 6 speech (PDF) before the 2009 International Association of Chiefs of Police Annual Conference, Kerlikowske, the director of the Office of National Drug Control Policy (ONDCP), was clear in his opposition to legalization. Scorning a recent opinion published in the Washington Post by two members of the group Law Enforcement Against Prohibition (LEAP), Kerlikowske urged the police officials at the conference to advocate against legalizing drugs.
“We owe it to the people we serve to speak out about the unintended consequences legalization would have and the toll it would take on the health and safety of our communities,” said Kerlikowske, who announced that ONDCP is creating a new fellowship program in order to give a policy platform to law-enforcement personnel who have firsthand knowledge of drug problems.
“Recycling the same people through the system, the default approach in place now, is not working,” Kerlikowske later added. “But let me be clear: A balanced and more effective approach does not mean legalization. It does mean being smarter about drug policy.”
Tom Angell, a spokesperson for LEAP, said that the fellowship program announced by Kerlikowske “looks like it could be an attempt to create an anti-LEAP speaker's bureau of anti-legalization cops.”
“It's great see that 'legalization' is finally working its way into the drug czar's vocabulary,” Angell said. “I guess it's difficult to ignore the growing political clout of the drug-policy reform movement when you've got police officers who fought on the front lines of the war on drugs calling for legalization on the op-ed pages of the Washington Post.”
Folowing the release of the medical-marijuana policy directive to federal prosecutors, Kerlikowske issued a lengthy statement (PDF) explicitly repudiating the notion that the guidelines represented either a tacit endorsement of medical marijuana or the first step toward legalization.
“To test the idea of legalizing and taxing marijuana, we only need to look at already legal drugs –- alcohol and tobacco,” wrote Kerlikowske. “We know that the taxes collected on these substances pale in comparison to the social and health care costs related to their widespread use.”
The Obama administration's drug czar promised to deliver a new National Drug Control Strategy in January that “will strike a balance between public health and public safety, recognizing that reducing demand through a community-wide approach is critical to our success.” But Kerlikowske also warned, “Legalization would only thwart our efforts and increase the economic and social costs that result from greater drug acceptance and use.”
From 'Rage and Despair' to Listening and Learning
In his speech, Kerlikowske did not tip his hand about specifics in the Obama administration's as-yet-unreleased strategy, but broadly indicated that its focus would largely rest on a revamp of demand-reduction strategies such as addiction treatment and prevention. Like many law-enforcement officials across the political spectrum, the former Seattle police chief has experienced a sea change in his opinion about the solution to the nation's drug problems.
“Over the course of my career, from St. Petersburg to Seattle, I learned a lot about the damage drug abuse does to the fabric of our society — and about the terrible toll it takes on individuals, families and communities across this country,” Kerlikowske told his former peers. “I'll never forget the rage and despair I felt when I worked undercover and I saw a drug dealer take a hit of marijuana — and then blow the smoke in the face of his toddler.
“But law enforcement didn't teach me everything there was to know about drugs, because 10 years ago, if you'd asked me what was wrong with drug addicts, I'd have told you, 'They need to get a spine,'” he said. “I thought, like a lot of people do, that drug addiction was primarily a moral failing, and that the cure was a simple matter of willpower; of addicts finding the resolve to stop using drugs.”
Over the years, Kerlikowske said, he began listening to researchers and learning about the disease of addiction. “It's a process of education that continues to this day — for all of us,” he said. “It's time to rethink our strategy. We must be smarter about our nation's drug problem. It's time to recognize drug abuse and addiction for what it is –- not just a law-enforcement and criminal-justice issue, but also a very complex and dynamic public-health challenge, one that demands a systematic, comprehensive, and evidence-based approach if we are going to be equal to the task.”
That's not too different from the words used by Kerlikowske's recent White House predecessors, up to and including Bush administration drug czar John Walters. In fact, Kerlikowske indicated that the Obama administration would continue to use the existing National Youth Anti-Drug Media Campaign and the adult-oriented TheAntiDrug.com website to prevent youth initiation of drug use.
But Kerlikowske also pledged to organize scattershot community-based prevention programs into “continuing prevention systems” that would provide repeated and targeted interventions to youths ages 12-20.
“Uncoordinated prevention efforts are not the fault of those who provide prevention services. The federal prevention funding process itself is uncoordinated, and frankly baffling in its complexity,” Kerlikowske said. “One of my priorities will be promoting blended funding streams among federal agencies to encourage communities to prepare for and adopt comprehensive prevention programs [and] … those funded through our Drug Free Communities Program.”
Kerlikowske called drug courts “an absolute must if we are going to have a fairer and more equitable justice system” and indicated that federal treatment resources would be directed at hard-core addicts and those involved in the criminal-justice system.
“Just as we know that a small percentage of criminals are responsible for a much larger percentage of crime, a small group, but one extremely active in their drug consumption, lies at the heart of our country's drug problem, but receives almost no treatment for their addictions,” he said. “If we're going to effectively deal with the drug problem, we must find effective ways to reach these people and change their behavior.
“We know that jail is not a solution — since all of us have made multiple arrests over our careers of the same drug-addicted person for a variety of crimes,” Kerlikowske told the audience of police chiefs. “What's needed is a true treatment system, one that makes use of evidence-based clinical practices and is well-integrated with the larger healthcare system.”