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Interview With the Drug Czar

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Kerlikowske briefs his boss.

By Mike Guy

07/02/12

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You've described recovery as “an afterthought.” The truth is, millions of Americans are in recovery, and the treatment industry makes $20 billion a year. In reality, it seems like it's more of a case of the government just starting to catch on. 

You're right. In the case of prescription drugs, until recently they were not the radar screen—except for the people who knew about the problem professionally or from personal experience. I would say recovery hasn't been on the radar either. People just think of it as a subset of treatment. Well, you know, you don’t go into treatment for 28 days, and then you are better, then you are cured. It doesn't work that way. Recovery is ongoing. And with people like David Carr from the New York Times out there pounding the pavement, there are a lot more people speaking about recovery from drugs than ever before. I think that is unbelievably helpful.

I think we're in the midst of a recovery movement. I think that’s why a website like The Fix can have such a robust readership.  

That’s right. It's a growing army.

Assuming we can agree that this is a good thing, do you believe it should be reflected in the government’s budget? How can the feds help feed the movement? 

I think the last thing we want to be involved in is going, okay, we recognize this is a problem, here are the details, now let’s just throw some money at it. Thing is, nobody has a lot of money to throw at anything right now. Also, there are collaborations going on now that, frankly, wouldn't exist if it was not for this bad economy. There are direct-to-treatment modules that are happening with law enforcement, that bypass the criminal justice system and the cost of booking, court costs and on and on, and go directly to the treatment door. I'm not sure these things would be occurring if it was not for the fact that you better figure out ways to do this better, faster, cheaper.

You said that addicts are not criminals, but people with a disease. Does that create any tension between how law enforcement is carried out against people who have drug problems? 

Look, recently I brought together 20 heads of big city narcotics units, along with five special agents in charge of DEA offices. We spent a day and a half at the Dallas airport hotel talking about whether we should be looking at drug addiction from a different point of view. Dr. Tim Condon, a professor at the Center on Alcoholism, Substance Abuse and Addictions at the University of New Mexico and the former Deputy Director of the National Institute on Drug Abuse, gave a presentation on addiction. Afterwards, one of the chiefs said he was going to bring Tim to his city and get him talking to the city council and the state legislature. Another narcotics commander said he'd never looked at the drug problem in that way before.

You just see less and less about how many arrests have to be made, and how big the seizures are. Now you see a lot more about community policing. And, it's about outcomes, and not just numbers on a graph. When I talked about this with legislators on Capitol Hill, they said, “Gee, you know, what are your colleagues going to think?” And I would say, frankly Congressman, or frankly Senator, my colleagues are way ahead of you. 

It should be looked at as less of a "War on Drugs" and a lot more of a public health problem. Recovery is that next leg on the stool.

One of your goals is the destigmatization of addiction. Has that been an uphill battle?

Right. But I don't think you can lead people to de-stigmatization unless you first convince them of the disease model. 

It’s hard to find agreement on that one, isn’t it?

It’s not easy! There are a number of people in the field who disagree with it. Look, there are people who are not addicted, and they make a voluntary choice to do drugs, and then they reach the point of addiction. I do not want to completely remove personal responsibility out of this issue either. Anyway, someone isn't going to have a successful program of recovery unless the person’s intent and focus and mindset is on this, and they get the support they need. We need to break down those barriers, the stigma, the laws—we do not need to make it harder for people to recover.

The barriers are already breaking down. 

Yeah. Prescription drugs have helped do that because it does cover such a wide array of people. People have a picture in their minds of a crack cocaine-user or heroin addict. Prescription drugs, well, nobody fits that profile. I went to a memorial service in fort Lauderdale for all of these people that died from pills. They were flashing pictures of the deceased during the presentation: here is a brother and a sister, aged 14, and then here is a 65-year-old man, and then here is a 27-year-old lawyer. Nobody would look at that group and say, "Gee, what do you think they all are?" Well, they are all dead, and they are all dead from prescription drugs.

Florida is a notoriously prolific producer of prescription pills.

They were the epicenter, yes. Now, they have really changed a lot. I mean you have an attorney general who really gets it. The Governor took a little convincing, but the legislator was fully on-board. I lived and grew up in Florida; it was often said that if seven manatees washed up dead on the shore, people in Florida would say, “Oh my God, what are we going to do?” But seven people a day are dying from prescription drugs.

At least 50,000 people have been killed in the Mexican Drug War. In that country's elections, two candidates have said that the United States' appetite for drugs is the engine behind the violence. Why isn't that part of our national conversation? 

Because the facts do not quite support it.

You don't think so?

No, I do not. I mean if our cocaine use is down—and every indication, from overdoses to admissions to treatment, shows it is down by 40%—and most of the cocaine that enters the United States comes through Mexico, then pretty clearly there would be a reduction in the level of violence in Mexico. I think, during the heat of Mexico's election process, there are a lot of things said by a lot of people. It probably even happens here in this country. I do not know. [Laughs

[Mexican President Felipe] Calderon was very courageous to calm the cartels. And the cartels are criminal enterprises; they are not just drug-trafficking organizations. Those cartels are involved in every type of criminal enterprise, every type—kidnapping, extortion and on and on. Evidence suggests they make more money from those revenue streams than from drug trafficking. I think—and President Calderon has told me in meetings—that this is a question of who is going to run this country. Is it going to be criminal enterprises that become state actors, or is it going to be the elected officials and their appointees? He said, "It is not that I have a big a choice as to whether or not I'm going to take them on." Pretty courageous.

Do you think the government can win the war?

Well, Calderon has crime reduction for the first five months of 2012, and he's been hard at it for over five years. None of these things, organized crime issues and reductions in violence, happen overnight. So, if he actually has begun to turn the corner—which is always a bad phrase to use—but if he has, and these numbers begin to hold at this reduction in violence, I think he should be given credit for that.

If Mitt Romney wins the US election, what sort of effect would that have on our drug policies?

I have only seen a couple statements that Governor Romney has made on the campaign trail about drugs. So, it would be unfair to speculate about the implications of a Romney presidency. In all of my meetings a lot with member of Congress, they all want similar things: to prevent kids from being involved in drugs; to figure out ways to save money; to see people involved in drugs or addicted to drugs go back to being productive citizens. So I would just leave it at that.

It has been hard to pin down exactly where Governor Romney stands on drug policy issues.

Well, it's hard to get any media attention on the drug issue, because America right now is all about jobs and the economy. So it is pretty difficult. That's why we try to talk about the drug issue in economic terms. What does it cost us in jobs lost? What does it cost us in jobs that are available and go unfilled? What does it cost us in emergency room visits? When you start looking at those numbers, you see that besides the human cost of the drug problem, the economic costs are also huge. So we have to keep talking about it in both ways.

And if President Obama is re-elected, will you stay on for another term as Drug Czar?

I serve at the pleasure of the President. 

Mike Guy is the Editor-in-Chief of The Fix

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