Make the Next Drug Czar a Doctor

At the age of 19, when I was a college freshman, motivated by the promise of some quick cash and adventure, I embarked on a Hunter S. Thompson–esque road trip. I got in my rusted-out Impala and drove from Berkeley to San Diego with a few kilos of marijuana in the trunk. It was an uneventful drive south. I delivered the weed to a friend of a friend, slept on his couch and headed home.

On the way home, however, I was stopped by a highway-patrol officer outside the city of Salinas. The officer called for backup and more police arrived. They thoroughly searched the car, even looking under the spare tire and unscrewing a flashlight. They found nothing, because there was nothing to be found. I look back with abject horror at how much my life since then would have been different if I’d been stopped on my way to — rather than from — my one and only drug deal.

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Had I been found guilty and sentenced for possession and dealing, I might have spent a decade or more in prison. During the years I was in college, started a family and built a career, I would have been in a cell. Upon release, I’d have had a criminal record. That and my interrupted education would have made me far less employable. While incarcerated, I may have learned how to navigate prison, but not life outside it. My youthful transgression would have all but destroyed my life. Would justice have been served? Would society have benefited? Would America have been safer?

Earlier this month, Attorney General Eric Holder issued a long overdue directive to federal prosecutors that ends federal mandatory sentencing for minor drug crimes, which have led to the incarceration of hundreds of thousands of Americans for drug charges, including many that were far less serious than mine. These laws, Holder said, will be replaced by a set of guidelines designed to decrease incarceration rates for “low-level, nonviolent drug offenders who have no ties to large-scale organizations, gangs or cartels.” It has provisions that will direct some violators to drug treatment.

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The Administration’s action is an important step forward in the movement to end the nation’s misguided — expensive, ineffective and harmful — approach to solving the nation’s drug problems. But it’s just the beginning of what must change if we’re going to effectively end a “war” that kills 350 Americans a day and costs the nation more than $400 billion a year in health care, criminal justice and lost productivity.

Now there’s an opportunity for President Obama to take another critical step forward. In early August, the Administration announced that Gil Kerlikowske, the nation’s drug czar, would become head of the U.S. customs office. Kerlikowske, a former cop, has run the Office of National Drug Control Policy (ONDCP), making him the top general in the war on drugs. Kerlikowske’s departure clears the way for the President to name a new ONDCP chief from the medical or public-health community, someone qualified to effectively address drug abuse and addiction for what they are — not criminal problems, but health problems.

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Before he became President, Obama publicly decried the country’s drug-war strategy. In 2008, when Jann Wenner of Rolling Stone asked him about the war on drugs, the President said, “I believe in shifting the paradigm, shifting the model, so that we focus more on a public-health approach, on prevention. [Our current approach] is expensive, it’s counterproductive, and it doesn’t make sense.” More recently, when the Administration announced its new drug policy and the 2013 National Drug Control Strategy budget, Obama reasserted a commitment to focus on addiction as a health problem. Announcing the Administration’s approach, Kerlikowske said, “This policy underscores what we all know to be true: we cannot arrest or incarcerate our way out of the drug problem.”

He’s right, and the Administration has moved forward with some bold policy changes. Besides the end of federal mandatory sentencing, the ONDCP’s national drug control budget for 2013 includes more money for prevention of drug use and treatment for addiction. Clearly the Administration has begun listening to addiction scientists, because its rhetoric emphasizes the medical community’s classification of addiction as a disease. Another step forward will come with a rarely discussed provision of Obamacare that requires insurance plans to fully cover addiction, along with the mental illnesses that often accompany it, just as they do other diseases.

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Despite these positive steps and the speechifying, critical policy shifts have yet to be made. There’s been no talk of making the mandatory sentencing prohibition retroactive, which means that hundreds of thousands of citizens, including a disproportionate number of African Americans, will remain in prison for minor drug crimes. There’s been no support for some critical harm-reduction strategies, including safe-injection sites for IV drug users, which have proved effective in other nations. And the Administration continues to battle states where marijuana has been legalized.

In fact, in Obama’s first term, there was an increase in the arrest rate for marijuana possession over the rate under President George W. Bush. Also, the Administration has repeatedly cracked down on marijuana growers, even though they were operating legally in their respective states. The greatest failure can be seen in the 2013 budget. Though there are some improvements, $15 billion of the $25 billion is earmarked for the same interdiction, law-enforcement and eradication programs that have failed to lower the supply of drugs and deaths from addiction for decades.

Now the President can make good on his promise to transform America’s drug strategy by replacing Kerlikowske with someone who has the knowledge, leadership skills and vision to combat drug use not as an issue of morality and legality, but as a health challenge. The new drug czar should be an effective leader and visionary from the addiction medicine or public-health field with expertise in the prevention and treatment of drug misuse and addiction — perhaps someone like Nora Volkow, the dynamic director of the National Institute on Drug Abuse, a renowned physician and researcher who has proved to be an effective administrator and advocate in the corridors of Congress.

Whoever is chosen, the new drug czar must be devoted to ending the failed war on drugs and declaring a new one. America’s war on cancer has lowered deaths from the disease every year since it was launched. The new ONDCP head will be in a position to wage the right war, not against drugs, but against the disease of addiction.

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