Terrance Heath's List: addiction

• 
   “Our insatiable demand for illegal drugs fuels the drug trade,” Clinton said. “Our inability to prevent weapons from being illegally smuggled across the border to arm these criminals causes the deaths of police officers, soldiers and civilians.”
   
   The statement, a formal acknowledgement of the demand for illicit drugs in the United States, which drives the production, transport and smuggling of narcotics, has never been publicly made by Washington officials. Off the record, American policymakers and diplomats admit that drug abuse is a “crisis” on a “societal” level. But the official stand has been one of denial: Illegal drug use is a scourge visited upon Americans by drug traffickers who must create demand for the narcotics they have to sell to stay in business.
• The view throughout Latin America has long been one of resentment: nations are coerced into declaring a “war on drugs,” not because there are epidemics of drug abuse in those countries, but because of the “insatiable” demand in the United States.
• “The hemisphere’s drunk finally stood up and admitted he’s an alcoholic,” a March 26 caller to TV Azteca told news anchors, who chuckled. “To hear Americans until now, you’d think that Mexicans were crossing the border, putting guns to their heads, shoving a tray with lines of cocaine and demanding, ‘Snort! Snort! Snort! Or I’ll blow your brains out!’”
   
   Laughter erupted among the studio audience.
   
   In a country obsessed with self-improvement, Mexicans are familiar with the “12 step” programs that are designed to help addicts.
   
   The first step in recovery is admitting the truth to others: “We admitted we were powerless over alcohol—that our lives had become unmanageable,” is how alcoholics begin sober lives.

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• Mexico's federal attorney general called Monday for a hemispheric battle against drugs that targets poverty and addiction, arguing that focusing on beating cartels in Mexico will only push the problem elsewhere.

  Giving the luncheon address at The Associated Press annual meeting, Eduardo Medina-Mora said Mexico inherited the drug problem after the U.S. successfully shut down the Caribbean cocaine route in the 1980s, forcing powerful Colombian cartels to turn to their Mexican counterparts. As Mexico succeeds in putting pressure on its gangs, drugs are likely to simply go elsewhere, he said.

• Medina-Mora focused much of his speech on the social costs of the drug trade, from the poor who seek drug profits by participating in the illegal trade to the addicts in the developed world who drive demand. He said countries need to battle those underlying social problems, adding that "simplistic approaches divide us, keep us ignorant, and give advantages to criminals."

  "Unfortunately, our success is not going to end the drug problem," he said. "If the demand for drugs does not change, drugs, as water, will always find their course. They will find the path of least resistance."

  Medina-Mora also pushed the U.S. to reimpose an assault weapons ban, arguing that the U.S. gun trade was arming cartels south of the border. He said nearly 52,000 firearms have been seized in Mexico in the past two years and more than half of those were assault weapons. That's five times the number of weapons seized from the Revolutionary Armed Forces of Colombia, or FARC, rebels last year.
• Mexico's drug-related homicide rate has soared to 10,657 killed between December 2006 and March 2009. Of those, 90 percent of the victims are believed to have been involved in the drug trade, while 988 have been policemen. With that violence has come an increase in organized crime, as gangs branch out into kidnappings and extortion.

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• In the past year, stepped-up U.S. pressure in Bolivia and Peru to wipe out coca--the leafy Andean bush that can be processed into cocaine--has met increasingly violent protests.
  
  And no wonder. Small farmers' dependence on coca revenue has never been greater. More than half of Peru's 26 million live on less than US$2 a day. About 70% of Bolivia's 8.3 million lives in poverty. In some rugged areas, coca is the only crop that can flourish.
  
• Unfortunately, the U.S. zero-coca policy is fueling that war. Washington continues to condition increased aid for alternative development on meeting eradication targets, leaving Bolivia and Peru vulnerable to more social unrest. That is a crucial mistake.
• Obviously, the conflict is not just about drugs. It's the economy, estupido. Free-market, reforms have yet to alleviate poverty or create enough jobs. The Council on Hemispheric Affairs The Council on Hemispheric Affairs (COHA) is a Washington, D.C.-based non-governmental organization (NGO) founded in 1975, with the goal of promoting awareness of hemispheric issues and encouraging the formulation of rational political and economic U.S. policies towards the region.
  ..... Click the link for more information., meanwhile, says the eradication program costs rural communities in Bolivia $200 million annually. "We are against drug trafficking," Marisela Guillen, secretary-general of Peru's 3,000-member Agricultural Producers' Association of the Apurimac-Ene River Valleys, recently told the BBC BBC
   in full British Broadcasting Corp.
  
  Publicly financed broadcasting system in Britain. A private company at its founding in 1922, it was replaced by a public corporation under royal charter in 1927. . "We just want to survive."
  
  Coca farmers are not interested in getting high. They want to feed their families. That's why, no matter how many times they watch police destroy their crops, these poverty-stricken farmers will replant re·plant
  v.
  To reattach an organ, limb, or other body part surgically to the original site.
  
  n.
  An organ, limb, or body part that has been replanted. .
• New priorities. Alternative crops such as oranges, cotton, pineapple, bananas, rubber and palm oil just can't compete with coca. Cocaleros can earn up to $6 a kilo--five times what they earn on a kilo Thousand (10 to the 3rd power). Abbreviated "K." For technical specifications, it refers to the precise value 1,024 since computer specifications are based on binary numbers. For example, 64K means 65,536 bytes when referring to memory or storage (64x1024), but a 64K salary means $64,000.
  ..... Click the link for more information. of coffee. Much of the scant funds for alternative crops get soaked up in red tape and corruption, leaving little for farmers. In Peru, cocaleros demanded the withdrawal of several nongovernmental organizations Transnational organizations of private citizens that maintain a consultative status with the Economic and Social Council of the United Nations. Nongovernmental organizations may be professional associations, foundations, multinational businesses, or simply groups with a common interest in  working in alternative development, claiming most resources stay with the NGOs.
  
  Some alternative crops, meanwhile, are subject to tariffs and trade restrictions in Europe and the United States. In November, for example, the European Union European Union (EU), name given since the ratification (Nov., 1993) of the Treaty of European Union, or Maastricht Treaty, to the
  
  European Community  is expected to begin levying tariffs on Colombian flowers and fruit.
  

  • The problem is that -- just as with addicts in some communities in the U.S. -- there are economic realities that have to be adderssed first. Why can't other crops compete or feed their families as well?
    
    Before people can "just say no," they've got to have something to say yes to.
• The United States must allow these poor Andean countries to undergo a gradual eradication program while introducing alternative crops with tariff-free status, adequate infrastructure to get products to market and subsidies not to grow coca. If the U.S. can spend billions of dollars each year to pay American farmers not to grow certain crops, they can spend millions to keep Andean peasants from working for the drug trade.
  
  Unless Andean peasants receive the same return from alternative crops, they will not give up coca, at least not without a fight. Offer Andean farmers a real alternative and they will happily get out of the coca game.
  

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• A commission led by three former Latin American heads of state has called the 30-year U.S. "war on drugs" in Latin America a failure and urged a drastic change in policy.
  
  The Latin American Commission on Drugs and Democracy issued a report Wednesday, "Drugs and Democracy: Toward a Paradigm Shift," which calls for the creation of a Latin American drug policy and proposes three specific actions under the new paradigm: treat addicts as patients in the public health system; evaluate decriminalisation of cannabis possession for personal use; and reduce consumption through public education campaigns primarily directed at youth.
• The report calls for a review of U.S. prohibitionist strategy, which it says has deficiencies, and a look at the benefits and drawbacks of the harm reduction strategy followed by the European Union (EU). 
  
   The levels of drug consumption continue to grow in Latin America while there is a tendency toward stabilisation in North America and Europe, according to the report.  
  
   The report cites Columbia and Mexico as nations where U.S. prohibitionist policies, despite the large investment of resources and loss of innocent lives, have failed to put an end to drug trafficking and narco-violence. It cautions other countries from adopting these kinds of policies and urges them to search for innovative alternatives.  
  
   The long-term solution for the drug problem is to drastically reduce the demand for drugs in the main consumer countries, the report states. As U.S. and European domestic markets are the main consumers of the drugs produced in Latin America, the report calls on the U.S. and EU to share the responsibility faced by Latin American countries to design and implement policies leading to an effective reduction in their levels of drug consumption.

  • Incarceration is not a deterent to the addict. Nor will incarceration alone solve an addiction problem. It may get the idividual away from their substance of choice (or not, considering the availability of drugs in prison) but it doesn't deal with the arrested development left in addiction's wake, in every realm of the individuals life.
• One such proposition is to change the status of addicts from drug buyers in the illegal market to patients cared for in the public health system. This will weaken the foundation of the drug business by reducing the demand for illegal drugs and lowering their price.
• The report calls the convenience of decriminalising the possession of cannabis for personal use to be evaluated from a public health standpoint and on the basis of the most advanced medical science.
• The report calls the U.S. policy of massive incarceration of drug users questionable, both in terms of respect for human rights and its efficiency. That policy is not applicable to Latin America, given the penal system's overpopulation and material conditions.
• Rather, public policy should be targeted to fighting the most harmful effects of organised crime on society, such as violence, institutional corruption, money laundering, arms trafficking, and the control over territories and populations, the report states.

  • These are all things that are likely to decrease with decriminalization, but will have to be addressed in other ways since decriminalization is still the 800 lb. gorilla in the room.

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• Ten months after R. Gil Kerlikowske became Seattle's police chief, two of his officers arrived at the home of JoAnna McKee, where she ran a co-op giving medical marijuana to patients and teaching them to grow their own. Neighbors, the police told her, had been complaining. Soon, a "cease and desist" order was tacked to her door. 

   

   But instead of shutting down the Green Cross Patient Co-Op, Kerlikowske's director of police-community partnerships made a suggestion: Move it from her West Seattle house to a commercial area. She found a nearby storefront, and under Washington state's medical marijuana law, people could once again bring doctors' orders to get relief from pain. "The police could have come in here like gangbusters," McKee said. "But they didn't. It was a case of let's see whether we can work this out so everybody could get what they want." 
• That episode the summer of 2001 typifies the approach to illegal drugs that Kerlikowske, nominated by President Obama to lead the White House Office of Drug Control Policy, has displayed during nearly nine years as Seattle's top law enforcement officer. In a city with greater tolerance for drugs than much of the United States, he has seldom bucked the prevailing local sentiment. Seldom, though, has he been out front.
• According to legal and community leaders in Seattle familiar with his work, his views are in sync with the drug policies Obama has said he will pursue: a reorientation away from the Bush administration's intense focus on curbing the supply of illegal drugs and toward greater emphasis on preventing and treating addiction. As drug policy director, he would oversee a staff of more than 100 and a $440 million budget. In particular, Kerlikowske has supported King County's drug court, one of the most active in the country, which gives people arrested on drug charges a chance at treatment rather than jail.

  • For people arrested and charged with carrying an amount of drugs clearly for personal use and not distribution, this is an opportunity to address drug abuse or dependency (if it exists) that would go unaddressed or poorly addressed in the criminal justice system.
• Kerlikowske has made no secret that he has seen drug's damaging effects firsthand. He adopted his first wife's son, Jeffrey, at age 2. Jeffrey Kerlikowske, now 39, dropped out of high school, moved out of the house and has been arrested repeatedly on drug and other charges since he was 18, police records show. The father and son have not been in touch since 1995, sources said.

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• • In 2007, an estimated   19.9 million Americans aged 12 or older were current (past month) illicit   drug users, meaning they had used an illicit drug during the month prior   to the survey interview (Figure 2.1).   This estimate represents 8.0 percent of the population aged 12 years old   or older.
     
     
   
  • The overall rate of   current illicit drug use among persons aged 12 or older in 2007 (8.0 percent)   was similar to the rate in 2006 (8.3 percent) and has remained stable   since 2002 (8.3 percent) (Figure 2.2).
• In 2007, an estimated   22.3 million persons aged 12 or older were classified with substance dependence   or abuse in the past year (9.0 percent of the population aged 12 or older)   (Figure 7.1). Of these, 3.2   million were classified with dependence on or abuse of both alcohol and   illicit drugs, 3.7 million were dependent on or abused illicit drugs but   not alcohol, and 15.5 million were dependent on or abused alcohol but not   illicit drugs.

• If confirmed by the Senate, Kerlikowske, a 36-year police veteran, will emphasise preventing drug use in the U.S. over combating the supply of illegal drugs from foreign countries. 
  
   "The success of our efforts to reduce the flow of drugs is largely dependent on our ability to reduce demand for them," Kerlikowske said in a ceremony at the Eisenhower Executive Office Building.  
  
   Unlike in previous administrations, the position of drug control director will not be a Cabinet position, intended to give Biden a larger role on the issue, an administration official told the Washington Post.
• The war on drugs was declared by President Richard Nixon almost 40 years ago. After being enthusiastically carried out since then, analysts say attention and funding to the drug problem waned after the attacks of 9/11.
• The Obama administration’s promotion of treatment and outreach comes as a sharp departure from the policies of the Bush administration. Under Bush, money to international programmes doubled, while funding for prevention and treatment fell by one quarter, John Carnevale, an economist who worked at the Office of Drug Control Policy under three presidents, told the Washington Post.
• In mid-February, the Latin American Commission on Drugs and Democracy issued a report, "Drugs and Democracy: Toward a Paradigm Shift," calling for a review of U.S. prohibitionist strategy, which it says has major deficiencies. The report also examined the benefits and drawbacks of the harm reduction strategy followed by the European Union, with a key recommendation to treat addicts as patients in the public health system.
• "Our nation’s drug problem is one of human suffering," said Kerlikowske at a ceremony announcing his appointment. "[A]s a police officer but also in my own family, I have experienced the effects that drugs can have." 
  
   Kerlikowske’s stepson, Jeffrey Kerlikowske, 39, has been arrested several times in the past on drug charges. 
  
   Obama himself has admitted to past drug use, saying that as a young man he smoked marijuana: "I inhaled frequently...that was the point," said Obama, in contrast to Pres. Bill Clinton’s campaign statement that he had tried, but not inhaled, marijuana.  
  
   Obama also wrote in his book that he used "a little blow [cocaine] when [he] could afford it." It was a candid admission in light of Bush’s refusal to discuss what, according to many accounts, was his regular cocaine use as a young man. 
  
   Understanding that regular people use drugs and focusing on domestic demand, however, will not solve all the ills wrought by drugs and the drug trade, especially internationally.  
  
• "Even with the best policy in place, the impact on reduction of demand is going to take a long time," said Michael Shifter, vice president for policy and director of the Andean programme at the Inter-American Dialogue. "This is no solution to the immediate crisis in countries like Mexico."

  • Solving the immediate crisis in Mexico may require action that looks like "business as usual," but -- as in other areas -- the administration can do what's necessary to alleviate current conditions, while taking steps in a new direction.
    
    This is not a choice between neglecting one situation in favor of another. We'll have to do more than one thing at a time, because both situations are urgent.

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• In a step that Democrats hope will lay the groundwork for the most significant overhaul of the state’s drug penalties in a generation, a state commission on Tuesday recommended creating more uniform sentencing guidelines and allowing judges to send more drug offenders to treatment centers instead of prison.

• After working for two years, the commission recommended creating uniform standards for determining which offenders are drug-addicted and allowing judges greater authority to select treatment instead of mandatory incarceration. Currently, judges are highly limited in the kinds of sentences they can give drug offenders.

  In a sign that the issue is ripe in the Capitol, many Democratic lawmakers and advocates for changes to drug laws said on Tuesday that the recommendations did not go far enough. Some pledged to press for changes that would do more to roll back the Rockefeller-era laws’ mandatory sentence requirements, which have long been criticized as overly punitive.

• The White House said yesterday that it will push for treatment, rather than incarceration, of people arrested for drug-related crimes as it announced the nomination of Seattle Police Chief R. Gil Kerlikowske to oversee the nation's effort to control illegal drugs. 

   

   The choice of drug czar and the emphasis on alternative drug courts, announced by Vice President Biden, signal a sharp departure from Bush administration policies, gravitating away from cutting the supply of illicit drugs from foreign countries and toward curbing drug use in communities across the United States. 
• Since President Richard Nixon first declared a war on drugs nearly four decades ago, the government has spent billions of dollars with mixed results, according to independent studies and drug policy scholars. In recent years, the number of high-school-age children abusing illegal substances has dipped, but marijuana use has inched upward, and drug offenders continue to flood the nation's courts.
• "The success of our efforts to reduce the flow of drugs is largely dependent on our ability to reduce demand for them," Kerlikowske said yesterday at a ceremony attended by his former law enforcement colleagues. "Our nation's drug problem is one of human suffering, and as a police officer but also in my own family, I have experienced the effects that drugs can have."

  • The choice of Kerlikoske, combined with his own words and experiece, inspire hope that we can move from an approach to drug addiction that focuses more on healing than on punishment.
• Kerlikowske's adult stepson, Jeffrey, has been arrested in the past on drug charges, an issue that the police chief referenced in his remarks yesterday.
• On the campaign trail, Obama and Biden promised to offer first-time, nonviolent offenders a chance to serve their sentences in a drug rehabilitation center rather than in federal prison. In promoting wider use of drug courts, the administration is embracing an idea that has broad support in theory but has never been a main path for people with drug addictions who are charged with crimes.
• The nation's first drug court originated in Miami in the late 1980s at the urging of Janet Reno, who went on to become President Bill Clinton's attorney general. By the mid-1990s, the federal government was providing money for communities to plan and set up such courts -- although not to help operate them in the long term.

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• Someone described insanity as doing the same thing over and over and expecting a different result each time. That's a perfect description of the war on drugs.

• The United States is the largest illegal drug market in the world. Americans want their weed, crack, cocaine, heroin, whatever. And they're willing to pay big money to get it.

  The drug suppliers are only too happy to oblige. The Mexican drug cartels now have operations in 230 American cities. That's 230 American cities!

• What do you suppose the total price tag is for this failed war on drugs? One senior Harvard economist estimates we spend $44 billion a year fighting the war on drugs. He says if they were legal, governments would realize about $33 billion a year in tax revenue. Net swing of $77 billion. Could we use that money today for something else? You bet your ass we could. Plus the cartels would be out of business. Instantly. Goodbye crime and violence.

  If drugs were legalized, we could empty out a lot of our prison cells. People will use this stuff whether it's legal or not. Just like they do booze. And you could make the argument that in some cases alcohol is just as dangerous as some drugs. I know.

  • We are a long, long way from seriously talking about legalization. But there is much to be done on harm reduction and on the vailability of treatment and rehab for those who seek it.
    
    It certainly can't be worse than the War on drugs.

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• Coffee shrubs the color of army fatigues cover the hills above this village, which is set in a deep valley cut by the River Samana. 
  But near the peaks, the bright green stripes of another crop can be seen between the coffee, spelling trouble for Colombia's most renowned industry and the United 
  States' drug war. 

  No one here will claim the brilliant fields of coca, the key ingredient in cocaine. But farmers acknowledge that some among them have yanked up coffee plants in the 
  past year and replaced them with crops that have a more profitable and reliable, if illegal, market. Along mountain roads, pickup trucks with beds filled with coca 
  seedlings now pass buses stuffed with burlap sacks of coffee. 

• "Coffee has been fundamental to our economy," said a storeowner in this village of 1,000, about 90 miles northwest of the capital, Bogota. "We all rely on it. But 
  right now a coffee farmer can't even pay for the basics. Coca is new to us here, so we don't know what it will bring. So far it has been only a grain of salt for our 
  economy." 

  What is squeezing the coffee farmers are the caprices of economic globalization. Years of good growing weather worldwide and a rising number of countries planting 
  the beans have increased supplies and sent world prices tumbling. As income flowing back to villages like this falls, farmers find themselves pushed away from 
  Colombia's most renowned crop toward its most notorious. 

  • Cutting into supply might take more than prosecution or persecution, but also addressing econmic issues that make it more profitable for farmers to grow coca than food or other crops.
• The coffee crisis, as it is called here, has helped create a countrywide recession. Unemployment is near 20 percent, and higher in the countryside where war and 
  scant public resources make poverty nearly inescapable. That, in turn, has given the country's various armed groups -- Marxist rebels on one side, a counter-guerrilla 
  paramilitary force on the other -- a larger pool of idle young men and women from which to fill their ranks. Recruiting has never been easier.

• It would be a reach to say that Juan Valdez, the iconic Colombian coffee farmer of television advertising, has turned to drugs. Although hard numbers are impossible 
  to come by, evidence and informed estimates suggest that only about 1,000 of the country's 560,000 coffee farms have scrapped coffee plants in favor of coca or 
  opium poppies. But just about all coffee farmers wonder how they are going to survive at the current prices. 

  Archangel Cifuentes, picking beans in the town of Chinchina one recent morning, said his weekly salary had fallen from $50 to half that within a year. "Even with a 
  good crop, the prices are so low we make nothing," he said, his hands darting from the bright red beans to the yellow bucket around his waist. "You Americans have 
  to drink a lot more." 

  The switch is occurring mostly on the remote edges of the country's coffee heartland, where there is little state presence. Most of those who have changed over 
  maintain tiny illegal plots alongside larger coffee fields in hopes that prices will rise again. 

  • Farmers in Latin American companies are squeezed between the war on drugs and the relentless march of globalization, which must feel alot like economic warfare as they are forced to switch from subsitence farming to growing cash crops that they can't eat and that don't pay them enough to surviv.
• In the old days, Nyholm said, "Colombian hearts would beat faster at the sight of a coffee bush. Now we are going to have to start looking at alternatives within the 
  coffee zone itself. But people are going to have to accept that legal alternatives to coffee may never yield as much money as coca, although they will not have the 
  violence that goes with the drug trade. There is no magic solution."

  • If the cash crops they wor forced to switch to don't pay anymore, and subsistence farming isn't viable any more, how many options do they have left?

• The bonanza years of the 1960s and 1970s, when shrewdly marketed Colombian coffee traded on commodities markets near $3 a pound, have ended in a supply 
  glut. Colombian coffee now sells for about 62 cents a pound on the New York commodities exchange, generating just 10 percent of the country's legal export 
  income. It once accounted for more than half. 

  A big reason for the glut is Vietnam. With the soil and altitude in which coffee shrubs thrive, it was a major exporter before the Vietnam War and reentered the world 
  market in about 1980. Today, it is exporting more coffee than Colombia, and though its beans are generally of a lower quality than Colombia's, they are helping drag 
  down prices. A pound of Vietnamese coffee sells for about 16 cents. 

  "Vietnam is dumping," said Jorge Cardenas, head of the National Federation of Colombian Coffee Growers, using a term that meansselling on world markets at 
  prices that are illegally low under trade law. He said Colombia's labor regulations make it impossible to produce coffee for less than 50 cents a pound. "We cannot 
  compete," he said. 

  To export Colombian coffee, a farmer or company must receive federation approval. Only 30 companies have that stamp, and together they control 70 percent of all 
  coffee exports. The remaining 30 percent is controlled by the federation, which keeps a portion of its revenues for social development and has channeled about $1 
  billion over the past decadeinto building schools, clinics and roads in coffee-growing regions. 

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• In his appointment of Seattle Police Chief Gil Kerlikowske, Obama has nominated the most progressive person to hold that position in the nation’s history. Kerlikowske is in a position to change the nation’s “lock ’em up” attitude and refocus the issue of illegal drugs where it belongs: public health.

   

  At first glance, the selection of a police officer as drug czar might suggest the old government response: arrest, prosecute and punish as many “offenders” as possible. But Kerlikowske comes from a state that has been at the forefront of drug policy reform.

   

  Seattle, where Kerlikowske headed the police force from 2000 until his appointment, has taken a more practical approach. Its citizens voted, in 2003, to make marijuana prosecution the lowest law enforcement priority. The city has been a champion of using the public health system rather than criminal justice to address problems caused by illegal drugs. It has promoted anti-addiction treatments, which reduce the demand for drugs, thus getting dealers off the street. And to reduce HIV transmission among IV drug users, the city of Seattle has listed on its Web site the locations where addicts can get clean needles.

   
• Currently, the War on Drugs costs the federal government approximately $20 billion a year. In 2004, there were more than 40,000 Americans locked up for nonviolent marijuana offenses. Incarcerating these people costs us more than $1 billion a year. And while most of the 800,000 people who are arrested every year for marijuana offenses don’t end up doing time, taxpayers still have to pay the substantial police and court costs — money most governments can no longer afford.

• President Obama caught even close observers off-guard with his mid-February nomination for the nation’s new drug czar, R. Gil Kerlikowske.

    

  Kerlikowske, 59, Seattle’s police chief, with nearly 40 years in law enforcement behind his badge, will direct the White House Office of National Drug Control Policy (ONDCP), pending Senate approval.

    

  But Kerlikowske isn’t just any urban police chief. He’s the top cop of a city with a progressive reputation on several drug-related matters, including needle-exchange programs and marijuana possession laws.

    

  Kerlikowske has a reputation as a levelheaded and effective leader, having served as police chief in three other cities—Buffalo, N.Y., Port St. Lucie and Fort Pierce, Fla.—all of which recorded decreases in serious and violent crime during his tenure.

    

  Although Kerlikowske’s opinions on drug policies reforms are still largely unknown, he differs from the last drug czar, John Walters, in many ways.
• For one, the police chief has not tried to interfere with Seattle’s needle-exchange programs. For another, Kerlikowske is on the record as someone who believes that safer, healthier communities require stricter gun controls; the restoration of voting rights to ex-prisoners (as well as re-entry programs); community-involved policing; and alternatives to sentencing for nonviolent drug offenders, especially in the form of drug courts.

• By contrast, while directing the ONDCP, Walters made it clear he wasn’t interested in considering alternatives to the status quo. “Whatever challenges await, President-elect Obama will not have to reinvent the wheel when it comes to keeping a lid on the use of illegal drugs,” Walters wrote in a Wall Street Journal op-ed on Dec. 5. “Our policy has been a success—although that success is one of Washington’s best kept secrets.”

    

  But the National Academy on Public Administration (NAPA) disputes that assessment. In its recently released Senate-commissioned report, the nonpartisan coalition found that Walters and his predecessors consistently relied on questionable, single-source data and unscientific research in the ONDCP’s media campaigns.

• NAPA also reported that, under Walters, the ONDCP had a disproportionate number of GOP political appointees and people working supervisory roles. (Even potential interns were asked how they voted in the presidential elections during interviews, according to NAPA). If confirmed, Kerlikowske will inherit a poorly staffed office. (More than 25 percent of the ONDCP’s employees left in January.)

    

  Ethan Nadelmann, director of the national drug policy reform organization Drug Policy Alliance, says Kerlikowske is up to the task. “Kerlikowske isn’t going to be in this alone,” he says. “President Obama has made a very public commitment to certain reforms, including his support for federal funding of needle exchange and an end to the crack/powder cocaine disparity.”

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• It has long been suspected that humans have an ancient history of drug use, but there has been a lack of proof to support the theory.

  Now, however, researchers have found equipment used to prepare hallucinogenic drugs for sniffing, and dated them back to prehistoric South American tribes.

  Quetta Kaye, of University College London, and Scott Fitzpatrick, an archeologist from North Carolina State University, made the breakthrough on the Caribbean island of Carriacou.

  They found ceramic bowls, as well as tubes for inhaling drug fumes or powders, which appear to have originated in South America between 100BC and 400BC and were then carried 400 miles to the islands.

  While the use of such paraphernalia for inhaling drugs is well-known, the age of the bowls has thrown new light on how long humans have been taking drugs.

• 1. Talk to Americans as if we are thinking adults. (This worked surprisingly well for the president during the campaign.) Explain that substance abuse is a permanent challenge, not a temporary problem to be solved in a burst of enthusiasm. Tell cultural conservatives that drug users and, yes, even drug sellers are actual human beings, not stage extras in the culture wars, and that a "drug-free society" will arrive on the Twelfth of Never. Tell libertarians, and some liberals, that the drug problem isn't just some statist or reactionary myth: Drug abuse, and not just the drug war, causes great harms.
• 2. You'll be told that we have a national strategy resting on three legs: enforcement, prevention, and treatment. Don't believe it. There is no coherent strategy. Enforcement, prevention, and treatment are the names of three quarrelling constituency groups whose pressures you will sometimes need to resist and whose dearly-held beliefs you must be ready to challenge.
• The biggest prevention program, D.A.R.E., has never been shown to reduce actual drug use; the treatment evaluation literature looks better until you notice how heavily it relies on simplistic before-and-after designs; law enforcement isn't even asked to show that its activities have useful results. There are useful things to be done in all three categories, but resist the temptation to just keep feeding the beast more resources.
• 4.There are some real "'drug wars"' raging: in Afghanistan, in Colombia, and in northern Mexico. Those wars matter terribly to the countries involved, but no outcome of those wars is likely to make the drug situation in the United States noticeably better or worse. We can't solve our drug problem in other countries; the drug traffic adapts, and will find new sources of supply and smuggling routes as long as there are U.S. customers with money. Reducing the drug trade's contribution to the carnage is more important than reducing the flow of drugs. Tell the Afghan and Mexican governments to pick whatever strategies they think will best protect their citizens and defeat the Taliban in Afghanistan and the violent drug gangs in Mexico, whether or not those strategies include eradicating crops or extraditing dealers.
• 5. We can help by shrinking our domestic markets. Offenders under criminal justice supervision account for half of all hard-drug consumption. Hawaii's Judge Steven Alm has shown that frequent testing and swift, automatic, but relatively mild sanctions can sharply reduce methamphetamine use among probationers. This is a cheap solution that also actually shrinks the population behind bars by reducing both probation revocations and arrests for new crimes. But it works only if the authorities can organize themselves to deliver the sanctions.
• Carefully adapted to local conditions, testing-and-sanctions can be extended nationwide, to every probationer and parolee, and everyone released on bail, who has an illicit-drug problem. The current practice of forcing large numbers of drug users into treatment, with incarceration as the alternative, wastes resources. Voluntary treatment should be more broadly provided. Coerced drug treatment should be reserved for those who don't respond to the threat of short jail stays.
• 6. Treatment needs to be more accessible and more accountable. Good news: even lousy treatment has benefits greater than its costs. Bad news: much of the treatment actually delivered is, in fact, pretty lousy. Demand to see results, and insist on rigorous evaluations. Focus resources on effective programs. It's an outrage to have addicts dying of overdoses while on waiting lists for methadone treatment.

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• A recent report commissioned by the Maryland General Assembly has concluded that state services for drug addicts and alcoholics falls far short of the need, a problem it says is most profound in Prince George's County. 

   

   The report comes as new figures show that several counties, including Prince George's, regularly return hundreds of thousands of dollars in unspent substance abuse treatment funds to the state. 

   

   According to the report, which was compiled by University of Maryland researchers working in conjunction with a Harvard Medical School professor, the state would have to admit 14,423 more people into public or private drug treatment programs each year to meet the need. In Prince George's alone, 4,606 more people each year need treatment than receive it. A gap exists in other area counties too -- Montgomery needs 2,950 more treatment admissions annually, and Anne Arundel needs 755. 

• Surely, we thought, college-educated suburbanites like us could locate professional help: drug counselors, doctors, therapists specializing in addiction. Surely detoxification centers would treat desperate addicts and work out a payment plan. Surely we could check her into some kind of residential treatment program with a minimum of delay.

  We were wrong.
• During this initial foray into the drug-treatment world, we trolled the Internet night and day. We Googled "heroin addiction" and thumbed through phone books. It wasn't that there was no information; the information overwhelmed us, without providing answers. We called one place after another. But when private clinics learned that Nicole had no insurance and had been determined ineligible for Medicaid, most simply said "sorry" and hung up; and at $15,000 to $25,000 for a 28-day residential stay, they were out of middle-class reach.

  • The Duda's were learning something I realized the night I woke up in my parked car after my last drink, staggered inside, got sick to my stomach and then looked in the mirror. I realized that if I kept going down the road I was headed down, there would be no treatment or rehab for me. There wouldn't be any money to pay for it.
• The public, government-funded centers were stuffed to the gills, often with patients from prison-related programs. As one counselor told us, an addict can get in faster if he commits a crime than if he just asks for help. "There is a false sense in the public that treatment is one phone call away," says Mike Gimbel, former director of substance abuse education and prevention at Baltimore's Sheppard Pratt Health System, now president of his own consulting firm. "It's a crisis, because people believe they can get help, and it's not there."
• This is a normal pattern for most addicts; those who have successfully gotten clean say it took them several attempts over months or years. "They've been using and they keep using, because it gives them something, and they don't want to give that up," says Yngvild Olsen, a Harford County internist certified in addiction medicine and the medical director and acting deputy health officer for the county Health Department. "Yet they hate the life."

  • The failure rate of treatment makes it easy to say that it's not worth it, but the success rate in terms of getting addicts into recovery is at least the same as prison and probalby better.

• But when your kid falls off the wagon, don't expect the same attitude the diabetic gets. People tend to see addiction as an immoral choice, a character flaw. And even though treatment has been shown to reduce drug use by 40 to 60 percent, many people view it as a revolving door for addicts who thumb their noses at sober living. The media spotlight on celebrities who drop in and out of rehab doesn't help.

  Since the public hasn't bought the disease model, Gimbel says, politicians aren't willing to invest more public dollars in treatment. "Politically speaking, it's more expedient to combat the drug problem by hiring more police and building more prisons," he says. "The public thinks we can arrest our way out of this problem."

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• Domenici has a daughter diagnosed with atypical schizophrenia. He got involved in the parity issue after joining a National Alliance on Mental Illness support group nearly 20 years ago. On his way home from work, he and his wife, Nancy, would meet with other parents of children with mental health problems.

  "The first real understanding of how broad the problem was came from those meetings where I met with mothers and fathers who had children who were mentally ill, and they were going bankrupt because they couldn't pay the health bills, or their children were in jails instead of hospitals," Domenici said.

  He said perceptions about the ability to treat mental health problems have changed greatly over the years, but coverage has also become an expensive proposition. So, he and others, such as the late Sen. Paul Wellstone, D-Minn., began pushing for health insurance parity. Those who would have to bear most of the expense offered the most resistance.

  "Those who stood to lose fought hard and that was principally insurance companies and businesses," Domenici said.

  Employers and insurers were concerned that legislation would have required plans to cover a "telephone book" of conditions, raising costs beyond what companies and their workers could afford and potentially negating companies' ability to offer any health coverage at all.

  • Of course, members of Congress and their families rarely experience the difficulty in getting mental health treatment that everyday Americans face when attempting to get care for their relatives and loved ones.
    
    The mentally ill and the addicted are among those populations whom it will probably never be profitable to serve, for the most part. But their illnesses -- and the cost of so many in these populations going untreated -- are all too real.

• In 1996, Sens. Wellstone and Domenici won passage of a law banning insurance plans that offer mental health coverage from setting lower annual and lifetime spending limits for mental treatments than for physical ailments.

  The pair again teamed up in 2001 on a predecessor to the legislation now before the House. After Wellstone was killed in a plane crash in 2002, Sens. Edward Kennedy, D-Mass., and Mike Enzi, R-Wyo., took on larger roles in getting a bill passed in the Senate.

  The requirement for equal treatment in insurance coverage would apply to health plans that cover more than 50 employees — potentially reaching 113 million people nationwide.

• For those Health Blog readers who didn’t manage to read every line of the ballyhooed bailout bill the Senate passed last night, allow us to direct your attention to page 310 (Title V, Subtitle B), home to the “Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.”

   

  What’s a mental health bill doing in a piece of legislation designed to grease the gears of global finance? Turns out, it’s just a bit of Congressional housekeeping.

   

  The Senate and the House both passed the mental health bill last week. The bill requires mid-sized and large businesses that offer mental health coverage to provide benefits that are comparable to the benefits provided for physical ailments. It was a compromise years in the making, and drew broad support.

   

  The bill passed the House as a standalone measure but was folded in with other legislation in the Senate; in order to send the bill off to the President (who supports the bill), both houses have to pass it in identical form.

• More health-care action from Congress: After long negotiations, the House and Senate have come to an agreement on mental health parity.

   

  After wrangling over the issue for more than a decade, a deal has emerged that seems to satisfy a pretty wide range of interest groups, the WSJ reports.

   

  Under the bill, employers who offer mental health coverage will have to provide benefits that are comparable to those for other maladies. Under current law, it’s fairly common for plans to, say, charge higher co-pays for mental health coverage than for other kinds of health care.

   

  The bill exempts employers with fewer than 50 employees. And it allows employers to choose which, if any, mental health conditions will be covered.

   

  “[W]e think this is a responsible approach to extend mental-health parity and mental-health coverage,” an exec at the National Retail Federation told the WSJ. The director of legislative advocacy for the National Alliance on Mental Illness called the bill “an enormous step.”