(San Diego Union Tribune)

May 20, 2001

No Retreat, No Surrender; A Challenging Agenda for the New Drug 'Czar'

by K. Jack Riley and Martin Y. Iguchi

John Walters, the nominee for director of the Office of National Drug Control Policy, will inherit a difficult job. Since Walters left ONDCP in 1993, the nature of the drug problem has shifted in a number of ways.

Cocaine use, for example, is down substantially, and there have been improvements in the quality and availability of treatment. Overseas, drug production in Peru and Bolivia has declined sharply. At home, drug-related crime, including homicide and robbery, has fallen to near record lows.

On the other hand, an estimated 26 million Americans used illegal drugs last year, many of them on only a few occasions, but a disturbing number of them with great frequency. Moreover, new epidemics that will challenge policy makers for years to come have emerged. Methamphetamine use has risen sharply, and juveniles and young adults appear to be increasing their use of "club drugs" such as Ecstasy and ketamine. Colombia has emerged as a significant heroin and cocaine producer, and the United States itself now supplies much of its own methamphetamine and marijuana.

In short, the problem of substance abuse in this country is a dynamic one. Consequently, policy strategies must adapt to confront these changing realities.

What are some of the policy directions Walters and his agency need to consider?

Let's take an inventory:

Rehabilitation. Currently, more than 600,000 people are released from prison into the community annually, up from less than 400,000 in 1989 when Walters began his first tour of duty at ONDCP. Large portions of these offenders end up back in prison, and much of this cycling in and out of the correctional system has to do with drug use. Many of these felons had drug use problems that went untreated in prison and that go unaddressed after release.

We urgently need strategies that better link these offenders to treatment and skills-enhancement services. These services will not only help the offenders themselves, but will help the communities in which the burden of re-entry is concentrated. California's Proposition 36, which diverts low-level and non-violent drug offenders into treatment rather than sending them to jail or prison, is one potential approach. Expanding opportunities for drug-using offenders to participate in drug treatment both in-prison and post-release is another.

Voters across the nation are making increasing use of ballot measures to address drug issues. Recent examples include the passage of "medical marijuana" initiatives and asset forfeiture reforms in several states, and the passage of Proposition 36 in California. Cumulatively, there is a message in the passage of these reforms: the public is disillusioned about the prospects of effective reform coming from Washington.

From a public policy perspective, many of these reforms are poorly written and difficult to implement. The challenge is to identify the threads of the reform movement that represent clear and appropriate calls for change, and to develop ways to adopt the positive features of these efforts.

We suggest that Proposition 36 in California, as flawed as the measure is, deserves support. If Proposition 36 works as intended, drug users with otherwise clean criminal records will be diverted from prison and jail into community-based treatment. Such treatment offers the prospect of allowing the user to hold down a job, keep the family structure intact, and provides at least as good an opportunity for addressing the person's illness as correctional-based treatment, at potentially far lower costs. The primary challenge, then, is to patch one of the initiative's weaknesses and ensure that the treatment offered under the initiative is effective and evidence-based. Nobody loses if this proposition is exploited to its full potential.

Interdiction. Since the close of the 1980s, the goal of controlling drug supplies has been complicated by the opening of the border under NAFTA and the rise in sophisticated communication and smuggling mechanisms. At a strategy session last fall, policy leaders on source country and interdiction issues pointed to a number of additional factors that make the job more difficult. The universal complaint voiced was that U.S. policy was driven by tactical, rather than strategic considerations, and that planning was constrained to fit within yearly congressional allocations. A broader, more coordinated strategy is called for, so that resources can be more optimally used. In addition, we need to recognize that a significant amount of drug production now occurs in the United States, particularly methamphetamine and marijuana.

Treatment. Although much progress has been made in learning how to provide effective treatment -- in community, correctional and other settings -- several new challenges are emerging. Specifically, only one in three individuals requiring treatment are getting it.

It is important to remember that a majority of illicit drug users are employed on a full-time basis. Recognizing this, support for legislation requiring insurance coverage for substance abuse treatment would be a relatively efficient way to increase access to care. Such an effort would result in less drug use, improved productivity in the work place, and relatively negligible increases in private sector health care costs.

In addition, we are not doing enough to enroll adolescent users, one of the highest risk populations, in treatment programs. Adolescent treatment programs need to be designed to address young users' need for both treatment and life skills services. Another challenge is the development and promotion of effective treatment for stimulant users.

Additionally, buprenorphine, a pharmacological treatment for opiate abuse, is emerging as a powerful new tool for treating heroin users in the United States. The medication will be widely available through office-based physician practices, and we urge the new czar to expedite this process, while making arrangements to carefully monitor the impact of this medical therapy.

Faith-based programs. We know little about how, or if, faith-based programs work. It seems intuitive that spiritual and religious leaders are important resources for drug users, and that faith may be an important foundation upon which recovery can be built. However, faith by itself is likely to be an insufficient tool for managing a substance abuse problem. It is important that evidence-based standards of care be established and that we develop faith-based demonstration programs to test these concepts before they are promoted into widespread use.

Prevention. Prevention programming has expanded enormously since 1989, and we now know that such efforts can be effective at controlling the spread of drug use. However, components of the federally supported Safe and Drug Free Schools program requires careful reconsideration. The politically entrenched but ineffective DARE programs should be replaced.

Race. In 1989, the racially disparate consequences of drug policies, such as mandatory minimum sentences and highway enforcement against drug couriers, were only just beginning to become clear. It is now evident that current drug policies have vastly different impacts across racial groups. One in 29 black males are imprisoned in this country, compared to 1 in 240 white males. In highway driving, blacks are far more likely to be stopped despite driving patterns that are no different from those of whites.

The consequences of these disproportionate impacts are potentially enormous in light of policy changes that have accumulated over the last decade. Convicted drug felons may now be denied access to public housing, public assistance, educational support, and public health care. There is no evidence that these policies contribute to reducing drug use, but there is reason to suspect that they help prevent successful re-entry, employment, and, perhaps, recovery. More broadly, these policies corrode links between the minority communities and public officials.

The challenges awaiting the new nominee and his agency are substantial. Doubtless, the nature of the drug problem and its myriad public health and safety dimensions will continue to change. In response, we urge Walters and ONDCP to continue the development of robust, evidence-based interventions.

Riley is director of RAND's Public Safety and Justice Program (formerly RAND Criminal Justice). Iguchi is co-director of RAND's Drug Policy Research Center.

This commentary originally appeared in San Diego Union Tribune on May 20, 2001. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.