The Last Drug Czar?

The mixed record of Obama’s outgoing drug chief.

Gil Kerlikowske heads for a press conference at the Mexican Foreign Ministry building on June 22, 2011 in Mexico City.
National Journal
Lucia Graves
March 13, 2014, 7:06 a.m.

It might as well have been a life­time ago when Gil Ker­likowske began his job as the na­tion’s top drug of­fi­cial back in 2009.

When Pres­id­ent Obama ap­poin­ted him to be dir­ect­or of the Of­fice of Na­tion­al Drug Con­trol Policy — a po­s­i­tion known as the “drug czar” — only a dozen-plus states had leg­al­ized med­ic­al marijuana; a poll show­ing a minor­ity of Amer­ic­ans sup­port leg­al­iz­a­tion could still be con­sidered “re­cord break­ing;” and the dis­par­ity in sen­tences for users of crack and users of co­caine was still 100-1. The idea that two states would soon fully leg­al­ize the re­cre­ation­al use of marijuana seemed ab­surd.

Ker­likowske was fresh off a gig as po­lice chief in Seattle, a city known for ex­per­i­ment­ing with pro­gress­ive drug pro­grams, giv­ing re­formers some hope and drug war­ri­ors some heart­burn. But after a ten­ure that proved to be re­l­at­ively con­ven­tion­al, Ker­likowske has been tapped to head Cus­toms and Bor­der Pro­tec­tion, and is ex­pec­ted to be re­placed by someone who could rep­res­ent a sea change in fed­er­al drug policy.

When Ker­likowske was first ap­poin­ted, re­formers hoped it signaled a shift from the typ­ic­al fed­er­al ap­proach em­phas­iz­ing ar­rest and pro­sec­u­tion to a more mod­ern one, centered around edu­ca­tion and pre­ven­tion. It was a no­tion Ker­likowske had paid con­sid­er­able lip ser­vice to, prom­ising in his first in­ter­view as drug czar to end the “war on drugs” and, later, to pro­mote pub­lic health solu­tions and a “21st cen­tury” ap­proach.

People on the en­force­ment side of things wor­ried that would come at the ex­pense of law en­force­ment. As it turns out, they needn’t have wor­ried.

“He’s been an ex­tremely valu­able part­ner and someone we could re­li­ably ex­pect to work with us, co­oper­ate with us, and ap­prise us of where the ad­min­is­tra­tion was headed,” said Jim Pasko, ex­ec­ut­ive dir­ect­or of the Fraternal Or­der of Po­lice, the na­tion’s largest law-en­force­ment labor or­gan­iz­a­tion. “We were very happy with him.”

The White House budget for 2014 de­votes 57 per­cent of drug-con­trol spend­ing to pun­ish­ment and in­ter­dic­tion while just 43 per­cent went to treat­ment and pre­ven­tion. Ker­likowske has noted such num­bers in­creased treat­ment and pre­ven­tion fund­ing from pre­vi­ous years, and there’s some truth to that. But look a little fur­ther back, and you’ll see OND­CP is just now bring­ing this ra­tio in­to line with about where George W. Bush had it in fisc­al year 2004.

Marijuana Ma­jor­ity spokes­man Tom An­gell was un­der­whelmed by what Ker­likowske billed as pro­gress. “If the ad­min­is­tra­tion really be­lieves drug ab­use is a health is­sue that we can’t ar­rest our way out of, they need to put their money where their mouth is and stop em­phas­iz­ing de­vot­ing so many re­sources to the same old failed ‘lock ‘em up’ policies,” An­gell said. “It’s quite dis­con­cert­ing that spend­ing for the Bur­eau of Pris­ons is go­ing up at a time when the at­tor­ney gen­er­al of the United States says we are in­car­cer­at­ing far too many people for far too long at too great a cost.”

It’s not just Ker­likowske’s re­cord on marijuana that re­formers take is­sue with. The num­ber of over­dose deaths from heroin has in­creased dra­mat­ic­ally in re­cent years, grow­ing 45 per­cent between 2006 and 2010, ac­cord­ing to OND­CP. The up­tick in deaths has been shown to be cor­rel­ated with the the re­cent crack­down on pre­scrip­tion drugs. Ker­likowske has ad­mit­ted that heroin “was not on the radar screen” dur­ing most of Obama’s first term, ac­cord­ing to The Wash­ing­ton Post, and that he “didn’t do everything I should have” to raise aware­ness of the prob­lem.

Kev­in Sa­bet, a former OND­CP of­ficer who now runs the anti-leg­al­iz­a­tion group Smart Ap­proaches to Marijuana, doesn’t hold Ker­likowske re­spons­ible for that. “No one can pos­sibly blame the of­fice for de­vot­ing so many re­sources — so quickly — to re­du­cing the pre­scrip­tion-pill epi­dem­ic,” he said in an email. “Ac­tion was swift and cer­tain, as it had to be. Is the cur­rent surge in heroin ad­dic­tion a res­ult of a crack­down on pills? I don’t know, but no one can blame someone for tak­ing ac­tion on a hor­rible pub­lic-health crisis.”

Bill Piper, dir­ect­or of na­tion­al af­fairs for Drug Policy Al­li­ance, a pro-re­form group in Wash­ing­ton, sees Ker­likowske’s re­cord as mixed. “It’s in­ter­est­ing be­cause tra­di­tion­ally drug czars have been pro­pa­gand­ists for the fed­er­al war on drugs” he said. “Since the cre­ation of OND­CP, they’ve largely been cheer­lead­ers for the drug war; they’ve put polit­ics over sci­ence; they’ve op­posed re­form; and stifled de­bate. Drug czar John Wal­ters, who was Bush’s drug czar, once com­pared drug users to ter­ror­ists.”

By con­trast, Piper called Ker­likowske’s ap­proach “a re­fresh­ing change.” He sup­por­ted the Obama ad­min­is­tra­tion’s re­form agenda around crack sen­ten­cing re­form and over­dose pre­ven­tion, as well as syr­inge-ex­change pro­grams. He also helped to change some of the rhet­or­ic around the is­sues, con­stantly say­ing that drug re­form should be treated as a health is­sue in­stead of a crim­in­al-justice is­sue.

“All of that is good,” Piper said. “But his rhet­or­ic hasn’t al­ways matched up with his ac­tions. This is es­pe­cially the case with marijuana.”

Sa­bet blames en­vir­on­ment­al factors for any short­com­ings. “Gil Ker­likowske was one of the most ef­fect­ive drug czars, work­ing in one of the most dif­fi­cult en­vir­on­ments a drug-con­trol dir­ect­or has ever had to work in,” he said. “He was the head of drug policy in a White House largely ag­nost­ic about today’s great drug-policy de­bates, and that makes it dif­fi­cult.”

Some drug re­formers spec­u­late the White House moved Ker­likowske be­cause he’s out of step with the trend to­ward lib­er­al­iz­a­tion of marijuana, not­ing his out­spoken op­pos­i­tion to a Cali­for­nia ref­er­en­dum that would have leg­al­ized the drug in 2010. “It makes me won­der if that’s why he left,” Piper said.

A back­ground in law en­force­ment, or a hawk­ish polit­ic­al ca­reer, used to be an un­writ­ten re­quire­ment for as­sum­ing the po­s­i­tion of drug czar. Now, for the first time, we’re see­ing something dif­fer­ent.

Ker­likowske’s in­ter­im re­place­ment, act­ing dir­ect­or Mi­chael Bot­ti­celli, hails from a back­ground in pub­lic health and has even re­ceived ser­vice awards for pro­mot­ing re­cov­ery ad­dic­tion. Bot­ti­celli, who served as Ker­likowske’s deputy at OND­CP, is the former dir­ect­or of the Mas­sachu­setts Sub­stance Ab­use Ser­vices Bur­eau, where he ex­pan­ded treat­ment and re­cov­ery ser­vices and helped es­tab­lish early in­ter­ven­tion treat­ment pro­grams for ad­oles­cents. It’s un­clear wheth­er he’ll be form­ally nom­in­ated by the Obama ad­min­is­tra­tion, and even more un­clear that he could clear a Sen­ate vote. But if he is chosen, it would mark the first time in his­tory someone with a back­ground in pro­mot­ing ad­dic­tion re­cov­ery be­came the na­tion’s top drug of­fi­cial — since he’s in charge now, it already does.

“It’s still an open ques­tion on where he’s go­ing to be on marijuana,” said Drug Policy Al­li­ance’s Piper. “We hope that he’s evid­ence-based on that, but it’s nice to see someone at the helm who has a health back­ground in­stead of a law-en­force­ment back­ground. We’re hop­ing to be able to work with him where there’s com­mon ground.”

What We're Following See More »
STAFF PICKS
After Wikileaks Hack, DNC Staffers Stared Using ‘Snowden-Approved’ App
1 hours ago
WHY WE CARE

The Signal app is fast becoming the new favorite among those who are obsessed with the security and untraceabilty of their messaging. Just ask the Democratic National Committee. Or Edward Snowden. As Vanity Fair reports, before news ever broke that the DNC's servers had been hacked, word went out among the organization that the word "Trump" should never be used in their emails, lest it attract hackers' attention. Not long after, all Trump-related messages, especially disparaging ones, would need to be encrypted via the Snowden-approved Signal.

Source:
WARRING FACTIONS?
Freedom Caucus Members May Bolt the RSC
3 hours ago
WHY WE CARE

The Republican Study Committee may lose several members of the House Freedom Caucus next year, "potentially creating a split between two influential groups of House conservatives." The Freedom Caucus was founded at the inception of the current Congress by members who felt that the conservative RSC had gotten too cozy with leadership, "and its roughly 40 members have long clashed with the RSC over what tactics to use when pushing for conservative legislation." As many as 20 members may not join the RSC for the new Congress next year.

Source:
SOME THERAPIES ALREADY IN TRIALS
FDA Approves Emergency Zika Test
5 hours ago
THE LATEST

"The U.S. Food and Drug Administration on Monday issued emergency authorization for a Zika diagnostics test from Swiss drugmaker Roche, skirting normal approval channels as the regulator moves to fight the disease's spread." Meanwhile, the Wall Street Journal reports that a new study in Nature identifies "about a dozen substances" that could "suppress the pathogen's replication." Some of them are already in clinical trials.

Source:
MONEY HAS BEEN PAID BACK
Medicare Advantage Plans Overcharged Government
6 hours ago
THE DETAILS

According to 37 newly released audits, "some private Medicare plans overcharged the government for the majority of elderly patients they treated." A number of Medicare Advantage plans overstated "the severity of medical conditions like diabetes and depression." The money has since been paid back, though some plans are appealing the federal audits.

Source:
DESPITE CONSERVATIVE OBJECTIONS
Omnibus Spending Bill Likely Getting a Lame-Duck Vote
6 hours ago
WHY WE CARE

"GOP leaders and House Democrats are already laying the groundwork for a short-term continuing resolution" on the budget this fall "that will set up a vote on a catch-all spending bill right before the holidays." As usual, however, the House Freedom Caucus may throw a wrench in Speaker Paul Ryan's gears. The conservative bloc doesn't appear willing to accept any CR that doesn't fund the government into 2017.

Source:
×