07/13/14 Doug McVay
Century of Lies
Doug McVay reporting this week: The White House released its new annual drug strategy report so we hear from ONDCP Acting Director Michael Botticelli, plus NIDA Director Nora Volkow on heroin and prescription drugs.
Century of Lies July 13, 2014
DEAN BECKER: The failure of Drug War is glaringly obvious to judges, cops, wardens, prosecutors and millions more. Now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century of Lies.
DOUG McVAY: Hello and welcome to Century of Lies. I'm your guest host, Doug McVay, editor of Drug War Facts dot org. Century of Lies is a production of the Drug Truth Network. DTN is supported through the generosity of the James A. Baker III Institute for Public Policy and of listeners like you. Find us on the web at drug truth dot net, where you can find past programs and you can subscribe to our podcasts. You can follow me on twitter, where I'm at drug policy facts, and also at doug mcvay. The Drug Truth Network is on Facebook, be sure to give its page a Like, you can find Drug War Facts on Facebook as well, please give it a like and share it with friends.
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Let's get to the news.
The federal Office of National Drug Control Policy released its annual drug control strategy report last week. The administration has definitely adopted the language of reform. It must be said that they are doing some things right – supporting sentencing reforms, expanding availability of naloxone, advocating for syringe exchanges in spite of the congressional funding ban, and working with states to promulgate Good Samaritan 911 laws that allow people to seek help without having to fear arrest. Yet the feds are still blocking medical cannabis research, they're still waging a war against pain patients and their physicians, and they're still pushing laws that criminalize too many of us.
Drug war spending still favors supply-side law enforcement-focused programs, though the administration is trying to avoid acknowledging that fact. They say on the ONDCP website that,:
“In support of this Strategy, the President has requested $25.5 billion in Fiscal Year 2015. Federal funding for public health programs that address substance use has increased every year, and the portion of the Nation’s drug budget spent on drug treatment and prevention efforts – 43 percent – has grown to its highest level in over 12 years. The $10.9 billion request for treatment and prevention is now nearly 20% higher than the $9.2 billion requested for Federally-funded domestic drug law enforcement and incarceration.”
That is true.
However, it should be noted that from 2003 through 2008, total demand reduction spending – that is, treatment and prevention – outpaced federal domestic law enforcement spending. It was this administration which from 2009 through 2012 poured more money into domestic law enforcement than into all prevention and treatment programs. Thankfully – hopefully – they've seen the error of their ways.
Now go back to the numbers.
Twenty-five point five billion dollars is the total of the Fiscal Year 2015 budget request for drug control programs. Of that, ten point nine billion is for all treatment and prevention combined, and about 9 point 2 billion is for domestic law enforcement. Do the math, that's just 20 point one billion. The five point 4 billion remaining is split between interdiction, at about three point nine billion, and international law enforcement at about one point 4 billion. In other words, law enforcement-focused supply-side spending takes up more than 14 point four billion of the total spending request, in other words about 58 percent.
That's an improvement over years past, but not much of one. And it may not mean anything, thanks to Congressional deadlock and election year politics. The House and Senate have to agree to spending bills, which they send to the president. Unfortunately, the Senate is unable to even come to agreement on the rules for the budget debate. The federal fiscal year starts on October first, which means that Congress is supposed to have these done by the end of September. Unfortunately it is entirely possible the deadlock will continue through the 2014 general election. If that happens, then what's most likely to occur will be a continuing resolution, that is, they'll agree to continue programs at roughly the current levels of spending.
That would also mean killing for the time being amendments that had been passed on the house side, one of which would have prevented justice department and DEA funds from being spent to interfere with state-approved hemp production projects, and another of which would have stopped them from spending any funds to go after state-legal medical cannabis businesses.
Now, here's ONDCP's Acting Director Michael Botticelli, speaking about the new report.
MICHAEL BOTTICELLI: My name is Michael Botticelli. I am the director of the White House Office of National Drug Policy but I am also a person in long-term recovery from substance use disorders.
I am speaking on behalf of my recovery because for too long the statement associated with the disease of addiction has quieted too many of our fellow Americans who have struggled with this disease.
For far too long having a substance abuse disorder was seen as a moral failure, matter of weakness rather than recognizing it as the disease that it is. That is why I am so happy to be here today, the Treatment Center, to release the President’s very controlled strategy.
As one of the millions of Americans in recovery myself I can’t overstate the importance of this administration’s efforts to reform drug policy in a way that finally recognizes that substance use is a public health issue and not just a criminal justice issue. While law enforcement will always play a pivotal role in protecting our communities from drug-related violence and harm we know that we cannot arrest or incarcerate our way out of the drug problem.
Before I provide the plan I’d like to take a moment to address why addressing substance use disorders and its harms is so vital not only to Roanoke, Virginia but also to this nation. According to the Center of Disease Control and Prevention drug overdose deaths now surpass homicides and tragic crashes as the leading cause of injury death in America. Most of this is driven by the abuse of opioids - a group of drugs that include heroin and prescription pain killers.
According to the CDC approximately 110 Americans on average die every single day from drug poisoning deaths. Prescription drugs were involved in more than one-half of the 41,300 drug poisoning deaths in 2011. Opioid pain relievers were involved in nearly 17,000 of these deaths. There were about 4,400 drug poisoning deaths involving heroin. Right here in Virginia heroin overdose deaths have risen from 101 in 2001 to 197 in 2013.
As each of you already know the damage caused by drug use and substance use disorders projects far beyond those individuals we have lost to overdoses. Drug use tears families apart and drives crime. It hinders academic performance among young people. It further strains our already overburdened criminal justice and public health systems and it places obstacles in many ways of prosperity by harming our economy.
In fact data from 2007 shows that in just one year drug use caused our nation an estimated 193 billion dollars due to health care costs, crime and lost productivity. Even though this country comprises just 5% of the world’s population we incarcerate almost one-quarter of the world’s prisoners.
More than 219,000 federal inmates are currently behind bars – almost one-half of them are serving time for drug-related crimes and many have an underlying substance use disorder.
These facts demonstrate that drug use and its consequences pose a serious challenge that affects all of us one way or another. The truth is all of us know someone – a family member, a co-worker, a neighbor, a friend - who has been touched by the consequence of drug use from those struggling to recover from a substance use disorder to victims of drug-related crime to those struggling for a second chance despite a previous criminal record.
This is why we have a shared responsibility to reduce drug use and its consequences. Doing so will not only make our nation healthier and safer but will also ensure that our nation is prepared to meet the challenges of the 21st century.
Our approach to this challenge should be guided by what experience, compassion and, most importantly, science demonstrate about the true nature of substance use disorders in America. The strategy we are releasing today represents an alternative approach. It outlines more than 100 ongoing actions that are the building blocks of drug policy reform.
Central to this strategy and to this administration’s overlooking drug policy is the science-based understanding that substance use disorders are a disease that can be prevented, treated and from which one can recover.
This strategy begins with an emphasis on prevention. We know that preventing drug use before it begins - particularly among young people – is the most cost-effective way to reduce drug use and its consequences in America. That is why this strategy lays out actions for expanding national and community-based programs including our Drug Free Community Support program - the work that prevents substance use in schools, on college campuses and in the workplace.
This strategy also calls on the medical community to expand programs like screening, brief intervention and referral to treatment that empower health care professionals to intervene early at the first signs of trouble. Early detection and treatment of a substance use problem is more humane and less costly than dealing with the consequences of addiction including crime and incarceration later on.
This strategy supports efforts to make access to treatment a reality for millions of Americans. As we have seen here today treatment works. Now the Affordable Care Act for the first time in history requires insurance companies to cover treatment for substance use disorders just like they would cover any other chronic disease like diabetes or hypertension.
By expanding insurance coverage this new law – the most significant piece of drug policy reform in generations – expands access to addiction treatment for millions of Americans who need it. Expanding Medicare coverage in Virginia can make a real and substantial difference in people’s lives. We cannot leave people behind.
This strategy gives a voice to people in recovery from substance use disorders and outlines steps to help lift the stigma often associated with this disease. Today there are millions of Americans in recovery who are healthy, responsible and engaged members of the community.
The strategy works to reform the laws and regulations that impede recovery including those that place obstacles in the way of housing, employment, obtaining a driver’s license or student loan because of a prior conviction for a drug-related offense.
This strategy also supports “Smart on Crime” approaches to law enforcement such as drug courts. It is notable that Roanoke was the site of the first drug court in Virginia. Today more than 2,700 other drug courts across the country are diverting hundreds of thousands of non-violent drug offenders every year into treatment instead of prison.
This strategy also supports ground-breaking diversion programs as well including the drug market interventions which take community policing approach to shutting down open-air drug markets. We’re going to see an example of that later today in Roanoke.
This new strategy also addresses some of the most urgent challenges we are facing today, in particular, the abuse of opioids ( a class of drugs that include both prescription drugs and heroin). With reports of heroin use in many communities including right here in Virginia we are growing increasingly concerned by the potential transition from prescription opioid abuse to heroin and injecting drug use. This strategy pursues a comprehensive approach to addressing this rising threat.
We are working to increase that use of FDA-approved medications that treat opioid use disorders including providing treatment in the criminal justice system. We are working with the national AIDS policy, federal partners and state and local governments to develop a collaborative approach to address substance use disorders as well as the public health issues that result in increased use of syringes including viral hepatitis and HIV.
We have intensified our focus on overdose prevention and intervention to include educating the public about overdose risks and interventions. Increasing access to naloxone and emergency overdose emergency medication and working with states to promote “good Samaritan laws” and other measures that we know help save lives.
We are also working with law enforcement partners across the country and working with the world to disrupt and dismantle criminal organizations involved with the trafficking of heroin. Through all of these efforts we are working to improve data collection on heroin use, production, trafficking and street-level sales.
Let me close by noting why we’ve come here to make this announcement. Not only has Roanoke like so many other communities in America been hard hit by this national opioid overdose epidemic it is also a shining example of how communities can work together to address our shared drug challenge. Right here in southwest Virginia we are seeing treatment providers located with experts in the criminal justice and prevention arenas. We are seeing law enforcement work on a first name basis with public health communities and we are seeing lives saved every day.
That is what it takes – real cooperation with diverse individuals in groups working toward a common goal. This is what the future of drug policy reform looks like in America.
Thank you for the opportunity to be here.
DOUG McVAY: You are listening to Century Of Lies, a production of the Drug Truth Network. I'm your guest host Doug McVay, editor of Drug War Facts.
The administration's focus on opioids is not new. The White House held a summit on opiate and prescription drug use in mid-June, so from that event, here's the director of the national institute on drug abuse Dr. Nora Volkow with more detail on the fed's strategy:
NORA VOLKOW: I get criticized and many others get criticized for describing this as an epidemic of prescription opioid use but I don’t really know any other better way of describing it if you look at the numbers and how fast these numbers have crept into our country.
What we do with science is actually to try to understand the symptoms that can give us information that can hopeful help to resolve the problems. If you look at the problem of prescription abuse we know the prevalence following the illegal drugs and marijuana the most prevalent drugs abused in our country are prescription medications.
Of them the top prescription medications are opiate analgesics. And why are opiate analgesics used in order for abuse purposes? Because they stimulate opiate receptors. opiate receptors are actually active receptors in the brain.
Opiate receptors, though, are also partially regulating our perception of pain. We give the medication the medication is going to be effective because it is stimulating those centers that regulate pain but, at the same time, you also see centers that are activated by reward and that is why opiate medications can be diverted and why they are abused and why they can produce addiction.
So understanding under the right conditions these medications can be safe and very valuable for those who need them versus understanding on what conditions they can actually enhance these rewarding and addicting properties is crucial as we do prevention and therapeutic interventions.
It is different than other drugs. We are faced with a particularly complex challenge which is a concept that if you were to come to me on cocaine or methamphetamine addiction and I said, “Let’s get rid of cocaine, amphetamine, nicotine addiction off the surface of the earth” no one would suffer but here we have psychotherapeutics that can be life-saving on certain instances so we cannot just erase them from the earth.
How do we address this? I think that is an issue that we have to correct but I also applaud you for your honesty. We need to be willing to observe the phenomena in order to change it even though sometimes we may not want to be so candid as to state it. In my view, as a scientist, if I’m not objective, if I don’t put the data in front of us than what am I doing?
While it is correct that the pharmacological characteristics of opioids make them a minimal for diversion and that’s why they are being diverted and why they produce addiction. That’s not the only reason why we have this epidemic of opiate prescriptions. We have also the epidemic because it has been a massive increase in the ability of these medications and we know from epidemiological studies that one of the factors that determines the prevalence of use of substance is how easily available they are.
Another factor is cultural abnorms. In the case of prescription opiates one of the reasons why the individual state that they favor these medications is because of they believe they are safe because they are prescribed by physicians. The reality is that when these medications are taken outside of the medical context or even within the medical context without adequate supervision and monitoring they can be as dangerous and as addictive as illicit substances.
How do we think we can manage it? Well, just for those who are not necessarily pharmacologist we have known from the research of substance abuse is that the same drug, the same quantity of the drug that have more or less addictive potential on the basis of how fast it gets into the brain. The faster it gets into the brain, the stronger its rewarding effects - the greater its addictiveness. This explains why when you take a drug orally it is much less addictive than when you inject it because oral takes 60 minutes in order to get it into the brain and injection gets into the brain within 3 minutes.
That’s why, again, one of the strategies that has been used quite effectively but is not totally proven is that administer these medications in ways that you cannot inject them or snort them. That, in and of itself, increases the likelihood that they will be diverted. It is not 100% proven.
What led to this massive increase in opiate prescriptions? Yes, people are taking them because they think they are safer because they are [inaudible] but why did we end up with this massive quantity of prescription medications?
At the same time that we are seeing this phenomena that I call an epidemic there is another very epidemic-looking like phenomena of massive amount of individuals in the United States with severe chronic pain. The Institute of Medicine reported that there are at least 100 million Americans suffering from moderate to severe pain. In the meantime there has been an urgency for the health professionals to address the proper treatment of individuals that are suffering from pain.
Chronic pain, if untreated, data suggests that one-third of them is at risk of suicidal behavior. With that these two things are colliding. So what happened is that health system started to more aggressively treat pain but they did it without the adequate education of background that would allow them to ultimately treat their patients with pain and prevent them from becoming addicted.
Thus this reflects two points that straight forward have been addressed before that even though they sound simple they are crucial in this epidemic - education of the health care system in the proper measurement of pain including management of opioid medications and education of the health care system in substance use disorders. Most physicians don’t know how to screen for substance use disorders. They don’t know how to recognize it and they don’t know how to intervene.
So these two phenomena facilitated the excessive prescription of opioid medications while at the same time it does not necessarily follow that even though we are massively prescribing medications we are properly treating chronic pain patients.
When I speak massively when I was speaking...well, over a 20 year period we went from something like 70 million prescriptions of opioid per year in our country to close to 210 million - a three-fold increase in 20 years. Over those 20 years we saw a three-fold increase in overdoses. Over the last ten years we have seen a five-fold increase in admission for substance use treatment.
We do know that over prescription and I call it over prescription because as the attorney general was speaking of recovering tons of medications you cannot have it both ways. If we are recovering tons of medications it is because we are prescribing more medication than is needed - again, highlighting the area of intervention that is crucial.
As we planned right now and are aware of the devastating consequences of this epidemic that is highlighted by the number of overdoses that now actually been pinpointed by this striking rise in deaths from heroin and, Mr. Chairman, you may not be aware of how important the intervention was for us making us aware of how stiff the increases are in heroin in our country. The CDC has its release for the 2011 and over one year we’ve seen more than a 30% increase in overdoses from heroin.
This is a very, very fast moving trend and we need to stop it. We have the tools we need to stop it right now. So, what is it that right now that we can do? We need to educate the health care system in the proper prescription of these medications. There are many myths...one of them, for example, is as many of my colleagues believe is that if you have chronic pain and they give you an opiate medication you are not going to become addicted to it. Well, it is wrong. It is wrong because we are now seeing patients that have never taken a drug that are being treated with opioids and the lack of knowledge about addiction in their physicians did not protect them from becoming an addict.
We need to improve on the education of medical students, of specialty physicians, of pharmacy and nurses handling, screening and treatment of chronic pain. We need to also implement education on substance use disorders so that they can recognize it.
It so happens we don’t have many medications for drug addiction but it so happens that we have medications for the treatment of opioid addiction. We have it – methadone, buprenorphine, devitrol – they work! Not only do they work at decreasing heroin consumption, in preventing relapse, in ensuring that the patient recovers - it decreases the likelihood of getting infected with HIV, it decreases the likelihood that they end up in the criminal justice system and - guess what?! - it decreases their likelihood of overdosing.
And, yet, we are not implementing them. You can look at different numbers but between 10 and 20% who need it get it so the majority of patients are not getting medications that could prevent these overdoses. Why? Because implementation is not straight forward. You may have evidence but that doesn’t necessarily mean that it changes behavior. I think in terms of the area of research that is very important is research on implementation to help us understand how to implement these treatments in the health care system, in the criminal justice system because the evidence is already there.
As we look into the future, as the attorney general was saying, we have these gigantic brains, of course, in order to solve solutions. 50 years ago we were going out there into the moon, right? We uncover the human genome. We have the capacity to do better in substance use disorders.
I’m delighted that we have medications for the treatment of opiate addiction but how many medications do we have for other diseases...like HIV? An example of how extraordinary we can be in solving problems this is a disease that emerged in the late 70s, early 80s and now there are patients with this disease that have access to many types of medications that they can choose and live basically a normal life – they are going to die of something else – not the HIV.
Why? Because we invested the resources on that disease. Yes, the disease of addiction is treated very differently than the other diseases. We need to recognize that we can actually expand on the access of medications.
An area as we, as an agency, are very interested in is the recognition, on the one hand, that we need better treatments for addiction but we also need better treatments for the management of pain. Unfortunately we do not have effective medications to handle severe pain that does not have adverse effects. This is an area that should be prioritized, an area that, for us, we are funding research to develop medications that will not be addictive and will be much less likely to be diverted.
In the addiction field let’s be creative. There are many things that we can do. We can create for medications for opioids, for example, medications that cannot be injected because they have to be ingested and digested in your stomach. For addiction let’s take advantage of what others are doing in other fields – cancer, infectious diseases, development of vaccines so that we can protect from abuse.
In the issue of preventing overdoses we have naloxone. Naloxone works. If you have ever given naloxone to a patient that has overdosed naloxone works. If the patient was in a coma and was not from an opioid it will have no ill effects. If we have a medication that works and doesn’t have side effects we should make it as accessible and available as possible.
We are funding user-friendly naloxone that can be applied by not just medical and trained personnel but by someone that is an observer of someone that may have had an overdose.
Ingenuity, again, that is what we are speaking about. We are extraordinary ingeniousness – our human brains. Most of the patients, many of the patients...one of the stories that I hear constantly is they go to wake them up and the child is dead. Many of these opioid overdoses occur overnight but we have these technologies and mechanisms to detect when someone’s breathing goes wrong or gets disrupted. I have someone that calls me and someone is laying in my basement and the police can get in 5 minutes....why can’t we apply these technologies in order to be able to save those lives?
We have the tools what we need is the will to do it and I want to thank Mr. Botticelli because the way that we are going to succeed is knowledge is not sufficient – it is crucial but not sufficient. We need to implement it and that requires a partnership between the different organizations and different individuals coming together to solve a problem that is solvable. It is our responsibility to solve. It is also an urgent problem.
So as Mr. Holder said, we need to act and we need to act urgently.
Thank you, very much.
DOUG McVAY: That's it for this week. I'm Doug McVay and this was Century of Lies. Thank you for listening. You can find a recording of this show and past shows at the website drug truth dot net, where you can check out our other programs and subscribe to our podcasts. Follow me on Twitter, where I'm @ Drug Policy Facts and @ Doug McVay. The Drug Truth Network is on Facebook, be sure to give its page a Like, you can find Drug War Facts on Facebook as well, please give it a like and share it with friends. Spread the word. Remember: Knowledge is power.
We'll be back next week with more news and commentary on the drug war and this Century Of Lies. For now, for the drug truth network, this is Doug McVay saying so long. So long!
For the Drug Truth Network, this is Dean Becker asking you to examine our policy of Drug Prohibition.
The Century of Lies.
This show produced at Pacifica Studios at KPFT, Houston.
Transcript provided by: Jo-D Harrison of www.DrugSense.org