12/07/14 Michael Botticelli

Century of Lies

Doug McVay reports: This week: We look at the man who would be czar, Michael Botticelli.

Audio file



DECEMBER 7, 2014

DOUG MCVAY: Hello and welcome to Century of Lies. I'm your host, Doug McVay, editor of Drug War Facts dot org. Century of Lies is a production of the Drug Truth Network, which comes to you through the Pacifica Foundation Radio Network and is supported by 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.

Now, on with the show.

I thought that this week I'd be reporting that the nomination of Michael Botticelli was moving forward. The Senate Judiciary Committee held a hearing, it had gone well, the committee vote was scheduled for December Third. Then the committee met, and rather than vote on his nomination – which is considered a slam-dunk – the vote was held over until next week.

If this were the beginning of the session, that would be no problem, but it's not. The session is about to end. The House has a target date of December Twelfth for adjournment. The Senate hasn't announced a date yet, but the budget has to be approved by the end of December Eleventh so most people aren't looking beyond that date. The budget was supposed to be approved and signed by September Thirtieth, which is the end of the federal fiscal year. That failed, and a Congressional agreement kept the government in operation – until next week, when that runs out. Either both houses will pass an omnibus spending bill, or, what's more likely, there will be a continuing resolution that will keep funding at the same levels throughout the government, and all the debates will be carried over until the next session.

There is also a remote possibility that we could have what's called a trainwreck. That's when Congress fails to agree on a budget and they refuse to pass a continuing resolution, so the government technically runs out of money. If that happens, then all so-called non-essential services would shut down. Programs which related to national security and public safety would stay open, also programs like Social Security which are written into permanent law would be unaffected. The Post Office would still deliver mail, so packages, cards, and letters would arrive no later than they do any other year.

I'm not going to go further into details. The chances are good that a shutdown will not happen. Of course since the next election is two years away, some members may feel they could risk the loss of a little political capital. Basically, next week I'll be watching quite a bit of C-SPAN.

Anyway, back to Botticelli. There is a meeting of the full Judiciary Committee scheduled for November Tenth to discuss some nominations, probably including Botticelli – at the time of this recording, the agenda has not been made available, but it's likely that's the date. If the committee votes on his nomination and approves it, it goes to the Senate. There has been no reported opposition to Botticelli so if the nomination makes it the Senate, he'll make it. If they don't vote on Botticelli's nomination this Wednesday, then it may have to wait until the next Congress, which convenes in January. Again there is no known opposition to Botticelli, so the question is begged, why are they putting it off?

Unfortunately, I haven't found an answer to that, so while we're waiting let's hear from the man who could become the next drug czar. Loyal listeners will recall that not long ago we featured audio from Botticelli's confirmation hearing, which was held on November thirteenth. It's always good to hear what an official has to say to members of Congress, especially members he has to suck up to – like the Senate Judiciary committee. Now, let's hear what he says to other folks. The Harm Reduction Coalition held its 2014 conference in Baltimore, Maryland. Botticelli made the very short trip from DC to deliver his remarks to the conference in person. Here then is that audio:

MICHAEL BOTTICELLI: Good morning, Baltimore. Can you hear me? Good morning, Harm Reduction Coalition. So, I really want to thank Daniel for that really warm and kind introduction. You know, I tend to kind of use his approach to policy here, and when I was in Massachusetts, I shamelessly stole everything that, good that people did, and I continue to make sure that we have that response at the federal level.

And I will also say, you know, it's really interesting, but I think it's also kind of no coincidence that during my entire time working for the HIV/AIDS department in Massachusetts and then the substance abuse bureau in Massachusetts, that I never came to a harm reduction, uh, coalition, uh, conference. And I sent staff and everyone came. So it's somewhat, quite honestly, I think, fitting that my first appearance here is as the acting director of office of national drug control policy.

You know, I think all of you know that nothing happens by accident, so it's, I think it really is no coincidence that I'm here and I really want to thank you for all of the work that you're doing today, and I'm really pleased to be opening this meeting. This year's theme, crossroads and intersections: doing together what we cannot do alone, could not be more timely or more urgent. I am really pleased by the relationship that our office has had with the Harm Reduction Coalition, and that will continue to grow. And today I have the privilege of being here to discuss issues of common concern and urgency for all of us. I hope that my presence here reflects the Obama administration's commitment for continuing drug policy reforms.

I do again want to thank Daniel for that introduction, but I also really want to thank Daniel and Whitney Englander and Allan Clear for their continuous engagement and collaboration with our effort to make sure that our federal policy reflects the needs of people on the ground. Our partnership is formed around common goals, including saving lives. They are helping us find new ways to move the drug reform agenda together.

I want to talk a little bit more about the Office of National Drug ControL Policy, or ONDCP, and what we have done during the Obama administration regarding drug policy, and identify opportunities for working together in the future. There are three issues that I want to discuss today: sentencing reform, prescription drug abuse prevention, including overdose prevention, and medication-assisted treatment.

ONDCP is mandated by statute to publish the president's national drug control strategy, which lays out the administration's approach to drug policy along action items worked out in coordination with our federal partners. In 2010, the inaugural strategy included a chapter devoted to breaking the cycle of drug use on, and incarceration. When I was in Massachusetts, I remember the words of former director Kerlikowske, basically saying that we cannot and will not arrest and incarcerate our way out of this problem.

The Department of Justice is responsible for one of our greatest achievements to date: a completed item to reduce sentencing disparti – disparities between crack and powder cocaine. Despite scientific evidence that crack and powder cocaine cause similar physical, psychological and social effects, the US Sentencing Commission had a long-standing rule in place that provided much stiffer penalties for crack cocaine sales.

I've seen this impact of the rule firsthand. A few weeks ago, in celebration of recovery, I invited several folks in recovery to come to the White House. One of those guests was a man named Michael Baynard. Michael was born into a rough neighborhood in Compton, California. He was a bright teenager and his mom did her best, but the circumstances he was born into prevailed, and he got mixed up with a gang in high school. He dropped out, he developed a substance use disorder involving crack cocaine, and found himself homeless, alone, and in despair.

In 1996, he was arrested and convicted for possession of less than a gram of crack. Under California's three-strikes law, he was sentenced to 25 years. In prison, he stopped using drugs and spent his time appealing his sentence. In 2002, six years after his conviction, his appeal went to a US District Court where a judge named Spencer Letts, after carefully reviewing his case for 2-1/2 years, overturned the sentence and freed Michael.

Since his release, Michael has spent his time mentoring others in recovery and working to prevent teens in Compton from joining gangs or using drugs. He earned his GED and is now enrolled in college and working full-time. Michael's story proves that behind a rap sheet, there is a real person, often struggling with a substance use disorder, who needs treatment more than he needs a jail cell. As you know, the crack and powder cocaine sentencing disparity disproportionately affects people of color. Admittedly, these reforms have not completely eliminated these disparities, and there is more we can do in this area and more we must do.

Over the next two years, this administration will continue to focus on reducing disproportionality in our criminal justice system, diverting people away from arrest and incarceration and reducing the consequences of having a criminal record.

In our – after our inaugural strategy, it became apparent that abuse of prescription drugs, specifically opioid analgesics, was a serious issue that needed focused coordination and federal action. In 2010 alone, more than 38,000 Americans died from drug overdoses and drug-related deaths, and they outnumbered motor vehicle fatalities. Just over 22,000 of those overdose deaths involved prescription medications, and most of those deaths, almost 17,000, involved prescription opioids like Oxycontin and hydrocodone. These are not illegal drugs, they are available by prescription through a regulated industry. New data from a study of insurance enrollees suggests that the rate of overdose deaths increases dramatically as the rate of opioid use increases.

To address the problem of non-medical use and overdose, the administration in 2011 released its prescription drug abuse prevention plan, which had the twin goals of reducing non-medical use and reducing negative medical consequences including overdose by 15% by 2015. The plan was meant to be an extension of our overall strategy which calls for increased access to treatment, including medication-assisted treatment, and expanded availability of naloxone.

The prescription drug abuse plan contains four pillars. Sorry, I'm not good at working the slides and talking at the same time, so you'll have to read along. Given our former director's background in law enforcement as Daniel talked about, we were also uniquely situated to work on access to naloxone for first responders. Law enforcement and first responder naloxone programs are particularly important because law enforcement agencies are in rural, suburban, and urban areas, and so is the overdose problem. So naloxone programs combined with good samaritan laws are making a difference.

The Boston area has been hard hit by the opioid epidemic, as many parts of this country have, and police departments there have moved quickly to get naloxone into officers' hands. In February, ONDCP and Senator Ed Markey held a roundtable at a fire department in Taunton, Massachusetts. The room was packed with city council members, nearby mayors, and parents of children who had overdosed. In the middle of the discussion, a call rang out over the intercom. First responders were being dispatched to the scene of a possible overdose just a few streets away. The law enforcement community in that region has stepped up to meet the challenge, and it all started in Quincy, Massachusetts, where more than 300 lives have been saved by first responders with naloxone.

You know, I know I represent the nation but, you know, I see some of my friends here from Massachusetts who were really instrumental in getting that work done, so raise your hands. Since that time, state and local law enforcement agencies across the country have begun to carry naloxone, and more and more states have enacted overdose prevention and good samaritan laws across this country.

Our federal partners have also magnified our efforts. In June, the Veterans Health Administration recommended overdose education and naloxone distribution as part of medical care to at-risk veterans, and they have an interim policy for naloxone distribution. Their mail-order pharmacies now carry naloxone, and this week the VA reported it already had nine reported reversals. And it doesn't stop there. In July, Attorney General Holder and I convened a day-long conference on law enforcement and naloxone, and issued an announcement urging federal law enforcement agencies to explore equipping staff with naloxone.

In August, President Obama announced an executive action on military and veterans, which included department of defense law enforcement employees carry naloxone. While opioid overdose is rare in active duty military, the DOD saw this as an opportunity for a federal agency to lead by doing the right thing and publicizing this life-saving tool.

We have also been working to promote co-prescription of naloxone. SAMHSA and colleagues at the Boston Medical Center have partnered with us on webinars to – on overdose prevention for physicians, with the American Psychiatric Association and the American College of Emergency Physicians. We have evidence to suggest that our activities are beginning to make a difference. In 2012, for the first time in over a decade, overdoses involving prescription opioids decreased from the previous year. At the same time unfortunately and as all of you know, heroin overdoses are clearly on the rise.

While data suggests that only a small percentage of those who misuse prescription drugs transition to heroin, we know that four fifths of new, newer heroin users began by misusing prescription pain medication. This tells us that we need to continue our efforts on focusing, preventing the non-medical use of prescription pain medication, enhance our intervention efforts, and enhance better access and more timely access to treatment.

Chronic prescription drug abuse and heroin use we know are intertwined, but it demonstrates that we must ensure that treatment is available and particularly medication-assisted treatment is recognized as the standard of care for opioid addiction. Individuals in need of this medication for their substance use disorder should not be denied such treatment. According to the National Survey on Drug Use and Health, see I'm not good at flipping my slides – according to the National Survey on Drug use and Health, we have a major treatment gap in this country. It is important that we work to make, to make evidence-based available with the same sense of urgency that we feel for increasing access to naloxone.

We are committed to improving treatment access because we know that for many people with serious substance use disorders, medication-assisted treatment is crucial. It can mean the difference between homelessness and a substance use disorder, or full-time employment and recovery. It can mean the difference between hope or despair, between life or death.

I had a truly serendipitous moment one morning this summer, this is a true story. I was running early for a roundtable with some of the leaders in the substance use disorder field. And we were meeting to strategize and hear ideas about what more the federal government can do to, to reduce the magnitude of the opioid problem. Had a few minutes to kill so as usual I ducked into a nearby Starbucks to grab a coffee.

As I walked in, a woman introduced herself to me. It was her first week on the job, her first job since entering recovery. Her story started like so many: she was prescribed powerful opioid painkillers after surgery, grew dependent, and could not afford the price of prescription medications on the street, and began by injecting heroin. Her daughter was in college at the University of Maryland but she found herself living on the streets. When she was committed to getting better, two things made recovery possible: Supportive housing and access to buprenorphine.

We also know that naloxone won't save everyone. Some people will use alone, some people will be found too late. We cannot assume that with naloxone is enough when many people who might have benefe, uh, benefited from treatment failed to get it, perhaps because of a wait list, lack of insurance, or fear and shame. We are pleased that Dr. Joshua Sharfstein will be here at this meeting. A paper he recently published showed that expanding access to methadone and buprenorphine saves lives. Simply put, people maintain on medication-assisted treatment, don't die.

This tells us if we identify and treat folks before they transition to heroin, that we will reach our harm reduction goals. But we cannot expect people to treat themselves, or diagnose themselves, and we must make treatment available. We are currently reviewing opportunities to leverage federal grant and contracting dollars to ensure government funded medication-assisted treatment is provided to those who need it.

Finally, I want to just mention that since the beginning of this administration, our office has been involved in ensuring access to other means to improve the health of people involved with opioids, who began injecting. Despite the Congressional ban on federal funds for needle exchange, we recognize that syringe services programs, as part of a comprehensive public health effort to reduce injecting, uh, to reduce infectious diseases from injection drug use, and to help get injecting drug users into treatment and eventual recovery.

Thirty six states plus the District of Columbia currently have syringe exchange programs. We are working with our federal partners to implement the viral hepatitis action plan. It is particularly important, it is particularly important to ensure that drug users in treatment are not categorically denied access to new cures for hepatitis C.

We are also working with the Office of National AIDS Policy to reduce new infections among people who, uh, are injecting drugs. Increasing the number of people who know their status, and ensuring those who have HIV are referred, engaged, and retained in care.

Finally, I want to share a quote with you from President Obama. A few weeks ago he said, “we live in cynical times, and Washington feeds that cynicism. But I always tell people, cynisim – cynicism never cured a disease, cynicism never built a business. Cynicism is a choice, but hope is a better choice.” As a person in recovery, I have learned that patience is essential. We must meet people with, where they are, and help more people on the path to better health.

We have a lot to do, and we can, and must, and will do better. But we should all have faith. We have tools, we have naloxone, we have treatment, we know what works, but most of all, I think I know what's coming next, we have each other. Together, we can work toward the same mutual goals: to reduce the consequences of drug use, to prevent overdose deaths, to help people live safer and healthier lives. Thank you everybody for the work that you do, and let's get to work.

DOUG MCVAY: That was Michael Botticelli, acting director of the Office of national Drug control policy, speaking to the Harm Reduction Conference last October in Baltimore, Maryland.

In a way that speech made history, because Botticelli is the highest-ranking member of ONDCP to physically attend a Harm Reduction Coalition conference. He is not the highest-ranking member of ONDCP to ever address a Harm Reduction Coalition Conference. That would be his predecessor, Gil Kerlikowske. The last international conference was in 2012 in Portland, Oregon. Kerlikowske did not travel across the country to be there in person but he did record a video address to the conference, which was played during the opening plenary session. Here then is that audio:

GIL KERLIKOWSKE: Hi. Gil Kerlikowske, Director of National Drug Control Policy. I'm sorry that I cannot be with you in Portland, but on behalf of the Obama administration I want to thank you for your work, and I'd like to take a moment to discuss steps we can take together to reduce drug use and its consequences.

First I want to thank each of you for your commitment to addressing the drug problem in America. You work hard every day to help others, and like many of us across America working on the drug issue, you do it with little or no recognition. So on behalf of this administration, thank you.

As all of you know, drug overdose deaths represent a serious public health emergency in America. According to the CDC, there are about 100 overdose deaths every day in this country, remarkably drug overdose deaths now outnumber deaths from gunshot wounds or from car crashes. As policymakers, we have a responsibility to respond to this challenge in a holistic way. This urgency is what drives our administration's work to reform drug policy.

Drug policy should be considered a public health issue, not just a criminal justice issue. Those who suffer from substance use disorders should never be stigmatized and tossed aside, or considered beyond helping, and science, not dogma or ideology, should drive our policies. We're serious about this commitment to reform, and that's why this summer we visited Project Lazarus in North Carolina, to highlight the role that naloxone plays in reversing overdose and set a national goal of reducing overdose deaths.

That's why, despite subsequent action by Congress, this administration lifted the ban on federal funding for needle exchange after a decade of inaction. That's why the President signed the Fair Sentencing Act into law, which addressed the longstanding and unjust disparity in sentencing for crack and cocaine. And that's why we worked so hard to pass the Affordable Care Act, which for the first time in history requires insurance companies to treat drug addiction the same way they would any other disease. But this isn't enough. We must do more, and we must work together.

There are some who will seek to divide us by focusing on where we disagree. But for the sake of progress we must find more ways to work together instead. Proactively supporting the use of naloxone and needle exchange is a major milestone for us. At the same time I hope you will join us to support other innovative efforts.

Programs like Screening, Brief Intervention and Referral to Treatment enable doctors to recognize and treat substance use early, before it becomes a more serious problem. Evidence-based programs like our national youth anti-drug media campaign use advertising to encourage young people to make healthy decisions and reject drug use in the first place. Programs like drug courts refer nonviolent offenders into treatment instead of prison.

Well, I'm proud to be the first Director of National Drug Control Policy to address the harm reduction conference, and I hope you share my optimism and my hope that we can work together. At the end of the day, we're all trying to build a healthier and safer America. Thank you and best wishes for a successful conference.

DOUG MCVAY: That was Gil Kerlikowske, formerly the director of the Office of National Drug control Policy, addressing the Harm Reduction Conference in 2012, while he held that office.

Now, get ready to mark your calendars. December 17th is the 100th anniversary of the Harrison Narcotics Act, the day the US began its 100 year long drug war – its century of lies. On that day, people in towns and cities around the nation will hold rallies at local courthouses to call for an end to prohibition. You can get involved by emailing the Drug Truth Network's executive producer Dean Becker, he's dean @ drug truth dot net.

And that's it for this week. I'm your host Doug McVay, and this was Century of Lies. Thank you for listening.

Century Of Lies is a production of the Drug Truth Network. We're heard on 420 Radio dot org on Mondays at 11 am and 11 pm, and Saturdays at 4 am, all times pacific. We're heard on time4hemp dot com on Wednesdays between 1 and 2pm pacific along with our sister program Cultural Baggage. And we're on The Detour Talk Network at TheDetour dot US on Tuesdays at 8:30pm. A few of the stations out there carrying Century Of Lies include WERU 89.9 FM in Blue Hill, Maine; WPRR 1680 am 95.3 fm in Grand Rapids, Michigan; WIEC 102.7 FM in Eau Claire, WI; WGOT-LP 94.7 FM in Gainesville, FL; KRFP 90.3 FM in Moscow, Idaho; and Free Radio Santa Cruz 101.3 fm in Santa Cruz California.

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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!