When I broke the news on Huffington Post on August 2 that White House "drug czar" Gil Kerlikowske was leaving, having been nominated to serve as Commissioner of Customs and Border Protection, I insulted Mr. Kerlikowske and dismissed his record on matters I did not review, relying on prejudices I formed regarding other subjects such as drug "legalization," whether the Administration's anti-drug program was "balanced," as he claimed, and on marijuana policy. I deeply regret that I was unfair to Mr. Kerlikowske and misled the readers of Huffington Post regarding his support and commitment on important public health issues. I must amplify the correction I added to the August 2 post.
Mr. Kerlikowske early-on promoted two critical public health initiatives in drug policy: First, he followed up on providing sterile syringes to injecting drug users to stop the spread of HIV and hepatitis. The support of sterile syringe exchange as a public health measure had been blocked ONDCP directors Barry McCaffrey in the Clinton Administration and John Walters in the Bush Administration. He recognized the importance of stopping the spread of HIV/AIDS among injecting drug users and recognized their humanity and dignity in the way his predecessors did not.
Second, in the same spirit, he recognized that the dissemination of naloxone into the environments of opiate users, many of whom are using drugs illegally, would stop overdoses from becoming fatal. Having naloxone available among drug users and where drugs are used is critical to saving lives until emergency medical care can be brought to bear. [See his remarks at 00:27:00 of this speech to Project Lazarus in NC which makes naloxone available to people who may be at risk of suffering an overdose.]
In addition, Mr. Kerlikowske promoted the use of methadone as a maintenance therapy for opiate addiction. This has been a continuing controversy in the world of drug treatment. This controversy continues despite a large body of research that shows that providing methadone to persons who have been using opiates illegally and compulsively can help them stabilize, minimize "craving" of the opiate high, and participate successfully in long-term treatment programs, leading employment, education and restored family life.
However, people can get high on methadone. There is an illegal market in diverted methadone. People frequently overdose and die from using methadone. For those whose philosophical or spiritual approach to drug treatment includes complete abstinence from "drugs," providing methadone to persons who are in recovery from addiction is a contradiction, and often seen as "enabling" behavior. Mr. Kerlikowske resisted those arguments and argued on the ground of the research.
Around the world, there is even greater resistance to the use of methadone, especially in Russia where there is a vehemence against any form of harm reduction, and a deep commitment to the rhetoric and attendant policies of total war on drugs. Mr. Kerlikowske is believed to have quietly encouraged the Russians to change their position on methadone every time he met with Russian drug abuse officials, and traded on his experience as a career law enforcement officer and police chief to advocate for robust public health interventions.
Mr. Kerlikowske also resisted Russian pressure to eradicate opium crops in Afghanistan which would alienate farmers from the Afghan government and the Western coalition battling the Taliban.
Mr. Kerlikowske reached out to the Harm Reduction Coalition and sent a video greeting to their national conference in October 2012. For almost two decades, ONDCP had sneered that "harm reduction" was a code word for drug legalization, and it was highly significant that he so warmly acknowledged the role of harm reduction and harm reduction workers in public health. I have sent an apology to Mr. Kerlikowske at his office.
Given how President Obama has ignored most of the questions put to him in his various on-line forums and petitions about marijuana or drug prohibition and violence, perhaps it was unreasonable for me to have expected his drug czar to be publicly marching in front of the Administration.
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