Our coverage of the possible nomination of Rep. Jim Ramstad as "drug czar" has kicked up quite a fuss, spurring many comments here and a sign-on letter by addiction professionals that was cited by John Tierney in this week's New York Times.
Nearly 300 leaders in the addiction treatment field so far have added their signatures. Now, the Minnesota Independent is reporting that Ramstad's real ambition is to serve as the head of the Substance Abuse and Mental Health Services Administration (SAMHSA).
While that sounds better than having him in charge of drug policy overall as "drug czar," in fact, it is a position in which he could possibly do more damage by replacing evidence-based treatment with ideology "behind the scenes."
Let's look once at his record. With politicians, I find that support for needle exchange tends to be a good proxy for whether you "follow the data" or follow the political winds of ideology. As we know, Ramstad went with ideology -- and even when he had a recent chance to revise his position to allow Washington, DC to use its own money for such programs, he remained firmly stuck in the past and voted to try to block that.
Then, there's methadone and other maintenance treatments. Against the weight of an Institute of Medicine study -- the Institute of Medicine is the agency charged by Congress with resolving medical controversies with data -- he opposed maintenance so much that he didn't want to give insurance parity for coverage.
In other words, while parity would have advanced all other addiction treatments, if his early parity bills had passed, the best-supported treatment for heroin addiction would have become harder to get.
Is someone who opposes what the science says is the best treatment for heroin addiction really someone we want in charge of the agency which is supposed to help disseminate evidence-based care?
And, of course, there's his earmark and other support for Teen Challenge. This is a "treatment provider" which claims that addiction is a sin, not a disease -- and the only help it offers for addicts is conversion to a particular form of Christianity. No medication, no evidence-based therapies, no credentialed counselors -- it doesn't even advise participation in 12-step programs, which is the one treatment modality we know Ramstad favors!
Ramstad sponsored a bill to change the name of the National Institute on Drug Abuse to the National Institute on Diseases of Addiction. As I wrote yesterday, either he really doesn't believe addiction is a disease -- in which case, he's a hypocrite and not someone we want running a treatment agency or he doesn't vet programs that he supports, in which case he's also not a good choice to head an agency that funds various kinds of treatment and initiatives [pdf] for promoting the best care.
The head of SAMSHA should be someone who promotes evidence-based treatment -- not someone who only supports the science when it bolsters his personal beliefs.
[And, so that I don't have to write this piece ever again, Ramstad should not be considered as head of the National Institute on Drug Abuse -- the agency in charge of research on addictions at NIH, no matter what name it turns out to be given -- either!]