Interview with the Drug Czar

In a rare sit-down, Gil Kerlikowske discusses a new emphasis on recovery, the pill epidemic, and Mexico's drug war

Published July 2, 2012 3:43PM (EDT)

Soldiers stand guard next to bags of marijuana being displayed to the media at a military base on the outskirts of Monterrey, Mexico.        (Reuters/Tomas Bravo)
Soldiers stand guard next to bags of marijuana being displayed to the media at a military base on the outskirts of Monterrey, Mexico. (Reuters/Tomas Bravo)

This article originally appeared on The Fix.

Officially, Gil Kerlikowske is the Director of the Office of National Drug Control Policy. Unofficially, he's known as America's Drug Czar. Tall, affable and impeccably groomed, with an ONDCP lanyard around his neck, Kerlikowske is the former chief of the Seattle Police Department, where he oversaw the force's shift to diverting attention away from arresting people for marijuana possession. When he was nominated by President Barack Obama to run the ONDCP and craft the nation's drug policies, he said, "There is much work to be done." Indeed, there still is. His appointment was viewed with guarded optimism by drug law reform advocates — and in fact Kerlikowske has proven, in this shark-tank political climate, to be far and away the most progressive Drug Czar the country has had.

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Recently, Kerlikowske gave a speech at the Betty Ford Center in Rancho Mirage, CA, in which he discussed a "paradigm shift" in the way America views addicts. "Drug addiction is not a 'moral failing' on the part of the individual," Kerlikowske told the audience. "It’s a chronic disease of the brain that can be treated." For many, this isn't a new concept. But it's a welcome statement when it comes from a bully pulpit long dominated by remorseless drug warriors like retired General Barry McCaffrey (who recently told The Fix that Portugal's example of drug decriminalization was "bullshit").

Kerlikowske invited The Fix to visit him on a sweltering summer afternoon in Washington, DC, for a rare face-to-face interview. He greets us in the doorway of his office, housed in a nondescript office building a block away from the White House, and asks, "Hot enough for you?" In a wide-ranging interview, he sounds off on the Recovery Movement, the government having missed the boat on crystal meth, the toll of the prescription pill epidemic, and even bath salts.

Mike Guy: In your speech at the Betty Ford Center, you signaled that our national drug policy will put more emphasis on recovery. Is this a shift in the Obama Administration’s thinking?

Gil Kerlikowske: Well, it’s more of the continuing shift in my thinking. Coming into the job, I said, “Look, I think I understand the law enforcement part. But frankly, the details of treatment, medicine, addiction, recognition and then recovery — they really were not in my lane. So as we started to look for a more balanced approach, I realized we were lacking the balance, particularly with recovery and addiction as a disease, and that we needed to remove the stigma of addiction. It is almost kind of like we're trying to use a 3-legged stool, with aspects of law enforcement making up those three legs. By adding recovery to our overall drug policy, we want to have a fourth leg in the stool. That is where we are headed.

You were the chief of the Seattle Police Department before your appointment at the ONDCP. As a cop, did you have a notion of what addiction was?

No, no. Not at all.

What were some of the big surprises when you took office?

There were so many! One was that I recognized that people in law enforcement and criminal justice almost always have the fingers pointed at them. They're told to do something about the drug problem in a neighborhood, do something about the drug dealing downtown, do something about drug-related crime, and on and on. When you are in the business of law enforcement, you’re here because you can do things, take charge, make decisions. And quite often mayors, councilors, elected officials turn to law enforcement as an answer to those problems.

So part of education has been realizing that, look, if we just continue to use this one tool — law enforcement — we are not going to make any real progress. And you know, some of my colleagues in law enforcement are pretty happy to embrace that, too, because it'll mean the finger is pointed perhaps less at them.

Adding recovery as a pillar of the national drug policy is a great concept, but when we look at the ONDCP budget for 2013, there's nothing allocated for recovery services. Why is that?

Well, I think the money sometimes lags behind the change in philosophy and the change in discussion.

Do you coordinate with the president’s advisers about his re-election campaign platform on drug policy?

No, not at all. There is a very specific part of the ONDCP’s authorization that precludes us from being involved in any federal election issue. And that’s actually a very good thing, because frankly the nation’s drug policy should not be a partisan issue. And I have not found it the least bit partisan when we have been up on Capitol Hill discussing it. I’ve never personally donated to any state or local election campaigns. The best thing I could do as a police chief was to try and run a good police department. So my involvement in politics — other than voting and some donations, but not the kind that the super PACs would be too aware of — is pretty minimal.

Did I hear you say that you haven't found the drug policy to be a partisan issue on Capitol Hill?

That’s correct. Not at all.

I find that really surprising.

You know, I do not. When you start talking about how to keep a community or a city safe, you don't find a lot of chest-thumping when it gets down to the nitty-gritty. Sure, out on the stump, there is a lot of, “Well, we need more mandatory minimums, etc.” But the changes that are coming in criminal justice are nothing short of significant. There will be changes in sentencing, changes in the way we look at drugs, reductions in prison populations — these changes will impact the country for decades.

At the same time, the nature of the drug problem seems to be changing radically. It's not about street drugs like cocaine and heroin anymore, it's about prescription pills.

Well, cocaine use is down significantly. With heroin, all of the anecdotal information and news clips we get every day in the past year or so shows either a treatment or law enforcement professional talking about an increase in heroin use. We see that as a result of us putting the pressure on prescription drugs.

And yet last week Congress shot down efforts to put rational controls on hydrocodone. As the nation’s Drug Czar, is that a disappointment?

When I was getting ready for Congressional confirmation, a staffer who was playing the part of Senator Chuck Grassley, asked me, “Are you aware that more people die from prescription drug overdoses than any other drug?” And I said, “Well, actually, no, I am not.” Listen, this is a complicated problem. Do we reduce the quota put on pharmaceutical companies? Do we put restrictions on the number of prescriptions that can be written? What you realize, once you get into this issue, is how incredibly complicated it is. From kids who get pills for free from any medicine cabinet in America, to the phenomenon of doctor-shopping. The problem is, it is killing people, and the age range is incredible: 14 to 65. It knows no demographic, it knows no ethnic, gender, or economic class. It is clearly an equal-opportunity addiction.

One that often leads to a heroin problem.

It can.

So what do you do about it? If you’re not given the tools in Congress to address the problem, what direction do you go in?

Well, we do have a lot of tools. And I think we are really making a lot of progress on prescription drugs. There are a couple of things that are troubling. One is, if you become addicted to opioids and you move to heroin. You have a heroin-naïve population, mostly because heroin has not been a big issue or threat to this country in a good number of years — since French Connection kind of movies. So, we have a relatively stable heroin-injecting population. Lots of people are naïve about it now; many feel that if they snort it and smoke it, they will not become addicted. You talk to a treatment person and they'll say, "Yeah, and about three weeks later those people smoking it are IV drug users."

The other concern is this: As you put the pressure on the pills, then people turn to heroin. So, the harder question that you asked is, "Okay, what do you do about it?" So I'm convening a group of federal counterparts right now to talk about heroin. The data on drugs always lags, as you know, but you cannot really ignore the anecdotal evidence about heroin. We don't want to be a group that says, "Here is the next tidal wave,” and have it not appear. You know how many tidal waves of drug problems have come out, surged across the country, and then turn out to not be quite so bad?

Bath salts, for instance.

Synthetics and bath salts could end up being a huge problem, but you do not want to cry wolf. Also, you don’t want to be too far behind the curve, and say, "Well, if we just wait for two or three years until we get more data from DAWN [the Drug Abuse Warning Network], and more data from treatment ..." Then, you end up missing it, like we did with crystal meth. We missed that one on a national level, but if you were in a little town in Iowa, and you're devastated by meth, you don’t really care what the national data tells you.

You've described recovery as “an afterthought.” The truth is, millions of Americans are in recovery, and the treatment industry makes $20 billion a year. In reality, it seems like it's more of a case of the government just starting to catch on.

You're right. In the case of prescription drugs, until recently they were not the radar screen — except for the people who knew about the problem professionally or from personal experience. I would say recovery hasn't been on the radar either. People just think of it as a subset of treatment. Well, you know, you don’t go into treatment for 28 days and then you are better, then you are cured. It doesn't work that way. Recovery is ongoing. And with people like David Carr from the New York Times out there pounding the pavement, there are a lot more people speaking about recovery from drugs than ever before. I think that is unbelievably helpful.

I think we're in the midst of a recovery movement. I think that’s why a website like The Fix can have such a robust readership.

That’s right. It's a growing army.

Assuming we can agree that this is a good thing, do you believe it should be reflected in the government’s budget? How can the feds help feed the movement?

I think the last thing we want to be involved in is going, okay, we recognize this is a problem, here are the details, now let’s just throw some money at it. Thing is, nobody has a lot of money to throw at anything right now. Also, there are collaborations going on now that, frankly, wouldn't exist if it was not for this bad economy. There are direct-to-treatment modules that are happening with law enforcement, that bypass the criminal justice system and the cost of booking, court costs, and on and on, and go directly to the treatment door. I'm not sure these things would be occurring if it was not for the fact that you better figure out ways to do this better, faster, cheaper.

You said that addicts are not criminals but people with a disease. Does that create any tension between how law enforcement is carried out against people who have drug problems?

Look, recently I brought together 20 heads of big city narcotics units, along with five special agents in charge of DEA offices. We spent a day and a half at the Dallas airport hotel talking about whether we should be looking at drug addiction from a different point of view. Dr. Tim Condon, a professor at the Center on Alcoholism, Substance Abuse and Addictions at the University of New Mexico and the former Deputy Director of the National Institute on Drug Abuse, gave a presentation on addiction. Afterward, one of the chiefs said he was going to bring Tim to his city and get him talking to the city council and the state legislature. Another narcotics commander said he'd never looked at the drug problem in that way before.

You just see less and less about how many arrests have to be made and how big the seizures are. Now you see a lot more about community policing. And, it's about outcomes, and not just numbers on a graph. When I talked about this with legislators on Capitol Hill, they said, “Gee, you know, what are your colleagues going to think?” And I would say, frankly Congressman, or frankly Senator, my colleagues are way ahead of you.

It should be looked at as less of a "War on Drugs" and a lot more as a public health problem. Recovery is that next leg on the stool.

One of your goals is the de-stigmatization of addiction. Has that been an uphill battle?

Right. But I don't think you can lead people to de-stigmatization unless you first convince them of the disease model.

It’s hard to find agreement on that one, isn’t it?

It’s not easy! There are a number of people in the field who disagree with it. Look, there are people who are not addicted, and they make a voluntary choice to do drugs, and then they reach the point of addiction. I do not want to completely remove personal responsibility out of this issue, either. Anyway, someone isn't going to have a successful program of recovery unless the person’s intent and focus and mindset is on this, and they get the support they need. We need to break down those barriers, the stigma, the laws — we do not need to make it harder for people to recover.

The barriers are already breaking down.

Yeah. Prescription drugs have helped do that because it does cover such a wide array of people. People have a picture in their minds of a crack-cocaine user or heroin addict. Prescription drugs, well, nobody fits that profile. I went to a memorial service in fort Lauderdale for all of these people that died from pills. They were flashing pictures of the deceased during the presentation: Here is a brother and a sister, aged 14, and then here is a 65-year-old man, and then here is a 27-year-old lawyer. Nobody would look at that group and say, "Gee, what do you think they all are?" Well, they are all dead, and they are all dead from prescription drugs.

Florida is a notoriously prolific producer of prescription pills.

They were the epicenter, yes. Now, they have really changed a lot. I mean you have an attorney general who really gets it. The governor took a little convincing, but the legislator was fully on-board. I lived and grew up in Florida; it was often said that if seven manatees washed up dead on the shore, people in Florida would say, “Oh my God, what are we going to do?” But seven people a day are dying from prescription drugs.

At least 50,000 people have been killed in the Mexican drug war. In that country's elections, two candidates have said that the United States' appetite for drugs is the engine behind the violence. Why isn't that part of our national conversation?

Because the facts do not quite support it.

You don't think so?

No, I do not. I mean, if our cocaine use is down — and every indication, from overdoses to admissions to treatment, shows it is down by 40% — and most of the cocaine that enters the United States comes through Mexico, then pretty clearly there would be a reduction in the level of violence in Mexico. I think, during the heat of Mexico's election process, there are a lot of things said by a lot of people. It probably even happens here in this country. I do not know. [Laughs.]

[Mexican President Felipe] Calderon was very courageous to calm the cartels. And the cartels are criminal enterprises; they are not just drug-trafficking organizations. Those cartels are involved in every type of criminal enterprise, every type — kidnapping, extortion, and on and on. Evidence suggests they make more money from those revenue streams than from drug trafficking. I think — and President Calderon has told me in meetings — that this is a question of who is going to run this country. Is it going to be criminal enterprises that become state actors, or is it going to be the elected officials and their appointees? He said, "It is not that I have a big a choice as to whether or not I'm going to take them on." Pretty courageous.

Do you think the government can win the war?

Well, Calderon has crime reduction for the first five months of 2012, and he's been hard at it for over five years. None of these things, organized crime issues and reductions in violence, happen overnight. So, if he actually has begun to turn the corner — which is always a bad phrase to use — but if he has, and these numbers begin to hold at this reduction in violence, I think he should be given credit for that.

If Mitt Romney wins the US election, what sort of effect would that have on our drug policies?

I have only seen a couple statements that Governor Romney has made on the campaign trail about drugs. So, it would be unfair to speculate about the implications of a Romney presidency. In all of my meetings a lot with members of Congress, they all want similar things: to prevent kids from being involved in drugs; to figure out ways to save money; to see people involved in drugs or addicted to drugs go back to being productive citizens. So I would just leave it at that.

It has been hard to pin down exactly where Governor Romney stands on drug policy issues.

Well, it's hard to get any media attention on the drug issue, because America right now is all about jobs and the economy. So it is pretty difficult. That's why we try to talk about the drug issue in economic terms. What does it cost us in jobs lost? What does it cost us in jobs that are available and go unfilled? What does it cost us in emergency room visits? When you start looking at those numbers, you see that besides the human cost of the drug problem, the economic costs are also huge. So we have to keep talking about it in both ways.

And if President Obama is re-elected, will you stay on for another term as Drug Czar?

I serve at the pleasure of the President.

Mike Guy is the Editor-in-Chief of The Fix

By Mike Guy


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