Framing addiction less as enemy than as illness

By Mike Lillis 3/18/10 8:56 AM

Quietly, free of headlines and fanfare, the Obama White House is toning down the bellicose “war-on-drugs” position that has defined U.S. narcotics policy for the last 25 years.

Appearing in Vienna last week for the 53rd annual United Nations meeting on global drug policy, administration officials shifted from attacking drug use as a crime to be penalized and moved toward a strategy of tackling addiction as an illness to be treated, a number of health and human rights advocates who attended the event said.

Drug reformers for years have promoted so-called “harm reduction” measures as a more effective and humane way to treat drug addiction and the diseases that often accompany it — an approach that runs counter to the punitive attitude epitomized by the Reagan administration’s “war on drugs.” And while the Obama White House — behind Gil Kerlikowske, the White House drug czar, and his deputy, Thomas McLellan — remains officially opposed to the hot-button harm reduction language, officials have also conceded that the current strategy isn’t working, advocates say. That sharp break from past administrations has left reformers hopeful that the Obama White House will mark a new era in the nation’s fight against drug abuse — one that prioritizes treatment and prevention above rap sheets and prison time.

“There was virtually no reference to a criminal justice approach,” Allan Clear, executive director of the Harm Reduction Coalition, an advocacy group, said of the U.S. delegation in Vienna. “I’m just so used to being appalled by their behavior … It was very encouraging.”

Deborah Peterson Small, executive director of Break the Chains, another group advocating for drug-policy reforms, agreed, noting a brand new willingness among White House officials to embrace certain elements of the harm reduction strategy. When she spoke about treatment reforms to U.S. drug officials in Vienna in 2008, Small said, the entire delegation walked out on her. “This year it was completely different,” she said. “We finally had a sense that they were listening.”

The comments mark quite a departure from those that drug reformers were making a year ago at the same U.N. event, where the Obama administration killed international efforts to include harm reduction language as part of a U.N. document that will guide the next decade’s global drug policy. Harm reduction refers to things like drug-substitute treatments and clean-needle exchanges — programs being tried (with promising results) in a number of countries to battle the spread of HIV/AIDS, Hepatitis C and other drug-related illnesses. The White House has argued that the broad harm reduction language is “ambiguous” and could include controversial programs the administration doesn’t support, including drug legalization, drug consumption rooms and heroin prescription initiatives.

But there are clear signs that the attitude is changing — and the policies are beginning to follow suit.

With Obama’s vocal support, for example, Congress last year repealed the 21-year-old ban on federal funding for needle exchange programs. And last week in Vienna, not only did the United States endorse a new U.N. resolution promoting access to controlled medicines for legitimate medical purposes (commonly considered to include drug dependency treatments, like methadone for heroin addiction), but it co-sponsored a separate declaration designed to tackle the treatment gap plaguing HIV patients. The latter resolution, while it doesn’t mention harm reduction specifically, references a U.N. technical guide promoting certain harm reduction measures, like needle exchange and opioid substitution therapy. Rebecca Schleifer, advocate for the health and human rights division at Human Rights Watch, said this week that the HIV document represents “the most vocal support” the White House has ever given for HIV-treatment efforts focusing on human rights.

Opponents of needle exchange and other harm reduction measures argue that the human rights groups have misinterpreted the signals coming from the White House in Vienna. “If you read Kerlikowske’s statement,” said Lana Beck, spokeswoman for the Drug Free America Foundation, “clearly there’s nothing there to indicate any change.”

That part is true. The remarks prepared for Kerlikowske — officially the director of the Office of National Drug Control Policy, or ONDCP — reiterated the administration’s opposition to the broader harm reduction language, arguing that the term “creates unnecessary confusion” and might be misused to “promote drug use.” Still, drug reformers were quick to point out that the drug czar declined to include those passages when he addressed the crowd in Vienna — more evidence, they say, that the U.S. is consciously toning down its traditional war-on-drugs rhetoric.

“Traditional advocates of harm reduction recognized that the United States was a different animal [this year],” Clear said.

The ONDCP did not return calls for comment.

For health and human rights advocates, there remains a long way to go. Like any number of emotionally charged issues, drug policy is often dictated more by entrenched ideology than evidence-based rationality. And on Capitol Hill, there remains a strong sense that drug users are criminals to be punished, not patients to be treated. For proof, look no further than the debate over needle exchange. Although a long list of public health organizations — including the National Institute of Medicine, the Centers for Disease Control and Prevention, the World Health Organization and the American Public Health Association — had endorsed needle exchange as an effective way to reduce HIV/AIDS without increasing drug abuse, the politics of Washington kept the ban in place for more than two decades prior to last year’s repeal.

Not that some lawmakers aren’t trying to reform the punitive mindset surrounding drug use. Sen. Jim Webb (D-Va.), for example, has long-criticized the criminal justice system for packing the nation’s prisons with non-violent drug users. A description of his reform proposal notes that the the war on drugs hasn’t diminished drug use, it hasn’t brought the multi-billion dollar drug industry under control, and it targets minority offenders disproportionately. The system, he says, is “broken, unfair, [and] locking up the wrong people.”

The Senate Judiciary Committee approved the Webb proposal in January, leaving supporters hopeful that Democratic leaders will bring the bill to the chamber floor later this year.

Meanwhile, health and human rights advocates have vowed to continue their push for health-centered drug reforms, encouraged by the tone of a White House that seems set to place a greater emphasis on treatment, health and human rights.

“That would put us on par with most other countries — like Iran,” Small quipped, “instead of being the leading jailer in the world.”

This article originally appeared in the Colorado Independent, accessed 23 March 2010.