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The problem with the White House's heroin program

President Obama’s chief scientist for drug control policy from 2009 to 2012 is unimpressed.
Barack Obama
President Barack Obama departs after speaking about his Clean Power Plan, Monday, Aug. 3, 2015, in the East Room at the White House in Washington. 

With the country in the grips of a great American heroin relapse, the White House on Monday announced a new strategy to subdue the epidemic, pairing law enforcement officials with public health workers and deploying them in 15 states rife with opioid addicts.

The program, funded by $2.5 million from the Office of National Drug Control Policy, is billed by the Obama administration as an example of the president’s emphasis on treatment, not jail, for drug users. But as word spread, high profile critics attacked the plan as an attempt to co-opt the rhetoric of reform without adopting the actual policies.  

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Thomas McLellan was President Obama’s chief scientist for drug control policy from 2009 to 2012, the person in charge of programs precisely like this one. He’s watched in horror as the death rate for heroin overdoses has quintupled since 2002, cutting through class and color lines to become as popular as crack cocaine in the 1980s—all without inspiring a major federal response. 

“Our reply is $2.5 million?” an incredulous McLellan told msnbc. “That is not close to the financial commitment that is needed.”

“There are research-tested, cost effective public health and public safety measures that could reduce opioid use and related deaths, but not at this price,” he continued. “I hope they ultimately take this problem seriously and provide the commitment the public is looking for.”

Former congressman Patrick Kennedy, a recovering addict and one of McLellan’s strongest allies in the push for better care, largely agreed. "The heroin epidemic is ravaging the country," he told msnbc. "Officials need to step-up and address its dire consequences in all 50 states, not just a handful of counties." 

Both Kennedy and the influential Drug Policy Alliance also took issue with the substance of the president's new plan. "Half of what they’re doing is right – the focus on health and overdose prevention – but the other half, the side that focuses on the failed arrest and incarceration policies of the past is destined to ruin lives and fail," said Bill Piper, director of the Drug Policy Alliance’s office of national affairs.

In an earlier interview with msnbc, Ethan Nadelmann, the executive director of the Drug Policy Alliance, was even harder on Obama's approach to substance abuse. Nadelmann is a powerful reformer, nicknamed “the real drug czar” and praised for pushing a harm-reduction model that has been proven to work oversees.

Nadelmann sees drug policy as existing along a continuum, from “lock’em up, hang’em, pull out their fingernails, Singapore, Saudi Arabia” all the way down to “essentially no controls whatsoever, maybe a little for kids.” Unfortunately, he says, American drug policy under Obama is way too close to the hang’em end of the spectrum—and this new heroin program won’t change the administration’s position much in his eyes.

That’s because it’s a bait-and-switch. It’s promoted as a treatment-first program, but the details lean heavily toward enforcement and incarceration. It calls for 15 drug intelligence officers and 15 health policy analysts to collect data on overdoses and trends in heroin trafficking. Everyone will feed the data back to a joint health-law enforcement coordination center, which will distribute the data across state lines.

That’s great for cops. They need fresher leads on where heroin is coming from, who is moving it, and where it’s being purchased. But public health officials don’t need to know the intricacies of trafficking in order to respond to an ongoing epidemic. In a hopeful sign, the program will reportedly train first responders to save lives with naxolone, a controversial opiate-blocker that can pull users back from the edge of death.  

But naxolone is not a cure. It’s a second chance. And without proper follow-up care, McLellan argues, it’s a second chance we’ve been squandering, and not just with heroin.

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Drug and alcohol abuse in general has exploded nationwide, according to the Centers for Disease Control and Prevention, which has tracked a two-fold rise in drug-related deaths in a generation.

Most American addicts are not in treatment, however, not even a free 12-step program. Of those who are in treatment, the vast majority will quit or start using again within a year, studies show. And the result is an endless loop of denial, decline, recovery, and relapse.

So what do we do? “It’s not rocket science,” McLellan told NBC News last year as part of a special series on Heroin in America. It’s simple, he says. We need to offer people five years of care, beginning with rehab, progressing through stages of monitoring, and ending up in an out-patient setting. That’s it: acute care, monitoring, and consequences. We already provide it to drug addicted airline pilots, McLellan points out, and we get success rates above 80%.

The White House, for its part, defended its dual focus on health and enforcement. Michael Botticelli, director of National Drug Control Policy said in a statement on Monday that heroin is “both a public health and a public safety issue.”

But addiction, according to the best science, is a brain disease that can never be cured by the cops. It’s a chronic disease, a lot like diabetes. While absorbing the White House’s new Heroin Response Strategy as a treatment option, consider what it would sound like if the same program were applied to people with a blood-sugar problem.

It would mean busting people with bad diets, shaking them down for details on where they get their food, and launching a multi-state response to the big food cartels that are pushing this stuff down our throats. Then it would mean discharging the user to a church basement somewhere for a 28-day rehab program. Two months later, most likely, they’d be sick again.