Deploying Public Health Strategies to Address Drug Addiction

Drug addiction is fundamentally a public health issue, says Michael Botticelli, acting director of National Drug Control Policy, in this New Thinking podcast. Botticelli explains why law enforcement must work in tandem with public health to address addiction and how his own personal experience with addiction informs his work. In keynote remarks at Community Justice 2014, Michael Botticelli discusses the importance of public health strategies in addressing drug addiction. (April 2014) MICHAEL BOTTICELLI: You know I say I’m not unique in the sense that I’m one of 23 million Americans who are in recovery. What makes it unique is I get to sit at the White House and kind of do this work. ROBERT V. WOLF: Hi, this is Rob Wolf, director of communications at the Center for Court Innovation. I am in San Francisco at the Community Justice 2014 and I have the pleasure of sitting down right now with Michael Botticelli, who is the acting director of the White House Office of National Drug Control Policy. Thank you so much for taking the time to speak with me. BOTTICELLI: It’s great to be here, Rob. WOLF: I wanted to ask you a few questions about your role as what is sometimes referred to, and has been over the years, as drug czar. And I thought a great way to segue into this conversation is really to ask you if that term really captures your work, and what you think about it. Perhaps there’s been an evolution in thinking about the role of the office. BOTTICELLI: I actually really hate the term drug czar, only because I think it, you know, the term czar actually means something that kind of coordinates things, which is really what we do, but I think it’s been associated with previous administration’s policy about the war on drugs, which is clearly not what this administration is all about, so I don’t like the term because I think it raises, for people, this kind of very law enforcement-centric, arrest people for addiction. So I really, I don’t like the term drug czar. You know, and the other piece for me is I have a very atypical background in terms of someone who’s leading our agency. So, I don’t come from a law enforcement background, I come from a public health background, I’m in recovery myself. Maybe some of it is I don’t associate myself with the drug czar, so that’s probably why I don’t like the term. WOLF: You’re talking about your public health background and I wonder if you think people see illegal drugs as an either/or situation, as either a law enforcement problem or if they’re coming from your perspective, as a public health problems, and it just depends on the orientation that a police chief might think of it as a law enforcement problem and a treatment provider thinks of it as public health. BOTTICELLI: I actually think things are dramatically changing in terms of that kind of focus, and you know, part of my job I get to talk to a tremendous amount of local law enforcement officers who will say, you can’t arrest our way out of the problem, and understanding that this is a public health issue. So I just participated in a conference in Washington with over 200 local law enforcement across the country, and it’s really interesting for me to hear things like, we can’t arrest our way out of the problem, that we have to partner with public health in terms of the work that we do. And quite honestly, I think that that’s the function of our office, in terms of how do we continue to bridge—you know, law enforcement does play a crucial role in terms of the public safety consequences, and making sure we have safe communities, and trying to minimize the impact that drugs have on our community. But I think there’s a growing understanding that this is fundamentally a public health related issue. And so part of our job, at our office, is how do we continue to bridge that gap between public health and law enforcement, in terms of the strategies. I think a lot of the work that we’ve done on overdose prevention, I think has moved that conversation dramatically and we’ve seen the dramatic uptake of the use of naloxone, which was a highly effective, highly safe overdose prevention medication by local law enforcement. And I think that’s dramatically changed the conversation. So, so I don’t—I think people are understanding that we actually do need this balanced approach between law enforcement and public safety, and that we can’t just you know, I always say we can’t incarcerate addiction out of people. And so, you know, I think they understand that we have to have primarily a public health response, but in partnership with law enforcement. WOLF: Since the conference here is a community justice conference, I wonder if you think that problem solving courts like drug courts or re-entry courts, community courts, can play a role in addressing the problematic use of drugs, and can they also contribute to reframing the debate about getting law enforcement and public health advocates working more collaboratively? BOTTICELLI: So problem-solving courts looking at any opportunity to divert people away from the criminal justice system has been part of our strategy since the beginning of the administration. And I would absolutely agree with you that I think these problem-solving courts and drug courts have really shown the way in terms of well wait a second here, we can have a different kind of approach here, other than just incarcerating folks. I think we’ve seen the explosion of, particularly, drug courts, not only in the United States but internationally. And so I think that we have about 2,700 drug courts here in the United States. They are in 22 countries. So I think there’s a growing understanding that if you partner the criminal justice folks with the public health folks, that we really can have effective strategies here. I think you know that many, many states across political stripes have really been engaged in wholesale justice reinvestment. I think they’ve understood that incarceration is both costly and ineffective in terms of dealing with people with substance use disorders. So, and I think clearly, you know, you’ve seen the work and the changes that have come out of the attorney general’s office around, and with, the president, in terms of fairer sentencing laws and really looking at how do we make sure that we’re not incarcerating folks who really need to be dealt with, in terms of treatment related issues. WOLF: And how do you see getting police prosecutors, probation departments, and particularly law enforcement, so police, to pursue public safety buy also incorporating these lessons of public health, prevention, and treatment, concretely, rather than just saying—well it’s a public health problem, so let’s bring in some public health advocates—let them do it. Can law enforcement actively also engage in public health? BOTTICELLI: I absolutely think so, and I think that’s a lot of the work that we’ve been doing. And you know, so first and foremost, we want to make sure that law enforcement, like other people, understand what addiction is, and understand what it means and how it affects judgment, and how it affects people’s ability to make decisions. And you know, there’s been models in other areas, particularly in terms of mental health, of how, on the street, can you really not turn this into an arrest. you know, again, I think I’ve heard from many, many law enforcement folks who’ve seen—and I think particularly with the prescription drug issue—have seen that they’re arresting the same people over and over again, and how ineffective that is to be able to do that. And I also, again, think that the overdose situation has changed dramatically. I think that many of these law enforcement are seeing kids from their own community who are overdosing, and understanding that we need to have another response to this. So I think it’s been helpful, and I’m not saying that there are not pockets of resistance or pockets of change, but I do think that there’s a building momentum around not just a direct kind of local law enforcement response, but a larger criminal justice response to people with addictive disorders. WOLF: Let me ask you, and you referred to it yourself in the beginning of the interview, and your official bio notes that you’re in long term recovery yourself. And I just wonder how your personal experience informs your work. And do you think recovering addicts can or should play more active roles in developing drug policies? BOTTICELLI: So maybe I’ll start with the last first. You know, obviously being in recovery, I do feel that people who come from affected communities should be part and parcel of the policy and decision-making. I have a long career in public health and I did a lot of work around HIV and AIDS, where clearly the consumer voice, you know, needed to be at the table. And there used to be an expression—nothing about us without us. And I carry that with me in terms of our work that we do on both the national and local levels. You know, I say I’m not unique in the sense that I’m one of 23 million Americans who are in recovery. What makes it unique is I get to sit at the White H...