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August 27, 2013 10:40 AM What Obama’s Drug Policy Gets Right

By Keith Humphreys

After initially accusing President Obama’s outgoing drug policy director Gil Kerlikowske of opposing public health measures in drug policy, Eric Sterling had the class to publically acknowledge Kerlikowske’s health-oriented reforms:

[Kerlikowske] recognized the importance of stopping the spread of HIV/AIDS among injecting drug users and recognized their humanity and dignity in the way his predecessors did not. Second, in the same spirit, he recognized that the dissemination of naloxone into the environments of opiate users, many of whom are using drugs illegally, would stop overdoses from becoming fatal.

Sterling also praised Kerlikowske’s support of opiate substitution therapies (e.g., methadone maintenance), which the administration expanded within the Tri-Care insurance program for military personnel and their families and spread internationally through the President’s Emergency Plan For AIDS Relief (PEPFAR).

In addition to the points Sterling raised, one could also note that the Administration’s signature legislation — the Affordable Care Act — mandates full coverage in Medicaid and health insurance exchanges for addiction treatment. That’s the biggest stride the federal government has taken towards health-oriented drug policy in at least 40 years and probably ever.

Sterling’s explanation for why his first article was inaccurate is powerfully honest and important:

I insulted Mr. Kerlikowske and dismissed his record on matters I did not review, relying on prejudices I formed regarding other subjects such as drug “legalization,” whether the Administration’s anti-drug program was “balanced,” as he claimed, and on marijuana policy. I deeply regret that I was unfair to Mr. Kerlikowske and misled the readers of Huffington Post regarding his support and commitment on important public health issues.

Sterling was by no means alone in his assumption that anyone who opposes drug legalization also opposes health oriented drug policy reform. But historically and cross-culturally, opinions on those two matters have not intersected in a consistent way. For example, among the people who identify themselves as “harm reductionists” around the world are many individuals who want all drugs legalized and many individuals who regard that idea with terror and hostility (Mainly because of the experience of legal tobacco). Among people who support legalization are individuals who favor increased availability of addiction treatment and individuals who are quite skeptical of the addiction treatment enterprise. And among people who oppose drug legalization –President Obama being a prominent example — are individuals who want to augment the quantity and quality of health services for drug users.

Philosophical matters aside, it is sometimes mistakenly assumed that cutting drug law enforcement is the only way to find the funds for expanding health services for drug users. But as Mark Kleiman has observed, government spends five times as much money on health care as it does on criminal justice. Health services for drug users are not expensive and can easily be paid for within our nearly $3 trillion health care system whether the criminal justice system grows, shrinks or stays flat.

Sterling deserves praise for his public acknowledgement of the health-oriented reforms of the Administration, and for his clarification of how support for legalization and support for drug policy reform are not isomorphic. That makes the high ratio of tweets, likes, links and comments on his first piece versus his second rather disheartening. The misinformed attack was seized upon and widely disseminated. The fact-filled apology drew far less attention.

That doesn’t speak well of the state of drug policy debate on the Internet. But here’s a way you can perhaps make it better. If you follow a blog or social network page that ballyhooed Sterling’s first piece, pass along the corrected piece and ask that it be taken seriously. If you get a good response, you will have helped elevate the qualty of drug policy debate. If however you get nervous coughs and a change of subject, you can still help the public debate by not wasting your time with such an integrity-challenged website in the future.

[Cross-posted at The Reality-based Community]

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Keith Humphreys is a professor of psychiatry and behavioral medicine at the Stanford University School of Medicine.

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