Some say government's new strategy to fight drug addiction needs more funding

By Amy Goldstein
Washington Post Staff Writer
Monday, May 24, 2010

For the first time, the federal government has set a goal of reducing diseases and deaths caused by drug addiction, as well as the number of American teenagers and adults who use illegal substances.

The surgeon general will produce a report to try to focus attention on the escalating abuse of legal but dangerous prescription drugs. And federal officials are urging family doctors and public clinics to help detect addictions early by paying closer attention to whether their patients use illicit drugs.

Such emphases, part of the maiden National Drug Control Strategy to emerge from the Obama administration, set a different tone from its predecessors under the Bush administration, which focused more heavily on slowing the flow of illegal drugs into the United States. But in the two weeks since the White House issued the 117-page strategy, a growing chorus of drug-policy specialists has begun to complain that President Obama and his aides are not putting enough money behind their efforts to reconfigure the nation's drug-fighting approach.

"We have a great strategy and not a lot of means to implement it," said John Carnavale, a drug-policy consultant who used to work for the government and wrote earlier versions of the national drug-control strategy for three previous presidents in the 1980s and '90s. "That's our worry."

Overall, the White House has asked Congress to increase spending next year by 3.5 percent on the broad spectrum of drug-control activities -- from curbing drugged driving and expanding drug courts to subsidizing opium and coca farmers in other countries to switch to legal crops. That increase is less than the 4.1 percent increase that President George W. Bush sought to combat drug abuse in 2002, the year his administration developed its first national drug-control strategy.

Moreover, even drug-policy experts who like the new plan's tone say they are disappointed that about two-thirds -- about the same proportion as under Bush -- of the $15.5 billion proposed for drug control in 2011 would be used to try to cut the supply of illegal drugs rather than to lessen people's desire for them.

"The rhetoric is different but the money is essentially the same," said Joseph A. Califano Jr., director of the National Center on Addiction and Substance Abuse at Columbia University.

In particular, Califano, who led the Department of Health, Education and Welfare (now Health and Human Services), said the White House has not devoted enough money to the National Institutes of Health's National Institute on Drug Abuse to finance research into new medicines to treat addictions. The administration has asked Congress to increase NIDA's budget next year by $35 million to nearly $1.1 billion, but that would leave the institute with $100 million less than it had last year, according to budget figures in the drug-control plan.

"There isn't a really whopping increase in the NIDA budget commensurate with the fact we have learned so much about . . . how this stuff affects the brain in ways we never knew," Califano said.

The strategy is produced annually by the White House's Office of National Control Policy, which was created in 1988. Obama last year lowered the office's status, so its director no longer is part of the president's Cabinet.

The director, R. Gil Kerlikowske, said the strategy represents a new approach that was informed by his extensive travels, collecting advice around the country in the past year. He noted that the president has requested a 13 percent increase for drug-prevention efforts, which is greater than the budget proposes for other aspects of drug control, such as law enforcement or trying to block drugs from entering the country.

Beyond the specific federal funding, Kerlikowske said, the new strategy envisions that federal money will be leveraged in various ways. For instance, he said, the plan would pay for experiments in which a network of communities would try to apply the best research evidence to prevent teenagers from starting to use drugs. And it calls for NIH's drug-abuse institute to give medical schools information for use in training primary care physicians and other health-care professionals to screen and treat patients for drug addictions.

In addition, Kerlikowske said, the law Congress passed this spring to overhaul the health-care system has the potential to make drug treatment more accessible, because millions of Americans with drug addictions are now uninsured. The law is designed to expand, in a few years, the number of people covered by either Medicaid or private health plans sponsored by new state insurance marketplaces. Substance abuse treatment must be available through both kinds of insurance.

More fundamentally, Kerlikowske said, "I reject the whole argument" that drug-fighting money can be thought of as two distinct parts. "The country is really ready for a complex discussion about a complex problem, and not a bumper sticker answer about supply versus demand."

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