SOMETIMES YOU JUST CAN’T GET THERE FROM HERE – A REVIEW OF THE OFFICE OF NATIONAL DRUG CONTROL POLICY AND ITS DIRECTOR

John Giordano, Doctor of Humane Letters, MAC, CAP, Addiction Treatment Consultant

A few months ago, USA Today ran a damning report titled: “U.S. deaths from alcohol, drugs and suicide hit highest level since record-keeping began.” This wasn’t a human interest story so we didn’t get to know these folks for who they really were. They were just like the rest of us in the respect that they were born in a hospital, had parents, grandparents, sisters and brothers, aunts and uncles. They had relationships with kids they went to school with and developed romances. Some were married and had children of their own. Most had jobs and careers. However, what differentiated these people from others, is the state of their mental health.

In the USA Today report, Health Policy Reporter, Jayne O’Donnell, takes a comprehensive look at what is driving avoidable deaths in this country and provides some solutions that can help curb the trend. The most recent data from 2017 revealed that the number of deaths from alcohol, drugs and suicide hit the highest level since federal data collection started in 1999 – 153,845 – or a 6 percent increase over 2016.

One “take away” that I saw was that not enough is being done on a national or governmental level to prevent these deaths. Jayne O’Donnell quoted Psychologist Benjamin Miller, chief strategy officer of the Well Being Trust, as saying broader efforts are needed to address the underlying causes of alcohol and drug use and suicide. “It’s almost a joke how simple we’re trying to make these issues,” he says. “We’re not changing direction, and it’s getting worse.”

I found these sentiments concerning as they come in the wake of a government drug policy overview titled: ‘the National Drug Control Strategy’ and published on the letterhead of The Executive Office of the President of the United States in January 2019. This is an annual report provided by the Office of National Drug Control Policy. The ONDCP was created by the Anti-Drug Abuse Act of 1988 and is a White House agency that is not beholden to any government body or group; they answer only to the President. The director, who is often colloquially known as the Drug Czar, James W. Carroll Jr., has the president’s ear and sets the national drug policy.

Carroll’s background has many in the addiction treatment field in an uproar. He is a bit of a political animal, in that prior to working as the White House deputy chief of staff, he held a similar position in George W. Bush’s administration. After nearly three months working at this post for the current administration, Carroll was appointed by the President on February 9, 2018 to head the Office of National Drug Control Policy. He was confirmed by the U.S. Senate nearly a year later on January 2, 2019, and sworn in by Vice President Mike Pence on January 31. Prior to serving in the White House, Carroll was a Washington, D.C., Counsel at the Ford Motor Company and General Counsel of the Ford Motor Company Fund. He has absolutely no healthcare or addiction treatment credentials on his paper thin resume; a stark contrast to his predecessor, Michael Botticelli.

Upon Carroll’s confirmation, the White House unequivocally reaffirmed their intention to fight the opioid crisis and drug addiction, stating that it’s a priority for this administration. White House spokesperson Sarah Huckabee Sanders said in a statement that: “We have full confidence in Jim to lead ONDCP to make significant strides in combating the opioid crisis, reducing drug use, and coordinating US drug policy.”

All of these affirmations didn’t make much of a believer out of Psychologist Benjamin Miller, and a whole lot of other addiction treatment professionals. I suppose no one should be surprised that Carroll’s first attempt at providing a comprehensive drug policy – the National Drug Control Strategy – left many professionals underwhelmed.

The strategy outlined in this policy piece is focused on achieving one overarching strategic objective: ‘Building a stronger, healthier, drug free society today and in the years to come by drastically reducing the number of Americans losing their lives to drug addiction in today’s crisis, and preparing now to dominate the drug environment of the future. This will be done by preventing initiates to drug use, providing treatment services leading to long-term recovery for those suffering from addiction, and aggressively reducing the availability of illicit drugs in America’s communities.

This is a pretty heady statement that appears on the second page of the report. Sadly, it’s nothing more than repackaged political platitudes intended to make you think something is being accomplished in effectively combating drug addiction when in reality there is no viable direction or action to resolve this issue whatsoever.

I’m not the only one to think this. One lawmaker said the report was “a 23-page pamphlet. It fails to meet even the most basic requirements in the law.” ABC News reported that the new strategy, overseen by the Office of National Drug Control Policy, was analyzed by the Government Accountability Office, which found that the efforts lack quantifiable and measurable objectives.

Perhaps the most critical critique of Carroll’s policies came from the U.S. Government Accountability Office (GAO). After careful review, Triana McNeil, the GAO’s acting director of strategic issues, testified to the House Oversight Committee that Carroll’s report is “completely void of any performance measurement system. How can ONDCP track its own progress,” she asked. “How can ONDCP be held accountable, without this critical system in place?”

It’s politicos like Carroll that lead me to question our government’s resolve to end this drug crisis. I’m sure Carroll is a fine person, but he is uniquely unqualified for a position that can mean the difference between life and death.

What I find truly amazing is that we’ve learned nothing from our past drug epidemic. Most people are not aware that in the late 1800’s and early 1900’s Americans consumed more opium per capita than the Chinese who at the time were marred in opium addiction for over a century. It was in this time period that a German pharmaceutical company introduced a new product that they claimed could cure opium addiction. Their new product was Diamorphine, more commonly known as heroin.

Recognizing the dangers these drugs presented to Americans, then President Theodore Roosevelt appointed renowned physician and pathologist, Dr. Hamilton Wright, to the newly created position of the United States Opium Commissioner on July 1, 1908. For all intent and purposes, Dr. Wright was America’s first Drug Czar.

The biggest challenge confronting Dr. Wright is identical to the issues we face today – politicians’ aversion to regulating commerce. No politician wants to be perceived as a detriment to business; apparently even at the expense of their own constituents’ lives.

In 2017, over 73,000 people died an avoidable death at the hands of drugs. In that same time, $35 billion was spent on addiction treatment, 10’s of billions was spent on opioid pain killers, Indivior raked in over $1.3 billion on sales of their U.S. approved Medication-Assisted Treatment (MAT) drugs Suboxone and Subutex, and the list goes on. Much of the money coming in goes towards the salaries of high income earners such as doctors, nurses, nurse practitioners, therapists, researchers, treatment center owners, share holders and so on. Politicos recognize this is a huge industry with a lot of money changing hands and are fearful any change they might implement and/or support that could curb this deadly drug epidemic has the potential of getting them unelected.

As America’s first Drug Czar, Dr Wright was faced with the same challenge, albeit on a smaller scale, but was undeterred. He worked tirelessly giving Americans the facts and cajoling politicians to do what’s best for the people. His efforts were rewarded with the passage of the 1914 Harrison Narcotics Tax Act which regulated the importation, manufacturing, distribution, and prescribing of narcotics. Doctors were forbidden to prescribe narcotics to addicted patients. It was Dr. Wright’s view that this was merely extending their addiction. In short order, America’s first drug epidemic came to an abrupt close.

In comparing Dr. Wright to our current Drug Czar, James W. Carroll, I see very little in common. Dr. Wright was knowledgeable, committed and driven whereas Mr. Carroll shares none of these characteristics. There is an old saying; ‘sometimes you just can’t get there from here’; which in this case means don’t expect much from this administration.

If there is any hope to be found these days, it’s in the fact that state and local municipalities have stepped up to do the federal government’s work. Today, there are nearly 1,000 lawsuits against opioid manufacturers and distributors brought on by small towns, and villages, cities, counties, parishes and states. Many of these lawsuits have been in the works for a while and will go before a judge and jury before year’s end. The impact of these law suits can already be felt. Doctors across the country are already limiting their opioid prescriptions. This will not end the drug epidemic, but it sure feels like a good start – a shifting of the tides.

The ONDCP also needs to add evidenced-based holistic addiction treatment modalities in conjunction with the psychological model.

John Giordano is the founder of ‘Life Enhancement Aftercare & Chronic Relapse Recovery Center,’ an Addiction Treatment Consultant, President and Founder of the National Institute for Holistic Addiction Studies, Chaplain of the North Miami Police Department and is the Second Vice President of the Greater North Miami Beach Chamber of Commerce. He is on the editorial board of the highly respected scientific Journal of Reward Deficiency Syndrome (JRDS) and has contributed to over 69 papers published in peer-reviewed scientific and medical journals. For the latest development in cutting-edge addiction treatment, check out his website: http://www.HolisticAddictionInfo.com