Bourne was in charge of the nation's drug problem under President Jimmy Carter. His official title was Special Assistant to the President for Health Issues. Bourne resigned in 1978 after being caught writing a fraudulent prescription for a staff member and after rumors spread that he used cocaine at a NORML Christmas party he had attended. This is the edited transcript of an interview conducted in 2000.

I had been hired by President Carter, who was then the governor of Georgia, to set up a statewide drug treatment program. . . . One of my longtime friends and college classmates, Robert DuPont, was already running the drug treatment program in Washington, D.C. Governor Carter said that he wanted me to set that up in all the major cities in Georgia. So I agreed.

A group of a half-dozen of us was running programs, mainly methadone maintenance programs, in major cities around the country. . . . People concerned about drug abuse recognized my program as one of these big successful programs. Shortly after, President Nixon set up the Special Action Office for Drug Abuse Prevention (SAODAP) and Jerry Jaffe was made the director. Bud Krogh, the contact person in the White House, came to Georgia to ask if I would come and be the deputy to Dr. Jaffe in charge of the treatment programs. So that's how I ended up coming to Washington....

Jaffe was one of the people who got admiration from different quarters. What was the Jaffe model? What was his mantra?

Jerry Jaffe was a very brilliant thinker. He deserves the credit for what was done nationally in the early years of the drug abuse treatment. If we stuck with the Jerry Jaffe model, we'd be infinitely better off today than we are now. Jerry Jaffe felt that the key to dealing with a drug abuse epidemic was to make treatment totally available to anybody who wanted it. The fundamental philosophy was that no drug addict could say, "I want treatment, but there's no place I can get it."

This was predicated on a number of things. One, that people are led into drug abuse by people who were already addicted--sort of like an infectious disease--so if you could reduce the number of addicted people, you would limit the spread of the disease. And if you can get virtually everybody who is addicted into treatment, you would essentially stop the spread of the epidemic. And at the same time, you had a concerted effort to limit the supply of drugs. Not in the sort of brutal, oppressive way that we had in later years, which was quite destructive. You began with the growers, and you worked with crop substitution programs. You went after major traffickers who were exploiting the drug issue to make large sums of money, but don't penalize the street-level traffickers or street-level sellers. Most of them were just addicts themselves. . . .

How was it possible to make it a health problem? Was it because so many people were starting to use drugs?

Yes. You had this explosive increase in the use of drugs, which was due to a variety of factors. There were two crucial events in the Nixon administration. One was the discovery that large numbers of GIs in Vietnam were addicted to heroin. The other event was discovering the link between street crime and people who were addicted, which was really first demonstrated most significantly in Washington, D.C. The Nixon administration was really determined to say that they were lowering street crime, because that had been part of the issues that they had run on and promoted. And when it was pointed out to them that if you treated the fifty percent-or-higher of people who ended up in the D.C. jails and were heroin addicts, you could dramatically reduce street crime in the city.

And then secondly, when you had large numbers of GIs in Vietnam addicted to heroin, you couldn't attack them as moral reprobates. You had to say, "These poor fighting men have unfortunately become victims of heroin, and we've got to treat them in a very humane way." It would just be politically unacceptable for Nixon to attack military people who were in the war zone, fighting for the country. Those two factors convinced Nixon that a public health strategy was the most appropriate line to pursue, even though his previous pattern, and his natural inclination, were of a hard-line law enforcement approach to drugs. . . .

One of the interesting things is how the drug problem is defined. At that time, it was defined as hard-core heroin use, even though marijuana use was rising.

. . . Marijuana really was not seen as a serious public health problem--then, or today. It was viewed as very much a secondary issue. Subsequently, there was an effort to imply that marijuana was a public health problem, to justify the tough measures taken against those who experimented with it. But it was really a very phony effort. It was policymakers trying to hide behind the skirts of science, trying to say that marijuana poses a threat to the health of young people.

Taking any drugs is probably not a good idea. But it certainly posed no significant public health problem. In many ways, it's somewhat reminiscent of 50 years ago when moralists argued that masturbation was morally wrong. They couldn't just argue that it was morally wrong, so they argued that it made you insane. They were able to get enough physicians to say, "Yes, masturbation makes you insane," and people argued that this was causing insanity. Therefore, you were justified in condemning masturbation. I see the same sort of process with the use of marijuana, which is a trivial health problem.

. . . In the previous cycle against drugs, Harry Anslinger had said marijuana will make you insane.

Yes, and there was a movie, Reefer Madness, that was widely distributed, which tried to reinforce that view.

That movie became a camp classic. People were saying that what the government tells us on drugs is useless. Did that contribute to how young, college-age pot smokers thought of marijuana?

Yes, I think so. It reinforced the notion that the government lies to you, and you can't believe what the government says. And they were saying it's some ulterior motive, because to say that smoking marijuana is dangerous is patently absurd and clearly untrue, and therefore the government has to be lying. . . .

But it didn't only disillusion people about the honesty of the government. Smoking marijuana then became very important as a symbolic gesture against the government. . . . In many respects, the symbolism of marijuana smoking is at the heart of public policy towards it today, only it's now the reverse. Marijuana smoking has become a symbol of the political philosophy of the 1960s, and people want to crush marijuana smoking as a way of essentially crushing a political generation. We're really talking more about cultural wars than we are talking about drug wars.

Back in the Nixon time, Nixon didn't like hippie pot-smoking types. A lot of people think that he tried to pick up people in the March on Washington because they were smoking, but really they were political enemies. . . .

. . . I think he did continue to use marijuana smoking as a way of going after people that he disapproved of politically. On the other hand, the heroin treatment program proved such a public relations success of the Nixon administration, that they were willing to shelve the marijuana issue to some extent. They made the drug issue a winner, and they didn't want to be creating some sideshow that would detract from that. So they sort of ended up giving marijuana a free ride during that latter part of the Nixon administration.

The Narcotics Treatment administration study linking crime and heroin addiction, and then the problem in Vietnam with GIs becoming addicted made President Nixon condone the use of methadone. That is pretty striking. Did that strike you as unusual--that it would be federally sanctioned?

I don't think I ever gave it a thought. It's like condoning penicillin to treatment pneumonia. It was the drug of choice at the time. It had been clearly demonstrated in program after program that if you wanted to save somebody's life from heroin addiction, methadone maintenance was the most effective way to do it. If you were going to rely on the experts and people like Jerry Jaffe, you had to buy into that. It never occurred to me that methadone per se was an issue. Are you going to accept the addiction as a public health problem, or are you going to view it as a moral issue? Once Nixon said, "Because this is what the experts are telling me, I will accept that this is a public health problem, and they have a strategy and a drug for dealing with it." Then the use of methadone was automatic.

When you were in Washington, you were already a close friend of Governor Carter's. . . . Were you encouraging him from Washington to run for president?

. . . We had already made the decision that he would run. We had a small group, just four or five people, working with Carter in 1972, actually beginning before McGovern's defeat. We were preparing a plan for the four-year strategy for Carter to run for president. When Bud Krogh came and invited me to come to Washington, I talked to Carter about whether or not I should take the job. He said, "You take it, and as soon as they are ready to formally announce that I'm running for president, you can leave there and set up the Washington campaign office in the presidential race," which is in fact what I did. So the whole time that I was in Washington working for SAODAP, I was at the same time flying back to Atlanta on weekends to work in the development of Carter's strategy. . . .

In the Carter administration, SAODAP was totally divorced from the law enforcement side and the supply side. Did that free you up? How did that work?

Under the legislation that set up SAODAP, it focused only on the demand side, so it was really treatment oriented. The law enforcement side, under Miles Ambrose, was a separate operation. And the State Department was separate, and ran its own operation. Under the Ford administration, new legislation consolidated the whole policy coordination of the drug abuse program under one person in one office in the White House. Ford did not implement that legislation, so there was nobody in that particular job during the four years. When Carter came in, I was appointed to that position. So I was essentially the first drug czar with a total responsibility for foreign police, law enforcement, treatment. We also involved the CIA, the Coast Guard, Treasury, and anybody else in the federal government--all coordinated together in one policymaking group, and under one office. . . .

In his campaign speech and then in office, Carter supported decriminalization. What was the stated policy when you got in on drugs?

It was very clear. The policy that we enunciated was that this was a public health problem, that each drug needed to be dealt with separately because of the different strategy of approach was required for each drug. Heroin was the major public health problem. We had a strategy in place that had begun in the Nixon years. We refined it a little, but we set out to deal with heroin by specifically treating the heroin problem. . . .

We did not view marijuana as a significant health problem--as it was not--even though there were people who wanted to construe it as being a public health problem. Nobody dies from marijuana smoking. Marijuana smoking, in fact if one wants to be honest, is a source of pleasure and amusement to countless millions of people in America, and it continues to be that way. . . .

The view then with the Carter administration was that you should not have penalties that are more damaging to the individual than the problem that you're trying to solve. We have no influence over what penalties the states set, but the decision that we made in the Carter White House is that, as far as federal law was concerned, the possession of less than an ounce of marijuana means that you're a user, not a seller, and it should be made a misdemeanor. It would still be illegal, but it would be something more like a traffic ticket. If you had more than an ounce and you were clearly a trafficker, then there would be more severe penalties, and it would remain a felony. . . .

I think there was a pretty rational policy. Where a drug posed a serious health threat, there was an intensive focus to provide a treatment program. Where marijuana or other milder drugs were of minimal consequence, then we wanted to be sure that we didn't damage people legally by hurting them with the law in a way that marijuana was not going hurt them. . . .

Let's talk about the supply side. . . . Why did it seem like a good idea to go after the supply in Mexico?

Curtailing the supply just made sense as part of the overall strategy. Perhaps now in retrospect it seems a little naïve, but it looked a very doable kind of proposition. Heroin in particular was being grown in only a few parts of the world--mainly the Turkish-Iran border area, the Golden Triangle of Asia, and Mexico. And we thought if we could convince the people growing opium that there were other crops they could grow instead, we could reduce the production of heroin and gradually have the supply coming to the US decline.

Under the Nixon administration, they had successfully broken this so-called French Connection, where opium came out of Turkey, through Marseilles and came to the US. We believed that probably you could work a similar strategy in Mexico and the Golden Triangle. And indeed, I think to begin with, some of the crop substitution programs, particularly in Asia, did work quite well. Spraying of opium in Mexico also had some degree of success. Years later it became apparent that you could grow opium in many other places in the world, and that, as one source dried up, people started growing it somewhere else. As of today, we haven't been able to significantly dent the supply of heroin in the world. But at that time it did look like a doable proposition.

Can you tell me a little bit about the trip you took to Mexico, and the issue of spraying marijuana crops with paraquat?

We went on that trip primarily to look at the spraying program for getting rid of opium, but they flew us by helicopter to many area where marijuana was also being cultivated. The Mexicans were far more concerned about marijuana cultivation, because they felt that it was being used significantly domestically, and it was creating an economic problem for them. . . . They wanted us let them use the helicopters that were spraying the opium to also spray the marijuana. We didn't feel strongly either way, but said, "If you want to get chemicals yourself, you're welcome to spray the marijuana." And they got the chemicals from Europe. . . .

The paraquat issue played very differently in the US. It was a real tangle. Can you tell me about that?

It became one of these sort of non-issues that took on a life of its own. The Mexicans said, "When we're not using US-donated helicopters to spray the opium fields, can we spray marijuana? Because that's a problem to us." And we said, "Yes, we don't provide you the chemicals for doing it, because it's not that high a priority for us. But if you want to purchase the herbicide paraquat with Mexican funds to spray marijuana, you're welcome to use the helicopters to spray marijuana when they're not being used to spray opium."

The National Organization for the Reform of Marijuana Laws, NORML, had had a steep decline in its membership after Carter came into office, and talked about decriminalizing as a more rational approach towards marijuana smoking. Many of them were concerned with finding an issue that would regenerate their revenues and their membership. Somebody said some of the marijuana coming from Mexico is probably contaminated with paraquat. In practice, paraquat just kills marijuana very, very quickly. Once marijuana has been hit by paraquat, there's no way that you're going to be able to harvest it, take it to the States and market it.

But a lab purporting to test whether marijuana had been contaminated with paraquat was set up, and they announced very early in a press release that they had tested a large number of samples of marijuana coming from Mexico and that it was contaminated with paraquat. NORML then filed suit against the US government to prohibit and try to get a restraining order to stop the spraying of paraquat in Mexico, even though the spraying was not being done by the US government--it was being done by the Mexican government.

I suppose there are no phony issues in the political arena, because perception, rather than reality, is everything. But this was in no sense a real issue in terms of paraquat posing any health danger to American marijuana smokers--not to mention the fact that they were still asking to be protected for something that was illegal. . . .

In 1976, 1977, the parents' movement started to get notice. What do first remember hearing about Keith Schuchard and this Atlanta-based parents' movement?

I had been aware of the parents' movement in Atlanta before I left Atlanta, and they'd been at the very minimal level. But groups--and this was just one of them--had come to the state legislature in Georgia, and they'd made a lot of noise along the lines of, you know, "Carter's too liberal on drugs. We don't want treatment. We want more aggressive law enforcement. These people aren't sick, they're criminals, and we want to lock them all up and put them in prison. Heroin isn't the issue, it's marijuana smoking by suburban white kids--our children--that we're worried about." Quite frankly, Carter and I had regarded these people as pretty inconsequential gadflies that you see in politics but are really of no particular consequence, and we essentially ignored them.

Once I was in the White House, they continued to make a noise, and write letters and so forth. I don't think that even there we viewed them as a particularly consequential force, but what they were saying was both ill formed and so antithetical to the strategies that we were pursuing. And we had people on the other side, and people in the black community of an equal extreme saying, "You're not doing enough for black people, African-Americans in New York or the inner cities of the country." So the Atlanta group was really just another sort of pressure group that we were dealing with. We were trying to steer the middle course, and I didn't view them as being that different from many groups that we were dealing with. . . .

Eleven states decriminalized, and Alaska legalized. But then in 1978, it turned back. What do you think happened?

I don't know how much credit to give to the parents' movement. I don't know whether there was a change. I think it probably had to do with the ebbing support for President Carter. He was in serious trouble because of the economy. . . . Conservative hard-liners . . .were attacking him from the right, saying to increase defense spending. He was being attacked by the unions, particularly the UAW, and the Congressional Black Caucus for cutting federal spending. He was really under assault on all sides. Oil prices were quadrupling, inflation was going through the roof, interest rates were going up, and he was then losing his credibility with the country on something like this, rather than being seen as somebody who was leading us, policy-wise, in a new direction on drugs. He was seen as somebody who was vulnerable and on the defensive. When that happened, the tide had begun to turn, whether it was the parents' movement who deserve the credit or whether there were other local factors. That was the beginning of the receding of the tide. . . .

What was your relationship with DEA?

. . . I only came to realize later the extent to which bureaucratic wars in Washington often transcend the pursuit of policy, and that one of the objectives in DEA always was to increase its budget and its influence in Washington.

One way of doing that was to always say the drug problem is getting worse. "We need more agents, a bugger budget and more clout to be able to fight the war." If you're winning the war against heroin, and the person in the White House says we have reduced overdose deaths to the lowest levels in the last 30 years, everybody in DEA says, "They're going to cut our budget. They're going to reduce our agents. Some of us are going to be laid off."

In that sense, I didn't really understand the degree to which the bureaucracy goes on when people like me just come and go. If you're going to be a 30-year person with DEA, you are concerned about the growth of your agency, the size of your budget and assuring that your job is there to the end of your days when you retire.

And so there was a different kind of cultural setting in DEA from what we had in the White House. Our view was, "We've got four years before the reelection campaign to really show we've made dramatic progress on the drug issue." That was not the view within the DEA bureaucracy. They were very eager to make big busts, to break big traffickers, to get a lot of publicity to show they were doing a great job, and if they had more money, more agents, they could arrest more traffickers. It was a different sort of mindset and a different sort of value system.

If you could treat the problem right away . . .

If you could treat the problem right away, then who would need DEA? . . .

In 1974, you wrote an article . . . called "The Cocaine Myth," saying it was more or less not dangerous. Tell me about that.

I still believe that. Cocaine itself, powdered cocaine, poses a fairly minimal health threat. It's been widely used for thousands of years. . . . It is an exciting, euphoria-producing recreational drug. Most people who get into difficulty with it do so because they have preexisting emotional problems, and they use the cocaine as a way of trying to self-medicate those problems, and they become increasingly dependent on it. I'm not saying there aren't people who don't get into serious difficulty with cocaine. But there are people who kill themselves skiing because they run into trees. That is the nature of the risk that you take on if you enjoy that experience. . . .

In 1978, seven people in the US died from the effects of cocaine. Two of them were people who were smuggling, and swallowed condoms full of cocaine as they were coming to the US, so it wouldn't be detected. The condoms had then broken in their stomachs, and they'd had a massive dose of cocaine that killed them. But a health threat from the recreational use of cocaine, or even the dependent use of cocaine, was pretty minimal. If you compare it to 400,000 dying every year in the US from the effects of cigarettes, it's absurd to look at cocaine as a health problem. . . .

What numbers you do look at? What indicates that something is a public health problem?

Firstly, you look at deaths related to it--mortality. The second is morbidity: To what extent does the use of this drug compromise your otherwise effective functioning? It may be psychological impact, that you're intoxicated too much of the time to be able to do your job. Or it interferes with your financial welfare or your emotional relationships with people, or it may cause a physical problem that is less than lethal. Those are the indicators that you look at with any public health problem.

Ten percent of the US is alcoholic--has a problem that seriously impairs their functioning due to the use of alcohol. Four hundred thousand people die a year from the effects of smoking cigarettes. By comparison, with drugs, even heroin, you're talking about a miniscule health problem. But you can't justify punitive laws unless you have some reason that we have to have these punitive laws. So you then have a completely misrepresented and distorted argument that this poses a health threat to the country. It's utter nonsense.

. . .

You went to NORML's Christmas party. . . .

There were various events. (Laughter). There was an event right after the inauguration in 1977, I guess it was the annual meeting of NORML or something--where Keith Stroup invited me to come and speak about the administration's policy, which I did. And I could see when I was speaking that there were people in the back of the hall smoking joints. I did tell Keith at that point that that just created a big problem for me, because I couldn't be there. I couldn't be in charge of drug policy and have people visibly breaking the law in my presence.

There was another annual meeting which may be the one you're referring to, which I either couldn't go to or didn't want to go to because of the previous event. And he said, "I understand that, but tonight we're having a party at the home of William Paley," who was the son of the owner of CBS television. And he said, "Please come by, because people are very upset that you didn't come and speak at our former sessions, and it would be nice if you came to my party." So I went to that party, where again, people were using drugs. And I didn't stay there terribly long and I left. That was the last I heard of that party until many months later.

Tell me what happened. You had just prescribed something for your assistant. . . .

Yes, I had a woman working for me who previously worked for the House Intelligence Committee. She had a number of personal emotional problems, which I still consider confidential and which I shouldn't discuss. But she was under a lot of stress and pressure. I suggested that she go to see a psychologist friend of mine. She didn't want to do that, because she was worried that it would jeopardize her security clearance. . . . She then came to me on, I think, July 4, and said she had not gone to the psychologist for these reasons. She thought if she had a few good nights' sleep she'd be all right, and could I write her a prescription for some kind of sedative?

I probably normally would have written a prescription for barbiturates, but I had just been involved in this big campaign to get physicians around the country not to prescribe barbiturates on an outpatient basis. So there were a variety of other sedatives that were regularly prescribed at that time . . . so I just wrote her a prescription for 12 pills, which was a pretty small amount. And she said that she didn't want it on her record, and she'd rather that I used a pseudonym or something, so I used a pseudonym for her. I signed my own name to the prescription and used a pseudonym for her, which is common in normal medical practice. . . .

Then, what happened is that she asked her roommate to get the prescription filled for her. Her roommate went to a pharmacy and a state drug inspector happened to be in there. The pharmacist said to this woman, "Is this your name here?" And she said, "No, it's actually my roommate's," and so they then tried to call me to be sure that it was a legitimate prescription. They couldn't reach me. And then they said to this woman, "What is your roommate's name?" and she gave her roommate's name. It was not the name of the person on the prescription.

So a degree of concern developed, and before I knew it, the district attorney in this area could see a political opportunity that he couldn't resist. He jumped in and called a press conference about this prescription, investigating it, and somebody in the White House is involved. And it was something I did for totally legitimate medical reasons. It wasn't, in retrospect, very smart in the political context that I was working in.

What happened then? What's it like to be in the middle of a Washington media frenzy?

It's not nice. It's not nice. The media just piles on. You're just hounded day and night. And the real problem for me was that President Carter was in Europe on an economic summit trip at that point. He was really struggling in the polls. The meeting in Europe had been extremely successful. He was to come back from Europe and hold a press conference, at which he was to take credit for all the accomplishments of his economic summit. My colleagues in the White House said, "You know, he's going to come back and the only thing they're going to want to ask him about is this situation over this prescription. And it will just pop the balloon of all of the positive press we want to get about the economic summit." So I decided, out of loyalty to him, that I owed it to him to resign, which I did. . . .

There was a period between the first publicity and the time that I resigned where people were sort of scurrying around trying to dig up other stories. One story was that I had treated a drug addict in Georgia who, it turned out, was involved with some big trafficking networking to Brazil. This was before I came to the White House, because it was long before I even got involved with Carter. Two prosecutors from New York had come to see me about this patient, and all we had talked about was did I know that this fellow I was treating was involved in trafficking, did I know any of his friends. I didn't at all, I mean, he was just a patient to me. And this story ran, saying that I had previously been investigated because of the connection through one of my patients to this drug networking operation in Brazil, which was absolute nonsense. It was a totally fabricated story.

Then Keith said, "Six months ago, he was at this party given by William Paley, and there was coke being used there, and I'm sure he was one of the people who used coke," which again was not true. But there was no doubt coke was being used at that party.

There were those kinds of things, and others. . . . There was just more and more momentum. . . . These are very difficult situations to tolerate, and I think in the White House, your first obligation is to the president. You are only there because of the president who gave you your job, and you're there to serve him and make his life easier. If you reach a point where you're making his life more difficult for him, then you shouldn't probably be there anymore. That was my view, and in the long run it has not affected my relationship with President Carter at all. We're still very good friends. . . .

How did drug policy change under President Reagan?

There was a dramatic change when the Reagan administration came in, because they essentially abandoned completely the public health approach to the problem of drug abuse. They equated on moral grounds the use of any of these drugs as being equal to each other, and abandoned any effort for the federal government to play a role in trying to deal with the drug problem. A difficulty with heroin was that we had a known technology, methadone maintenance, as a way of treating it. There was not a comparable analogy with cocaine.

But under Reagan, there was no effort made to find any effective treatment for cocaine addicts or to provide it on a large scale. Instead, you had a sort of inane policy of "Just Say No," which is like telling someone who's depressed, "Have a Nice Day." And essentially it's an abdication of any responsibility for dealing with the problem, and an effort really just to exploit it politically.

And that's what happened. Build more prisons, arrest more people. I think it was quite coincident with a period when people were concerned about crime problems in the cities. You had in certain respects the use of cocaine, crack cocaine, and the laws against it, as a way of sort of ethnically cleansing young African-American men from the inner cities of America.

And so today you have the US with a larger percentage of its population in prison than any other nation in the world. More than fifty percent of the people in prison are there for drug offenses, and the majority of those people are African-Americans, even though they represent a relatively small percentage of the population. . . . .

I don't want to seem so egocentric as to suggest that the whole world revolves around me. But I think the real turning point in this was the moment that I left the White House.

It ended the era of the focus on dealing drugs as a public health issue. From the point after I left, it then became a political, law enforcement, and moral issue, and there were obviously other players like the family, the parents' movement and other factors. But if I had to point to any one moment when the whole perspective changed, I think that would be the perspective. I think other people would probably generally see it that way. . . .

When Reagan first came in, I would call the National Institute on Drug Abuse every month to get the overdose figures. And from the moment Reagan came in, the number of people dying from drugs went up week by week by week, because they were abandoning all the treatment programs, all of the public health approach. They were hiring people to work in the drug programs or drug policies office who had no background in drug abuse, or certainly not in drug abuse treatment.

Eventually they refused to give me the overdose death figures anymore. They said, "We've decided that's not a useful measure of the effectiveness of the drug programs." And that was at a point when the overdose deaths had almost doubled since Carter left office, or certainly since I departed. It was a decision that people dying from drugs, or reducing the deaths, was not an important objective. The objective was, can you appeal to suburban voters who have this rational or irrational fear about their children smoking marijuana? And that is what you want to appeal to.