PROFESSOR SAM DASH: It is really with great pleasure that I welcome General McCaffrey's participation in this symposium, here, as our luncheon speaker. Of course you all know him as the director of the Office of Drug Control Policy of this country.
He was nominated to the position by President Clinton and confirmed by unanimous Senate vote on February 29, 1996. He serves as a member of the President's Cabinet, the President's Drug Policy Council, and the National Security Council for drug-related issues. But he is a real American hero.
I'm delighted to introduce General McCaffrey. We're very pleased to have you
Now, I would argue--you're gonna have a responsible discussion on the drug issue, on informed exchange of idea. A couple a things. First of all, you know, if this was economic policy, national agricultural policy, interstate commerce, we'd have to agree on some facts, and then go on to debate alternative conclusions and hypotheses. That's worth debating.
But we all learn in College 101 logic, you can't argue about facts. They either are or they're not. And you gotta finally have some consensus on what are the numbers, and, you know, is there a neurochemical way of seeing brain addiction?
And there's some documents, and there's some people who are organizing these programs, and you gotta know about 'em. You can't set up a straw man argument and say isn't that remiss, evil, wrongheaded, and then construct an alternative reality until you know what's going on.
And that, it seems to me--thank you, Professor Dash--is the reason for Georgetown University holding a forum like this.
Now I've got 154 people, probably another 50 liaison officers from various agencies of Government. We're the, by law, the people who are charged with trying to integrate sensible drug policy at the federal level, and I, and I underscore at the federal level because of that's only one sort of modest aspect of it. The real problem about drug abuse is at community level, and it involves a terrible self-destruction caused by these products. There aren't many of them, by the way. There's only a dozen, or so, that literally create these intense feelings of euphoria, that far exceed, predictably, will far exceed the kind of pleasure you get out of this first-rate lunch, out of sexual intercourse, out of drinking water, out of seeing a sunset in Hawaii. They just predictably generate these intense feelings of pleasure, and they do so in almost all of us, whether it's Demerol or alcohol, or cocaine or methamphetamines. That's the deal.
That's why people use drugs--because of the pleasure sensation. They like what it does for their brain. And the problem is--you know--it's too bad there's no free lunch in life--that after some period of time, many of us, but not all of us, but high numbers of us find that we have altered the neurochemical function of the brain through poly drug abuse, and, suddenly, from euphoria, we're in abject misery.
We cannot believe our own disgusting, immoral behavior. We're, we're frightened by our alienation from our family. We're getting arrested all the time in the most degrading of situations. Male street prostitution. Burglary. Breaking into cars.
We haven't been employed in a decade, and then, suddenly, I'm 35 years old, white male, and I have been in abject misery since my late teenage years. That's the deal. And I got there, according to Alan Leshner, by entering into a series of behaviors in which protective factors and risk factors, the sort of the cumulative impact on my environment, allowed me to continue down a trail to where I join the 5 million of us who are chronically addicted to drugs.
By the way, there's another 10 million, or so, who have such a terrible abuse pra--pattern with alcohol, that they fall into the same category. They're just in abject misery, and, you know, all of them, you know, say, "Well, who are these guys? Aren't they all minority, crazy guys, poor guys, city guys, East Coast, West Coast. Surely, surely, it's not somebody like me and my kids."
Well, I don't know. You know, turns out that's just not the case. Turns out that the problem of drug abuse in America affects just about anybody who gets involved in this behavior, particularly when you're young.
You know, if you try cocaine at age 30, you start smoking a joint or two in your third year of law school, if you start popping beers in your face after your second baby, at age 25, the statistics of it are pretty clear. That's not as statistically predictive in--of a bad outcome as a 12-year-old boy or girl smoking pot on weekends, and that kid puts themselves in a 79-fold higher likelihood of having a chronic drug abuse problem.
Now, argue about the number. You know, Herb Klever's reaction to you would be all we're reasonably sure is, the more you do it, the younger you are, the greater the probability of ending up in a dysfunctional legal, social, medical situation.
And so we don't want our kids using drugs, real bad. And then--and, by the way, when you start looking at real high rates of drug abuse--well, highest rates of drug abuse in our society are health professionals. ICU nurses, anesthesiologists, people who have access to Percocet, Percodan. You know, you go down to the Talbott-Marsh [ph] Clinic in Atlanta, it's great fun, sit there in a room, 25 docs, white female, 45-year-old plastic surgeon, San Francisco, chronically abusing alcohol and Percocet, and now into street drugs, and she's under indictment, and her professional life is in chaos, and her family is alienated, and she's in abject misery.
There is sort of a difference, though. She's got 14,000 bucks for the best treatment program in the country, and thank God the DEA has got her license to write prescriptions. So we find that the program of drug treatment for, you know, chronically-addicted physicians works pretty darn good, thank you.
You know, a year out from treatment, they're up in the 90 percent plus favorable response rate. Now go to the other end. What's the lowest rate of drug abuse in our society? Active members of the armed forces. Your grandchildren, grandsons, your kids, your nephews, these boys and girls out in the street at age eighteen. They come in--come into the armed forces and they don't use drugs too much. About a percent or two. Part of the reason's the drug testing. Part of the reason's military discipline. A good piece of the reason, however, I would argue, is we got sergeants, and sergeants act like parents are supposed to act, and they set standards, and they treat people with respect, and they put high demands on 'em, and they also say, hey, kid, you wanna use drugs on this ship, in this squadron, in this battalion--we will separate you from us. We won't lock you up. You can't stay with us any longer. And so drug abuse rates in the active armed forces, the same kids who are out here smoking a joint or two, in many cases, during their adolescent years, don't use drugs in the military.
By the way, some of you heard this statistic before, and it's sort of counterintutitive to many of you. One of the lowest rates of drug abuse in our society are African Americans under the age of thirty use less booze, cigarettes, heroin, crack cocaine rates for the black population, younger, are lower than for the general population. That's the deal.
So you gotta, you gotta understanding, it seems to me--and, by the way, I hold this mirror up to American society just to underscore that you and I have got to see this as a community problem, not as a problem that's based on socioeconomic class, racial background, et cetera. What are you gonna do about it? Is it hopeless?
I personally believe that the issue, from a strictly intellectual sense, isn't all that complicated, and I'd give you alternative social propositions that are complicated. Racism is tough to understand and deal with 'em--deal with. Poverty is very difficult to get a handle on, and then engineer some solution to correct it.
You know, transforming this society to an information-based society, that's a tough dilemma to look at. But drug abuse, we actually, turns out, have a lotta people in this country who know what they're talking about. A bunch of 'em aren't in this room and they publish books, and there are journals, and they're physicians, and they're people like Avram Goldstein at Stanford University, and, you know, they have created the science of addiction.
It turns out there's a lot that's known about it. So what's our problem? Why don't we do something about it? It's hard to get organized in a free society. The solutions, it turns out, involve working with institutions and people at community level. This is what your national drug policy is. This isn't a federal drug policy. This is the national drug policy. But the law got rewritten. Now there is a national drug strategy that lasts for--I still call it a 10-year strategy. Congress calls it a 5-year strategy. We put out annual reports.
We said if you wanna solve a complex social phenomena in America, you need to get budget considerations that are out beyond the next three months, stupid. You need a 5-year budget horizon. That's what we do in national defense issues. By law, we now have to have a 5-year drug budget to unite the nine appropriations bills of the thirteen in the U.S. Congress that deal with the drug issue. This document isn't very good. It's about a C-minus, but at least it now exists, and if I, I get you, and people like you, and the Congress and the news media to debate the budget in its out years, we'll get better off. That's what we do in other important national issues.
Now I say the budget isn't very good, because if you look at the out years, it doesn't reflect the implications of success. If we actually believe that prevention and treatment pay off, then we should anticipate--we won't have nearly 2 million people behind bars, 85 percent of whom have a drug-related problem in 2007. You don't see those kinda reflections in the budget yet, but I think as the debate starts to focus on how you move a democracy, you gotta get that budget document, which is required by law, to reflect the actual organizational thinking.
Now here's another one. Performance measures of effectiveness. The budget is the input function. The strategy is the process, and here's the output function. If you're gonna run 3M corporation or IBM, or almost any organized human activity, you have to decide, what are you trying to achieve?
You gotta de--design the variables, you gotta measure whether you're getting there. This is probably one of the most creative things in Government. It's about 20 percent done. You know, we've identified 12 target outcomes. We know the conditions we're trying to achieve in America.
There's 86 variables that have been designed to achieve the twelve outcomes, and now we're trying to build databases to measure whether or not the strategy and the money is achieving the output we claimed we were gonna achieve. This is hard work. Easy to run your mouth about it, but you, you gotta organize human activity in this nation of 270 million people, and, you know, you, you believe in drug treatment? Well, good for you.
I'm glad to hear that, because the problem is you have to build an institution to handle 200 or so suffering clients, and it has to be a team approach, and there has to be a physician there to deal with nutrition problems, and HIV positive, and you've gotta get a psychiatrist in there so we can treat your congruent mental health problems, and you gotta have an inpatient residence facility, and you gotta follow 'em for five years, and you gotta have counselors, some of whom are in recovery, who have to be monitored, trained, and credentialed.
This is hard work. This isn't yapping and rhetoric. This is organizing health care for 5 million chronically-addicted Americans.
Finally, you gotta bring the research community into some kind a congruent system. There's all sorts of pieces to it. By the way, the NIH piece I think worked spectacularly well. I'm very impressed by what they do. But there's a lot of other pieces to it. There's 40-some-odd agencies of Government, including law enforcement, that have to have some scheme, so that research bucks aren't just grinding away for the fun of it. They are apparently tied to the strategy, and that's what we're trying to do.
Finally, we've got--most of this does not happen in my office. I'm, you know, a public policy gu--weeny, try and spur laws, public spokesperson. I chair the President's Drug Cabinet Council. Lots of important things that I can do, but most of this hard work has to get done in, in community level, state level, private treatment partnerships, prevention partnerships.
What I can do is create a sensible environment to do that, and we think we're achieving that purpose. One of your slides in there--some of us had an interesting debate on our--is most of the money going to overseas wars in Colombia and Bolivia?
Another one is isn't it true that nothing's changed, and that only during the Nixon years, for cripe sakes, did we have anybody that really got the drug issue? God. You know, the man will come back, if he hears all this praise for his counter--counter drug effort. But, you know, let me just, if I can, tell you, you can't argue about bucks. All right.
In FY 96 there were $13.5 billion in bucks. Today, there's $19.2 billion. And if you look at how we invested this, there is a disproportionate increase in drug treatment. It's actually 3.8 billion today. Five years ago, it was one billion less. I don't think it's adequate. I just think we got half the adult treatment capacity in the country we need. I think we got 20 percent of the adolescent treatment capacity we need.
I think we lack parity in the health insurance industry for drug treatment and mental health care. Outrageous, by the way, Mr. Taxpayer. You oughta stand up for your rights. Don't let your public dollars go to pay for drug treatment programs for my son, if I've got Blue Cross/Blue Shield. Let's, let's get some sensible policy. But we're moving in the right direction.
You look at prevention education dollars. They've skyrocketed 52 percent. That's the facts. And, oh, by the way, we're now down on a hearing on the Hill, Dr. Don Vereen, my deputy, a brilliant, Harvard-trained public health guy, physician, psychiatrist, drug research person, down there defending the media campaign, a billion dollar, five-year program to help shape youth attitudes toward drug abuse. We think we're moving in the right direction.
Is it working? Are there Orwellian statistics, or are there inconvenient statistics? And the--I think the quick answer is, look, there's nothing all that complicated about this. If we get parents and community leadership, and law enforcement and business leadership, and those who work with youth, and coaches and educators, and if we create attitudes among our young people, who are listening to us--if we shape a drug-resistant culture in adolescent years, in the outyears, drug abuse will go down.
But, now, what are we gonna do about the chronically addicted? We, we have an irrational criminal justice and drug policy. We must link drug treatment and criminal justice. We gotta get at the problem of the chronically poly drug abusing felon who's actually broke into your car, and you're terribly disappointed in his behavior. He stole your purse, or whatever. Now we gotta do something rational about it, and we're working on that.
We brought together a national assembly, thanks to Laurie Robinson, Jerry Travis, Janet Reno, Donna Shalala. We brought in 1100 people from all over the country, none of whom are in this room except Laurie. They were the people who were the corrections director from every state. They were state legislators. They were the health directors. They came together. We had four days. We had the Cabinet officers who were involved in it, who stayed in the room. We produced a white paper which you have not read, and you need to get a copy of it, and see what we're actually doing.
And now we've got state assemblies going, and we're trying to rewrite legislation, because, by the way, it turns out, most of the drug problem has nothing to do with the Federal Government.
If you're talking about criminal justice policy, health policy, welfare policy, it's state legislation. You gotta go find the state capital. You got all your NGOs, here, in Washington lobbying me. You're in the wrong place. You gotta go to these other capitals, and try and change the law.
We're pretty optimistic. I don't know. I, you know, I wouldn't have volunteered for this job. You know, I tell people, the only reason I got here is 'cause the President and then the Vice President put the arm on me, and then my dad told me to take the job. So here I am. We gotta pretty good bubble of energy going, and we gotta lotta money flowing into some smart coffers.
Thanks very much for the opportunity to talk to you.
General McCaffrey is willing to answer any of your questions and we have about
15-20 minutes before we have to go back. So please, we have a microphone here.
Do we have any other microphones? Just this one microphone. If you have a
question, come up to the microphone and ask it.
Thank God for AA and NA. We need more. Now I don't wanna hear any discussion
about, well, let the churches and AA, NA, handle the problems of 14 million
past month drug users. Oh, no, no, no. We need federal dollars and more of 'em
in drug treatment and prevention, and education. But thank God for AA.
It would seem to me, that this would be a perfect time for you and the Federal
Government to come forward and say let's work out compromises.
I fully support the study. It's on our Web page. The study said a couple a things. One, it says, smoked marijuana isn't medicine and won't be. It's a, a burning compound that starts with 400-plus chemical compounds, that ends up with more than 2,000. It puts unknown dose rates of 35 some odd cannabinoids into your serum levels. It spikes serum levels and it causes--it's carcinogenic, and it doesn't help with glaucoma, and, oh, by the way, though, there may be benefit in cannabinoid-based drug treatment for certain subpopulations, particularly for those who don't respond to available drug therapy, and in combination with other drugs. We agree.
So synthetic THC de--is now available in pharmacies, prescription through your
By the way, I also think this whole medical marijuana thing's a crock, by and
large. I actually--you know, I look at people and I say you gotta be able to
tell me with a straight face, that you actually think, you know, a prostate
cancer patient is gonna ask for a giant blunt to get stuck in his face in the
ICU ward to handle pain management. Come on. I've been there. And by the
way, we've a problem in American medicine 'cause they don't think pain kills
you, and so they don't do it very well.
I compliment you for you willing to take questions from an audience such as this.
The--you spoke about the performance measurements of, of evaluation, and it's a very interesting document. You called it one of the most creative things in Government. You mentioned the twelve drug strategy impact targets that you wanted to do, you know, things--you know, just to review a couple of them. Reduce the number of chronic drug users by 20 percent by 2002. Reduce the availability of illicit drugs in the United States by 25 percent by 2002. Reduce the rate of shipment of illicit drugs from source zones by 15 percent by 2002.
But in the document, for example, with respect to the number of drug users, it says, "At this point, no official survey-based Government estimate of the size of this drug-using population exists."
So you're proposing to reduce a number, precisely, that you don't know what it is.
Or, for example, you know, with respect to the supply of drugs into the U.S., the problem is there are no official Government estimates of the available supply of drugs in the U.S.
But that's a number you're telling the Congress you're going to reduce by a
precise amount, by a precise number--
Now I would also suggest to you that we've gotten a lot further, 'cause we brought in some of the most noted scientists, epidemiologists, mathematicians, statistical people in the country. We've identified the gaps in our data.
I would also suggest to you, though, that whenever I use a stat, I know where it came from, and I'll--normally, if we have an extended dialogue, I'll tell you the limitations of the stat I'm using.
For example, numbers like heroin addiction. You can find numbers that go from 255,000 up to the one I'm currently using, 980,000, if I remember the last time we updated it, and those are all valid scientific studies.
If you do the household survey, you don't count people sleeping under a bridge, if you--or people in the armed forces. So there are limitations on the data. But having said that, I would argue we have, through six major federally-funded studies, a pretty good handle, consistent patterns of data on who's using drugs in America, between Don, Duff, Adam--we know, by and large, who comes in the hospital emergency rooms, who's arrested, what drugs they claim they have.
When it comes to drug production, although we've got some very soft numbers
like marijuana production, we've got some very hard numbers like cocaine and
heroin, where, by and large, we're reasonably terms of reporting to Congress,
we actually do produce written reports that we put on the Web, that we will
footnote and stand behind
My question is for what other form of illness do we incarcerate people for
punitive mea--punitive reasons? Is it an appropriate response to a health--
The big problem of poly drug abuse in America is you look at the couple a million folks behind bars--is that many of them--studies vary--somewhere between 50 and 85 percent have an arrest sheet that says burglary or traffic accidents, or whatever. But the problem is they're chronically abusing alcohol and illegal drugs.
And so, in that sense, the real problem isn't letting 'em outta jail or putting 'em in jail. It's effectively addressing their chronic addiction through science-based treatment.
But, mostly, Americans don't get arrested, certainly by the Federal Government for simple possession of, of drugs they are personally abusing.
I'd also suggest to you that--
And, now, if you're looking for an analogy of, Does anyone else get arrested for a medical problem? try driving drunk tonight and killing somebody, and we will arrest you and prosecute you, not for being an alcoholic but for causing severe social harm.
So your, your--there's actually a good base to your question but I'd ask you to
move your concern to how do we get effective drug treatment, the criminal
justice system. That's the problem. Not busting somebody for two joints.
And so, to that extent, we would support it. The problem with it is, very
deviously, there were two things stuck in the proposition, in my view, one of
which said no money spent on drug testing, and those of us who know about the
process of addiction know the chances of the drug court system working, this
miracle that we've taken from a dozen drug courts, and more than seven hundred,
that if you can't call me in and drug test me three times a week, and give me a
tongue lashing because I flunked it, too--if you can't do that, you're, you
just don't understand--
So we don't think that the deputy sheriffs of America, the cops at 2:00 o'clock
in the morning, are going to bother to enforce control of the law on the
streets, if they know it's the third time before you'll go behind bars for 24
hours. Those two propositions, we think, are gonna ruin the drug court system.
So we're opposed and so I think will be most people that listen to the actual
concerns of the--
Your statistics themselves here show that the drug war in Latin America is not
working. The cocaine use has not gone down, it's gone up, and you've been--
And my concern is that within the past week and a half, ten civilians have died in Bolivia because of the drug war. Many more have died in Colombia, and many more will continue to die unless our policy changes.
My question is how many more civil--innocent and unarmed civilians have to die
before we realize our policy is not working.
The--well, I think many people, right-thinking people share your concern about the real tragedy that's engulfed 40 million people. Colombia, I've been going there, off and on, since I was a lieutenant in the Army. I have great sympathy for them. The overwhelming majority of 'em have nothing to do with drug production or drug use. They grow flowers and coffee beans.
There--there's a million of 'em who are internal refugees, a half million of
'em have fled the country. They're a 3-hour flight from Miami. You know, it's
just a dreadful situation, and a lot of it's caused by, in our view, 26,000
heavily armed insurgents, narco insurgents from the far right to the far left,
who are destroying Colombian democratic institutions--
There's actually been a net reduction of cocaine production in the Andean Ridge in the past four years.
The Colombian program actually worked in eastern Colombia, and we saw a
movement of some 16,000 people in drug production into the southern part of
Colombia, a largely uninhabited part of the nation, not much of an
infrastructure road network, government presence, where now we see these
murderous rightists, the paramilitary forces, the FARC, the ELN, with lots of
shining machine guns, and, and buying international representation, who are
gonna be confronted by Colombian authorities.
About 80 percent of it goes to Colombia, of which half goes in a mobility package to the Colombian police and armed forces to buy 18 Blackhawk helicopters, or less, and 45 Huey 2's.
So there's gonna be funding in there for Peru, Bolivia, Colombia, Ecuador, Venezuela. There's a huge chunk a money in there for three forward-operating locations. The driving nexus of all these--there's $5 million in there, in there to enhance human rights security monitoring in Colombia. There's money in there to develop the Colombian judicial system. There's money in there to try and better provide common rules of evidence among Latin America nations. It's a pretty coherent program, and, by the way, our piece, 1.3 billion, is part of Plan Colombia, which is the, the Colombian government's output, which is $7.5 billion, and that's a 3-year plan that involves 4.5 million--$4.5 billion of their money and the rest of it's either U.S., European Union, Japan, et cetera.
It's pretty long term, it's coherent and balanced. Our own view is that we ought to support Colombian democratic institutions to confront the drug trade.
You know, a year--three years ago, there was a lot less coca and heroin in this country than there is now.
It's gone up 140 percent in three years. They're now producing 520 metric tons of cocaine. They're producing eight metric tons of heroin. That's the problem.
And outta that comes some--there's a debate over numbers--how much money flows outta that. Well, the DEA and I think on this end, $57 billion a year gets spent on illegal drugs by 6 percent of the population.
On the other end, my guess is somewhere between 500 million and a billion flows
into the FARC, the ELN, the paramilitaries, and gives them this absolute
blowtorch capability to create violence and misery in Colombia. We're proud to
stand with them.
And Professor Dash, thank you--
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