The Rarely Acknowledged Public Health Achievements of Obama’s Drug Policy

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.

Comments

  1. James Wimberley says

    ¨Health services for drug users are not expensive …
    Do they save money overall, through reductions in the crime, law enforcement and criminal justice bill? If you only prevent one drug-related murder, you have still saved several million (discounted value of lifetime legitimate earnings of victim and perp + cost of investigation, prosecution, and incarceration of perp + a guess at marginal cost of insecurity to third parties).

    • Keith Humphreys says

      At the current-level of under-investment, expanding substance use disorder treatment is essentially free in all costs analyses (e.g., if you include emergency room visits, HIV, violence, unemployment etc.). As it expands, this will at some point no longer be true, but so what? No other area of health care is expected to pay for itself, rather we evaluate the value based on the health outcomes generated. We do $50,000 heart operations because it helps the person live, period. We need to think that way about addiction treatment rather than asking it to save money.

  2. koreyel says

    Speaking of rarely acknowledged Public Health Achievements….
    I only found out recently (thru the AARP magazine) this this is true regarding ObamaCare:

    Under the law, children under age 19 will be able to get their teeth cleaned twice a year, as well as receive X-rays, fillings and medically necessary orthodontia. In addition, children under age 19 will be entitled to an eye exam and one pair of glasses or set of contact lenses a year. Relatively few health plans cover children’s dental or vision services today.

    http://pubs.aarp.org/aarptm/20130809_PR?folio=23#article_id=317227

  3. Mark Kleiman says

    Just to reinforce Keith’s point: true-believing libertarians *HATE* publicly-funded drug treatment, just as they hate any other public attempt to help people who need it.

    The strongest version of libertarian anti-paternalism holds that there is no such thing as drug abuse or drug addiction; those are merely labels that some people choose to apply to the choices made freely by other people. (This is the view of Stanton Peele and of the late Thomas Szasz, but it’s implicit in much libertarian thought, and in much economic thought under the label “revealed preference.”) If there’s no disease, there can by definition be no cure.

    • Mike says

      While not directly related to the specifics of Keith’s post, it’s not just some libertarians who continue with travel at 80 mph with their heads where the sun don’t shine. Bad policy remains a very bi-partisan consensus.

      Indicative of my earlier comment about paying for prisons and its wide application as the one sure excuse to continue to waste public funds on ineffective policy, there’s this hot news from California just now, where Gov. Brown along with a few Dems, a lot of Republicans and the currently in favor welfare-make-work program, law enforcement, joined together to pledge — in spite of a very slow-coming federal court order to finally reduce Cali’s infamous prison overcrowding in the face of a continuing austere budget situation…

      “We are not, any of us, willing to release an additional single prisoner…”
      http://www.latimes.com/local/political/la-me-pc-california-prison-crowding-20130827,0,307013.story

      So they’ll find the money somewhere to keep going through the motions. Too bad these folks aren’t mimes. They’d do far less damage to society. It’s hard to fix plain stupid, but apparently not hard to get elected as plain stupid. In this political environment, yes, any incremental improvement in health care related to drug policy is welcome. It’s like peeing into a hurricane, though, and trying to stay dry. All of us will certainly get wet before we get smart enough for democracy to fix this if we leave it to the current cohort of “leaders” or leave it governed by the current crop of what passes for “policy.”