December 31, 2008
Dear Dr. DonaldVereen:
I am a psychologist with 30 years experience treating patients with drug and alcohol problems, founding member and twice past-president of the Addiction Division of New York State Psychological Association, trainer and author. See my background on my website, www.andrewtatarsky.com
It is my understanding that you are part of the team advising President-elect Obama on his selection of the next heads of ONDCP and SAMHSA. If that is not so I wonder if you would advise me who is.
Based on reports that Congressman Jim Ramstad is under consideration for heading ONDCP or SAMHSA, in conjuction with a large group of colleagues, I organized a sign-on letter to President-elect Obama expressing strong reservations about Rep. Jim Ramstad for either of these positions. The letter outlines these concerns and makes suggestions about what kind of leadership we believe would be suitable and what direction the next administration's drug policy should take. I am attaching the letter and a press release about it to this note.
At present we have over 430 mental health and substance use treatment professionals, researchers, academics and other concerned citizens signed on. You can see the list of signers at my website. Many are leaders in their fields who you know well.
I am aware that there are other groups, including Friends of NIDA, that have expressed their views on these matters. In many respects we are in agreement with their views but differ in some important ways.
So,I ask that you deliver this letter to President-elect Obama and consider our point of view in your selection process.
I would be very honored to have an opportunity to discuss these issues with you and others on the team. I could also organize a representative group of professionals who have signed the letter.
I look forward to you response and any thoughts about how we might support President-elect Obama in making the best choices for America for these critically important issues.
Sincerely,
Dr. Andrew Tatarsky
Wednesday, December 31, 2008
Tuesday, December 30, 2008
Drug War Chronicle Feature: Looking Forward -- Who Should Be the Next Drug Czar?
from Drug War Chronicle, Issue #560, 11/14/08
If there is one man who symbolizes and epitomizes the federal war on drugs, it is the head of the White House Office of National Drug Control Policy (ONDCP), colloquially known as the drug czar's office. For the last eight years, that man has been John Walters, a protege of conservative moralist Bill Bennett, the first ONDCP drug czar. With his anti-marijuana media campaigns, his innumerable press releases, and his interference in various state-level initiatives, Walters has been drug reform's bête noire.
Now, Walters and his boss, President Bush, are preparing to exit stage right, and the Obama administration will have to choose his successor. Given the foreign wars and failing economy facing the incoming administration, filling the drug czar position doesn't appear to be a high priority for the new resident at the White House. Only one name has been publicly mentioned, Los Angeles police chief William Bratton, and he has said he's not interested. A US News & World Report list of potential White House appointments doesn't even list any names for consideration as drug czar.
But for people interested in undoing some of the harms of the Bush era drug war, ONDCP is very important. As ONDCP explains on its home page:
"The reform community needs to be looking at someone who has a comprehensive public health orientation or who has an evidence-based focus," said Eric Sterling, former counsel to the House Judiciary Committee and currently president of the Criminal Justice Policy Foundation. "This would be someone who says goal number one is treatment of people with hard-core addiction problems and number two is to make sure our prevention programs are effective and well-grounded."
Sterling mentioned a couple of possibilities. "I don't think it's realistic to think we can get a reform sympathizer in there. It's not going to be Ethan Nadelmann. It needs to be someone who has administrative experience in some capacity. One possibility would be Chris Fichtner, the former head of mental health for the state of Illinois," Sterling suggested.
Fichtner is an associate professor of psychiatry at the University of Chicago who has worked with drug reformers in Illinois. He testified in favor of medical marijuana bills in Illinois and Wisconsin.
"Another possibility, someone I know the reform community had a lot of respect for before he went into government is Westley Clark, head of the federal Center for Substance Abuse Services," Sterling continued. "He's African-American, been at the federal level for a long time, has experience managing a federal agency, and a lot of experience in the field."
"If we had our druthers," said National Organization for the Reform of Marijuana Laws (NORML) executive director Allen St. Pierre, "it would be somebody like Ethan Nadelmann, with a comprehensive understanding of drugs, but that's a wet dream." Instead, he said, one name being kicked around was Mark Kleiman, a professor of Public Policy at the UCLA School of Public Affairs who has written extensively on drug policy and whose innovative ideas sometimes raise as many hackles in the reform community as they do among drug warriors.
Click here to continue reading article at Stop the Drug War.com
If there is one man who symbolizes and epitomizes the federal war on drugs, it is the head of the White House Office of National Drug Control Policy (ONDCP), colloquially known as the drug czar's office. For the last eight years, that man has been John Walters, a protege of conservative moralist Bill Bennett, the first ONDCP drug czar. With his anti-marijuana media campaigns, his innumerable press releases, and his interference in various state-level initiatives, Walters has been drug reform's bête noire.
Now, Walters and his boss, President Bush, are preparing to exit stage right, and the Obama administration will have to choose his successor. Given the foreign wars and failing economy facing the incoming administration, filling the drug czar position doesn't appear to be a high priority for the new resident at the White House. Only one name has been publicly mentioned, Los Angeles police chief William Bratton, and he has said he's not interested. A US News & World Report list of potential White House appointments doesn't even list any names for consideration as drug czar.
But for people interested in undoing some of the harms of the Bush era drug war, ONDCP is very important. As ONDCP explains on its home page:
So, who is it going to be? Drug reformers and others consulted this week by the Chronicle had few actual suggestions -- some worried that anyone suggested or supported by the reform movement would be doomed -- but plenty of ideas about what type of person should replace Walters. And some even speculated about the possibility of just doing away with the drug czar's office altogether."The principal purpose of ONDCP is to establish policies, priorities, and
objectives for the Nation's drug control program. The goals of the program are
to reduce illicit drug use, manufacturing, and trafficking, drug-related crime
and violence, and drug-related health consequences. To achieve these goals, the
Director of ONDCP is charged with producing the National Drug Control Strategy.
The Strategy directs the Nation's anti-drug efforts and establishes a program, a
budget, and guidelines for cooperation among Federal, State, and local
entities.
"By law, the director of ONDCP also evaluates, coordinates, and oversees
both the international and domestic anti-drug efforts of executive branch
agencies and ensures that such efforts sustain and complement State and local
anti-drug activities. The Director advises the President regarding changes in
the organization, management, budgeting, and personnel of Federal Agencies that
could affect the Nation's anti-drug efforts; and regarding Federal agency
compliance with their obligations under the Strategy."
"The reform community needs to be looking at someone who has a comprehensive public health orientation or who has an evidence-based focus," said Eric Sterling, former counsel to the House Judiciary Committee and currently president of the Criminal Justice Policy Foundation. "This would be someone who says goal number one is treatment of people with hard-core addiction problems and number two is to make sure our prevention programs are effective and well-grounded."
Sterling mentioned a couple of possibilities. "I don't think it's realistic to think we can get a reform sympathizer in there. It's not going to be Ethan Nadelmann. It needs to be someone who has administrative experience in some capacity. One possibility would be Chris Fichtner, the former head of mental health for the state of Illinois," Sterling suggested.
Fichtner is an associate professor of psychiatry at the University of Chicago who has worked with drug reformers in Illinois. He testified in favor of medical marijuana bills in Illinois and Wisconsin.
"Another possibility, someone I know the reform community had a lot of respect for before he went into government is Westley Clark, head of the federal Center for Substance Abuse Services," Sterling continued. "He's African-American, been at the federal level for a long time, has experience managing a federal agency, and a lot of experience in the field."
"If we had our druthers," said National Organization for the Reform of Marijuana Laws (NORML) executive director Allen St. Pierre, "it would be somebody like Ethan Nadelmann, with a comprehensive understanding of drugs, but that's a wet dream." Instead, he said, one name being kicked around was Mark Kleiman, a professor of Public Policy at the UCLA School of Public Affairs who has written extensively on drug policy and whose innovative ideas sometimes raise as many hackles in the reform community as they do among drug warriors.
Click here to continue reading article at Stop the Drug War.com
Friday, December 26, 2008
The Evidence Gap - Drug Rehabilitation or Revolving Door?
NYTimes.com
By BENEDICT CAREY
Published: December 22, 2008
ROSEBURG, Ore. — Their first love might be the rum or vodka or gin and juice that is going around the bonfire. Or maybe the smoke, the potent marijuana that grows in the misted hills here like moss on a wet stone.
But it hardly matters. Here as elsewhere in the country, some users start early, fall fast and in their reckless prime can swallow, snort, inject or smoke anything available, from crystal meth to prescription pills to heroin and ecstasy. And treatment, if they get it at all, can seem like a joke.
“After the first couple of times I went through, they basically told me that there was nothing they could do,” said Angella, a 17-year-old from the central Oregon city of Bend, who by freshman year in high school was drinking hard liquor every day, smoking pot and sampling a variety of harder drugs. “They were like, ‘Uh, I don’t think so.’ ”
She tried residential programs twice, living away from home for three months each time. In those, she learned how dangerous her habit was, how much pain it was causing others in her life. She worked on strengthening her relationship with her grandparents, with whom she lived. For two months or so afterward she stayed clean.
“Then I went right back,” Angella said in an interview. “After a while, you know, you just start missing your friends.”
Every year, state and federal governments spend more than $15 billion, and insurers at least $5 billion more, on substance-abuse treatment services for some four million people. That amount may soon increase sharply: last year, Congress passed the mental health parity law, which for the first time includes addiction treatment under a federal law requiring that insurers cover mental and physical ailments at equal levels.
Many clinics across the county have waiting lists, and researchers estimate that some 20 million Americans who could benefit from treatment do not get it.
Yet very few rehabilitation programs have the evidence to show that they are effective. The resort-and-spa private clinics generally do not allow outside researchers to verify their published success rates. The publicly supported programs spend their scarce resources on patient care, not costly studies.
And the field has no standard guidelines. Each program has its own philosophy; so, for that matter, do individual counselors. No one knows which approach is best for which patient, because these programs rarely if ever track clients closely after they graduate. Even Alcoholics Anonymous, the best known of all the substance-abuse programs, does not publish data on its participants’ success rate.
“What we have in this country is a washing-machine model of addiction treatment,” said A. Thomas McClellan, chief executive of the nonprofit Treatment Research Institute, based in Philadelphia. “You go to Shady Acres for 30 days, or to some clinic for 60 visits or 60 doses, whatever it is. And then you’re discharged and everyone’s crying and hugging and feeling proud — and you’re supposed to be cured.”
He added: “It doesn’t really matter if you’re a movie star going to some resort by the sea or a homeless person. The system doesn’t work well for what for many people is a chronic, recurring problem.”
In recent years state governments, which cover most of the bill for addiction services, have become increasingly concerned, and some, including Delaware, North Carolina, and Oregon, have sought ways to make the programs more accountable. The experience of Oregon, which has taken the most direct and aggressive action, illustrates both the promise and perils of trying to inject science into addiction treatment.
Evidence-Based Treatments
In 2003 the Oregon Legislature mandated that rehabilitation programs receiving state funds use evidence-based practices — techniques that have proved effective in studies. The law, phased in over several years, was aimed at improving services so that addicts like Angella would not be doomed to a lifetime of rehab, repeating the same kinds of counseling that had failed them in the past — or landing in worse trouble.
“You can get through a lot of programs just by faking it,” said Jennifer Hatton, 25, of Myrtle Creek, Ore., a longtime drinker and drug user who quit two years ago, but only after going to jail and facing the prospect of losing her children. “That’s what did it for me — my kids — and I wish it didn’t have to come to that.”
When practiced faithfully, evidence-based therapies give users their best chance to break a habit. Among the therapies are prescription drugs like naltrexone, for alcohol dependence, and buprenorphine, for addiction to narcotics, which studies find can help people kick their habits.
Click here to continue reading article at the New York Times
By BENEDICT CAREY
Published: December 22, 2008
ROSEBURG, Ore. — Their first love might be the rum or vodka or gin and juice that is going around the bonfire. Or maybe the smoke, the potent marijuana that grows in the misted hills here like moss on a wet stone.
But it hardly matters. Here as elsewhere in the country, some users start early, fall fast and in their reckless prime can swallow, snort, inject or smoke anything available, from crystal meth to prescription pills to heroin and ecstasy. And treatment, if they get it at all, can seem like a joke.
“After the first couple of times I went through, they basically told me that there was nothing they could do,” said Angella, a 17-year-old from the central Oregon city of Bend, who by freshman year in high school was drinking hard liquor every day, smoking pot and sampling a variety of harder drugs. “They were like, ‘Uh, I don’t think so.’ ”
She tried residential programs twice, living away from home for three months each time. In those, she learned how dangerous her habit was, how much pain it was causing others in her life. She worked on strengthening her relationship with her grandparents, with whom she lived. For two months or so afterward she stayed clean.
“Then I went right back,” Angella said in an interview. “After a while, you know, you just start missing your friends.”
Every year, state and federal governments spend more than $15 billion, and insurers at least $5 billion more, on substance-abuse treatment services for some four million people. That amount may soon increase sharply: last year, Congress passed the mental health parity law, which for the first time includes addiction treatment under a federal law requiring that insurers cover mental and physical ailments at equal levels.
Many clinics across the county have waiting lists, and researchers estimate that some 20 million Americans who could benefit from treatment do not get it.
Yet very few rehabilitation programs have the evidence to show that they are effective. The resort-and-spa private clinics generally do not allow outside researchers to verify their published success rates. The publicly supported programs spend their scarce resources on patient care, not costly studies.
And the field has no standard guidelines. Each program has its own philosophy; so, for that matter, do individual counselors. No one knows which approach is best for which patient, because these programs rarely if ever track clients closely after they graduate. Even Alcoholics Anonymous, the best known of all the substance-abuse programs, does not publish data on its participants’ success rate.
“What we have in this country is a washing-machine model of addiction treatment,” said A. Thomas McClellan, chief executive of the nonprofit Treatment Research Institute, based in Philadelphia. “You go to Shady Acres for 30 days, or to some clinic for 60 visits or 60 doses, whatever it is. And then you’re discharged and everyone’s crying and hugging and feeling proud — and you’re supposed to be cured.”
He added: “It doesn’t really matter if you’re a movie star going to some resort by the sea or a homeless person. The system doesn’t work well for what for many people is a chronic, recurring problem.”
In recent years state governments, which cover most of the bill for addiction services, have become increasingly concerned, and some, including Delaware, North Carolina, and Oregon, have sought ways to make the programs more accountable. The experience of Oregon, which has taken the most direct and aggressive action, illustrates both the promise and perils of trying to inject science into addiction treatment.
Evidence-Based Treatments
In 2003 the Oregon Legislature mandated that rehabilitation programs receiving state funds use evidence-based practices — techniques that have proved effective in studies. The law, phased in over several years, was aimed at improving services so that addicts like Angella would not be doomed to a lifetime of rehab, repeating the same kinds of counseling that had failed them in the past — or landing in worse trouble.
“You can get through a lot of programs just by faking it,” said Jennifer Hatton, 25, of Myrtle Creek, Ore., a longtime drinker and drug user who quit two years ago, but only after going to jail and facing the prospect of losing her children. “That’s what did it for me — my kids — and I wish it didn’t have to come to that.”
When practiced faithfully, evidence-based therapies give users their best chance to break a habit. Among the therapies are prescription drugs like naltrexone, for alcohol dependence, and buprenorphine, for addiction to narcotics, which studies find can help people kick their habits.
Click here to continue reading article at the New York Times
Drug Czar of My Dreams
The Huffington Post
Matt Elrod
Posted December 18, 2008 | 10:26 AM (EST)
For over 35 years America's war at home, the Drug War, has been raging. Owing in large part to drug war excesses, the United States now locks up more of its citizens than any nation on earth -- more than 2.3 million, with half a million of them behind bars for nonviolent drug offenses alone. That is more than Western Europe, with a much higher population, incarcerates for all crimes combined.
The historic election of Barack Obama signals a unique opportunity to begin to heal one of America's worst open sores and end the drug war, but that is not going to happen unless President-elect Obama nominates someone exceptional to the position of drug czar, or director of the White House Office of National Drug Control Policy. The appointment of "moderate" will not be sufficient, particularly when President-elect Obama's stated goals are to repeal the harshest drug sentences, remove federal bans on syringe-exchange funding to reduce HIV/AIDS, allow medical cannabis research, and support treatment alternatives for low-level drug offenders.
The Christian Science Monitor recently opined, "In his selection of a 'drug czar,' President-elect Obama needs to place more emphasis on addiction as a health problem," Christian Science Monitor, December 3, 2008. Columnist Maia Szalavitz, who covers addiction and treatment issues, perhaps put it best, "We need someone who knows the science, recognizes that there are many paths to recovery -- and understands that dead addicts can't recover," "Obama Drug Czar Pick: No Recovery from War on Drugs?", Huffington Post, November 21, 2008.
A significant reallocation of scarce resources from criminal justice to public health solutions is long overdue, but drug policy is multi-disciplinary and international in scope. We have had cops, doctors and soldiers. Call me crazy, but I think our drug czar should be an experienced drug policy expert who comprehends the full breadth, depth and importance of this issue on day one.
I have seen Reps. Dennis Kucinich and Ron Paul, and Judge Jim P. Gray suggested in comments appended to articles and blog posts on the topic, but I think Dr. Ethan Nadelmann, executive director of the Drug Policy Alliance, personifies the consummate drug policy expert, in both domestic and international affairs, that I would like to see directing the drug czar's office.
To this end, I started a petition called, "Drug Czar of My Dreams."
Perhaps Nadelmann for drug czar is too much to hope for but, with any luck, this petition will at least encourage President-elect Obama to think twice about his choice of drug czar. In addition to your signature and feedback, I would appreciate your help with promoting this petition.
Matthew M. Elrod
Matt Elrod
Posted December 18, 2008 | 10:26 AM (EST)
For over 35 years America's war at home, the Drug War, has been raging. Owing in large part to drug war excesses, the United States now locks up more of its citizens than any nation on earth -- more than 2.3 million, with half a million of them behind bars for nonviolent drug offenses alone. That is more than Western Europe, with a much higher population, incarcerates for all crimes combined.
The historic election of Barack Obama signals a unique opportunity to begin to heal one of America's worst open sores and end the drug war, but that is not going to happen unless President-elect Obama nominates someone exceptional to the position of drug czar, or director of the White House Office of National Drug Control Policy. The appointment of "moderate" will not be sufficient, particularly when President-elect Obama's stated goals are to repeal the harshest drug sentences, remove federal bans on syringe-exchange funding to reduce HIV/AIDS, allow medical cannabis research, and support treatment alternatives for low-level drug offenders.
The Christian Science Monitor recently opined, "In his selection of a 'drug czar,' President-elect Obama needs to place more emphasis on addiction as a health problem," Christian Science Monitor, December 3, 2008. Columnist Maia Szalavitz, who covers addiction and treatment issues, perhaps put it best, "We need someone who knows the science, recognizes that there are many paths to recovery -- and understands that dead addicts can't recover," "Obama Drug Czar Pick: No Recovery from War on Drugs?", Huffington Post, November 21, 2008.
A significant reallocation of scarce resources from criminal justice to public health solutions is long overdue, but drug policy is multi-disciplinary and international in scope. We have had cops, doctors and soldiers. Call me crazy, but I think our drug czar should be an experienced drug policy expert who comprehends the full breadth, depth and importance of this issue on day one.
I have seen Reps. Dennis Kucinich and Ron Paul, and Judge Jim P. Gray suggested in comments appended to articles and blog posts on the topic, but I think Dr. Ethan Nadelmann, executive director of the Drug Policy Alliance, personifies the consummate drug policy expert, in both domestic and international affairs, that I would like to see directing the drug czar's office.
To this end, I started a petition called, "Drug Czar of My Dreams."
Perhaps Nadelmann for drug czar is too much to hope for but, with any luck, this petition will at least encourage President-elect Obama to think twice about his choice of drug czar. In addition to your signature and feedback, I would appreciate your help with promoting this petition.
Matthew M. Elrod
Monday, December 22, 2008
Press Release: Possible Obama Pick for “Drug Czar” or head of SAMHSA Criticized by Hundreds of Substance Abuse and Mental Health Treatment Professiona
For Immediate Release:
Contact: Andrew Tatarsky, PhD (212) 633-8157
Monday, December 22, 2008
Possible Obama Pick for “Drug Czar” or head of SAMHSA Criticized by Hundreds of Substance Abuse and Mental Health Treatment Professionals, Researchers and
Academics
Ramstad’s Positions on Syringe Exchange, Sentencing Reform, Medical Marijuana and other Issues Unscientific and Harmful Say Experts
Leading Substance Abuse and Mental Health Experts Suggest Six Positions that Leaders of ONDC and SAMHSA Should Support
A growing number of professionals have expressed concern about reports in the media that President-elect Obama may be considering appointing Republican Congressman Jim Ramstad (R-MN) either as the next “Drug Czar”, director of the Office of National Drug Control, or as director of SAMHSA, the Substance Abuse and Mental Health Services Administration. In a letter to President-elect Obama released today, over 250 clinicians working with patients with substance use problems and nearly 150 researchers, academics and other concerned citizens warn that Ramstad is not the man for either of these jobs because his record suggests that his perspective is ideologically based and at odds with science.
The letter applauds Rep. Ramstad’s support for expanding access to drug treatment and improving addiction awareness and it honors his own personal triumph over addiction. However, in spite of these contributions, Ramstad has supported unscientific faith-based treatment while opposing evidence-based practices such as methadone maintenance and syringe exchange, two of the most effective interventions for addiction and transmission of infectious disease that save lives. He has also consistently opposed congressional efforts to stop the arrest of patients with HIV/AIDS, cancer and other illnesses who use prescribed medical marijuana in states where it is legal and he has failed to co-sponsor legislation that would eliminate sentencing disparity between crack cocaine and powder cocaine, despite the fact that there were three different crack/powder reform bills in the 110th Congress. These positions clearly conflict with President-elect Obama’s stated positions on these issues.
These professionals call for President-elect Obama to select leaders for these critically important positions who are committed to reducing the harms associated with both drugs and punitive drug laws and who will base their decisions on science rather than politics or ideology.
They call for leaders who will support evidence-based treatment across the spectrum including:
They also call for leaders who will treat substance abuse and dependence as health issues rather than as criminal issues and be committed to:
The letter concludes, “There are many roads to recovery and recovery can take different paths…these views are in the best interests of individuals struggling with substance use disorders and all Americans”.
Click here for a copy of the letter and a complete list of signatories
New York Times
The Tierney Lab: Putting Ideas in Science to the Test
Drug Czar Controversy
December 8, 2008, 12:23 pm
— Updated: 12:23 pm --
By John Tierney
Some researchers in substance-abuse treatment and advocates for the medical use of marijuana are alarmed at reports that Representative Jim Ramstad, a Republican from Minnesota, is a candidate to become the next drug czar — the director of the office of National Drug Control Policy. In a joint letter to President-elect Barack Obama, coordinated by Andrew Tatarsky, the past president of the division of addictions of the New York State Psychological Association, dozens of academics and other professionals in substance-abuse treatment write:
This country needs a drug czar who supports evidence-based policies and one who will make decisions based on science, not politics or ideology. We strongly believe that Congressman Ramstad is not that person.
Rep. Ramstad voted in 1998 in favor of making permanent the federal funding ban on syringe exchange. In 2000, he voted to prohibit the District of Columbia from spending its own locally-raised funds on syringe exchange programs, and in 2007, he voted against lifting the same DC ban, despite decades of research showing that syringe exchange programs reduce the spread of HIV/AIDS, save lives, save money, and do not increase drug use. Representative Ramstad has also c onsistently opposed congressional efforts to stop the arrest of patients with HIV/AIDS, cancer, and other illnesses who use medical marijuana to ease their pain and suffering in states where it is legal.
Similar concerns have been raised in another joint letter, coordinated by the Drug Policy Alliance endorsed by more than three dozen other public-health, criminal-justice and drug-treatment organizations. They write to Mr. Obama:
You showed strong leadership on the campaign trail by pledging to lift the federal funding ban on syringe exchange programs, end the excessive federal law enforcement raids aimed at medical marijuana patients, and eliminate the crack/powder cocaine sentencing disparity. . .
We urge you to nominate for drug czar someone with a public health background, who is committed to reducing the spread of HIV/AIDS, hepatitis C and other infectious diseases, open to systematic drug policy reform, and able to show strong leadership on the issues you believe in.
The costs of the war on drugs are summed up by Ethan Nadelmann, the executive director of the Drug Policy Alliance, in a Wall Street Journal op-ed article celebrating the 75th anniversary of the repeal of Prohibition. After noting that that the repeal was popular not just among drinkers but also non-drinkers worried about the rise in organized crime and other consequences of Prohibition, Mr. Nadelmann writes:
They saw what most Americans still fail to see today: That a failed drug prohibition can cause greater harm than the drug it was intended to banish.
Consider the consequences of drug prohibition today: 500,000 people incarcerated in U.S. prisons and jails for nonviolent drug-law violations; 1.8 million drug arrests last year; tens of billions of taxpayer dollars expended annually to fund a drug war that 76% of Americans say has failed; millions now marked for life as former drug felons; many thousands dying each year from drug overdoses that have more to do with prohibitionist policies than the drugs themselv es, and tens of thousands more needlessly infected with AIDS and Hepatitis C because those same policies undermine and block responsible public-health policies.
And look abroad. At Afghanistan, where a third or more of the national economy is both beneficiary and victim of the failed global drug prohibition regime. At Mexico, which makes Chicago under Al Capone look like a day in the park. And elsewhere in Latin America, where prohibition-related crime, violence and corruption undermine civil authority and public safety, and mindless drug eradication campaigns wreak environmental havoc.
The joint letter to Mr. Obama organized by Dr. Tatarsky suggests a different approach: "We need a new bottom line for U.S. drug policy so that treatment is more available and addiction is treated like a health issue, not a criminal issue. To paraphrase former Baltimore Mayor Kurt Schmoke, we need a surgeon general, not a military general or police officer."
What do you think of Mr. Ramstad as drug czar? Do you have any other nominees for the job? Or other advice for Mr. Obama on drug policy?
Contact: Andrew Tatarsky, PhD (212) 633-8157
Monday, December 22, 2008
Possible Obama Pick for “Drug Czar” or head of SAMHSA Criticized by Hundreds of Substance Abuse and Mental Health Treatment Professionals, Researchers and
Academics
Ramstad’s Positions on Syringe Exchange, Sentencing Reform, Medical Marijuana and other Issues Unscientific and Harmful Say Experts
Leading Substance Abuse and Mental Health Experts Suggest Six Positions that Leaders of ONDC and SAMHSA Should Support
A growing number of professionals have expressed concern about reports in the media that President-elect Obama may be considering appointing Republican Congressman Jim Ramstad (R-MN) either as the next “Drug Czar”, director of the Office of National Drug Control, or as director of SAMHSA, the Substance Abuse and Mental Health Services Administration. In a letter to President-elect Obama released today, over 250 clinicians working with patients with substance use problems and nearly 150 researchers, academics and other concerned citizens warn that Ramstad is not the man for either of these jobs because his record suggests that his perspective is ideologically based and at odds with science.
The letter applauds Rep. Ramstad’s support for expanding access to drug treatment and improving addiction awareness and it honors his own personal triumph over addiction. However, in spite of these contributions, Ramstad has supported unscientific faith-based treatment while opposing evidence-based practices such as methadone maintenance and syringe exchange, two of the most effective interventions for addiction and transmission of infectious disease that save lives. He has also consistently opposed congressional efforts to stop the arrest of patients with HIV/AIDS, cancer and other illnesses who use prescribed medical marijuana in states where it is legal and he has failed to co-sponsor legislation that would eliminate sentencing disparity between crack cocaine and powder cocaine, despite the fact that there were three different crack/powder reform bills in the 110th Congress. These positions clearly conflict with President-elect Obama’s stated positions on these issues.
These professionals call for President-elect Obama to select leaders for these critically important positions who are committed to reducing the harms associated with both drugs and punitive drug laws and who will base their decisions on science rather than politics or ideology.
They call for leaders who will support evidence-based treatment across the spectrum including:
- Non-abstinence based interventions like Motivational Interviewing, opiate substitution treatment and abstinence oriented treatment for appropriately matched patients
- Integrated treatment for patients with co-occurring disorders
- Syringe exchange programs to halt the spread of HIV and hepatitis-C
They also call for leaders who will treat substance abuse and dependence as health issues rather than as criminal issues and be committed to:
- Sentencing reform
- Better educating criminal justice professionals associated with drug courts in the complexities of substance use problems and their treatment and
- More fully involving clinical staff in decisions about individuals mandated by drug courts to treatment
The letter concludes, “There are many roads to recovery and recovery can take different paths…these views are in the best interests of individuals struggling with substance use disorders and all Americans”.
Click here for a copy of the letter and a complete list of signatories
New York Times
The Tierney Lab: Putting Ideas in Science to the Test
Drug Czar Controversy
December 8, 2008, 12:23 pm
— Updated: 12:23 pm --
By John Tierney
Some researchers in substance-abuse treatment and advocates for the medical use of marijuana are alarmed at reports that Representative Jim Ramstad, a Republican from Minnesota, is a candidate to become the next drug czar — the director of the office of National Drug Control Policy. In a joint letter to President-elect Barack Obama, coordinated by Andrew Tatarsky, the past president of the division of addictions of the New York State Psychological Association, dozens of academics and other professionals in substance-abuse treatment write:
This country needs a drug czar who supports evidence-based policies and one who will make decisions based on science, not politics or ideology. We strongly believe that Congressman Ramstad is not that person.
Rep. Ramstad voted in 1998 in favor of making permanent the federal funding ban on syringe exchange. In 2000, he voted to prohibit the District of Columbia from spending its own locally-raised funds on syringe exchange programs, and in 2007, he voted against lifting the same DC ban, despite decades of research showing that syringe exchange programs reduce the spread of HIV/AIDS, save lives, save money, and do not increase drug use. Representative Ramstad has also c onsistently opposed congressional efforts to stop the arrest of patients with HIV/AIDS, cancer, and other illnesses who use medical marijuana to ease their pain and suffering in states where it is legal.
Similar concerns have been raised in another joint letter, coordinated by the Drug Policy Alliance endorsed by more than three dozen other public-health, criminal-justice and drug-treatment organizations. They write to Mr. Obama:
You showed strong leadership on the campaign trail by pledging to lift the federal funding ban on syringe exchange programs, end the excessive federal law enforcement raids aimed at medical marijuana patients, and eliminate the crack/powder cocaine sentencing disparity. . .
We urge you to nominate for drug czar someone with a public health background, who is committed to reducing the spread of HIV/AIDS, hepatitis C and other infectious diseases, open to systematic drug policy reform, and able to show strong leadership on the issues you believe in.
The costs of the war on drugs are summed up by Ethan Nadelmann, the executive director of the Drug Policy Alliance, in a Wall Street Journal op-ed article celebrating the 75th anniversary of the repeal of Prohibition. After noting that that the repeal was popular not just among drinkers but also non-drinkers worried about the rise in organized crime and other consequences of Prohibition, Mr. Nadelmann writes:
They saw what most Americans still fail to see today: That a failed drug prohibition can cause greater harm than the drug it was intended to banish.
Consider the consequences of drug prohibition today: 500,000 people incarcerated in U.S. prisons and jails for nonviolent drug-law violations; 1.8 million drug arrests last year; tens of billions of taxpayer dollars expended annually to fund a drug war that 76% of Americans say has failed; millions now marked for life as former drug felons; many thousands dying each year from drug overdoses that have more to do with prohibitionist policies than the drugs themselv es, and tens of thousands more needlessly infected with AIDS and Hepatitis C because those same policies undermine and block responsible public-health policies.
And look abroad. At Afghanistan, where a third or more of the national economy is both beneficiary and victim of the failed global drug prohibition regime. At Mexico, which makes Chicago under Al Capone look like a day in the park. And elsewhere in Latin America, where prohibition-related crime, violence and corruption undermine civil authority and public safety, and mindless drug eradication campaigns wreak environmental havoc.
The joint letter to Mr. Obama organized by Dr. Tatarsky suggests a different approach: "We need a new bottom line for U.S. drug policy so that treatment is more available and addiction is treated like a health issue, not a criminal issue. To paraphrase former Baltimore Mayor Kurt Schmoke, we need a surgeon general, not a military general or police officer."
What do you think of Mr. Ramstad as drug czar? Do you have any other nominees for the job? Or other advice for Mr. Obama on drug policy?
Tuesday, December 16, 2008
Regarding the Selection of Directors of the Office of National Drug Control (the Drug Czar) and the Substance Abuse and Mental Health Services Agency
It was reported that Representative Ramstad has been lobbying to head up SAMHSA, the Substance Abuse and Mental Health Services Administration, with greater support from mental health and substance abuse professionals. The concerns that led to our sign on letter opposing Rep. Ramstad's possible selection as the next Drug Czar are even more applicable to his selection to head SAMHSA where he could do even more damage to the treatment of people with substance use disorders. For this reason I sent a note to the more than 350 signers of the first letter asking if they would support an ammendment to the original letter to express our str ong concern about Rep. Ramstad being selected for either agency, ONDC or SAMHSA. The support was unanimous and the letter was ammended. The ammended letter is posted below and the first version of the letter remains up on this blog.
********************************************************
December 16 2008
Dear President-Elect Obama,
As substance use and mental health professionals treating patients with substance use disorders, we are concerned about reports that you may be considering Congressman James Ramstad as our next “Drug Czar”, the director of the Office of National Drug Control Policy, or as director of the Substance Abuse and Mental Health Services Administration (SAMHSA) . This country needs leadership in these agencies that supports evidence-based policies and that will make decisions based on science, not politics or ideology. We have reason to believe that Congressman Ramstad is not that person.
While we applaud Representative Ramstad for his courageous and steady support for expanding drug treatment access and improving addiction awareness, and honor his own personal and very public triumph over addiction, we have strong reservations about his candidacy for these positions.
In his twenty-eight years in the U.S. House, Rep. Ramstad has consistently opposed policies that seek to reduce drug-related harm and create common ground on polarizing issues. Rep. Ramstad voted in 1998 in favor of making permanent the federal funding ban on syringe exchange,, in 2000, he voted to prohibit the District of Columbia from spending its own locally raised funds on syringe exchange programs, and in 2007, he voted against lifting the same DC ban, despite decades of research showing that syringe exchange programs reduce the spread of HIV/AIDS, save lives, save money, and do not increase drug use. Rep. Ramstad has also consistently opposed congressional efforts to stop the arrest of patients with HIV/AIDS, cancer, and other illnesses who use prescribed medical marijuana to ease their pain and suffering in states where it is legal.
Unlike you and Vice-President-Elect Biden, Rep. Ramstad has also failed to cosponsor any legislation eliminating the sentencing disparity between crack cocaine and powder cocaine, despite the fact that there were three different crack/powder reform bills in the 110th Congress. A number of recent studies have found that long prison sentences are one factor driving disproportionate rates of HIV/AIDS infections in communities of color. A primary task of the next Drug Czar should be to deal with this and other issues related to over-incarceration.
We need leadership that is committed to reducing the harms associated with both drugs and punitive drug laws. Leaders who support:
- Treatment interventions across the spectrum of readiness to change such as: Recovery Readiness, Motivational Interviewing, and other interventions which do not require abstinence for active substance users just beginning to work on their substance use; substitution treatments like methadone and buprenorphine (the most proven effective treatments for opiate dependent patients); and abstinence-focused in- and out-patient treatments for those working toward abstinence and recovery
- Integrated treatment for patients with co-occurring psychiatric, medical, and lifestyle problems – a group that makes up the majority of patients with serious substance use disorders
- Syringe exchange programs to halt the spread of HIV/AIDS and hepatitis C,. This is an intervention that has been proven to dramatically reduce the transmission of infectious disease and reduce drug use in the injecting population without increasing drug use
We need a new bottom line for U.S. drug policy so that treatment is more available and substance abuse and dependence are treated as the health issues they are, not criminal issues. To paraphrase former Baltimore Mayor Kurt Schmoke, we need a surgeon general not a military general or police officer.
We need leaders at ONDC and SAMHSA who welcome and encourage new ideas and research and who are committed to reducing the number of nonviolent offenders behind bars. These leaders should be fully committed to major sentencing reform. There should also be greater emphasis on educating our judges, prosecutors, and parole and probation officers to the complexities of substance use disorders and the process of change and recovery. When patients in treatment for substance use disorders "slip" it is more the norm than not; as an expected part of the process of change, it should not lead to automatic termination of treatment and incarceration. These decisions need to be made in conjunction with the clinical staff working with these patients who have the expertise to make them.
Our leadership on drug policy and treatment must understand that there are many roads to recovery and recovery can take different paths. We strongly believe that our views are in the best interests of individuals struggling with substance use disorders and all Americans and we hope they will be considered in your choices for these critically important positions.
Thank you.
Sincerely,
Andrew Tatarsky, PhD
Founding Executive Board Member and Past President, Division on Addictions, New York State Psychological Association
Debra Rothschild, PhD
Past President, Executive Committee, Division on Addictions, New York State Psychological Association
Howard Josepher, LCSW
President & Chief Executive Officer, Exponents
Alexandra Woods, PhD
Officer, Executive Committee, Division on Addictions, New York State Psychological Association
Julie Barnes, PhD
Executive Board Member, Division on Addiction, New York State Psychological Association
Click here to view the additional signatures to this letter
Thursday, December 11, 2008
Not Drug Czar -- Ramstad Now Wants to Head Treatment Agency. Just Say No!
Maia Szalavitz
Posted December 11, 2008 12:46 PM (EST)
The Huffington Post
Our coverage of the possible nomination of Rep. Jim Ramstad as "drug czar" has kicked up quite a fuss, spurring many comments here and a sign-on letter by addiction professionals that was cited by John Tierney in this week's New York Times. Nearly 300 leaders in the addiction treatment field so far have added their signatures. Now, the Minnesota Independent is reporting that Ramstad's real ambition is to serve as the head of the Substance Abuse and Mental Health Services Administration (SAMHSA).
While that sounds better than having him in charge of drug policy overall as "drug czar," in fact, it is a position in which he could possibly do more damage by replacing evidence-based treatment with ideology "behind the scenes."
Let's look once at his record. With politicians, I find that support for needle exchange tends to be a good proxy for whether you "follow the data" or follow the political winds of ideology. As we know, Ramstad went with ideology -- and even when he had a recent chance to revise his position to allow Washington, DC to use its own money for such programs, he remained firmly stuck in the past and voted to try to block that.
Then, there's methadone and other maintenance treatments. Against the weight of an Institute of Medicine study -- the Institute of Medicine is the agency charged by Congress with resolving medical controversies with data -- he opposed maintenance so much that he didn't want to give insurance parity for coverage.
In other words, while parity would have advanced all other addiction treatments, if his early parity bills had passed, the best-supported treatment for heroin addiction would have become harder to get.
Is someone who opposes what the science says is the best treatment for heroin addiction really someone we want in charge of the agency which is supposed to help disseminate evidence-based care?
And, of course, there's his earmark and other support for Teen Challenge. This is a "treatment provider" which claims that addiction is a sin, not a disease -- and the only help it offers for addicts is conversion to a particular form of Christianity. No medication, no evidence-based therapies, no credentialed counselors -- it doesn't even advise participation in 12-step programs, which is the one treatment modality we know Ramstad favors!
Ramstad sponsored a bill to change the name of the National Institute on Drug Abuse to the National Institute on Diseases of Addiction. As I wrote yesterday, either he really doesn't believe addiction is a disease -- in which case, he's a hypocrite and not someone we want running a treatment agency or he doesn't vet programs that he supports, in which case he's also not a good choice to head an agency that funds various kinds of treatment and initiatives [pdf] for promoting the best care.
The head of SAMSHA should be someone who promotes evidence-based treatment -- not someone who only supports the science when it bolsters his personal beliefs.
[And, so that I don't have to write this piece ever again, Ramstad should not be considered as head of the National Institute on Drug Abuse -- the agency in charge of research on addictions at NIH, no matter what name it turns out to be given -- either!]
Posted December 11, 2008 12:46 PM (EST)
The Huffington Post
Our coverage of the possible nomination of Rep. Jim Ramstad as "drug czar" has kicked up quite a fuss, spurring many comments here and a sign-on letter by addiction professionals that was cited by John Tierney in this week's New York Times. Nearly 300 leaders in the addiction treatment field so far have added their signatures. Now, the Minnesota Independent is reporting that Ramstad's real ambition is to serve as the head of the Substance Abuse and Mental Health Services Administration (SAMHSA).
While that sounds better than having him in charge of drug policy overall as "drug czar," in fact, it is a position in which he could possibly do more damage by replacing evidence-based treatment with ideology "behind the scenes."
Let's look once at his record. With politicians, I find that support for needle exchange tends to be a good proxy for whether you "follow the data" or follow the political winds of ideology. As we know, Ramstad went with ideology -- and even when he had a recent chance to revise his position to allow Washington, DC to use its own money for such programs, he remained firmly stuck in the past and voted to try to block that.
Then, there's methadone and other maintenance treatments. Against the weight of an Institute of Medicine study -- the Institute of Medicine is the agency charged by Congress with resolving medical controversies with data -- he opposed maintenance so much that he didn't want to give insurance parity for coverage.
In other words, while parity would have advanced all other addiction treatments, if his early parity bills had passed, the best-supported treatment for heroin addiction would have become harder to get.
Is someone who opposes what the science says is the best treatment for heroin addiction really someone we want in charge of the agency which is supposed to help disseminate evidence-based care?
And, of course, there's his earmark and other support for Teen Challenge. This is a "treatment provider" which claims that addiction is a sin, not a disease -- and the only help it offers for addicts is conversion to a particular form of Christianity. No medication, no evidence-based therapies, no credentialed counselors -- it doesn't even advise participation in 12-step programs, which is the one treatment modality we know Ramstad favors!
Ramstad sponsored a bill to change the name of the National Institute on Drug Abuse to the National Institute on Diseases of Addiction. As I wrote yesterday, either he really doesn't believe addiction is a disease -- in which case, he's a hypocrite and not someone we want running a treatment agency or he doesn't vet programs that he supports, in which case he's also not a good choice to head an agency that funds various kinds of treatment and initiatives [pdf] for promoting the best care.
The head of SAMSHA should be someone who promotes evidence-based treatment -- not someone who only supports the science when it bolsters his personal beliefs.
[And, so that I don't have to write this piece ever again, Ramstad should not be considered as head of the National Institute on Drug Abuse -- the agency in charge of research on addictions at NIH, no matter what name it turns out to be given -- either!]
Critics Attack Ramstad as Possible Drug Czar Candidate
Join Together.org
December 10, 2008
Former Rep. Jim Ramstad (R-Minn.) might not even be in the running for the job of Barack Obama's drug czar, but that hasn't stopped critics from saying he would be a poor choice because of his past opposition to needle-exchange programs and medical marijuana.
Ramstad's name has been floated as a possible pick for director of the Office of National Drug Control Policy (ONDCP) in the Obama administration, although some sources say he is more likely to be tapped as head of the Substance Abuse and Mental Health Services Administration (SAMHSA).
Letter-writing campaigns by the Drug Policy Alliance (DPA), a group of addiction-treatment professionals led by the past president of the addictions division at the New York State Psychological Association, and the National Black Police Association (NBPA) urge the president-elect not to make Ramstad the nominal chief of the national war on drugs.
"While we applaud Representative Ramstad for his courageous and steady support for expanding drug treatment access and improving addiction awareness, and honor his own personal and very public triumph over addiction, we have strong reservations about his candidacy for the drug czar position," according to the letter sent to Obama and signed by DPF and NBPA as well as a variety of AIDS prevention groups and others. "In his twenty-eight years in the U.S. House, Representative Ramstad has consistently opposed policies that seek to reduce drug-related harm and create common ground on polarizing issues."
Writing in the Huffington Post, Maia Szalavitz also criticized Ramstad for once earmarking $235,000 for the Minnesota chapter of the controversial Teen Challenge program.
Obama's transition team has not made any public announcements about filling the position of ONDCP director.
December 10, 2008
Former Rep. Jim Ramstad (R-Minn.) might not even be in the running for the job of Barack Obama's drug czar, but that hasn't stopped critics from saying he would be a poor choice because of his past opposition to needle-exchange programs and medical marijuana.
Ramstad's name has been floated as a possible pick for director of the Office of National Drug Control Policy (ONDCP) in the Obama administration, although some sources say he is more likely to be tapped as head of the Substance Abuse and Mental Health Services Administration (SAMHSA).
Letter-writing campaigns by the Drug Policy Alliance (DPA), a group of addiction-treatment professionals led by the past president of the addictions division at the New York State Psychological Association, and the National Black Police Association (NBPA) urge the president-elect not to make Ramstad the nominal chief of the national war on drugs.
"While we applaud Representative Ramstad for his courageous and steady support for expanding drug treatment access and improving addiction awareness, and honor his own personal and very public triumph over addiction, we have strong reservations about his candidacy for the drug czar position," according to the letter sent to Obama and signed by DPF and NBPA as well as a variety of AIDS prevention groups and others. "In his twenty-eight years in the U.S. House, Representative Ramstad has consistently opposed policies that seek to reduce drug-related harm and create common ground on polarizing issues."
Writing in the Huffington Post, Maia Szalavitz also criticized Ramstad for once earmarking $235,000 for the Minnesota chapter of the controversial Teen Challenge program.
Obama's transition team has not made any public announcements about filling the position of ONDCP director.
Monday, December 8, 2008
Drug Czar Controversy - Tierney Lab @ NY Times mentions Andrew Tatarsky's sign-on letter
December 8, 2008, 12:23 pm
By John Tierney
NY Times
Some researchers in substance-abuse treatment and advocates for the medical use of marijuana marijuana are alarmed at reports that Representative Jim Ramstad, a Republican from Minnesota, is a candidate to become the next drug czar — the director of the office of National Drug Control Policy. In a joint letter to President-elect Barack Obama, coordinated by Andrew Tatarsky, the past president of the division of addictions of the New York State Psychological Association, dozens of academics and other professionals in substance-abuse treatment write:
Similar concerns have been raised in another joint letter, coordinated by the Drug Policy Alliance endorsed by more than three dozen other public-health, criminal-justice and drug-treatment organizations. They write to Mr. Obama:
The costs of the war on drugs are summed up by Ethan Nadelmann, the executive director of the Drug Policy Alliance, in a Wall Street Journal op-ed article celebrating the 75th anniversary of the repeal of Prohibition. After noting that that the repeal was popular not just among drinkers but also non-drinkers worried about the rise in organized crime and other consequences of Prohibition, Mr. Nadelmann writes:
The joint letter to Mr. Obama organized by Dr. Tatarsky suggests a different approach: “We need a new bottom line for U.S. drug policy so that treatment is more available and addiction is treated like a health issue, not a criminal issue. To paraphrase former Baltimore Mayor Kurt Schmoke, we need a surgeon general, not a military general or police officer.”
What do you think of Mr. Ramstad as drug czar? Do you have any other nominees for the job? Or other advice for Mr. Obama on drug policy?
By John Tierney
NY Times
Some researchers in substance-abuse treatment and advocates for the medical use of marijuana marijuana are alarmed at reports that Representative Jim Ramstad, a Republican from Minnesota, is a candidate to become the next drug czar — the director of the office of National Drug Control Policy. In a joint letter to President-elect Barack Obama, coordinated by Andrew Tatarsky, the past president of the division of addictions of the New York State Psychological Association, dozens of academics and other professionals in substance-abuse treatment write:
This country needs a drug czar who supports evidence-based policies and one
who will make decisions based on science, not politics or ideology. We strongly
believe that Congressman Ramstad is not that person.
Rep. Ramstad voted in 1998 in favor of making permanent the federal funding
ban on syringe exchange. In 2000, he voted to prohibit the District of Columbia
from spending its own locally-raised funds on syringe exchange programs, and in
2007, he voted against lifting the same DC ban, despite decades of research
showing that syringe exchange programs reduce the spread of HIV/AIDS, save
lives, save money, and do not increase drug use. Representative Ramstad has also
consistently opposed congressional efforts to stop the arrest of patients with
HIV/AIDS, cancer, and other illnesses who use medical marijuana to ease their
pain and suffering in states where it is legal.
Similar concerns have been raised in another joint letter, coordinated by the Drug Policy Alliance endorsed by more than three dozen other public-health, criminal-justice and drug-treatment organizations. They write to Mr. Obama:
You showed strong leadership on the campaign trail by pledging to lift the federal funding ban on syringe exchange programs, end the excessive federal law enforcement raids aimed at medical marijuana patients, and eliminate the crack/powder cocaine sentencing disparity. . . We urge you to nominate for drug czar someone with a public health background, who is committed to reducing the spread of HIV/AIDS, hepatitis C and other infectious diseases, open to systematic drug policy reform, and able to show strong leadership on the issues you believe in.
The costs of the war on drugs are summed up by Ethan Nadelmann, the executive director of the Drug Policy Alliance, in a Wall Street Journal op-ed article celebrating the 75th anniversary of the repeal of Prohibition. After noting that that the repeal was popular not just among drinkers but also non-drinkers worried about the rise in organized crime and other consequences of Prohibition, Mr. Nadelmann writes:
They saw what most Americans still fail to see today: That a failed drug prohibition can cause greater harm than the drug it was intended to banish.
Consider the consequences of drug prohibition today: 500,000 people incarcerated in U.S. prisons and jails for nonviolent drug-law violations; 1.8 million drug arrests last year; tens of billions of taxpayer dollars expended annually to fund a drug war that 76% of Americans say has failed; millions now marked for life as former drug felons; many thousands dying each year from drug overdoses that have more to do with prohibitionist policies than the drugs themselves, and tens of thousands more needlessly infected with AIDS and Hepatitis C because those same policies undermine and block responsible public-health policies.
And look abroad. At Afghanistan, where a third or more of the national economy is both beneficiary and victim of the failed global drug prohibition regime. At Mexico, which makes Chicago under Al Capone look like a day in the park. And elsewhere in Latin America, where prohibition-related crime, violence and corruption undermine civil authority and public safety, and mindless drug eradication campaigns wreak environmental havoc.
The joint letter to Mr. Obama organized by Dr. Tatarsky suggests a different approach: “We need a new bottom line for U.S. drug policy so that treatment is more available and addiction is treated like a health issue, not a criminal issue. To paraphrase former Baltimore Mayor Kurt Schmoke, we need a surgeon general, not a military general or police officer.”
What do you think of Mr. Ramstad as drug czar? Do you have any other nominees for the job? Or other advice for Mr. Obama on drug policy?
Saturday, December 6, 2008
Letter to President Elect Obama Regarding the Selection of our Next Drug Czar…From Substance Use and Mental Health Treatment Professionals
Click here to sign-on to the letter at Andrew Tatarsky's website.
Dear President-Elect Obama,
As substance-use and mental-health professionals treating patients with substance use disorders, we are concerned about reports that President-elect Obama is considering Congressman James Ramstad as our next “Drug Czar,” or director of the Office of National Drug Control Policy. This country needs a Drug Czar who supports evidence-based policies and one who will make decisions based on science, not politics or ideology. We strongly believe that Congressman Ramstad is not that person.
While we applaud Representative Ramstad for his courageous and steady support for expanding drug treatment access and improving addiction awareness, and honor his own personal and very public triumph over addiction, we have strong reservations about his candidacy for the Drug Czar position. In his twenty-eight years in the U.S. House, Rep. Ramstad has consistently opposed policies that seek to reduce drug-related harm and create common ground on polarizing issues.
Rep. Ramstad voted in 1998 in favor of making permanent the federal funding ban on syringe exchange. In 2000, he voted to prohibit the District of Columbia from spending its own locally-raised funds on syringe exchange programs, and in 2007, he voted against lifting the same DC ban, despite decades of research showing that syringe exchange programs reduce the spread of HIV/AIDS, save lives, save money, and do not increase drug use. Rep. Ramstad has also consistently opposed congressional efforts to stop the arrest of patients with HIV/AIDS, cancer, and other illnesses who use medical marijuana to ease their pain and suffering in states where it is legal.
Unlike you and Vice-President-Elect Biden, Rep. Ramstad has also failed to cosponsor any legislation eliminating the sentencing disparity between crack cocaine and powder cocaine, despite the fact that there were three different crack/powder reform bills in the 110th Congress. A number of recent studies have found that long prison sentences are one factor driving disproportionate rates of HIV/AIDS infections in communities of color. A primary task of the next Drug Czar should be to deal with this and other issues related to over-incarceration.
We need someone committed to reducing the harms associated with both drugs and punitive drug laws. Someone who supports:
1. Treatment interventions across the spectrum of readiness to change such as: Recovery Readiness, Motivational Interviewing, and other interventions which do not require abstinence for active substance users just beginning to work on their substance use; substitution treatments like methadone and buprenorphine (the most proven effective treatments for opiate-dependent patients); and abstinence-focused in- and out-patient treatments for those working toward abstinence and recovery.
2. Integrated treatment for patients with co-occuring psychiatric, medical, and lifestyle disorders – a group that makes up the majority of patients with serious substance use disorders.
3. Syringe exchange programs to halt the spread of HIV/AIDS and hepatitis C,. This is an intervention that has been proven to dramatically reduce the transmission of infectious disease and reduce drug use in the injecting population without increasing drug use.
We need a new bottom line for U.S. drug policy so that treatment is more available and addiction is treated like a health issue, not a criminal issue. To paraphrase former Baltimore Mayor Kurt Schmoke, we need a surgeon general not a military general or police officer.
We need a Drug Czar who welcomes and encourages new ideas and research. We need a Drug Czar who is committed to reducing the number of nonviolent offenders behind bars. Our country's next Drug Czar should be fully committed to major sentencing reform. There should also be greater emphasis on educating our judges, prosecutors, and parole and probation officers to the complexities of substance use disorders and the process of change and recovery. When patients in treatment for substance use disorders "slip" it is more the norm than not; as an expected part of the process of change, it should not lead to automatic termination of treatment and incarceration. These decisions need to be made in conjunction with the clinical staff working with these patients who have the expertise to make them.
We need a Drug Czar who understands there are many roads to recovery and recovery can take different paths. We strongly believe that our views are in the best interests of individuals struggling with substance use disorders and all Americans and will be considered in your choice of the next Drug Czar.
Thank you.
Sincerely,
Andrew Tatarsky, PhD
Founding Executive Board Member and Past President, Division on Addictions, New York State Psychological Association
Click to view signatures already on the letter
Thursday, December 4, 2008
APSAD Annual Scientific Conference 2008 - Australasian Professional Society on Alcohol and other Drugs.
November 23 - 26, 2008 Part I (Sunday 23 Nov).
This year's APSAD conference was a fine affair. I must have been to 15 or more of these in most State capitals, Cairns and Canberra. I missed last year’s Fest in Auckland but those who attended said it was excellent. Like national leaders’ meetings with their funny hats, shirts and coats, each APSAD conference is characterised by its own conference attaché bag. This natural-inspired over-the-shoulder model was one of the few I could imagine using in the future.
The venue was splendid, Darling Harbour being just an 8 minutes (downhill) walk from Town Hall station which made me into a commuter again. With medical practice responsibilities I was a part-time conference goer.=C 2 Thus these notes are incomplete and (as usual) opinionated.
The Sunday afternoon pre-conference session had been booked by the only drug company with a major stake in our field. Reckitt-Benckiser is manufacturer of buprenorphine which is the only registered alternative to methadone, the latter being a generic drug with small bread-and-butter profit lines in comparison. The sponsors began with the topics of pharmaceutical abuse and innovations in addiction management, then ending with two presentations on the potential cardiac complications of methadone before a panel discussion to which I had been invited (and generously funded).
Adrian Dunlop spoke eloquently about the past, present and future of addiction treatments.
Dr Eric Strain covered some historical details of non-medical use of pharmaceuticals in the US, giving some results on prevalence and consequences from household surveys over 25 years. Apparently most users obtained their supplies from one doctor; many from friends or relatives with less only ~1% or less from the internet. Australian figures may be quite different as people are entitled to attend more than one doctor on Medicare. Another speaker quipped that if Australia had a Bill of Rights, it would include being able to attend “as many doctors as you like”. Dr Strain touched on the gap between occasional use and dependent use, something some of us may still forget because of the selected referrals we receive. The other major differences between American street heroin users and those abusing pain killers is that the latter are more likely to be employed, white race and non-injectors. Dr Strain was too modest to mention his own research on buprenorphine abuse and perhaps too polite to mention the reported non-medical use of buprenorphine, including a naloxone combination product which became the drug of choice (mostly injected) by more than half those presenting for treatment in Wellington, New Zealand (see Robinson 1993).
Dr Nick Lintzeris gave some pointers about pharmaceutical abuse in Australia. His talk ending with a plea to put methadone treatment, including side effects, into context both globally, as well as for individual patients. In his rather frequent exposure during the conference, he reminded us that there are much more relevant issues for opioid therapy as patients get older such as testosterone levels, calcium leaching, osteoporosis, dental, viral and bowel problems.
Jason White detailed the rather sparse literature on cardiac complications in methadone recipients. He seemed persuaded that the connection between methadone and torsade is significant and that methadone treatment could be restricted or further regulated as a result. As a demonstration of patients on ‘normal’ methadone treatment coming to torsade, he cited Pearson and Woosley’s report of 59 FDA notifications from 1969 to 2002. While not fully documented, from the limited data 12 could have been on ‘standard’ MMT, 8 of whom were over 40 years of age. This leaves just 4 reported ‘standard’ MMT cases in the USA over a 33 year period in the age group we normally start on MMT. Justo’s more recent literature review found only 6 of 40 cases reported could have been on ‘standard’ MMT cases without other triggering factors (85% had one or more of these known causes of QT prolongation aside from high methadone doses).
0A
QT prolongation on the cardiograph has long been know to occur in about a quarter of methadone patients yet its only serious consequence, ‘torsade de pointes’ tachycardia, hardly ever seems to occur in young patients (<40>40 years of age, electrolyte disturbance,20etc.
As our patient population on maintenance treatment gets older so we must be more vigilant about this and other eventualities. As with other related medical issues, close attention should be paid to cardiac status. This may include an ECG in those taking over 150mg, those prescribed other ‘at risk’ medications or those with HIV or personal/family history of unexplained syncope or fainting.
At this session I was delighted to finally learn the origin of the term ‘ether-a-go-go’ which is from the rhythmic dancing induced in the legs of doomed drosophila drones (flies) under the influence of ether in genetic experiments on channel blockers.
We were then shown a 15 minute video ‘interview’ with Colorado cardiologist Dr Mori Krantz detailing blow by blow the now supposedly conclusive case for methadone’s guilt beyond reasonable doubt in causing fatal arrhythmias. The final proof of any medical argument, we are told, involves randomisation of subjects and so the RCT by Wedam is proffered. This trial, a secondary analysis of ECG tracings obtained incidentally in a 1990s RCT, showed very high rates of QT prolongation in the first 4 months of MMT but no cases of torsade. On e of the panellists said to me privately that this appears to be rather persuasive of the safety of methadone rather than the opposite.
As above, hardly anyone has ever seen a case except in patients who are already stressed and in highly complex medical circumstances. I note that since his classic description of 17 non-fatal cases in 2002 (8 were pain management cases), Krantz has only reported two other individual cases of torsade, one of which was due to cocaine.
In the video, we are told that because one cannot diagnose an electrical disturbance after death, coroners are unable to detect whether the death was due to cardiac arrhythmia or respiratory depression from the drug. In fact many cases are very clear at autopsy as having the classic findings of post mortem sub-acute lung changes and high blood levels as to leave little doubt abou t the cause of death. So while Krantz’s proposition may be true for a certain minority, with a 20% mortality, there ought to be 4 times as many (80%) torsade survivors. Yet few if any of these ever seem to get to an emergency room (or ambulance) and have their potentially fatal problem diagnosed with a simple cardiograph tracing. Such reports are exceedingly scarce or non-existent. I called one of Australia’s busiest casualty departments to be told that their long-time medical director had never seen a case of methadone associated torsade. He also pointed out that for the past several years, modern cardiograph machines have given an automated print-out of QTc, making this information much more available that previously. This just might be the single most important cause of the ‘epidemic’ of electrical changes in the absence of actual symptomatic disease.
Further on in the presentation Krantz states the obvious it’s not to say that there is an epidemic of cardiac events in America”. Yet elsewhere he has written that large number of patients are at risk of developing torsade. Fanoe’s Copenhagen syncope study was put up as a written question in the video ‘interview’ (there was no interviewer as such) but Krantz failed to comment on it for some reason. Fanoe showed that out of 800 cases (with no torsade reported) that high rates of syncope (over 20% in most dose groups) in methadone patients was at least in part substantially explained by cardiac conduction problems such as torsade. This is hard to understand for a complication known to occur in less than 1% of patients). Krantz then alluded to Chugh’s Portland study suggesting that it lent support to his torsade theory, yet like so many of the other quoted references, this is another report which does not document any torsade cases. Perhaps I belabour the point. Where are all the bodies in this serial killing, Miss Marple?
[more about lives saved in another conference posting shortly]
Comments by Andrew Byrne ..
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dr Andrew Byrne MB BS (Syd) FAChAM (RACP)
Dependency Medicine,
75 Redfern Street, Redfern,
New South Wales, 2016, Australia
Email - ajbyrne@ozemail.com.au
Tel (61 - 2) 9319 5524 Fax 9318 0631
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Surgery web page: http://www.redfernclinic.com/#news
References:
Robinson GM, Dukes PD, Robinson BJ, Cooke RR, Mahoney GN. The misuse of buprenorphine and a buprenorphine-naloxone combination in Wellington, New Zealand. Drug Alcohol Dependence 1993 33;1:81-6
Strain EC, Stoller K, Walsh SL, Bigelow GE. Effects of buprenorphine versus buprenorphine/naloxone tablets in non-dependent opioid abusers. Psychopharmacology (Berl) 2000 Mar;148(4):374-83
Justo D. Methadone-Induced Long QT Syndrome vs Methadone-Induced Torsades de Pointes. Arch Intern Med 2006 166:2288
Wedam EF, Bigelow GE, Johnson RE, Nuzzo PA, Haigney MCP. QT-Interval Effects of Methadone, Levomethadyl, and Buprenorphine in a Randomized Trial. Arch Intern Med 2007 167;22:2469-2473
Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, D. Robertson AD, Mehler PS. Torsade de Pointes Associated with Very-High-Dose Methadone. Ann Intern Med. 2002 137:501-504
Krantz MJ, Rowan SB, Mehler PS. Cocaine-related torsade de pointes in a methadone maintenance patient. J Addict Dis. 2005;24(1):53-60
Krantz MJ, Garcia JA, Mehler PS. Effects of buprenorphine on cardiac repolarization in a patient with methadone-related torsade de pointes. Pharmacotherapy 2005 25:611-614
Fanoe S, Hvidt C, Ege P, Jensen GB. Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of Copenhagen. Heart 2007;93;1051-1055
Chugh SS, Socoteanu C, Reinier K, Waltz J, Jui J, Gunson K. A Community-Based Evaluation of Sudden Death Associated with Therapeutic Levels of Methadone. American Journal of Medicine 2008 121: 66-71
This year's APSAD conference was a fine affair. I must have been to 15 or more of these in most State capitals, Cairns and Canberra. I missed last year’s Fest in Auckland but those who attended said it was excellent. Like national leaders’ meetings with their funny hats, shirts and coats, each APSAD conference is characterised by its own conference attaché bag. This natural-inspired over-the-shoulder model was one of the few I could imagine using in the future.
The venue was splendid, Darling Harbour being just an 8 minutes (downhill) walk from Town Hall station which made me into a commuter again. With medical practice responsibilities I was a part-time conference goer.=C 2 Thus these notes are incomplete and (as usual) opinionated.
The Sunday afternoon pre-conference session had been booked by the only drug company with a major stake in our field. Reckitt-Benckiser is manufacturer of buprenorphine which is the only registered alternative to methadone, the latter being a generic drug with small bread-and-butter profit lines in comparison. The sponsors began with the topics of pharmaceutical abuse and innovations in addiction management, then ending with two presentations on the potential cardiac complications of methadone before a panel discussion to which I had been invited (and generously funded).
Adrian Dunlop spoke eloquently about the past, present and future of addiction treatments.
Dr Eric Strain covered some historical details of non-medical use of pharmaceuticals in the US, giving some results on prevalence and consequences from household surveys over 25 years. Apparently most users obtained their supplies from one doctor; many from friends or relatives with less only ~1% or less from the internet. Australian figures may be quite different as people are entitled to attend more than one doctor on Medicare. Another speaker quipped that if Australia had a Bill of Rights, it would include being able to attend “as many doctors as you like”. Dr Strain touched on the gap between occasional use and dependent use, something some of us may still forget because of the selected referrals we receive. The other major differences between American street heroin users and those abusing pain killers is that the latter are more likely to be employed, white race and non-injectors. Dr Strain was too modest to mention his own research on buprenorphine abuse and perhaps too polite to mention the reported non-medical use of buprenorphine, including a naloxone combination product which became the drug of choice (mostly injected) by more than half those presenting for treatment in Wellington, New Zealand (see Robinson 1993).
Dr Nick Lintzeris gave some pointers about pharmaceutical abuse in Australia. His talk ending with a plea to put methadone treatment, including side effects, into context both globally, as well as for individual patients. In his rather frequent exposure during the conference, he reminded us that there are much more relevant issues for opioid therapy as patients get older such as testosterone levels, calcium leaching, osteoporosis, dental, viral and bowel problems.
Jason White detailed the rather sparse literature on cardiac complications in methadone recipients. He seemed persuaded that the connection between methadone and torsade is significant and that methadone treatment could be restricted or further regulated as a result. As a demonstration of patients on ‘normal’ methadone treatment coming to torsade, he cited Pearson and Woosley’s report of 59 FDA notifications from 1969 to 2002. While not fully documented, from the limited data 12 could have been on ‘standard’ MMT, 8 of whom were over 40 years of age. This leaves just 4 reported ‘standard’ MMT cases in the USA over a 33 year period in the age group we normally start on MMT. Justo’s more recent literature review found only 6 of 40 cases reported could have been on ‘standard’ MMT cases without other triggering factors (85% had one or more of these known causes of QT prolongation aside from high methadone doses).
0A
QT prolongation on the cardiograph has long been know to occur in about a quarter of methadone patients yet its only serious consequence, ‘torsade de pointes’ tachycardia, hardly ever seems to occur in young patients (<40>40 years of age, electrolyte disturbance,20etc.
As our patient population on maintenance treatment gets older so we must be more vigilant about this and other eventualities. As with other related medical issues, close attention should be paid to cardiac status. This may include an ECG in those taking over 150mg, those prescribed other ‘at risk’ medications or those with HIV or personal/family history of unexplained syncope or fainting.
At this session I was delighted to finally learn the origin of the term ‘ether-a-go-go’ which is from the rhythmic dancing induced in the legs of doomed drosophila drones (flies) under the influence of ether in genetic experiments on channel blockers.
We were then shown a 15 minute video ‘interview’ with Colorado cardiologist Dr Mori Krantz detailing blow by blow the now supposedly conclusive case for methadone’s guilt beyond reasonable doubt in causing fatal arrhythmias. The final proof of any medical argument, we are told, involves randomisation of subjects and so the RCT by Wedam is proffered. This trial, a secondary analysis of ECG tracings obtained incidentally in a 1990s RCT, showed very high rates of QT prolongation in the first 4 months of MMT but no cases of torsade. On e of the panellists said to me privately that this appears to be rather persuasive of the safety of methadone rather than the opposite.
As above, hardly anyone has ever seen a case except in patients who are already stressed and in highly complex medical circumstances. I note that since his classic description of 17 non-fatal cases in 2002 (8 were pain management cases), Krantz has only reported two other individual cases of torsade, one of which was due to cocaine.
In the video, we are told that because one cannot diagnose an electrical disturbance after death, coroners are unable to detect whether the death was due to cardiac arrhythmia or respiratory depression from the drug. In fact many cases are very clear at autopsy as having the classic findings of post mortem sub-acute lung changes and high blood levels as to leave little doubt abou t the cause of death. So while Krantz’s proposition may be true for a certain minority, with a 20% mortality, there ought to be 4 times as many (80%) torsade survivors. Yet few if any of these ever seem to get to an emergency room (or ambulance) and have their potentially fatal problem diagnosed with a simple cardiograph tracing. Such reports are exceedingly scarce or non-existent. I called one of Australia’s busiest casualty departments to be told that their long-time medical director had never seen a case of methadone associated torsade. He also pointed out that for the past several years, modern cardiograph machines have given an automated print-out of QTc, making this information much more available that previously. This just might be the single most important cause of the ‘epidemic’ of electrical changes in the absence of actual symptomatic disease.
Further on in the presentation Krantz states the obvious it’s not to say that there is an epidemic of cardiac events in America”. Yet elsewhere he has written that large number of patients are at risk of developing torsade. Fanoe’s Copenhagen syncope study was put up as a written question in the video ‘interview’ (there was no interviewer as such) but Krantz failed to comment on it for some reason. Fanoe showed that out of 800 cases (with no torsade reported) that high rates of syncope (over 20% in most dose groups) in methadone patients was at least in part substantially explained by cardiac conduction problems such as torsade. This is hard to understand for a complication known to occur in less than 1% of patients). Krantz then alluded to Chugh’s Portland study suggesting that it lent support to his torsade theory, yet like so many of the other quoted references, this is another report which does not document any torsade cases. Perhaps I belabour the point. Where are all the bodies in this serial killing, Miss Marple?
[more about lives saved in another conference posting shortly]
Comments by Andrew Byrne ..
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dr Andrew Byrne MB BS (Syd) FAChAM (RACP)
Dependency Medicine,
75 Redfern Street, Redfern,
New South Wales, 2016, Australia
Email - ajbyrne@ozemail.com.au
Tel (61 - 2) 9319 5524 Fax 9318 0631
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Surgery web page: http://www.redfernclinic.com/#news
References:
Robinson GM, Dukes PD, Robinson BJ, Cooke RR, Mahoney GN. The misuse of buprenorphine and a buprenorphine-naloxone combination in Wellington, New Zealand. Drug Alcohol Dependence 1993 33;1:81-6
Strain EC, Stoller K, Walsh SL, Bigelow GE. Effects of buprenorphine versus buprenorphine/naloxone tablets in non-dependent opioid abusers. Psychopharmacology (Berl) 2000 Mar;148(4):374-83
Justo D. Methadone-Induced Long QT Syndrome vs Methadone-Induced Torsades de Pointes. Arch Intern Med 2006 166:2288
Wedam EF, Bigelow GE, Johnson RE, Nuzzo PA, Haigney MCP. QT-Interval Effects of Methadone, Levomethadyl, and Buprenorphine in a Randomized Trial. Arch Intern Med 2007 167;22:2469-2473
Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, D. Robertson AD, Mehler PS. Torsade de Pointes Associated with Very-High-Dose Methadone. Ann Intern Med. 2002 137:501-504
Krantz MJ, Rowan SB, Mehler PS. Cocaine-related torsade de pointes in a methadone maintenance patient. J Addict Dis. 2005;24(1):53-60
Krantz MJ, Garcia JA, Mehler PS. Effects of buprenorphine on cardiac repolarization in a patient with methadone-related torsade de pointes. Pharmacotherapy 2005 25:611-614
Fanoe S, Hvidt C, Ege P, Jensen GB. Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of Copenhagen. Heart 2007;93;1051-1055
Chugh SS, Socoteanu C, Reinier K, Waltz J, Jui J, Gunson K. A Community-Based Evaluation of Sudden Death Associated with Therapeutic Levels of Methadone. American Journal of Medicine 2008 121: 66-71
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