TAKING COMMAND IN DRUG CRISIS

General: As the nation's drug czar, Barry R. McCaffrey seeks to dispel
assumptions and stereotypes in a battle he thinks can be won.

On the well-trodden paths of the national drug debate, Barry R.
McCaffrey likes to surprise his audiences, undermining stereotypes and
shattering assumptions.

He tells them, for instance, that the rate of illegal drug use among
African-Americans younger than 30 is lower than that for white
Americans. That casual drug use peaked in 1979, when 14 percent of
Americans had used an illegal drug in the preceding month; the number
now is 6 percent.

He informs them that the United States consumes less than 4 percent of
the heroin produced in the world; Pakistan has more than twice as many
heroin addicts. That, in his opinion, "the worst drug ever to come to
the United States" is not heroin or crack cocaine but methamphetamine,
which has become the dominant drug used in many Western U.S. cities.

And that he long ago watched a huge community become devastated by
drug use and then bounce back to nearly eradicate the problem. That
was the U.S. Army, where he served for 36 years and achieved the rank
of four-star general before President Clinton appointed him director
of the White House Office of National Drug Control Policy four years
ago.

"I've had four combat tours," says McCaffrey, who spoke to The Sun
during a visit to Baltimore last week. "I've never seen greater
suffering in warfare than I've seen in substance abuse in this country."

McCaffrey, 57, is far from a drug libertarian. He has pushed hard
recently for military aid to the government of Colombia for its fight
against drug-running guerrillas. He opposes needle-exchange programs
and roundly rejects the idea of drug decriminalization, once urged by
former Baltimore Mayor Kurt L. Schmoke and currently by New Mexico's
Republican governor, Gary E. Johnson. He argues that such talk is
pernicious, partly because it mutes the anti-drug message to
middle-school children, whose behavior will determine the future of
drug use.

But in other ways, McCaffrey has defied the expectations that face a
general who becomes drug czar. In a nation with little enthusiasm for
spending tax dollars on drug addicts, he has become the most prominent
advocate for treatment. And his strongest advocacy has been for the
most controversial form of treatment: methadone for heroin addicts.

When New York Mayor Rudolph W. Giuliani astonished drug-use experts
last year by saying he wanted to phase out methadone programs,
McCaffrey took him on.

"Ultimately the general entered into a very public debate at
considerable political risk, because methadone is not overwhelmingly
popular with all of Congress," says Mark W. Parrino, president of the
American Methadone Treatment Association. "This man has made a
tremendous contribution."

McCaffrey has pushed to move methadone from restricted status in
heavily policed programs into the mainstream of medicine. Federal
regulations proposed in July would make it easier for stable methadone
patients to receive take-home supplies of the drug from their doctors.

"This is the most widely studied, documented drug in the annals of
American medicine," McCaffrey says. "Clearly it's a dangerous drug.
But so's morphine. So's heart medicine."

Though the country has almost 900,000 chronic heroin addicts, he says,
only 179,000 people are on methadone, a number he believes is far
below the need. Though methadone has been widely used since the 1970s,
eight states have laws or policies effectively preventing its use, he
says.

Opponents of methadone incorrectly think of it as "just another
addiction," he says. Instead, it should be seen as a well-proven
treatment for a disease that has severe consequences not only for the
patient but for the community, he says.

"Every day I'm on methadone I'm not going to break into your car and
steal your purse," he says. "Every day I'm on methadone I'm not going
to get infected with HIV."

McCaffrey, who knows plenty about warfare of the non metaphorical kind,
says the notion of a "war on drugs" has done huge damage, suggesting
that addicts are enemies and that total victory is possible.

He prefers a medical analogy. Cancer is an illness that, like drug
addiction, can be caused by behavior (smoking or diet) and in which
relapse is common.

"If you want to fight cancer, you focus on prevention," he says. "But
you know some people will get cancer anyway. And when they do, you
expect five years of treatment and you don't say to your grandmother,
'You got surgery already, and it didn't cure you, so that's it.'"

McCaffrey says that while casual drug use has generally been declining
since the 1970s, many U.S. communities are severely affected by
chronic addiction. Methamphetamine, smoked or injected, has ravaged
cities and towns all over the Western United States and in Hawaii,
even in locations such as Boise, Idaho. Eastern cities like Baltimore
have made little progress against hard-core addiction and the street
markets for heroin and cocaine they create.

"It is incredible to me that we will tolerate the most abject misery
and open lawlessness in parts of America, when not for a minute would
we tolerate it where I live" in the Washington suburbs, he says.

The suburbs are a big part of the cities' drug problem, he says,
noting the steady stream of suburbanites who visit cities, including
Baltimore, to buy their drugs. "It has to be a regional approach," he
says.

For those who despair over the scale of drug abuse, McCaffrey has a
lesson from history.

"In the mid-'70s, I'd say a third of the U.S. Army was regularly using
illegal drugs, and another third when they could get their hands on
them," he says. "We opened treatment centers in every hospital in
Germany. There was a huge treatment and prevention program. In 10
years, we went from a disaster to a drug-free Army, almost. Now they
get 1 percent, 2 percent positive rates on drug tests."

Even outside the controlled atmosphere of the military, drug use
should not be an impossible challenge, McCaffrey says.

"If I was the czar to deal with racism or poverty, I'd have a real
challenge," he says. "The drug problem's pretty simple. We know the
problem. We know what works. We have treatment protocols for drug
addiction that are more effective than many of the protocols for
cancer treatment."