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News (Media Awareness Project) - US: Part 1 of 3, NIGHTLINE, GETTING STRAIGHT
Title:US: Part 1 of 3, NIGHTLINE, GETTING STRAIGHT
Published On:1999-03-09
Source:ABC News - Nightline
Fetched On:2008-09-06 11:28:41
NIGHTLINE, GETTING STRAIGHT, PART I

COKIE ROBERTS This country's been waging a war on drugs for decades
now and so far we don't seem to be winning it. Over the next three
nights, Nightline will be examining the nation's drug policy based on
a critical assessment by Michael Massing. His book, called The Fix,
draws on a 1994 report by the Rand Corporation which found drug
treatment 10 times more effective than the interdiction of drugs at
the borders. The figures for this year's budget, two thirds of our
federal drug dollars will go to law enforcement, one third to
treatment. Joining us later to give us his status report on the drug
war, General Barry McCaffrey, the Clinton administration's point man
on drugs. But first, Nightline's Dave Marash with the story of a
possible breakthrough in the treatment of the nation's more than three
and a half million cocaine addicts.

DAVE MARASH, ABCNEWS (VO) Dr. Donald Landry of Columbia University's
College of Physicians and Surgeons hardly looks like a revolutionary.
But a new enzyme called a catalytic antibody that he has developed in
work commissioned by the federal drug czar's office could
revolutionize treatment for cocaine addiction.

DR. DONALD LANDRY Well, this is the molecular structure of cocaine and
the antibody first binds it.

DAVE MARASH (VO) Landry diagrammed what happens in the bloodstream
...

DR. DONALD LANDRY And then it has molecular machinery to clip this
spot.

DAVE MARASH (VO) When his antibody attacks and breaks apart molecules
of cocaine before they can get to the brain and turns cocaine into two
harmless substances.

DR. DONALD LANDRY And so now we have materials that are inactive. They
are not addictive, they are not toxic.

DAVE MARASH (VO) The Landry antibody has been tested on rats and mice
and has nullified the effects of what should have been a lethal
overdose of cocaine.

DR DONALD LANDRY In a model of cocaine overdose, we can give a dose of
cocaine that should kill 90 percent of the animals. If the animals are
pretreated with the antibody, 100 percent live.

DAVE MARASH (VO) Even more exciting, says Dr Landry, is what happened
when the antibody was used to preempt long-term use of cocaine.

DR. DONALD LANDRY In terms of a model of addiction, when we pre-treat
with the antibody, animals that used cocaine now can't tell the
difference between cocaine and salt water and the hope is that giving
an antibody that can persist in the circulation for weeks at a time we
might make that person relatively immune to the effects of cocaine.

DAVE MARASH (VO) So far, tests of Landry's antibody have kept rodents
off cocaine for up to 30 days, enough time to create a window of
opportunity for addicted people to undergo rehabilitation and therapy
to break their bad habits and move towards sobriety. Still to come,
tests on monkeys and perhaps within two years, on humans. If those
tests succeed, the results for treatment of cocaine could be improved
dramatically. (on camera) The problem is too few addicts are getting
treatment. The latest federal survey showed just one addict in four
desiring treatment actually getting it, which critics blame on a
federal drug fighting budget that spends twice as much on cutting drug
supplies as it does on controlling demand by treating addicted people.

MICHAEL MASSING I think we have our priorities backward.

DAVE MARASH (VO) Author Michael Massing recently published The Fix, a
history and analysis of federal drug policy since the 1960s.

MICHAEL MASSING The Rand Corporation did a study several years ago in
which they measure dollar for dollar the effectiveness of treatment,
law enforcement, border interdiction and programs abroad in Latin
America to try to reduce cocaine consumption and they found that every
dollar you put in treatment was seven times more effective than law
enforcement, 10 times more effective than interdiction and 23 times
more effective than international programs.

DAVE MARASH (VO) What Massing prescribes is going back to the policies
of the Nixon administration, when Dr. Jerome Jaffe ran the war against
drugs.

MICHAEL MASSING Basically they understood that the key to having an
effective drug policy was making treatment available to addicts at the
point when they want help.

GEN. BARRY MCCAFFREY This was the first time that we said the federal
government will assume responsibility for treatment.

DAVE MARASH (VO) When Jaffe was President Nixon's drug czar, he put
two thirds of the federal anti-drug budget into treatment.

GEN. BARRY MCCAFFREY We wrote contracts to sort of buy up the waiting
lists. When there were waiting lists we said how much would it cost
for you to expand enough to admit all of those people? And we
negotiated those costs and wrote the checks and expanded the waiting
lists disappeared.

DAVE MARASH (VO) The results?

GEN. BARRY MCCAFFREY If you're asking what was the impact of the
treatment itself, well, there were substantial declines in the
measures of the adverse effects of heroin use. Overdose deaths went
down. New cases of hepatitis went down. There were some reports that
in some places crime went down.

DAVE MARASH (VO) The bottom line, according to Jaffe
...

GEN. BARRY MCCAFFREY Every additional dollar spent on treatment more
than pays for itself in terms of reduced medical complications,
reduced crime and general increased employment, even if you don't
count the reduction of human suffering that's associated with it.

DAVE MARASH The Clinton administration's latest budget for fighting
narcotics hues to the formula of the past 15 years. Roughly twice as
much will go for slash and burn raids in Mexico and Peru, for border
interdiction and domestic police work as for drug treatment. In fact,
over the first seven years of the Clinton administration, the share of
drug control money spent for demand reduction has actually fallen slightly.

COKIE ROBERTS For ex-addicts, the hard road to recovery comes easier
when they're in treatment programs. We'll have more on that when Dave
Marash comes back with his report in a moment.

(Commercial Break)

DONNA After spending 11 days in detox, I came here and I wasn't still,
physically I was, you know, detoxed, but I still, you know, had
trouble seeing and I couldn't sleep and it was, I was in a nightmare.

DAVE MARASH (VO) Donna is one of a group of recovering addicts we met
at the Smithers Treatment Center, one of New York City's best known
facilities, the place Truman Capote came to fight his addictions, the
place that also started baseball stars Darryl Strawberry and Doc
Gooden on their roads to recovery. Seven years ago, when Donna started
treatment, 11 days in detox wasn't unusual. Today, it's almost unheard
of. And so is this.

DONNA I was fortunate enough to get a 28 day program here. A lot of
people now aren't able to get 28 days.

DAVE MARASH (VO) No, they aren't. Instead, says Smithers' director of
administration, most patients now do rehabilitation in ...

GERALD HOROWITZ, THE SMITHERS CENTER Between 12 and 18 days and that's
when people are able to access the treatment at all. The commercial
insurance, for example, is much more reticent to put anybody into an
impatient program as opposed to providing outpatient benefits for the
individual.

DAVE MARASH (VO) Which worries many recovering addicts because they
insist recovery is a long, hard process.

EDUARDO Twenty-eight days inpatient was just very, very beginning
cause my treatment was over six months. I did one month in here and
then five months outpatient and it is an ongoing process.

JIM When an individual is so completely addicted to a substance,
alcohol, heroin, cocaine, it takes over that person's life and all the
person's decisions, all his planning, all his activities in the course
of the day have to be factored around getting, using, recovering and
getting again.

DAVE MARASH (VO) There's so much to replace, so much to overcome, so
much to get done in rehabilitation until slowly over time new, better
obligations fill in the structures of everyday life. Jay, as we'll
call him, asked us not to show his face.

JAY I have structure in my life. I, you know, have a routine to my
life, you know? I have a dog. I raise fish. I raise plants. I, you
know, I have a girlfriend. I have, you know, I have a lot of things in
my life that I didn't have before and that's pretty much what tells me
that it's working for me.

DAVE MARASH (VO) So are these recovering addicts right? Are the
cutbacks in drug treatment dictated by HMOs and insurance companies
undermining its success? The truth is, says Dr Alexander DeLuca, (ph)
we don't know.

DR ALEXANDER DELUCA The risks would be that there would be, perhaps, a
higher relapse rate or a lower engagement in treatment rate. To my
knowledge, that has not been demonstrated.

RESEARCHER They plug this into any phone, any phone socket in the wall
and they hit send.

DAVE MARASH (VO) If there is a relationship between time spent in
treatment and success or failure, we should know more about it soon
through another project funded by the drug czar's office now underway
at the Treatment Research Institute of the University of Pennsylvania.
Data pours in around the clock from computers placed in dozens of
treatment centers and hospitals in five cities. Already, some 2,000
addicts' case histories are on file.

DR. HARBERT KLEBER, NATIONAL CENTER ADDICTION & SUBSTANCE ABUSE We've
been following them since they entered treatment and right now we're
in the one year follow-up phase.

DAVE MARASH (VO) This database allows drug treatment facilities to
tailor their programs to ever changing needs, defined in part by what
drugs are being most abused right now.

DR HARBERT KLEBER You need to know what you're dealing with. In the
mid-'80s, the big problem was cocaine. Increasingly in the '90s, the
problem is becoming heroin again, but out of the corner of our eye
we're keeping a watch out for methamphetamine, which is moving across
the country from the west coast.

DAVE MARASH (VO) Soon, there will be 25 cities and eventually plans
call for a national network acquiring and distributing real time
information on drug treatment immediately available to every
participating drug treatment provider.

DR HARBERT KLEBER And that provider will be able to look and see what
patient characteristics and what treatment characteristics have done
best together.

DAVE MARASH (VO) This project should benefit addicts, treatment
facilities and, says Dr Kleber, above all, policymakers.

DR HARBERT KLEBER Policy should be driven by science. What we can do
with these studies is show that treatment can work, that it can be
cost effective, that a dollar spent on treatment can save money elsewhere.

DAVE MARASH The debate whether you get more bang for your bucks
through cutting off supplies or moderating demand is an old one. But
soon, as that data piles up from around the country, the decisions on
it should be better informed than ever. I'm Dave Marash for Nightline
in Washington.

COKIE ROBERTS When we come back, I'll talk with General Barry
McCaffrey, director of the White House Office of National Drug Control
Policy.

(Commercial Break)

COKIE ROBERTS Joining me here in Washington is General Barry
McCaffrey, director of the White House Office of National Drug Control
Policy, what we commonly call the drug czar. Thank you for being with
us, General McCaffrey. Now, that interesting report Dave Marash showed
us about a possible cocaine blocker was from a drug conference, a
conference on cutting edge technologies that you sponsored today. What
do you think about that cocaine blocker?

BARRY MCCAFFREY, DIRECTOR NATIONAL OFFICE DRUG CONTROL POLICY Well,
we're very encouraged. You know, Don Landry is a brilliant guy. We
brought together yesterday, today and tomorrow more than 400
scientists from all over the country. About 100 scientific papers were
presented and among possibly the most important a work by Don Landry,
who's taken a very unusual and creative approach to using the
bloodstream to block cocaine. We're also finding another fellow, Dr.
Mike Cuhard, (ph) Emory University, who's working against cocaine
receptors in the brain itself. So there's great promise to be able to
finally give a tool to American medicine to deal with 3.6 million
addicted Americans. We desperately need something in the field in the
hands of drug treatment.

COKIE ROBERTS That's 3.6 million cocaine addicts?

GEN. BARRY MCCAFFREY Yeah, exactly.

COKIE ROBERTS All right, and General, though, that, of course, assumes
that these people are getting to treatment in order to be able to
receive any new technologies or treatments and you saw Dave Marash's
report saying that not enough people are getting to treatment, that
the numbers are too much enforcement, too little treatment.

GEN. BARRY MCCAFFREY Well, I clearly agree there isn't enough
treatment. You know, we've put on almost a billion dollar increase in
the treatment since FY'96 - an increase of 26 percent in federal
dollars. I might add, thanks to the cooperation of bipartisan support
in Congress, we've increased drug prevention funding by 53 percent. So
your viewers shouldn't miss the point that we actually get the point
that this strategy simply must be based on prevention of drug abuse by
adolescents and treatment of the four million addicted.

COKIE ROBERTS Well, then why are the numbers so lopsided? Why is it
two thirds money for enforcement, interdiction, etc., and one third
for treatment and treatment of demand?

GEN. BARRY MCCAFFREY Well, it's sort of a screwy way of counting it,
to be honest. The drug budget has gone from $13.5 billion in FY'96 to
$17.8 billion in the year 2000 and that has disproportionately been
invested in treatment and prevention. I think the bigger problem,
Cokie, is we simply lack health parity for drug treatment in the
private sector. And in addition, we've done an inadequate job of
providing drug treatment for those behind bars, 1.8 million Americans
behind bars, half of 'em have a compulsive drug using problem.

COKIE ROBERTS Well, let's talk about that for a minute because we just
heard one of these experts say that this should be policy by science.
That's something you've said several times.

GEN. BARRY MCCAFFREY Oh, absolutely.

COKIE ROBERTS It shouldn't be - but we do have a Congress which has
year in and year out passed crime bills which say that drug offenders
must go to prison, serve minimum sentences and the prisons are getting
filled up with these people. Women's prisons are being built by the
thousands. What, I mean is this policy by science?

GEN. BARRY MCCAFFREY Well, I think Attorney General Reno and Donna
Shalala and I all basically agreed you can't get at the problem of bad
drug policy simply by arresting people and locking them up. You've got
to have treatment available and that means not only prison based but
also follow on community oversight. That community oversight can
partially be based on the best drug program in the world, which is
Alcoholics Anonymous and NA. But still, we've got to put our money
where our mouth is and I believe the administration is now doing that
with increasing support by Congress.

COKIE ROBERTS What is the evidence of that when we see this new budget
still, as I say, with these lopsided numbers?

GEN. BARRY MCCAFFREY Well, it's $3.6 billion, Cokie. We've never had
that much money in drug treatment in our history and in addition we've
got Janet Reno with a serious amount of money behind the drug court
program. Three years ago there were 12 drug courts. Today there are
almost 500 either online or coming online. I believe before we walk
out of this, these offices, they'll be more than a thousand. So we are
moving in the right direction. But let me tell you what the problems
are. We've got to have some form of drug treatment health parity in
the health insurance business and we've got to more effectively get at
the problem of closing this treatment gap, particularly in the
criminal justice system.

COKIE ROBERTS The, but I know that there are problems in the private
sector, but in the public sector it seems to me we've gone through
cycles here and in the Eisenhower and Kennedy administrations you went
to these mandated minimums, prison sentences, enforcement, all the
stuff that we're seeing now. Then in the Nixon administration, more to
treatment ,we saw the Nixon drug czar earlier in the broadcast saying
treatment was the answer, and then back to enforcement. Is, do we just
not get the message? What's the problem?

GEN. BARRY MCCAFFREY Well, again, let me say, to put it in
perspective, there's never been more federal dollars in treatment
ever. It's gone up enormously just in the last four years. In
addition, I would tell you the drug addiction problem is bigger. There
are 4.1 million Americans who are compulsive drug users, another 10
million chronic alcoholics. So the problem is immense. The dimensions
of our response are inadequate. But I think we are moving in the right
direction. We'll never get there, though, just with federal funding.
We're going to have to have some form of health insurance parity for
drug treatment.

COKIE ROBERTS And what is the administration doing to get
there?

GEN. BARRY MCCAFFREY Well, we're putting a tremendous amount of
creativity into trying to link drug treatment systems with the
criminal justice system. That's the beginning. It's called Break The
Cycle. It's a Janet Reno concept. It says if you're arrested, and you
will be if you end up as a compulsive drug user, you're going to be in
mandated drug treatment. That's one piece of the puzzle. I think the
second one is we've done a lot of analysis. We believe it's probably
the case that the health insurance industry will save money under
smart management if we provide drug treatment instead of waiting until
these people show up in hospital emergency rooms or traffic accidents
or behind bars.

COKIE ROBERTS General, we only have a couple of seconds left, but do
you see any evidence that they are willing to go that route?
Prevention's been a tough one to sell to the health maintenance people
and the health insurance people.

GEN. BARRY MCCAFFREY Yeah, well, thankfully we've gotten a lot of
support out of people like Senator Campbell and Orrin Hatch and Joe
Biden and in the House by Denny Hastert, Rob Portman and Sandy Levin.
So I think there's an increasing number of congressmen who get the
point. There's four million chronic addicts and we simply have to get
effective drug treatment into place.

COKIE ROBERTS Thanks so much, General Barry McCaffrey.
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