MEDICAL LEADERS SUPPORT TREATMENT FOR DRUG USERS

WASHINGTON -- With drug abuse again on the rise and the Clinton
administration proposing major new treatment initiatives, America's medical
establishment argued Tuesday addiction can be treated as effectively as
diabetes or asthma.

That means the nation's current emphasis on punishment rather than treatment
is fundamentally flawed and a costly mistake, the doctors said, in an
unusually strong critique of government drug policy.

``We're hoping we can rebalance the way we approach this enormous problem,''
said Dr. June Osborn, the chair of the Physician Leadership on National Drug
Policy, which issued the critique. ``This doesn't mean the criminal justice
system has no role here, but it shouldn't be left to deal with addiction on
its own.''

Though this idea has been around for some time, the critique is the first
time the medical establishment has united to challenge government drug
policy. The group included 37 prominent doctors, including former members of
the Reagan, Bush and Clinton administrations.

``These findings echo the administration's efforts to provide more effective
drug treatment to addicts and to break the cycle of drug crime and
imprisonment,'' said Gen. Barry McCaffrey, the White House drug czar, who
was briefed on the report last week.

McCaffrey said his office would study the report during a conference next
week.

Treatment vs. punishment has long been the debate in drug policy, but
punishment has won out in recent history, as drug sentences have been
toughened and the number of drug-related sentences has ballooned. As of
1997, 60 percent of all federal prisoners were sentenced for drug
violations.

One of the difficulties facing the doctors is the public's views of the drug
problem are strikingly different than theirs. A new study showing the public
wants more jail time and less treatment for drug users was also released
Tuesday. The doctors said the public has been misled by media accounts, and
government should not be influenced by a misinformed public.

``Policy makers weigh public opinion more than they weigh the science,''
said Dr. Phillip Lee of the University of California at San Francisco
medical school and a former Clinton administration official. ``The
administration is cutting the money for treatment. This is a very wrong
decision.''

McCaffrey has supported treatment in the past but opposition from Congress
has made it hard for him to significantly change the administration's focus.

In comparing drug addiction to asthma or diabetes, the physicians face
criticism from those who argue addicts make a choice, while asthmatics do
not. The doctors countered with evidence drug addiction is in part
genetically determined.

``It would be very hard for someone who doesn't have the genetic trait for
alcoholism to become addicted to alcohol,'' said Dr. Thomas McLellan, a
psychology professor at the University of Pennsylvania. ``Yes, there is a
choice involved, but so is there in insulin-dependent diabetes. You wouldn't
be insulin-dependent if you watched your diet and reduced salt intake.''

Another concern has been drug addicts often relapse, making treatment a
losing battle. The doctors said treating drug addicts is as effective as
treating asthma or diabetes. About 50 percent of diabetics fail to go
through with their treatments. About 40 percent of drug addicts similarly
fail.

``Would you consider a 50 to 60 percent success rate in diabetes treatment a
success? Most of the world does. The same can be said of drug treatment,'
said McLellan.

While most Americans consider the war on drugs a failure, they don't want to
give up on a tough law enforcement solution, according to a new study in the
Journal of the American Medical Association. They view drug abuse as a moral
problem, while doctors see it as a public health problem.

The study also found most Americans get their information on drugs from both
news and entertainment programs on television. The coalition doctors said
they are making their unprecedented public push mostly to counter what they
see as misinformation.

``Public opinion has to be better informed than it is,'' said Dr. Lonnie
Bristow, a former president of the American Medical Association.

The coalition of doctors consists of several medical heavyweights, including
former Food and Drug Administration head David Kessler; Dr. Antonia Novello,
the Surgeon General for the Bush administration; Dr. Frederick Robbins, a
Nobel laureate in medicine; the deans of several prestigious medical
schools; and the heads of several professional medical associations.

Sending addicts to jail costs society much more than treating them, they
argue. The annual cost of jailing each addict is $25,900, whereas the annual
cost of treating each addict ranges from $1,800 for outpatient treatment to
$6,800 for long-term hospitalization.

``Society is paying way too much to deal with drug addiction,' said Dr.
David Lewis, a professor of medicine at Brown University.

Lewis was the catalyst for the critique. He had been researching a book on
the history of narcotic prohibition when he noticed the medical profession
as a whole had not embraced the overwhelming research supporting the
effectiveness of drug treatment.

``The thing I noticed was the medical profession bought the dope fiend
image,'' he said. ``Those doctors who advocated treatment were shot down and
thought to be on the fringe.''