SOME SAY GOVERNMENT'S NEW STRATEGY TO FIGHT DRUG ADDICTION NEEDS MORE FUNDING

For the first time, the federal government has set a goal of reducing
diseases and deaths caused by drug addiction, as well as the number of
American teenagers and adults who use illegal substances.

The surgeon general will produce a report to try to focus attention on
the escalating abuse of legal but dangerous prescription drugs. And
federal officials are urging family doctors and public clinics to help
detect addictions early by paying closer attention to whether their
patients use illicit drugs.

Such emphases, part of the maiden National Drug Control Strategy to
emerge from the Obama administration, set a different tone from its
predecessors under the Bush administration, which focused more heavily
on slowing the flow of illegal drugs into the United States. But in
the two weeks since the White House issued the 117-page strategy, a
growing chorus of drug-policy specialists has begun to complain that
President Obama and his aides are not putting enough money behind
their efforts to reconfigure the nation's drug-fighting approach.

"We have a great strategy and not a lot of means to implement it,"
said John Carnavale, a drug-policy consultant who used to work for the
government and wrote earlier versions of the national drug-control
strategy for three previous presidents in the 1980s and '90s. "That's
our worry."

Overall, the White House has asked Congress to increase spending next
year by 3.5 percent on the broad spectrum of drug-control activities
- -- from curbing drugged driving and expanding drug courts to
subsidizing opium and coca farmers in other countries to switch to
legal crops. That increase is less than the 4.1 percent increase that
President George W. Bush sought to combat drug abuse in 2002, the year
his administration developed its first national drug-control strategy.

Moreover, even drug-policy experts who like the new plan's tone say
they are disappointed that about two-thirds -- about the same
proportion as under Bush -- of the $15.5 billion proposed for drug
control in 2011 would be used to try to cut the supply of illegal
drugs rather than to lessen people's desire for them. ad_icon

"The rhetoric is different but the money is essentially the same,"
said Joseph A. Califano Jr., director of the National Center on
Addiction and Substance Abuse at Columbia University.

In particular, Califano, who led the Department of Health, Education
and Welfare (now Health and Human Services), said the White House has
not devoted enough money to the National Institutes of Health's
National Institute on Drug Abuse to finance research into new
medicines to treat addictions. The administration has asked Congress
to increase NIDA's budget next year by $35 million to nearly $1.1
billion, but that would leave the institute with $100 million less
than it had last year, according to budget figures in the drug-control
plan.

"There isn't a really whopping increase in the NIDA budget
commensurate with the fact we have learned so much about . . . how
this stuff affects the brain in ways we never knew," Califano said.

The strategy is produced annually by the White House's Office of
National Control Policy, which was created in 1988. Obama last year
lowered the office's status, so its director no longer is part of the
president's Cabinet.

The director, R. Gil Kerlikowske, said the strategy represents a new
approach that was informed by his extensive travels, collecting advice
around the country in the past year. He noted that the president has
requested a 13 percent increase for drug-prevention efforts, which is
greater than the budget proposes for other aspects of drug control,
such as law enforcement or trying to block drugs from entering the
country.

Beyond the specific federal funding, Kerlikowske said, the new
strategy envisions that federal money will be leveraged in various
ways. For instance, he said, the plan would pay for experiments in
which a network of communities would try to apply the best research
evidence to prevent teenagers from starting to use drugs. And it calls
for NIH's drug-abuse institute to give medical schools information for
use in training primary care physicians and other health-care
professionals to screen and treat patients for drug addictions.

In addition, Kerlikowske said, the law Congress passed this spring to
overhaul the health-care system has the potential to make drug
treatment more accessible, because millions of Americans with drug
addictions are now uninsured. The law is designed to expand, in a few
years, the number of people covered by either Medicaid or private
health plans sponsored by new state insurance marketplaces. Substance
abuse treatment must be available through both kinds of insurance.

More fundamentally, Kerlikowske said, "I reject the whole argument"
that drug-fighting money can be thought of as two distinct parts. "The
country is really ready for a complex discussion about a complex
problem, and not a bumper sticker answer about supply versus demand."