DEPUTY DRUG CZAR'S TOUGH MEDICINE - MORE SCIENCE

Dr. Andrea Barthwell cringes when she hears phrases like "zero
tolerance" and "gateway drug."

This might seem like an odd reaction from the White House deputy drug
czar, but then Barthwell is not your typical war-on-drugs hardliner.

Barthwell is the first physician appointed to a senior position in the
White House Office of National Drug Control Policy since the late 1980s.

An African American who spent most of her career helping stem
addiction among minorities and women with children in Chicago, she's
also a Democrat. In fact, her nomination was backed by liberal leaders
like the late Sen. Paul Wellstone of Minnesota.

So what is she doing in the Bush White House?

"I really thought about it," Barthwell said in an interview last week.
"It's the issue."

Addiction is an issue she cares about deeply.

She is the former medical director of Illinois Treatment Alternatives
for Safe Communities, a nonprofit that provides behavioral health
services for the criminal justice and child welfare systems. She
helped found the Chicago AIDS Task Force and served two terms as
president of the Illinois Society of Addiction Medicine.

Since her appointment in January 2002 as deputy director of demand
reduction, Barthwell said she has been working to instill a more
scientific -- and humanitarian -- approach to national drug policy.

"It is a completely different strategy than the war on drugs," she
said. "It shifts the focus away from the drugs and instead focuses on
the impact substances have on people, communities and our nation as a
whole."

Focusing on people means not only reaching the 6 million or so addicts
in America, but also targeting the estimated 10 million
"non-dependent" drug users, people who take illegal drugs
recreationally but are not addicted. The majority smoke pot.

A large part of Barthwell's job is implementing President Bush's
so-called Marijuana Initiative, launched last fall, which aims to
stamp out access to and use of cannabis.

Barthwell said the way to accomplish this goal is through the lens of
science.

"I always like to say, you get the advice that you seek. And President
Bush nominated me to serve in this position, not someone trained in
the arts of war," she said. "He was seeking advice from someone
trained in the healing arts. That's what I've brought to it and that's
the focus."

Part of her focus is getting rid of the mantra that marijuana is a
gateway to harder drug abuse, which she said is "just a theory."
Instead, she sees marijuana itself as dangerous to young people, based
on scientific evidence.

"It matters little as to whether it is a gateway or not," she said,
noting that more teenagers are in treatment for marijuana use than for
alcohol. "But it is damaging enough, potent enough that it can change
the trajectory of a person's life if they start using it before age
17."

With this in mind, the Office of National Drug Control Policy is
spending $149 million this fiscal year on a sweeping ad campaign. One
of the so-called anti-drug spots depicts teenagers dying in a car
crash after smoking pot. In another, a young woman who is date-raped
at a party after taking tokes off a joint. Barthwell said these spots
are meant to illustrate the impact marijuana has on teens'
decision-making abilities.

Smoking marijuana clouds judgment, Barthwell said. This is
scientifically proven.

Yet to be proven, she said, is pot as a legitimate form of pain
management.

As a physician, I wanted to have control over a delivery system, she
said, citing well-tread concerns on marijuana dosage and side effects.
She supports prescribing marinol -- which contains a synthetic version
of Delta-9 THC, an active ingredient in marijuana -- as an extremely
viable alternative for individuals who would want us to have smoked
weed as medicine.

Accepting smoked marijuana in pain management should be done through
scientific process, she said, with review from the Federal Drug
Administration, where she sits on the drug approval advisory board.
That process, she added, should not be brought down by local
referendums.

Barthwell's assigned task of swaying public opinion on medicinal
marijuana -- a contentious, political issue that ignites passionate
responses in almost everyone with a pulse -- won't be easy.

Dr. David Smith, founder of the Haight Ashbury Free Clinic and, like
Barthwell, a past president of the American Society on Addiction
Medicine, said he doesn't envy his colleague.

Obviously, she wouldn't have taken the position without thinking she
could do some good, Smith said. She is the top physician in addiction
medicine in government and, hopefully, she can shift the focus away
from criminal justice to treatment.

The nature of drug policy in America entangles Barthwell in criminal
justice matters. She is not soft on drug suppliers. She celebrates an
administration proposal to double funding for drug courts from $50
million to $100 million over the next two years.

And she has little sympathy for pot distributors like Ed Rosenthal. A
national figure in the medicinal marijuana movement, Rosenthal was
found guilty in January of violating three federal marijuana laws,
carrying a minimum sentence of five years.

Rosenthal was deputized by the city of Oakland in 1998 to grow
cannabis for chronically ill patients under the assumed protection of
a city ordinance and the state's 1996 Compassionate Use Act, which
allows use of the drug with a physician's consent.

U.S. District Judge Charles R. Bryer did not allow this information to
be admitted in Rosenthal's trial, citing it as an invalid defense in
federal court. Many jurors said they regretted their verdict upon
learning that Rosenthal had the city's permission to grow marijuana
for medicinal purposes.

Barthwell does not see Rosenthal's prosecution as excessive.

It seems excessive that someone would grow and distribute a controlled
substance, she said.

All this discussion about marijuana, however, seems to make her a bit
weary. She brightens when talk turns to scientific breakthroughs in
addiction medicine like buprenorphine, a promising drug therapy for
heroin addicts that can be administered in the privacy of a
physician's office.

We have lagged way behind where we could have been in this country had
there been a serious medication development program to treat addicts,
she said. I hope this White House can nurture that.