The White House

Office of the National Drug Control Policy

“Breaking down silos: Uniting Public Health and Law Enforcement to Pioneer a 21st Century Approach to Drug Policy”: Director’s Remarks at the First International Conference of Law Enforcement and Public Health

 

EXECUTIVE OFFICE OF THE PRESIDENT
Office of National Drug Control Policy
 
November 12, 2012
 
Remarks of Director Gil Kerlikowske – As Prepared for Delivery
First International Conference on Law Enforcement and Public Health
Melbourne, Australia
 
 
 
Good afternoon, and thank you to Professor Nick Crofts and the Centre for Law Enforcement and Public Health for bringing this unique conference to life. 
 
Thanks also to Warwick Jones and the Australian Institute for Police Management, the Nossal Institute at the University of Melbourne, and the Victoria Police—strong supporters of this conference and law enforcement and public health partnerships.   
 
Thank you all for the warm welcome to Melbourne.
 
I’m delighted to be here in Australia, a strong partner and close ally of the United States.
 
On behalf of the United States Government, we deeply value our relationship and appreciate the opportunity to join you for this historic conference. 
 
Building connections between law enforcement and public health is critical to the success of my work—and much of yours. 
 
I have spent the better part of my career in law enforcement working toward exactly the kind of partnership this meeting promotes. 
Such partnerships are critical to the public health and safety of both our nations—as leaders in the fields of law enforcement and public health, you know too well the harms caused by drug use. 
 
And I have found that such partnerships begin, strengthen, and flourish when we “break down silos.” 
 
As you know, the idea of “silos” has entered the vocabulary of how we talk about organizations. 
 
Silos, like specialties, can be a good thing. By focusing on one particular area, people develop vastly different, but equally valuable, knowledge and skill sets. Deep expertise in one area—data analysis or government relations, for example—contributes to the success of the organization as a whole. 
 
But when the walls between these different silos become so high that the people inside cannot communicate across them, the effectiveness of the organization suffers. 
 
In the private sector, this can translate into a loss of revenue or lower product quality. In government, it can lead to duplicative work and inefficiency.  
 
None of these is a positive outcome. But in drug policy, if we let silos separate public health and law enforcement communities from each other, the result will be measured not by dollars and cents, but by human life. 
 
Both the public health and the law enforcement communities bring crucial skills to the task of addressing drug use, and the Obama Administration believes these skills can enhance each other to decrease drug use and its consequences. 
 
In fact, we view drug use as a public health problem, not just a criminal justice issue. All around the world, I have witnessed a greater recognition from policymakers and the public that the drug issue is—fundamentally—an issue of public health. 
 
Years of research from some of the world’s top neuroscientists at the U.S. National Institutes of Health have shown that addiction is a chronic disease of the brain—and in the United States we have adapted our policies to reflect that knowledge.
 
It was not always this way. During much of the second half of the last century, drug policy was colored by the perception of addiction as a moral failing—simply a personal choice. This misunderstanding of the nature of addiction led to criminal justice policies that tended to criminalize chronic drug abuse. These policies established and fed cycles of drug use, arrest, incarceration, and re-arrest. 
 
The root cause of this cycle—substance dependence—was all too often ignored.
 
My office seeks to support a working environment—both in the policy world and  in the field—where public health workers and police see themselves as equal partners on the same mission: to promote public health and safety by preventing and treating drug use. 
 
When these two groups join together as partners, lives are saved. The use of naloxone, the opioid overdose reversing drug, by first responders is a perfect example of the power of this collaboration. 
 
I know that many of you are familiar with the value of equipping first responders with naloxone, and that here in Australia you’ve taken use of the antidote even further with a program in Canberra to train overdose bystanders to administer the drug. 
 
We have seen some police departments in the United States embrace this life-saving overdose antidote because often officers are the first to arrive at the scene. The results are stunning—in Quincy, Massachusetts, for example, the police department began carrying naloxone kits after struggling with one of the highest overdose rates in Massachusetts. 
 
Over the past 2 years, officers in Quincy have used it to reverse 69 overdoses. 
 
This type of collaboration embodies a 21st century approach to drug policy—one that is balanced, compassionate, and based on science, not assumptions or prejudice.  
 
In a time of economic uncertainty in the United States, the need for a forward-looking approach is more urgent than ever. 
 
Drug use exacts a staggering toll on society—the U.S. Department of Justice estimates that the health, workplace, and criminal justice costs of drug abuse to American society totaled $193 billion in 2007. 
 
Contributing to this immense cost are the millions of drug offenders who are under the supervision of the criminal justice system. For states and localities across America, the costs of managing these populations have grown significantly. 
 
Meanwhile, the violence associated with the global drug trade continues to threaten societies around the world.  
 
We need a different approach to drug policy—one that treats drug addiction as a disease and promotes a criminal justice system in which drug-related crime is addressed fairly and equitably.  
 
In the United States, we are trying to reform our public health and safety systems to enable health professionals to recognize the signs of drug addiction and intervene before the disease becomes a criminal justice issue.  And we are training law enforcement officials –including judges – to recognize how substance use disorders, particularly chronic disorders affect reasoning and judgment.
 
This reform requires a strong collaboration between the people who keep our citizens healthy and the people who keep our citizens safe. 
 
Yet, even when their missions closely align, the public health and the law enforcement communities so easily become “siloed” off from each other. 
 
We know there are significant differences between these two groups but these differences are not insurmountable.  
 
In fact, I would suggest that differences are not truly the barriers to working together—this conference is proof that law enforcement and public health groups are looking for more meaningful interaction, information-sharing, and collaboration. 
 
Enduring, effective partnerships will be forged through the creation of institutional “bridges” between these two silos. 
 
Let me give you an example. In the 1980s, we saw that some American communities were suffering from an extraordinarily high level of drug trafficking. 
 
The drug trade was wreaking havoc in these areas. And we saw that Federal, state, and local law enforcement groups were all working hard to curb it. But they were all working in isolation. 
 
Even though they shared the same mission, they had no mechanism for sharing the information, practices, and lessons gained from their work. This led to duplication of effort and less effective law enforcement.
 
Only a coordinated approach to curbing the drug trade in these communities would have the positive impact our citizens so desperately sought. 
 
So, in 1988, the US congress passed the Anti-Drug Abuse Act which established funding within the Office of National Drug Control Policy for the High Intensity Drug Trafficking Areas program, known as HIDTA. 
 
HIDTA facilitates cooperation between law enforcement groups, focusing on enhanced information-sharing, providing intelligence to various law enforcement agencies, and coordinating strategies across groups.   
 
The program has been extraordinarily successful. There are now 28 HIDTAs in the United States, funding more than 650 initiatives that go beyond law enforcement to encompass drug prevention and treatment.
 
I look at the success of the HIDTA program and see real promise for collaboration to effect social change. 
But I also see how much time and effort it took to build those bridges just within the law enforcement community. 
 
Building similar bridges between law enforcement and public health will not be fast or easy work. But it will change the face of one of the most daunting challenges of our lifetimes.
 
Based on lessons we have learned from HIDTA, it is clear that we can only break down silos by establishing a systematic, institutional system for collaboration. 
 
And we do have some real-world experience—and success—in cross-sector collaboration. Another program funded by my office, the Drug Free Communities program, distributes grants to local community-level coalitions across America. 
 
The receipt of these grants is contingent on these coalitions bringing multiple sectors of the community to the table—young people, parents, law enforcement, schools, businesses, churches, health professionals—to work together to reduce drug use.
 
Why is the need for this collaboration so great? Because when we lean too heavily on the tools of law enforcement—which has historically been the case—we risk overlooking the drug addiction that may be at the root of some criminal behavior. 
 
Most people who use drugs are not hardened criminals. Too often, their criminal behavior is often driven by an underlying health issue—addiction—that goes untreated in the criminal justice system. 
 
If we are able to create access points to drug treatment within the criminal justice system—through a strategic collaboration between law enforcement and public health—we can get at the root problem humanely and effectively—and reduce recidivism at the same time. 
 
Just last week, the California Department of Corrections and Rehabilitation released a report with significant findings in this regard.
 
The report tracked inmates released in 2007-2008 for 3 years after release and found that 63.7 percent of them returned to prison within three years. 
 
But the analysis found that those who participated in drug treatment programs returned to prison at about half the rate of those who did not.
 
Results like these give us hope for a balanced approach to the drug problem.  As a reflection of our commitment to this balance, the U.S. drug budget dedicates more funding to drug prevention and treatment than for Federal law enforcement. 
 
That funding provides strong support for alternatives to incarceration that help reduce recidivism across the United States. 
 
I am proud to share a few examples of criminal justice reform that have begun to disrupt the cycle of drug use, arrest, incarceration, and re-arrest that I mentioned before. 
 
Drug courts divert non-violent drug offenders into treatment facilities rather than jail or prison. They have operated in the United States for more than 20 years and involve collaboration between the judiciary, prosecutors, corrections agencies, drug treatment providers, and other community support groups. I know you are familiar with them here in Australia. 
 
These courts combine treatment with incentives and sanctions, mandatory and random drug testing, and aftercare. 
 
They are a proven solution to reduce substance use, prevent crime, and maximize limited financial resources, and exemplify the good that can result from a strong partnership between law enforcement and public health groups. 
 
In the US, there are more than 2,500 drug courts in operation today, and every year, approximately 120,000 Americans are connected with the treatment they need to overcome substance dependence—instead of incarceration. 
 
The success of drug courts is complemented by other innovative law enforcement programs, such as the Drug Market Intervention program.
 
This model is a strategic response to one of the most damaging influences on a community—an open-air drug market. Drug Market Interventions take a uniquely local approach by targeting individual drug markets within specific communities. 
 
The model targets drug dealers in two ways: 
  • The most violent offenders are prosecuted to demonstrate the consequences of continuing to sell drugs and commit serious crimes in the area. 
  • The strategy then calls for a community-based intervention with low level offenders, involving their friends, families, and community members. 
 
Law enforcement brings together local residents, leaders, and family members of these low-level drug dealers to stage a true intervention—and to unequivocally state their intolerance for criminal behavior. 
 
At the same time, offenders are offered the opportunity to change their lives. They are presented with a choice: either stop dealing drugs or face the maximum criminal penalties allowed. 
 
The choice to stop dealing drugs is supported by a spectrum of services that provide access to job training, housing, transportation, and health care.
 
The DMI program has resulted in real success in places like High Point, North Carolina, where four drug markets were closed—overall violent crime in the city fell 20 percent, driven by the reductions in the drug market areas. 
 
Another program, Hawaii’s Opportunity Probation with Enforcement, or HOPE, has produced positive results. It works by notifying high-risk probationers that violations will have swift, predictable consequences, and uses frequent random drug tests. 
 
Since 2009, more than 1,500 probationers (one of every six felony probationers in Oahu) have been enrolled in HOPE, all under the supervision of a single judge.  
 
HOPE differs from many current probation programs by: 
  • Focusing on immediate consequences for violations of probation or parole conditions, such as drug use or missed court-required appointments; 
  • Mandating drug treatment for probationers only if they continue to test positive for drug use, or if they specifically request a treatment referral; 
  • Providing immediate, consistent sanctions when a violation is detected; and 
  • Having employed probationers serve jail time on weekends so they do not jeopardize their jobs. 
 
In its analysis of the HOPE program, the U.S. National Institute of Justice found that HOPE probationers were 55 percent less likely to be arrested for a new crime and 72 percent less likely to use drugs than probationers in a control group. 
 
These programs are so effective because they address the root cause of criminality and because they provide clear and certain consequences to those who violate the law or the terms of their parole. 
 
Perhaps most importantly, they also connect those in need of help for their substance dependence issues to the treatment they need to build healthier, more productive lives. 
 
Programs like drug courts, Drug Market Intervention, and HOPE demonstrate that law enforcement can strategically and humanely reduce the drug trade, direct chronic drug users into the treatment they need, and strengthen communities historically burdened with the consequences of drug use. 
 
I am pleased to bring this message to a group that represents the future of smart, strategic resource management—a group that recognizes we must approach issues like substance use disorders holistically, because the siloed approach of the past has failed to effect lasting change. 
 
To address drug use effectively, we must move toward a solution that unites public health and criminal justice—and we must work to dismantle the barriers that keep them siloed from each other. 
 
I look forward to the outcome of this week’s meetings and am certain that the collaborations forged here in Melbourne will bear out innovation in the field for years to come. 
 
Thanks again for inviting me to speak here today.