• Drug Policy Reform at Home and Abroad

    Today is the International Day Against Drug Abuse and Illicit Drug Trafficking, an annual observation established in 1987 by the United Nations General Assembly. It is an important day to reflect on the progress the world has made against drugs and the many challenges still to be addressed. 

    One notable example of progress is the increasingly widespread support for a public health-focused approach to the drug problem. Just a few years ago, a focus on prevention, early intervention, behavioral and medication-assisted treatment, overdose prevention, and recovery support services was controversial in many areas of the world. In fact, there was a time when the word “recovery” was not even accepted in U.N. documents. But in 2014, a U.S. resolution on recovery at the annual U.N. global drug meeting (the Commission on Narcotic Drugs) easily won approval.  These discussions at the U.N. and elsewhere have led to a greater appreciation of the urgent need to reduce the stigma associated with substance use disorders – both out of genuine compassion and as a means to encourage those who need help to seek treatment.

    Implementing public health policies requires a lot of hard work and an investment in building treatment capacity, including training medical professionals on how to address substance use disorders through screening and early intervention. Once medical professionals are trained to screen patients for substance use, they can identify and address problems earlier. This type of assessment can result in huge long-term savings in future criminal justice and other public costs.

    Also critical to improving public health is the use of medications to treat addiction and the implementation of medication-assisted treatment (MAT) protocols. Although cultural and social stigmas regarding medications used to treat opioid use disorders persist in some places, clinical research has shown it is highly effective, reducing relapse rates and improving health outcomes significantly.

    Another encouraging development is the emerging global consensus in favor of alternatives to incarceration for people with substance use disorders.

    There are now over 2,900 drug treatment courts in the United States and dozens more internationally. Over the years, these specialized courts have continued to refine and improve their operations. This intervention has repeatedly demonstrated success in decreasing recidivism, driving drug use down, and reducing criminal justice costs.  In addition, DTCs break down the walls that too often divide justice and health agencies, allowing them to work together toward the same goal.  It is no surprise that international partners are studying these models and adapting them to the challenges they face in their countries.

    In just over a decade, Hawaii's Opportunity Probation with Enforcement (HOPE) and similar initiatives operating in about 40 jurisdictions have helped to inspire probation reforms across the United States.  The Swift, Certain, Fair approach reduces drug use, recidivism, and crime by employing brief, consistently applied sanctions for every probation violation.  Treatment is provided to those who request it.  An independent evaluation of the HOPE program found that participants – primarily methamphetamine users – were 55 percent less likely to be arrested for a new crime; 72 percent less likely to use drugs; 61 percent less likely to skip appointments with their supervisory officer; and 53 percent less likely to have their probation revoked.[1]

    As the international community prepares for the U.N. General Assembly Special Session on drugs in April 2016, the United States will advocate wider adoptions of vital reforms such as these around the world.

    More information about medication-assisted treatment and alternatives to incarceration is available at http://www.dpt.samhsa.gov, the National Association of Drug Court Professionals, and the SwiftCertainFair Resource Center.


    [1]  “Swift and Certain” Sanctions in Probation are Highly Effective: Evaluation of the HOPE Program, Office of Justice Programs, National Institute of Justice. Available at: http://www.nij.gov/topics/corrections/community/drug-offenders/pages/hawaii-hope.aspx



  • How Drug Courts Make the Case for Alternatives to Incarceration

    Director Botticelli with drug court graduate Donovan Simmons

    Director Botticelli with drug court graduate Donovan Simmons.

    Donovan Simmons was the type of person many judges might have written off. He had pled guilty to a series of criminal charges, including burglary, and had been sentenced to five years in prison.

    But Judge David Tapp of Somerset, Kentucky, refused to write Donovan off.

    Like many people who come into contact with the criminal justice system, Donovan had a long history of substance use disorders. He struggled with serious marijuana and opioid use disorders, which began as he tried to cope with childhood trauma. Donovan was ill and needed medical treatment, not jail.

    For decades, science has shown that addiction is a chronic brain disease—not a moral failing on the part of an individual. So treating the disease can give people caught up in the criminal justice system a chance to break free from the cycle of drug use, crime, arrest and imprisonment.

  • Community Policing and Drug Overdose: Where You Live Doesn't Have to Determine Whether You Survive an Overdose

    The odds of surviving a drug overdose, much like the odds of surviving a heart attack, depend on how quickly the victim receives treatment. But access to naloxone—which can reverse heroin and prescription drug overdoses--varies greatly across the country, even though all drug poisoning deaths have surpassed traffic crashes as the most lethal cause of preventable injury. Because police are often the first on the scene of an overdose, the Obama Administration has strongly encouraged local law enforcement agencies to train and equip their personnel with naloxone.

    Yesterday, the President traveled to Camden, New Jersey, a city that’s taken steps to create economic opportunity, help police do their jobs more safely, and reduce crime in the process. Yet another area where the Camden County Police Department is taking the right steps is with its creation of an overdose prevention program.  This program has reversed 68 overdoses since it started a year ago. Across New Jersey, law enforcement officers have used naloxone to respond to overdoses 888 times since 2014.

    By engaging with law enforcement in naloxone administration, we are truly pursuing a 21st century approach to drug policy and community policing--one that combines public health with public safety.

    Recently I met Corporal Nicholas Tackett, a police officer from Anne Arundel County in Maryland. Corporal Tackett has witnessed about 50 drug-related overdoses in his law enforcement career.

    He knows the signs of overdose, the looks on their faces. Now, with naloxone, he has a tool that enables him to save lives. Corporal Tackett brought me to the locations where his use of naloxone reversed the life-threatening overdoses of two people. Naloxone works, and it is an incredibly important tool.

    In October 2014, the Department of Justice released a Naloxone Toolkit for law enforcement. This toolkit is an online clearinghouse of more than 80 resources, such as sample policies and training materials designed to support law enforcement agencies in establishing a naloxone program. 

    In the past year, we have witnessed an exponential expansion in the number of police departments that are training and equipping their police officers with naloxone.  They now number in the hundreds and they are saving lives.

    The Police Department in Quincy, Massachusetts, has partnered with the State health department to train and equip police officers to resuscitate overdose victims using naloxone. The Department reports that since October 2010, officers in Quincy have administered naloxone in more than 382 overdose events, resulting in 360 successful overdose reversals.

    The Vermont Department of Health has been distributing Overdose Rescue Kits with naloxone to State police as well as to individuals through community-based partners. To date, naloxone has been deployed 146 times across the State.

    There is also collaboration taking place in rural and suburban communities. In Illinois, the Lake County State’s Attorney has partnered with various county agencies, including the Lake County Health Department; drug courts; police and fire departments; health, advocacy and prevention organizations; and local pharmacies to develop and implement an opioid overdose prevention plan.  As of February 2015, the Lake County Health Department had trained 828 police officers and 200 sheriff’s deputies to carry and administer naloxone, and more departments have requested this training.

    To build on these efforts, the President’s FY 2016 Budget directs the Department of Health and Human Services to permit the use of block grant funds for naloxone purchases. It also provides funding specifically for law enforcement to purchase naloxone.

    Where you live shouldn’t determine whether or not you survive an overdose. So our goal is to get naloxone in every community where overdose deaths are prevalent. Combined with evidence-based prevention programs and access to effective treatment, this approach will save the lives of many Americans.

    Michael Botticelli is Director of National Drug Control Policy. 


  • Honoring Courage and Saluting Sacrifice During National Police Week

    This week, Director Michael Botticelli joins thousands of law enforcement officers from across the country, President Obama, Attorney General Loretta Lynch, Secretary Jeh Johnson and other distinguished officials in Washington, D.C. to honor the lives of officers who have gave the ultimate sacrifice. 

    As part of National Police Week, Director Botticelli read the names of three fallen officers at the 27th Annual Candlelight Vigil at the National Law Enforcement Officers Memorial. Today, he will join President Obama at the 34th Annual National Peace Officers’ Memorial Service on the West Front Lawn of the United States Capitol.

    Law enforcement officers have a profound sense of duty to serve and protect their communities.  Every day, they place their lives on the line knowing they could be exposed to harm at any moment.  ONDCP honors all the brave men and women who have died to protect the safety of others. 

    During Police Week, we also particularly recognize officers on High Intensity Drug Trafficking Area (HIDTA) Task Forces who, despite the risks, remained steadfast and gave their lives in the line of duty, including Ogden Police Officer Jared D. Francom, Los Angeles Sheriff's Department Deputy Sheriff Jerry Ortiz, Glendora Police Detective Louis Pompei , FBI Special Agent Paul M. Sorce and Maryland State Police Corporal Edward M. Toatley.

    We owe all those who we have lost, and the men and women keeping us safe today, our deepest gratitude for protecting our families, homes and communities. 

  • The Indianapolis Star: "Work to prevent opiate drug abuse"

    Since Gov. Mike Pence issued a public health disaster emergency order in response to the state's HIV outbreak, public and private leaders have marshalled a remarkable effort to identify cases, provide care and support to those who have tested positive for HIV, and prevent new infections. This evidence-based approach is critical to effectively contain the outbreak.
    Last fiscal year, the federal government invested more than $23.2 million to support HIV, sexually transmitted disease and viral hepatitis prevention, treatment and response activities in Indiana. Federal-state partnerships like this are essential to achieving an AIDS-free generation.

  • We Don’t Have Time to Wait

    This is a picture of Taylor Smith from Holly Springs, Georgia, with her sister, Gabrielle.

    Taylor Smith photo

    Taylor Smith (right) with her sister, Gabrielle Smith.

    Taylor died of an overdose.

    Her mother, Tanya Smith, writes: 

    "Taylor was a freshman, junior varsity and varsity squad basketball and football cheerleader at Creekview High School; known for her quick wit and infectious squeaky laugh, she was an avid animal rescuer, and quickly came to the defense of those she felt were treated unfairly. She was 20 years old when she overdosed in the company of friends, who subsequently dumped her body in the yard of an abandoned trailer to avoid arrest for drug possession.”

    Taylor might still be alive if her friends had known that Georgia, along with 21 other states and the District of Columbia, has legal protections in place that shield people possessing drugs from criminal liability if they’re helping someone having an overdose. 

    Her mother Tanya has channeled her grief into action, pushing to make sure that law enforcement officers in her town now carry naloxone — the antidote for opioid overdose. 

  • Recovery Story: Patrick Kelley, Photographer to the Commandant of the Coast Guard

    When Coast Guard Petty Officer Patrick Kelley met Director Michael Botticelli last November on a flight to Panama for an Interdiction Committee meeting, they instantly bonded over their similar past: Both men are in long-term recovery from alcohol use disorders. For Kelley, Botticelli’s journey from alcoholic to 26-years-sober Director of National Drug Control Policy was inspiring – so much so that he decided to share his own recovery story with the Office of National Drug Policy.

    Two years ago, Kelley was in a dark place. His marriage was failing, and he found himself routinely drinking to excess, alone. He was hesitant to admit his alcohol problem to his Coast Guard colleagues because he worried that admitting he had an alcohol use disorder would damage his reputation or force him out of his job.

    After his decade-long struggle with alcohol culminated in one awful night, Kelley finally opened up about his substance use disorder and sought help within the Coast Guard community. He was amazed by the response: His friends and peers rallied around him and helped him into treatment. His biggest fear had been getting kicked out of the Coast Guard, but the opposite happened. He found that the Coast Guard has a compassionate, evidence-based response to service members in need of treatment for substance use disorders.

    In November 2014, the U.S. Coast Guard Headquarters established a 12-step support group that helps ensure that service men and women struggling with substance use disorders don’t have to feel isolated when seeking treatment.

    Director Botticelli sat down in March with Rear Admiral Maura Dollymore, the Coast Guard’s Director of Health, Safety and Work-Life, and other senior staff for a Coast Guard Prevention and Treatment roundtable discussion. At the meeting, Coast Guard leadership talked about the newly formed support group that helps service members like Kelley through treatment, and Director Botticelli offered his support for the Coast Guard’s prevention and treatment initiatives.

    Watch Patrick Kelley’s story, and share it with someone you know: 

  • ‘Reality TV’: House of Cards Highlights the Importance of Prescriber Education

    Spoiler alert: This post discusses  House of Cards Season 3.

    Although House of Cards is known mostly for its political drama and manipulative characters, season three’s story line about character Doug Stamper has highlighted the importance of prescriber education and the realities of relapse during recovery.

    After Doug’s six-month hospitalization to rehabilitate his leg, his doctor prescribes medication to address his anxiety and depression. She tells Doug she cannot prescribe him painkillers because of his history with alcohol use disorder. Yet after he falls and breaks his arm in the shower, an emergency room doctor prescribes Percocet, a mix of oxycodone and acetaminophen. Although Doug had been in recovery and attending Alcoholics Anonymous meetings for 14 years, the prescription triggers a relapse.  Initially regulating the amount of alcohol he drinks with a syringe, Doug eventually begins drinking uncontrollably until he meets with President Frank Underwood while intoxicated and asks for help. With the help of his brother, Doug is able to get sober again and become the President’s Chief of Staff.

    In recent years, the number of filled opioid prescriptions has increased dramatically. Although opioid pain relievers are among the most powerful medications available and can effectively relieve suffering for many patients, they also present grave potential for misuse.

    The first and most crucial step for the prevention of opioid misuse is to educate drug prescribers and dispensers. Practitioners, nurses, and pharmacists have a role to play in reducing prescription drug misuse. Unfortunately, prescribers receive little training in the risks associated with dispensing opioid pain relievers, especially for persons in recovery.

    The physician who treated Doug’s leg was familiar with her patient’s medical history. She knew an opioid prescription would be detrimental to his journey in long-term recovery. Meanwhile, the emergency-room doctor, who met with Doug only briefly, prescribed a highly addictive painkiller without first asking if Doug had any history of substance use or disorder. As we learn from House of Cards, it is essential that prescribers receive training regarding the substance use history of patients to prevent triggering a relapse for those in recovery.

    It is important to note, however, that Doug’s relapse was not out of the ordinary. A substance use disorder is a chronic disease, which means that for many in recovery, relapse is not only possible, but likely. Relapse rates for substance use disorders are between 40 and 60 percent—similar to those for other chronic medical conditions, such as diabetes, hypertension, and asthma. Just like these other conditions, substance use disorders do not discriminate: Anyone can possess the risk factors or fall into the cycle of misuse. Relapse is never a sign of failure for any patient; rather, it is a speed bump on the road to recovery. It is essential that prescribers receive training to aid in the recovery process and make this journey as smooth as possible.

    Doug Stamper is a fictional character in a dramatized television show, but his story of recovery and relapse is far from fictional. House of Cards illustrates how imperative it is for prescribers to know their patients’ histories before prescribing opioids. Doug’s story serves as a reminder to the friends and families of persons in long-term recovery that relapse of a substance-use disorder is as much a reality as it would be for any chronic medical condition, but that with their love and support, recovery is completely attainable.

  • Commission on Narcotic Drugs Endorses Alternatives to Incarceration for Substance Use Disorders

    Earlier this month, the United Nations Commission on Narcotics Drugs (CND) approved a resolution that called for justice and health agencies to work together to provide a range of alternatives to incarceration for those affected by a substance use disorder. The CND, held in Vienna, Austria, is the largest annual governmental meeting on drug issues with 53 member states. The White House Office of National Drug Control Policy initially proposed the resolution.

    “A global consensus is emerging that no nation can solve its drug problem by simply arresting and incarcerating those affected by a substance use disorder,” said Director of National Drug Control Policy Michael Botticelli, who represented the United States at the CND. “The United States is strongly committed to advancing strategies that bring justice and health agencies together on innovative solutions for drug-involved individuals wherever they are in the world.”

    The United States introduced the resolution, which emphasizes that too many individuals with substance use disorders around the world are serving extended prison sentences, but not receiving evidence-based treatment or other needed health services. Increasing the use of alternatives to incarceration and the provision of treatment for these individuals, whether in the community or in prison, supports sustained recovery from substance use disorders, promotes fairness, and reduces prison overcrowding.

    The resolution encourages all countries to utilize a range of alternatives to incarceration and other criminal justice reforms that also promote treatment for substance use disorders.  The health-related interventions referenced in the resolution include screening for substance use disorders, access to treatment, including medication-assisted treatment, counselling services and other behavioral health services, overdose prevention and treatment, recovery support services, treatment for HIV, hepatitis, and other infectious diseases and mental health disorders. The alternatives to incarceration and other reforms listed include reduced or suspended sentences, diversion programs before or during trial, home detention, community service, fines, victim restitution, random drug testing, and GPS tracking.

    Effective combinations of supervision and drug treatment, which are a subject of ongoing research in the United States, can result in more effective crime reduction, better health outcomes and lower prison costs. These alternatives can also allow incarcerated individuals with substance use disorders to return to their families and communities, while concurrently receiving treatment and helping to break the cycle of drug use, arrest, incarceration, relapse and re-arrest.

    The resolution, specifically called for the following:

    • Greater collaboration between health and justice agencies on alternatives to incarceration;
    • Establishment of mechanisms to “break down the silos” between health and justice agencies so they can work together better to provide health services for those under criminal justice supervision;
    • Training for justice officials on the effectiveness and importance of evidence-based treatment for substance use disorders;
    • Recommendation that governments review their drug sentencing practices to ensure that they allow for alternatives to incarceration for those affected by a substance use disorder; 
    • Collection and sharing of best practices and research on collaborations between justice and health agencies on alternatives to incarceration for those with a substance use disorder;

    The full title of the resolution is: Supporting the Collaboration of Public Health and Justice Authorities in Providing Alternatives to Conviction or Punishment for Drug-Related Offenses of a Minor Nature. The following countries co-sponsored the resolution: Australia, Ecuador, El Salvador,  European Union, Germany, Greece, Guatemala,  Israel, Lithuania, Mexico, Namibia, and Uruguay.

  • Celebrating Five Years of the Affordable Care Act

    Nora Zarabia faced a difficult – and all too common -- question when her 20-year-old son, Alex, was diagnosed with a substance use disorder. How was she going to pay for the help he needed

    Fortunately for Alex, Nora’s health insurance – thanks to the Affordable Care Act (ACA) – allowed him the opportunity to receive addiction treatment and care under her policy until age 26. After that, he can obtain insurance on his own that will cover his treatment needs. The ACA requires insurers to cover mental health and substance use disorder treatment at the same level they’d cover any other medical treatment. Without the care he received, Alex may not have entered recovery and gotten back on track at school, building the life he and his mom had hoped for.

    As we celebrate the fifth anniversary of the Affordable Care Act becoming law, we celebrate that millions more people have health insurance than before. And that’s not all there is to celebrate. The ACA establishes the biggest expansion of mental health and substance use disorder coverage in a generation. It requires insurers to provide mental health and substance use disorder benefits at parity with coverage for any other medical condition, like diabetes or heart diseases. In total, this expansion creates new opportunities for substance use disorder and mental health care for more than 60 million Americans.[i]

    Research highlights an increase in utilization of inpatient care for mental health and substance use disorder services among young adults between 2010 and 2012, according to the Health Care Cost Institute.[i]

    The Affordable Care Act offers a profound change for those who suffer from substance use disorders – one that has proven time and time again to save lives. Millions of Americans, like Nora and Alex, have had a burden lifted by having options and access to quality care.

    The Obama Administration is committed to restoring a balance to U.S. drug-control efforts by focusing on public health to reduce drug use and its consequences. By decreasing the number of uninsured Americans and cutting costs, the Affordable Care Act plays a crucial role in connecting Americans to the resources they need.

    We’ve made great progress: after five years of the Affordable Care Act, 16 million people have gained health coverage.

    That’s something to cheer about. So on this anniversary, let’s celebrate opportunity and progress – for our loved ones, for our communities, and for our nation.

    [i] Health Care Cost Institute, Issue Brief No. 8: Selected Health Care Trends for Young Adults (ages 19-25): 2007-2012. September 2014. Available online at http://www.healthcostinstitute.org/files/IB8_YA_09242014.pdf.

    [i]  U.S. Department of Health & Human Services, ASPE Issue Brief: Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans. February 2013. Available online at http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm