Drug Policy under Obama: substance beyond the rhetoric?

Despite pleasing indications the US may be considering alternatives to the war on drugs, conflicting words and actions mean any new direction on the part of the Obama administration remains ambiguous, argues Allan Clear.
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Since President Obama’s election, America’s Office of National Drug Control Policy (ONDCP) has been making noises about a change in its priorities and approach to illicit drug control. But the jury remains hung as little of substance has emerged so far. There have been some cautious reasons for optimism, but recent developments do make one wonder.

The political appointees within the ONDCP give an indication of how this new approach may look. New Director Gil Kerlikowske was latterly Chief of Police in Seattle – a city with a large needle exchange programme, in a part of the country that has integrated a harm reduction approach into its drug strategy and hosts an active drug reform community. New Deputy Director Tom McLellan is a well known drug treatment proponent.

Addressing the term ‘war on drugs’ was the first change. Kerlikowske declared it an unhelpful appellation and said changing the tack of the former strategy would be like altering the course of a massive oil tanker. Even before the appointments, the US publically reversed its position on syringe exchange by acknowledging that the science was clear and that it works. This was a very welcome 180 degree turn from the previous administration.

That said, it also became clear that a broader harm reduction approach remained taboo. Harm reduction is a health-based approach that takes into account the realities of drug use. It actively eschews moralistic and punitive approaches, such as those epitomised by the war on drugs. For the new administration, a philosophy of inclusion remains beyond the pale.

The Commission on Narcotic Drugs (CND) is a high-level United Nations drug meeting during which declarations and resolutions are developed and passed down to the United Nations Office on Drugs and Crime (UNODC) in an effort to set global drug policy. The March 2010 53rd CND meeting in Vienna represented another marker on how the US would present its new face to the international community. Last year’s meeting became a tempestuous event over the inclusion of the words ‘harm reduction’ in the major Political Declaration that climaxed the meeting. Although it’s a consensus driven event, 26 countries bolted at the close in protest at the ultimate exclusion of these two words. In the US, harm reduction ranks with socialism or free health care. It’s incomprehensible that ‘real’ governments use harm reduction as the designated approach to addressing drug use. To exclude this language is not only a denial of reality, but also a slap in the face of countries that have already embraced this approach.

As with pretty much all other progressive change movements, discussion and dialogue between camps under the previous US administration was non-existent. I remember leaving the 52nd CND meeting when an ONDCP staffer remarked that this was the first time that the US delegation had been allowed to meet with ‘drug legalisers’. Of course, within the ONDCP bubble, any group challenging the prevailing drug war paradigm is labelled a drug legaliser – a term that, according to US propaganda, has nothing to do with regulating drug markets and everything to do with selling crack to 10-year-olds. The ‘drug legalisers’ that talked to the delegation in Vienna last year included organisations like the Harm Reduction Coalition, Human Rights Watch and the Washington Office on Latin America – all of which seriously critique of the failings of US drug policies, but none of which have strategies to make drugs legal.

The 53rd CND promised to be a more convivial love fest than last year. We were promised a new approach, and were watching to see how the US presented itself. Could it be a uniting force or would it continue in its familiar, divisive approach? Things started looking up on the very first day, with opening speeches from Gil Kerlikowske and Tom McLellan. Both were eminently pragmatic, reasonable, knowledgeable — and devoid of war on drugs rhetoric.  McLellan took the treatment angle; and while Kerlikowske disappeared to trade war stories with the Russians, his Deputy stayed throughout and was quite a charm. Could it be that the glass is becoming more than half full?

In fact, as I noted in my post from the first day, Commission on Narcotic Drugs: Progress Towards a Pain Free World?, the US sponsored a resolution that may allow more access to pain medication for chronically or terminally ill patients. This may not seem like a big deal in the US, where patients in the last stages of illness are often provided with liberal amounts of pain medication, but this is not a global phenomenon.  As a recent report from Human Rights Watch notes, 150 countries have no access to medical opioids or other effective pain medication. No morphine, no Fentanyl – no nothing. For better or for worse when it comes to global drug policy, what the US says often goes, meaning this resolution could have a truly positive impact on peoples’ lives worldwide.

It was also refreshing to hear Tom McLellan critique the shortcomings of the current US drug treatment system on the second day (Read my full post, Reforming Drug Treatment in the US: Two Steps Forward, One Step Back). In contrast to the usual rhetoric which places all the blame for failure on users and accredits all good news to the wonders of the current system – McLellan called for market driven reforms that would take into account the needs of drug users.

But here’s the rub. Despite McLellan’s talk of a market driven system, the US is still averse to the inclusion of the words ‘people who use drugs’ in international resolutions and documents, and continues to actively work for the removal of this language. Of course, that clause usually appears in the context of including drug users’ input into policy and service development. If the US is serious about addressing stigma, exclusion and discrimination against people who use drugs, shouldn’t it come up with a plan that doesn’t stigmatise, exclude and discriminate against them?

So, despite a seemingly realigned approach to drug policy under the new administration, the US remains doggedly opposed to using the term 'harm reduction'. As I wrote in my CND wrap-up: Most Improved (Drug Policy) Player: the USA. This resistance comes even while the US explicitly supports many harm reduction practices. For example, the US statement regarding demand reduction reinforced support for needle exchange as well as every intervention that appears in the UNODC, WHO, UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users.

That said, the US still does not put any level of support into interventions that it does not feel are geared toward decreasing drug use, such as safe injection sites and heroin prescription programmes, despite evidence they do result in reductions in the use of illicit drugs.

Overall, the public face of the US at the 53rd meeting of the CND was a reasonable one. I found myself more in agreement than disagreement with most of the statements and presentations. It was middle ground; not so much about the elimination of all drug use, and more about a health-centred approach. However, the next and more meaningful step must be action.

The ONDCP is about to release its new drug strategy. At some point in its development, I participated in a 45 minute conference call with Director Kerlikowske and 10 or so drug reform groups who were invited to make three or four points towards the plan. On the one hand it was a tokenistic and nonsensical gesture, but on the other it was the first time that a diversity of input was actually considered – authentic or not. It’s hard to tell at this point whether the new approach is a cynical placation device or a more genuine but wary curiosity.

To compound matters, Tom McLellan has announced his resignation. He has denied a difference of opinion but claims he’s not cut out for government. This would come as no surprise if you’ve talked to him. He has an openness, whereas his praetorian guard of assistants and protectors have a closed visage of paranoia and suspicion. No one really thought McLellan was the true ‘great white hope’, but he did signify a positive move for drug users.

Now, you have to wonder what will come next. Will the ONDCP step out of its comfort zone and move beyond an abstinence-based approach? Will there be some heft, money and political clout behind the rhetoric?

We shall see, but doubts grow.

• Allan Clear is Executive Director of the US-based Harm Reduction Coaliation www.harmreduction.org.