Tuesday, March 30, 2010

Deputy Drug Czar Goes His Own Way

Doctors are part of the problem, says McLellan.

In a March 15 cover story titled “The American Way,” Drink and Drugs News  of the UK ran an insightful interview with America’s “deputy” Drug Czar, Thomas McLellan. Professor McLellan, deputy director of the Office of National Drug Control Policy, is not a cop, like his boss Gil Kerlikowske, or a retired Army general, like former Drug Czar Barry McCaffrey. McLellan is a rare breed, a treatment specialist, and brings an entirely different viewpoint to an office that has traditionally been strongly oriented toward law enforcement.

“In the US we’ve been thinking about addiction as just a lot of drug use,” McLellan told a group of addiction specialists and policy professionals at the Institute of Psychiatry in London. “And as a result we’ve been purchasing [treatment] stupidly. We can’t decide if addiction is a crime or a disease so we’ve compromised and given them treatments that aren’t any good.”

McLellan singled out doctors for special attention: “Most physicians are not trained in how to treat substance abuse. They don’t see it as a disease and don’t see why they should look for it.”

Treating addiction like any other medical condition is still a goal rather than a reality. “You may know that the relapse rates for diabetes, hypertension and asthma are almost identical to the relapse rates for any addictive disorder…. And no one puts their hands on their hips when a diabetic comes back and says, ‘I ate half a bucket of fried chicken and I forgot to take my insulin, and now I’m back here.’ They just treat them.”

If there are doctors who don’t believe in the disease model of addiction, we can’t be surprised if members of the general public—and addicts themselves--often feel the same way.  McLellan said that less than 3 % of all referrals for addiction treatment and specialty care originate with doctors. Moreover, roughly half of 12,000 smaller treatment programs in the U.S. have no doctor, nurse, or psychologist on staff. And counselors, who make up the majority of treatment staff, suffer from a 50 % turnover rate.

In addition, McLellan took on the traditional British aversion to methadone treatment for heroin addicts: “That this has been a battle, that you are either on methadone or you are on the path of truth, beauty and light, is artificial and unfortunate…. I’m now officially wagging my finger and saying not just to Britain, but to the whole damn field; get past this, this is an artificial contrivance. People ought to have the opportunity to get the medications and other services they need.”

McLellan also had choice words for politicians and policy makers who see incarceration as the only acceptable response to drugs and drug-related crime.  He referenced studies that “suggest very clearly that in a prison situation, when you release somebody with a drug problem, they are back and you’re going to do it all over again. It’s a bad business deal.”

Ongoing care—after prison, or after treatment—is essential to success. “I think residential care is important and necessary, but not sufficient,” McLellan maintained. “It is like having a very good junior high school education.”


Anonymous said...

Do you get the impression that McLellan is really steering the activities of the ONDCP? I know at least the ads coming out under Obama are much "better" IMO, e.g. worthy campaigns against drugged driving and recreation prescription use.

Dirk Hanson said...

I don't know, but I hope so. Like you say, the PR seems to be better than it ever has been.

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