Richard J. Bonnie
Physicians and Lawyers for National Drug Policy: A Public Health Approach
April 20, 2004
National Press Club, Washington, DC
10:00 – 11:00 AM
We are here today to announce the creation of Physicians and Lawyers for National Drug Policy:
A Public Health Partnership.
Lawyers and doctors in a partnership? Perhaps this sounds fanciful to you. After all, the very mention of doctors and lawyers in the same sentence evokes only one topic – and one on which there is only conflict, not collaboration: To one profession, malpractice litigation is the problem, while to the other it is the solution.
Perhaps collaboration between lawyers and doctors is unusual, but it is not unprecedented. In the 1950s, the two professions joined together to advocate for a more treatment-oriented approach to drug addiction. Although it took nearly 20 years, their common voice was eventually heard, and the nation’s drug policies underwent a profoundly important change. The Controlled Substances Act of 1970 set up a regulatory structure for balancing the medical need for psychoactive drugs against the risks of abuse and addiction. In 1972, Congress enacted legislation to promote voluntary drug treatment by cloaking it with a cloak of confidentiality under federal law. Federally funded treatment capacity was created in every state, and a strong research infrastructure was created in the NIH. Treatment-oriented diversion programs were embraced by many criminal justice agencies. Annual national surveys were initiated to monitor the prevalence of drug use in the adult and teenage populations. These were the pillars of a public health approach.
In the past 25 years, the strong consensus about the need for evidence-based drug policy based on a public health approach seems to have unraveled. Instead, we hear repeatedly about whether lawmakers should be “hard” or “soft” on drugs and those that sell or use them, or whether the emphasis should be on law enforcement or on treatment and education, or whether the goal is to reduce use, per se, or to reduce the harms associated with drug use.
PLNDP’s central aim is to help reestablish the kind of consensus that emerged in the early 1970s. We think that a new consensus can be forged around three basic ideas:
- Drug policies should be evidence-based so that policy-makers can be held accountable for results.
- Drug policies should be based on a public health approach. We’ll explain later more about what we mean by a public health approach, but one key point is that the central purpose of drug control is to protect the health and welfare of the population, not to stamp out evil.
- There should be more room for innovation at the state and local level. Ultimately the strongest forces for effective action can be mustered in the nation’s communities, with the help of coalitions of interested citizens.
How do we propose to go about this task of refocusing the nation’s drug policies? We intend to create permanent professional partnerships in every state and community to carry these messages to the public and to policy-makers. The bar associations and medical societies in some cities and states have already joined together in a collaborative effort. Over the next year we will create PLNDP affiliates in every state to provide the leadership that is now lacking in many parts of the country.
We are launching this important effort today.
We do not expect to sit on the sidelines. We want to get into the fray. So, while we have your attention, we thought it would be useful to present some specific ideas about the kinds of policies we will be supporting.
The first point to make is that alcohol is the most widely abused drug in this country and all over the world. The country has made remarkable progress over the past 20 years in reducing drunk driving – and this effort has been characterized by the three core ideas that we are emphasizing today: the interventions have been based on evidence of effectiveness, have been grounded in a comprehensive public health model (which includes enforcement of the law as a key element), and have been propelled by advocacy at the state and community level.
Drunk driving is still a major public health problem, and we need to stay focused on improving policy and practice in this area. We also need to give much more attention to the most serious drug problem among our nation’s youth – underage drinking. Almost one in five 8th graders and almost half of high school seniors report recent use of alcohol, compared with 21% of seniors who report recent use of marijuana. One in eight 8th graders and nearly 30% of seniors report recent heavy drinking. Age of first use is dropping and is 14 among the current cohort of teenage drinkers. The social cost of underage drinking, conservatively estimated, is $53 billion.
A recent study by the National Academy of Sciences, which I was privileged to chair, proposed an evidence-based 10-point strategy for reducing underage drinking. The central premise for our approach is that the only way that underage drinking can be reduced in a society in which adult drinking is normative behavior and alcohol is widely promoted and available is for everyone – including parents, colleges, alcohol retailers and producers, and the entertainment industries – to recognize the ways in which all of us facilitate underage drinking and to accept responsibility for reducing it. This must be a collective effort. States and communities all over the country are using the NAS report as a blueprint for action, and the federal government has recently established an interagency group to coordinate the federal role. This morning, only a few minutes ago, SAMHSA announced the kick-off of its “Too Smart to Start” campaign, which supports community-based efforts. Based on a thorough review of the evidence, the NAS report identified community mobilization and coalition-building as a key component of its proposed strategy. PLNDP expects its state and local affiliates to play an active role in this important campaign to reduce underage drinking.
Finally, I want to mention one important PLNDP priority for the coming year. We intend to take a good hard look at the evidence regarding the effects of drug and alcohol testing in the variety of settings in which it now occurs – on the job, in the schools, in health care, and in the criminal justice system. In general, the PLNDP perspective is that drug and alcohol testing and screening can be a useful public health tool when it can help identify people in trouble and promote their recovery, but that it should not be used as an instrument of harassment and punishment. It is difficult to draw that line in some contexts, especially in the criminal justice system. In a few minutes we will hear from Glenn Ivey, the State’s Attorney in Prince George’s County, Maryland, who will comment on the ways in which the criminal justice system can used to facilitate successful treatment of addicted offenders.
One context in which testing is not being used as often as it should be is in medical settings, and especially in trauma centers and emergency rooms. Studies repeatedly show that 40-50% of patients who show up in trauma centers were drinking at the time of their injuries. Most of these patients are chronic heavy drinkers. The evidence also clearly shows that a brief motivational intervention at such a “teachable moment” reduces alcohol consumption and the associated risk of injury. PLNDP believes that blood alcohol testing should be routinely conducted for patients admitted to emergency rooms for traumatic injuries, and that all legal and financial impediments to such testing should be removed. Dr. Samir Fakry, Chief of Trauma at the INOVA Fairfax Hospital in Virginia will explain what needs to be done.