Q&A: Beau Kilmer on President’s National Drug Control Strategy

September 2, 2009
by James Cooney, Ash Institute for Democratic Governance and Innovation

Included in President Barack Obama's agenda is revising the nation's approach to drug policy, a task of vast and immediate import given its inextricable link to national security (as with the escalating violence in Mexico), the economy (e.g. the economic burden of severe prison overcrowding), and, of course, our nation’s health care system.

Beau Kilmer PhD 2007 is now co-director of the RAND Drug Policy Research Center. Here he offers his thoughts on drug policy and what kind of strategy we might expect from the Obama Administration.

What new challenges, if any, must the Obama administration contend with as it develops a national drug control strategy? How does the landscape differ from, say, ten years ago?

An obvious challenge is addressing the security situations in both Afghanistan and Mexico. It was an important step for Secretary of State Clinton to publicly acknowledge that America’s “insatiable demand” for illicit drugs is contributing to the corruption and violence in Mexico. Most of the cocaine consumed in the U.S. enters via Mexican trafficking organizations, and continued cooperation with Mexican authorities to arrest violent, high-level traffickers will be vitally important; however, this will not have a large, sustained impact on U.S. demand. Most of the cocaine delivered in the U.S. is consumed by heavy users, and we know that a lot of these individuals are currently subject to community corrections (one in 45 adults are on probation or parole, according to the Pew Center on the States). Increasing the demand for, and supply of, treatment is critical, but it is not the only option for reducing consumption among heavy users. More can be done to create credible threats to reduce illicit drug use among those being supervised in the community.

The landscape has also changed dramatically as health care reform is now on the table. The Mental Health Parity and Addiction Equity Act of 2008 represented real progress, requiring private insurers to provide the same coverage for mental health and substance abuse disorders they do for physical illnesses. Yet this only applies to those insurers that cover mental-health and substance-abuse disorders. It will be interesting to see how the Substance Use and Mental Health Services Administration, Office of National Drug Control Strategy (ONDCP), and other departments weigh in on how substance-use treatment should be incorporated into health reform.

Can we expect from this administration any truly significant shifts in approach to, and policies around, drug control?

The federal government plays an important role in drug control, especially with respect to international supply reduction, distributing treatment and prevention dollars, and funding research. But those looking for significant policy change should pay attention to what is happening at the state and local levels. This is where most drug arrests take place, where decisions are made about allocating treatment dollars, and where parole and probation policy is created and enforced. As innovative practices in small jurisdictions gain recognition and budget restrictions force jurisdictions to change sentencing practices, we will see changes in drug policy and programs. Whether these programs will yield the same results when scaled up, and whether these policy changes will work, are important empirical questions.

And for better or worse, the state ballot initiative process is not going away. We will continue to see medical marijuana initiatives, as well as those that try to legalize and tax. Whether and how the Obama Administration responds to these initiatives will be insightful. While the Administration has already come out against marijuana legalization (ONDCP Director Kerlikowske: “Legalization is not in the president's vocabulary, and it's not in mine”), it also made waves when Attorney General Holder announced that the federal government would not raid medical marijuana dispensaries that abide by state law.

We will also likely see more state ballot initiatives and legislation seeking to divert more drug abusing offenders from prison to treatment. Bear in mind what happened after the passage of California’s “treatment not incarceration” ballot Proposition 36. Prop 36 allowed eligible non-violent drug offenders who pled guilty to enter a drug treatment diversion program instead of receiving a traditional sentence. These offenders knew they were allowed three treatment violations (e.g., not showing up for treatment) before they would be kicked out of the diversion program and that these violations could not be sanctioned with jail time. In response, criminal justice agencies and several treatment providers urged the legislature to allow flash incarceration (short jail terms) as an option for sanctioning these Prop 36 treatment violations and help create an incentive to comply. A bill to that effect was signed into law in July 2006, but a state court injunction deemed it inconsistent with the spirit of Prop 36 and, thus, unconstitutional.

This highlights the importance of seriously thinking about all of the implications of these state ballot initiatives before placing a vote.

Are there any recent innovations that the administration should consider when developing its drug control strategy?

Given the large number of people subject to community supervision – a group that accounts for a disproportionate share of heavy drug and alcohol use – the administration should pay close attention to strong evaluations of programs that prioritize swift, certain, and small sanctions for probationers and parolees who test positive for drugs or alcohol, or who do not show up for appointments. This idea of regularly testing and immediately punishing those who consume prohibited substances is not new, but it receives a growing amount of attention because of the expansion of the HOPE program in Hawaii and the 24/7 Sobriety Program in South Dakota. Both of these programs warn offenders that they will go to jail for a night or two every time they test positive or miss an appointment. The “innovation” here is the creation of a credible threat—in both programs every violation is actually punished.

I would be remiss not to mention an article published by Mark Kleiman and Harold Pollack, both HKS PhD grads, which includes a list of pointers for the new director of ONDCP. It’s full of insights, including the fact that primary physicians and emergency room personnel will see many more problem drug users over the course of a year than will substance abuse counselors. This highlights the importance of utilizing screenings and brief intervention techniques in these settings to identify problem users and enhance their motivation to change this behavior. My colleagues at RAND are doing some cutting-edge work involving brief motivational interviews with at-risk adolescents in a variety of settings. The short-term results for a primary-care clinic-based intervention with at-risk adolescents were positive. It is important to evaluate whether the changes associated with this innovative approach are maintained over the long-term.

Beau Kilmer

Beau Kilmer PhD 2007 is the co-director of the RAND Drug Policy Research Center.

Event: 10 Sept., 2009, AT 6 pm (EDT) the Ash Institute presents A Dialogue with the Drug Czar, a free Webinar featuring President Obama’s newly-appointed ONDCP Director, R. Gil Kerlikowske. Participate, and you will have the unique opportunity to impact policy.

"Increasing the demand for, and supply of, treatment is critical, but it is not the only option for reducing consumption among heavy users. More can be done to create credible threats to reduce illicit drug use among those being supervised in the community." - Beau Kilmer

Beau Kilmer

Kilmer discussing community corrections with graduate students at the Pardee RAND Graduate School-UCLA-USC-Pepperdine Policy Symposium. Photo provided.

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