Pubdate: Sun, 26 Apr 2015
Source: New York Times (NY)
Copyright: 2015 The New York Times Company
Contact: http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Alan Schwarz

MICHAEL BOTTICELLI IS A DRUG CZAR WHO KNOWS ADDICTION FIRSTHAND

BALTIMORE - Six recovering substance abusers sat in an inner-city 
treatment center, sharing their stories. When Michael's turn came 
around, he spoke of his former drug of choice, alcohol, and mentioned 
the night years ago when he drove drunk on the Massachusetts 
Turnpike, caused an accident and was arrested before passing out.

Michael then pulled out a picture of a friend's brother who recently 
died from mixing prescription painkillers with alcohol. He described 
his grief and visceral connection with the struggles of substance 
abusers in recovery.

"You are my people," he said, wiping one eye.

Catharsis is common in treatment centers, but Michael is not the 
typical former substance abuser: He is Michael Botticelli, the 
director of the White House Office of National Drug Control Policy, 
informally known as the drug czar. Mr. Botticelli is the first person 
in substance-abuse recovery to hold the position.

His history, far from the liability it once may have been, is 
considered evidence that the government is moving toward addressing 
drug abuse more through healing than handcuffs.

"Every other drug czar has had a military, political or police 
background," said Tom McLellan, a founder of the Treatment Research 
Institute in Philadelphia and an expert in substance abuse. "Nothing 
against them, but it's time to have that new perspective, and Michael 
brings it. He is the living example of what should be an expectable 
result of treatment - recovery."

Mr. Botticelli's agency, created during the Reagan administration's 
war-on-drugs initiatives, devises and controls the budget for 
national drug policies. It assists the State Department and Drug 
Enforcement Administration in dealing with governments of countries 
from which drugs are exported - such as Mexico, India and China - and 
works with domestic health and law enforcement officials on 
strategies to stem the supply and abuse of drugs, from heroin to 
prescription opioids.

Heroin abuse and deaths in the United States have risen drastically 
in recent years, particularly among the middle class and in rural 
communities. About 23,000 Americans died from overdoses of 
prescription painkillers and tranquilizers in 2013 -roughly double 
the total of a decade earlier, according to the National Institute on 
Drug Abuse. Other federal data shows that in 2013, 1.8 million people 
ages 12 or older received treatment at a facility for abuse of either 
alcohol or drugs.

Mr. Botticelli lived it himself: In 1988, after being arrested on 
charges of causing an accident while driving drunk on the 
Massachusetts Turnpike, he woke up the next morning handcuffed to a 
hospital bed. (He had previously used marijuana a few times, as well 
as cocaine, he said, "on a somewhat occasional basis.") He spent four 
months in a court-mandated outpatient treatment program for alcohol 
abuse, and soon left his job as an administrator at Brandeis 
University to work at a substance-abuse treatment center.

Mr. Botticelli, 57, has remained abstinent for 26 years, his only 
synapse-soothing substance being an occasional cigarette. He even 
refused a prescription for opioid painkillers after a significant 
medical procedure for fear they might awaken addictive behavior.

Raised in Waterford, N.Y., outside Albany, Mr. Botticelli directed 
the Bureau of Substance Abuse Services in Massachusetts for 10 years 
before joining the Office of National Drug Control Policy in November 
2012 as deputy director under Gil Kerlikowske, a former Seattle chief 
of police. Mr. Kerlikowske left the position last year to become 
commissioner of Customs and Border Protection, leaving Mr. Botticelli 
to succeed him.

John P. Walters, who served as the agency's director from 2001 to 
2009 under President George W. Bush, said he supported Mr. 
Botticelli's focus on improving treatment for abusers but expressed 
concern that it might distract from efforts to keep illicit 
substances like heroin and methamphetamine from entering the country. 
He criticized the Obama administration for removing the director from 
the cabinet in 2009, and said Mr. Botticelli would need to enlist 
more support from the Drug Enforcement Administration, the F.B.I. and 
the State Department to negotiate with foreign governments.

"Yes, we need to make treatment resources available to more people, 
but our goal is not to just treat victims but deal with supply 
reduction in a way that gets foreign countries and governments 
involved," said Mr. Walters, the chief operating officer of the 
Hudson Institute, a think tank.

Mr. Botticelli said he embraced his office's more traditional 
charges, like combating the flow of heroin across the United States 
border with Mexico. (This role explains his round-the-clock 
protection by United States marshals.) Yet some of his primary 
objectives do not attempt to stem substance abuse - they accede to its reality.

He wants police officers nationwide to be trained to use naloxone, a 
nasal spray or injection that can almost instantly resuscitate people 
who overdose on opiates; better education for prescribers of 
painkillers and other drugs so that they can recognize signs of abuse 
or addiction; and the distribution of clean syringes for intravenous 
drug users to stem the spread of infectious diseases like H.I.V. and 
hepatitis C.

"Locking people up for minor drug offenses, and especially people 
with substance-use disorders, is not the answer," Mr. Botticelli 
said. "It's cruel. It's costly. And it doesn't make the public any safer."

Mr. Botticelli said that as the social stigma associated with drug 
abuse dissuaded people from seeking treatment, the substance-abuse 
field should take cues from the gay rights movement. He lived that, 
too - he is gay and married his partner in Massachusetts in 2009.

"I almost found it easier to come out as being a gay man than a 
person in recovery," Mr. Botticelli said. "We're doing an amazing job 
decreasing the shame and stigma surrounding gay folks. There is a 
playbook for this."

Regarding the issue of medical marijuana, which 23 states and the 
District of Columbia have authorized despite its federal ban, Mr. 
Botticelli has said he opposes the legalization of cannabis unless it 
is formally approved by the Food and Drug Administration. Even if Mr. 
Botticelli had mixed feelings, the statute that created his agency, 
in 1988, specifically forbids the office to support legalizing any 
substance classified in Schedule I by the Drug Enforcement Administration.

Reporting primarily to Denis McDonough, the White House chief of 
staff, Mr. Botticelli splits time between his Washington office and 
touring the country visiting treatment centers, making speeches and 
consulting with local officials on how to improve services for those 
with substance abuse disorders. In late March, he went to Baltimore - 
sometimes called the heroin capital of America - for a typical tour.

Mr. Botticelli stopped first at Reach, an outpatient treatment 
facility that serves primarily patients covered by Medicaid. When he 
sat down with five adults recovering from abuse of various substances 
- - heroin, alcohol, painkillers, marijuana - they were reticent about 
sharing their experiences and opinions. Only after an awkward 10 
seconds did he say with a smile, "O.K., I'll start," detailing his 
own abuse history and allowing the others to open up.

"It means a lot to know there's somebody who understands," said 
Ashley Grimes, 22, who is in her second year of recovery from heroin 
abuse. "He's walked in the shoes we've walked."

After Mr. Botticelli spent an hour with doctors at the Johns Hopkins 
Center for Substance Abuse Treatment and Research, he rode with a 
police officer from Anne Arundel County, Nick Tackett, who used 
naloxone to save the lives of two people who had overdosed on heroin.

"You're doing something that police don't normally do - administering 
a drug," Officer Tackett said as they passed an abandoned one-car 
garage in which one of the overdoses occurred. "And two or three 
minutes later the person's alive."

As heartened as Mr. Botticelli was at that story, on the way home he 
shared a more somber one. Last year, he heard about a Virginia man 
whose 23-year-old son died in his arms from a heroin overdose. Mr. 
Botticelli invited the grieving father to lunch in the West Wing, 
where the father lamented that the death was his responsibility.

"It isn't your responsibility," Mr. Botticelli responded. "It's my 
responsibility."
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MAP posted-by: Jay Bergstrom