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New Drug Czar Tackles Weed, Prescription Pain Pills


Michael Botticelli brings an interesting personal story to a job that's reached an interesting moment in its history. He is acting director of the Office of National Drug Control Policy - acting drug czar, for short. President Obama has nominated him to the job permanently. He's also a recovering alcoholic, sober for 25 years. And he is coordinating national drug policy at a time of rapid changes in state laws controlling marijuana. It's also a time when prescription painkillers have become a huge drug problem. Michael Botticelli, welcome to the program.

MICHAEL BOTTICELLI: Thank you very much.

SIEGEL: First, marijuana - two states, Washington and Colorado, have legalized marijuana for medical and recreational use. Nearly 20 have legalized it for medical use. Do you see a movement there that cannabis will, in time, be a concern for the FDA, not the DEA or your office?

BOTTICELLI: I think when you look at the movement of states - Colorado and Washington - in terms of legalization as well as medical marijuana, really presents for us a significant public health issue. I think that legalization and, quite honestly, industrialization of marijuana in Colorado and Washington - I think really presents some issues as we've seen with marketing with alcohol and tobacco industries.

We see escalating use. We know that marijuana is addictive. About 1 in 9 people who use marijuana regularly become addicted. So it does present some challenges, I think, in coming at this from a public health perspective.

SIEGEL: Does it mean that people like you have to think in terms of federal regulations of marijuana rather than federal criminalization of marijuana?

BOTTICELLI: I don't. I think, you know, we remain firm in our opposition to legalization of marijuana. And again, I think that the movement toward legalization, I think, sends the wrong message, particularly to the youth of our country. And we've seen that born out in our statistics. So, you know, the perception of risk of marijuana use among youth is now lower than tobacco.

SIEGEL: But hearing your concerns, do you sense that you're trying to stand athwart history, here - that you're just on the wrong side of this and that the trends you speak of - we could say there's been a trend for 50 years of marijuana abuse.

BOTTICELLI: I don't believe so. And I actually hope not, Robert, because I do think that the public, quite honestly, has been getting some erroneous messages from the proponents of legalization. And so I think it's really important for us to make sure that the public is informed in terms of what the implications are, and what we have seen as it relates to dramatic change of public perception and use, particularly among youth in our country.

SIEGEL: You've said that your biggest concern is the abuse of prescription painkillers or opioids. Prescription pills are evidently gateway drugs to heroin use, heroine being a cheap substitute when the pills run out. First, are American doctors overprescribing, and are they part of this problem?

BOTTICELLI: I think if you track the epidemic of prescription pain medication that we have in the United States, you see a clear correlation between dramatic rise in the prescription of these pain medications. A prime goal of our office is to work with physicians. We actually want a balanced approach where Americans who suffer from pain get good treatment for their pain. But we also know that many people are getting these medications who don't necessarily need them - that physicians don't understand the history of someone. And making sure that they understand that there are risk factors attendant to these very powerful pain medications, so...

SIEGEL: You think that physicians don't understand the dangers of prescribing opiate-based pain killers?

BOTTICELLI: I think, you know, there's a larger context to this. For example, physicians get very, very little training in medical school as it relates to addiction issues in general as well as how to deal with those issues when prescribing pain medications. And a prime goal of our office is to expand the number of physicians who not only have some level of education around addiction, but also really know how to prescribe these very, very powerful drugs in a safe and responsible manner.

SIEGEL: If there is a significant volume of unwarranted opioid abuse in the country, why are so many opioids being produced by the drug companies? Do they assume that the illicit use of prescription drugs - over-prescription of the drugs is part of their market?

BOTTICELLI: I think if you look back over the history of the pharmaceutical industry, that they clearly play a key role both in terms of marketing and distribution of these pain medications. So, you know, I think the key and the linchpin to this is good prescriber education - to make sure that one - you know, people who do need theses medications are being prescribed appropriately, and that we are really doing a good job at monitoring people who are on these medications to make sure that they - if they are developing problems with them, that we're intervening with them and making sure that they get adequate access to treatment.

SIEGEL: You are not a stranger to addiction. You are a recovering alcoholic, I gather - sober for some time thanks to a 12-step program.


SIEGEL: How has that experience shaped your involvement in controlling drug abuse?

BOTTICELLI: You know, obviously I have a very deep and personal connection to the work that we're doing in terms of reshaping drug policy to make sure that we have a much more compassionate and humane response to people and families who suffer with addictive disorders. And, you know, there are ways that I use my own experience in looking at what were the missed opportunities along the way, and how does that translate to better programs and better policies to make sure that, again, we're preventing drug use from before it happens, we have good science and evidence - making sure that we have early intervention efforts?

And the last, and I think the most profound way, is treatment. One of the pieces of drug policy that I think is revolutionary is the dramatic increase in treatment resources given to Americans under the Affordable Care Act. Only about currently 1 in 9 people with an addictive disorder get care and treatment. And we know that not having insurance, and we know that insurance companies not providing an adequate benefit plays a significant role.

SIEGEL: You're a public health guy?

BOTTICELLI: I'm a public health guy.

SIEGEL: There've been generals who've had this office which is grandly named the office - or spoken of as the office of the drugs czar, implying enormous authority that perhaps you don't really have. Should we stop talking about a war on drugs? Is it - is that a metaphor that does not describe exactly what you've just been talking about?

BOTTICELLI: So this administration has never clung to a war on drugs approach and has never used that phrase in our rhetoric. And so I do think that under the Obama administration and with my nomination to this job, I think it's a continual evolution and acknowledgment that we need to deal with addiction and drug use as a public health issue and that, you know, we need a more compassionate and humane criminal justice response to this issue.

And again, you know, I was one of those people who was given a second chance - who had my own level of involvement in the - with the criminal justice system and was given a second chance to be a productive citizen. And that's the response that we want for all Americans.

SIEGEL: Michael Botticelli, acting director of the White House Office of National Drug Control Policy. Thank you very much for talking with us today.

BOTTICELLI: Thank you - my pleasure. Transcript provided by NPR, Copyright NPR.

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