Paradigm Shift: Efforts to Reform Drug Policy

Thursday, October 4, 2012

Gil Kerlikowske, director of the National Drug Control Policy, discusses global drug policy, including a new emphasis on programs that recognize drug addiction as a disease of the brain instead of a moral failure, domestic and international trends in drug consumption, and the diversification of transnational criminal organizations.

JACK DEVINE: So today it's the "Paradigm Shift: Efforts to Reform Drug Policy." And we're very fortunate today to have with us the director of the National Drug Control Policy Office, Gil Kerlikowske. And I think Gil was on his way here, and -- plane problems, so he's been kind enough to do this through a video.

I'd ask everyone to turn off their cellphones, including vibration, so that we don't interrupt the director. And the meeting, by the way, I should mention is possible through the generous donation of the Robina Foundation.

And I think without further ado, I think it'd be terrific for us to listen to the director give us his insights into the drug world today. And there is much to cover. And then after maybe 10 minutes or so, he and I have a dialogue. And then we'll open it up to the members for intense questioning.

So, Director, if I could turn it over to you?

GIL KERLIKOWSKE: Good. Thanks, Jack, very much. I hope everyone can hear me.

I am delighted to be with all of you. And I apologize; I think the airline mechanical gods and the weather gods all were aligned against us this morning. But thank you for making arrangements. And again, it's a delight to be with so many friends from the CFR.

Now, I think it's -- there's one person I'd like to point out and -- was -- you were kind enough to invite as a guest. We host a number of interns from graduate schools, undergraduate and also law schools. And Andrew Tawp (ph) is a guest of yours today who lives in New York City and was an intern with us on drug policy and statistics last year when he was a senior at Hamilton College. So thank you for including him.

Let me talk for a minute about drug policy, but let me also put it into some context. After that I really am looking forward to the questions.

When I first took the job a little over three years ago, I wanted to end this phrase and this discussion about the war on drugs. And in an interview with The Wall Street Journal, I was able to start that dialogue. And the war on drugs metaphor has been around for a long, long time. But frankly, it is inappropriate, and it's misleading.

As a longtime police professional, myself and my colleagues and many others, of course, in the criminal justice system know that we are not going to arrest our way out of this particular problem, our drug problem and drug use here in the United States. Law enforcement's always going to play an important and a vital role in addressing violent drug-related crime, but it can also be an incredible partner when it comes to working with drug courts, when it comes to helping to get people into treatment. I can't tell you in my travels around the country now for over three years how many people I have met that are in recovery, back taking care of their families and their communities, and had said that the person that helped get me back was a -- was a police officer, a sheriff's deputy, et cetera. And I think that's important.

But we have to approach this issue in this country, I believe, as much as a public health issue as it's been a public safety issue. Unfortunately, the debate always seems to be so polarized as if there were only two approaches to what is an incredibly complex problem. And it's either war on drugs -- which means essentially law enforcement, incarceration, interdiction, et cetera -- or drug legalization. I think this is just a totally false choice. Neither of the approaches is grounded in what the science tells us about the nature of this challenge.

And we have chosen a third way in drug policy. And that's a path that balances public health programs, law enforcement and international partnerships. The third way is rooted in the knowledge that drug addiction is a disease of the brain. It can be treated. People can recover it -- recover from it. And most importantly, it can be prevented. The scientific research from the National Institutes of Health and others have demonstrated that for a long time.

That is why my visit here today is also important because we get to talk about $84.6 million that has been given in the last month to grants. These are grants to 600 communities across the country to help bolster drug education across America. They're part of what we call our Drug-Free Communities Program that we are in -- are in partnership with Health and Human Services, that supports initiatives that are proven to prevent drug use among young people.

This has been going on since 1997. The Drug-Free Communities Program has been the nation's leading effort to mobilize communities to prevent drug use. And this program is uniquely affected because it recognizes that drug abuse is -- well, fundamentally, it's a local issue, and it's a local problem that requires local solutions. And so each drug-free community coalition leverages a small amount of federal funds to create their tailor-made, hyperlocal solutions that resonate with their particular community. Over the past 15 years the Drug-Free Community program has funded more then 1,600 community coalitions, and it's positively influenced the lives of really many thousands of youth.

(By ?) preventing drug use and interdiction -- are important; they're not our only challenges. And as you all are aware, we are also engaged in confronting violent transnational criminal organizations around the globe. And advocates for the legalization of drugs suggest that these criminal operations could cease to exist or they could be greatly impinged if government would legalize and regulate the sale of drugs like marijuana or cocaine.

Well, I wish the solution to transnational organized crime were straight forward, but it certainly is not. For example, in 2010 the RAND Corporation study found that Mexican criminal organizations may derive less than a quarter of their revenue from marijuana sales in the United States. Well, recently Alejandro Junco, a distinguished Mexican journalist and the owner of Grupo Reforma, made a compelling point. He said that the dominating cartels, once they establish territorial control, turn out to have the most profitable part of their operation, and that is selling protection to local businesses. Kidnappings, extortion, human trafficking, contraband, prostitution, piracy, anything that can make illegal money, these cartels are going to utilize. And the profitability of drugs can often be quite low to the profitability of some of these other funding streams.

So the suggestion that drug legalization would cause international crime to decrease dramatically is really a fallacy, and it's a distraction from the hemispheric efforts that we are going on to use to dismantle violent international criminal groups through strong government partnerships. And the partnerships have already, over these years, yielded extraordinary results, especially in Colombia, where a decades-long effort between the United States and the Colombian government has freed that country from the grip of violent drug trafficking organizations.

Most recently I am pleased to report that the constant pressure on coca crop producers has resulted in a sharp decrease in the amount of cocaine produced in Colombia over the last decade, and that's from an estimated 700 metric tons of potential pure cocaine production in 2001 to 195 metric tons in 2011, a 72 percent drop. And we've seen in Colombia that the collaboration between our two governments can significantly reduce cocaine production in the country as we aggressively seek to reduce demand for the drug here in America.

Well, fortunately, the success of Colombia is not limited to that country. Other nations in the region are stepping forward with their own commitments to reducing drug cultivation and production within their borders. The government of Peru has issued a comprehensive five-year counternarcotics strategy in March that emphasizes reducing the supply of drugs, alternative development to move farmers from drug cultivation to legal crops and a drug prevention and rehabilitation programs (sic) for citizens that have substance use disorders. The strategy includes some ambitious goals, including a 300 percent increase in the number of hectares to be eradicated over the next five years. The Peruvian government has already eradicated more hectares of illicit coca from January to September of 2012 than it did in all of 2011.

And the hard-won expertise of the Colombian National Police, who have reduced now the homicide rate in Colombia to a 27-year low, is being shared with Mexican and Central American law enforcement agents. All of you know this invaluable training could not be timelier, and we're grateful to the Colombian force for sharing their knowledge.

And because of our renewed emphasis on prevention and treatment, the United States is providing more than just military aid in support of the counter-drug effort across the world. In fact, some of the best, most innovative methods of drug prevention, treatment and recovery are developed right here in America. And in fact, about 85 (percent) to 90 percent of the drug treatment research is either conducted or funded here in the United States. And we want to export that valuable expertise and knowledge to partners around the world.

For example, the Community Anti-Drug Coalitions of America, a group known as CADCA, have funded training and technical assistance to those Drug-Free Community groups that I mentioned earlier since 1992. Well, in the past seven years international interest in CADCA has surged, and CADCA is now operating to provide this community capacity, this community building and this community strengthening in 16 countries on three different continents.

And we're providing support for treatment. In Afghanistan, for instance, where 90 percent of the world's opiates are growing, and where drug consumption is a great threat to the future of the country, the United States government directly supports 64 of the country's 82 drug treatment centers.

And by partnering with foreign governments to invest in the health and future of young people in these countries, we can lay the groundwork for increased international stability. The social instability caused by unchecked substance abuse, both abroad and here in the United States, threatens the health and productivity of the global community. As citizens of the most interconnected global community in human history, we know how important it is to support peace and stability throughout the world, which is why the United States government is so committed to international partnerships that reduce both the demand and the supply of illicit drugs.

This is a big picture, and as I mentioned before, this drug control strategy is based on the knowledge that addiction is a disease. It's based on policies designed to support the health and well-being of our people, and it's premised on the pledge that the government will support evidence-based solutions to substance dependence that actually work.

There's no silver bullet to international drug issues, and the problem is complex, and it requires complex solutions. But the data show that it is possible to reduce both the demand for and the supply of illicit drugs. A 30 percent decrease in drug use over the past 30 years in the United States proves that we can make a difference, and declines both in violence and coca cultivation in Colombia show that international partnerships can make a lasting positive impact abroad.

The administration is confident that a balanced strategic approach to the drug problem -- this one that emphasizes public health domestically, it supports drug supply reduction internationally -- is working.

And I know that we're not working in a vacuum on this, either. At an international summit on drug policy that I attended in Peru in June, I encountered near unanimous support for this type of balanced, comprehensive approach. And at the summit representatives from 60 countries voiced support for a research-based approach, which is exactly what the Obama administration is concentrating on. And with this level of international consensus, I'm confident we can continue to build and strengthen partnerships both domestically and abroad to reduce the harm caused by drug use.

Well, thank you for having me. I certainly wish I could be there with you in person. But it is very much appreciated, and I look forward to the questions. Thank you. (Applause.)

MR. DEVINE: Mr. Director, thank you very much for that presentation. Everyone should be aware it's on the record, and as we continue, it will remain on the record.

I was a little rude by not introducing myself. I'm Jack Devine. I spent many years in CIA. In the early '90s I ran the counternarcotics program at CIA, during the time that Escobar met his demise and the Cali cartels were vigorously attacked.

I think your comments are right on target in that the supply side is a holding action. In other words, we were very successful in getting rid of Escobar, but 50 little Escobars grew up and the problem continued. So I do think the demand side is terribly important.

And one of the first things I would ask is maybe your thoughts about the trends. I'm very pleased to see that cocaine -- when we were running this program in the early '90s, it was a thousand metric tons of cocaine that we were estimating was coming in the United States. It sharply -- it is sharply off the mark. Heroin's off the mark, as are synthetic drugs.

One of the things that I found as I was looking through some of the data is that marijuana is in the opposite direction, taking a significant increase, particularly among the youth in the -- at the high school level. And I think one of things that have troubled me through the years is what makes those trends, how do they change, and if you could share with us your perception of what you see happening in these major drug strains and why is -- why is it improving on one hand, and why are we seeing a comeback in another?

KERLIKOWSKE: Sure, let's talk just right now about what's going on inside the United States. So we're particularly pleased that within the United States, the cocaine use, especially since 2006, is down dramatically. You notice in my letter that was published in The Wall Street Journal this morning that methamphetamine use is also down by almost half over these last six or so years in the United States. Well, that's a combination of not only increased international cooperation, but I think it's also a combination of the education and information that people need in order to have the kinds of tools necessary to not abuse and use drugs.

It's also important to take a look at prescription drugs. Prescription drug problems in the United States have driven our overdose death rate to greater numbers than heroin and cocaine death rate combined. They've driven those numbers to more people dying from drugs in the United States right now than from gunshot wounds or from car crashes. That makes it the number one cause of accidental death. Prescription drugs aren't coming across the border; they're coming right out of medicine cabinets. And we're doing a lot on that.

Your point on marijuana is particularly helpful and interesting because around 2007 in the survey work, we began to see that young people had less of a perception about harm or risk of marijuana. And if you contrast that against tobacco use, in which young people wouldn't be seen smoking a cigarette, and yet marijuana doesn't seem to have anywhere near those kinds of perceptions of harm and risk, that was a concern. And usually when that is seen in the survey work, what happens is that within the next couple years -- and that's true here in the United States -- the increased use of marijuana among young people has in fact occurred.

DEVINE: One of the thoughts that, you know, have troubled me through the years is trying to ascertain why there's a shift. And I think we've talked about the supply side, and I think we've talked about rehabilitation. And just a second ago, I think very rightfully, you mentioned education, because I think -- how do we influence our young children to avoid or not be drawn to the use of marijuana? And it's my understanding that Congress has cut back funding in that area. Do you see that as a continuing problem in terms of being able to get the funding? And just how robust do you think education should be in this program, and how critical it is to changing the fads and trends of the youth?

KERLIKOWSKE: Well, I think it's important that we invest in education and information to young people that's straightforward, that doesn't involve scare tactics, about the dangers of drugs. We know from bringing in focus groups of young people that they want information that lead them to, one, make the right decisions about their health and their future, and two, that they'll give them the right tools to help them be in charge of their lives and to make those decisions.

At one time the Anti-Drug Youth Media Campaign was once $190 million. And I think you probably have enough people in that audience that remember "This is your brain on drugs," with the two fried eggs. Well, we -- that's been changed quite dramatically. Unfortunately, Congress did not fund it last year even though President Obama had requested $20 million. He has again requested $20 million. That is not a huge amount of money in this federal budget, especially for a program that we know from two published peer-reviewed documents showed that young people who have been exposed to these media campaigns, largely through social media, are more resistant to drug use. And so we are going to keep working with members of Congress, and the president is certainly supportive in that request.

DEVINE: Let's shift a minute to the international scene. And Mexico is near and dear to my heart, as it is to some others in this room, as I know. It's so critically important to combatting the drug problem. I know we have a huge initiative in the Merida campaign. Back in the early '90s, Mexico was a pass-through location, and today it has turned into an organizational problem with the various cartels that have sprung up.

President Calderon, I think, has had a very ambitious program and has attacked all the major cartels, a number of fatalities. As everybody in the room realizes, it's in the general perception an unsafe place. We have a presidential election that just took place, and I'm a tad concerned about the incumbent expressing a possible change in policy and worrying about the homicide rate s opposed to the cartel, if I understood him correctly.

So I think what would be helpful is your thoughts on how you view the Mexican situation today, how successful we've been, and do we see over the horizon any changes there that we should be concerned about.

KERLIKOWSKE: Well, first, during the last three-plus years, I've had about four trips to Mexico and about seven or eight all along the Southwest border. We publish here in the Office of National Drug Control Policy something called the Southwest Border Strategy, and that brings all of the equities of the federal government together, and it's updated every two years, to talk about how these approaches could be approached, mostly from a security standpoint.

But you were exactly right with Merida because some of the money after technology, helicopters, et cetera were provided, that some of the money was being used to strengthening communities, to looking at prevention.

President Calderon, who I am a great admirer of, has done -- attacked this issue with a great deal of force. He has often said it's a question of who's going to lead and run that country; will it be organized criminal groups or will it be the elected and appointed officials of the people of Mexico? These last five or six months seem to have shifted in his direction and in his favor not only in arrests but also in the reduction of violence.

It's also important to recognize that criminal cartels are not -- in Mexico and throughout the world -- are not just drug trafficking organizations. They are in fact organized crime enterprises involved in so many other types of crime, as I mentioned in my remarks. So I think the other part that I would mention to you is that we don't -- we don't see that with the incoming new president, Pena Nieto -- that he is also very concerned about violence, very concerned about crime and drugs, and he has hired the former head of the Colombia national police as an adviser, former General Oscar Naranjo. We think Colombia in many ways is a landmark or a template for quality policing and changes in security and changes in the way a government can approach drugs.

Lastly, just let me -- I think it's very unfair anymore to try and categorize countries as production countries, transit countries or consumer countries. I think we're all in this together. I think that the amount of drugs being consumed in all our countries and the drugs that pass through should give us all a pause to make sure that we're concentrating on both the public health of the people that we are pledged to support and their public safety.

MODERATOR: You know, one of the things I found when we were working this problem intensely, just how important the local support was and the need to raise the skill level and to provide them with the tools that are necessary. And I know we're continuing and have actually amplified it quite a bit.

One of the challenges that we ran into over and over again, including Mexico -- and I know we're on the record, so I think there's some delicacy here. But one of the problems that we encountered was the corruption issue and the difficulty of being able to work through that, and at the same time, the human rights efforts. So we were in there, and I think rightfully, providing support and -- to the -- to the locals. Are you finding these to be significant challenges, or is there anything there that we need to be mindful of?

KERLIKOWSKE: Under President Calderon's leadership, I think that the cooperation and the sharing of information among law enforcement entities on both sides of the border has increased dramatically and significantly. The quality of the information, the trust that has existed -- and has resulted, of course, not only in these last five or six months of decreased numbers of homicides but also, most recently, in the number of high-value targets or top-level cartel members that have been arrested. So I think that's important.

And I don't think President Calderon has been shy about addressing and talking about his concern about corruption. As you know, he had put forward a plan to change the policing system within the country of Mexico so that it was a more nationalistic system because of the concern about corruption at the local level among police forces or among other members of government. And that has not been passed. I don't know what its next status will be. But he has certainly, from many fronts, addressed this issue.

DEVINE: The other country that I think is worth touching on, on the other end of the world, is Afghanistan, which I think we all realize is the largest producing heroin country. And although most of it heads to Europe, there's some concern that as we pull out, whether or not there'll be a spike in production and whether we should be concerned about increase in heroin use around the world.

KERLIKOWSKE: I was in Afghanistan a couple years ago and have stayed very current with the issues involving that. We've been having bilateral discussions now for over three years with the Russian Federation because of their concern about heroin coming from Afghanistan and into Russia and to a large population of younger people -- primarily younger people who have a heroin addiction.

As the United States and the -- and the forces withdraw from Afghanistan, it's going to be important that the Afghan security forces, including the Afghan counternarcotics police, or the Counter Narcotics Police of Afghanistan -- the counternarcotics and -- under the ministry of Minister Zarar all have the tools and the capacity to continue to work on this issue and that they also address the issue of drug treatment for people within Afghanistan that have used heroin, or also opium, to a certain extent.

And I think that's why we should also recognize that as we approach this in a holistic way, prevention and keeping people from ever abusing or misusing the drugs, to a great extent, giving them the tools, is also an important way. And lastly, I know that there have been a number of improvements in what not only USAID but others have done in the ISAF forces to move farmers away from the growing of poppy and move them to other alternative licit crops that actually provide funding and provide sustenance to the -- to the people in that region.

DEVINE: I think we'd like to throw it up to members. But what would be a good drug discussion without touching one more time on legalization? I think you laid out a really excellent explanation there. But one of the things that I found interesting when I was in Mexico a few months ago, talking to the public security people there, there was concern that we were sort of gradually legalizing it, and they were pointing to California and that by medical use in California, were we starting to set the stage for a gradual acquiescence to legalization. And I think the last poll that I looked at had the American population about 50 percent. Do you share sort of the concern that through -- at the state level that, you know, we will be getting to a de facto sort of legalization, at least at the marijuana level?

KERLIKOWSKE: Well, I think there is a -- there is a real concern among our foreign counterparts in particular that the medicalization of marijuana is in fact de facto legalization in some ways.

You know, it was first passed in California in 1996. And (when ?) I became police chief in Seattle in 2000, it had passed in 1998. I think it went into effect in 1999.

Honestly, across the country, in these last -- it's only been in these last four-plus years that this issue has really shown itself to be incredibly problematic. As many people in California will tell you, it was never anybody's intention to see lots of 30-year-old young people, mostly white males, having medical marijuana cards. They never seem to be the sickliest group of people in this country.

And now you're starting to see some real pushback about this, not the pushback about people that want to use this, of course, in very concerning medical issues, but about exactly, as you stated, the kind of de facto legalization or hiding behind the medicalization issue. The state of Montana, both houses, repealed their medical marijuana laws that were about six years old. The state of California, in the effort to legalize marijuana in a proposition two years ago, the voters voted against legalization.

I think we need to approach this problem as a public health problem, that marijuana has never been through the FDA process, which is one of the most highly-regarded testing processes for medicine in the entire world, in order to give people something that's safe and effective. And it's important to recognize those things. And we'll just have to see how it goes.

DEVINE: I think this is a good moment to open it up to the members. I would just remind everyone to wait for the microphone. A lot of you are experienced with this. Speak directly into it. Stand up. State your name and your affiliation. And -- not that anyone needs to be reminded -- one question and concise.

So -- I see a hand. Carole, if you could --

QUESTIONER: Thank you very much. I'm Carole Artigiani from Global Kids. I'm just wondering if you could elaborate some more about the demographics of the users of any of our illegal drugs or prescription drugs in this country. I'm thinking about age, ethnicity and geography.

KERLIKOWSKE: A couple things are important in looking at who's using, abusing, misusing drugs. I think the highlight of trying to understand our drug problem has been most recently the amount of attention that's been given to prescription drugs, prescription drugs such as the very powerful opioid painkillers that are often remarked about in the press. And this covers every demographic, every economic class and every section of the country. So whether I visited Appalachia and talked to people, or whether I visited more urban environments like Fort Lauderdale and Broward County area of Florida, we see that the problem of prescription drugs can cross every demographic, age group, et cetera. And it can happen in a variety of ways, whether people going into somebody else's medicine cabinet or somebody that is legitimately prescribed a -- one of these drugs and then becomes addicted to it. And that's been important.

Marijuana use among youth has been the one that has, according to the Monitoring the Future study, has been the one that has been increasing. But it -- also, that use has been disproportionate in the Latino and African-American community among youth. And I think we need to be very concerned about these things because it's not going to help young people graduate from high school. It's not going to help our productivity or our workforce.

And we know that the most powerful voices about leading a life that's substance-free and free from drug abuse -- the most powerful voice certainly are the parents' or the trusted messengers', those trusted messengers being teachers, law enforcement officials, public health officials, doctors and others in giving kids the right tools.

So we have a wide array of drug problems, from methamphetamine to cocaine, to heroin, to prescription drugs and to marijuana, and -- but we can give young people the kind of armor that they need to resist it.

Thank you.


QUESTIONER: Thank you. Stephen Kass, Brooklyn Law School. I'd like to go back to ask you about the legalization issue and the effect on drug cartels. Your comment suggested that because drugs are, at least for advanced cartels, a modest part of their cash flow, that we would not break them up by legalizing and regulating drugs here. I think that's basically what you said.

But it would -- it would be the case, wouldn't it, that they would have less incentive to export drugs into the United States. It's not to say that there wouldn't be kidnapping and other activities in Mexico or elsewhere, but we might have less supply of drugs coming into the country if there were less financial incentive for that, and maybe some of those groups would not become as well-established as they are if they didn't have the major profits at the outset. I wonder if you could comment on that. Thank you.

KERLIKOWSKE: Sure. I'm happy to comment on that in particular. And I think there is a RAND Corporation piece, especially on reducing violence and the fact that the president has been so clear about us recognizing our responsibility not only to lower our own demand in this country but also to be a good partner in all of those other ways.

So here are a couple things that often get missed. Unfortunately, the United States has become a pretty good producer of drugs themselves, whether it was the painkillers that I talked about that are coming right out of our medicine cabinets to marijuana. So the marijuana grown on our public lands is a significant problem, but also the marijuana that's grown throughout the country hydroponically. So we're certainly not dependent on drugs -- especially along a border now that is considerably more secure than it had been in the past, so we're certainly not dependent on -- and neither are the cartels -- in bringing in drugs in order to make significant sums of money.

Methamphetamine use, even though it's down to less than half a million current users in the United States -- methamphetamine use can be met in this country oftentimes by people kind of making their own in a method that involves pop bottles, called the shake and bake method, and providing that small amount of methamphetamine, not the -- not the superlabs, but that small amount that's needed or used or abused by others.

So I don't really see people that have become involved in organized crime changing many of their tactics. I often said they're not going to go back and get an MBA and go to work for Coca-Cola or Microsoft in Mexico because part of their profit stream has been reduced.


MR. DEVINE: I think this one -- let's -- yeah, you're next. OK. You got it. Yes.

QUESTIONER: OK. Sorry. Ronnie Heyman, GAF Industries. About three or four years ago I heard a talk by former President Vicente Fox of Mexico, in which he pleaded with us to consider legalizing drugs in this country because it would so help him in -- you know, south of the border to control crime.

My question to you is, why on earth hasn't the FDA looked at marijuana and studied this? If states are legalizing it, why has this not been examined? They examine every other kind of thing at the FDA.

KERLIKOWSKE: I think there are a bit of separation between this medicalization of marijuana, which 17 states have passed, with a variety of varying laws and guidelines, versus the legalization issue. I think it's important to recognize that oftentimes when somebody talks about -- and a former head of state, like President Fox, talks about legalization of drugs, you know, they're no longer responsible for the safety and security and the health of people. They no longer sit in the -- in the office and have to deal with those kinds of issues. And so it's always interesting to me that after people -- some people leave office, there becomes this new insight or new knowledge about this.

We know that every country has its own consumption problems themselves. And as I visited drug treatment centers in Guatemala or in Mexico -- and I know that President Calderon's wife, the first lady, Margarita Zavala, has made drug treatment and drug prevention, for her six years, a signature issue -- that we all have to look at how we can reduce our own demand within the -- within our own countries, and we have to make those -- and we have to make those decisions.

Now, the issue of whether or not the FDA -- I mean, that's a question, really, that does need to be asked to the FDA for a response. But one of the drivers of medicine in this country is whether or not a pharmaceutical industry is going to make money from that. And if you're -- if it's almost a billion dollars to take a product from development to market, you'd better make sure that that -- that that drug has large market value and real staying power.

None of the pharmaceutical industry representatives that I've talked to see any benefit at all in marijuana as a part of the profit. They also recognize that there are things on the market now called Marinol, Cesamet, and in final drug stages -- trials is something Sadavex (ph). All of these have property of the cannabinoids to do certain things. They don't have any of the properties that get people high.

DEVINE: Let's try one from the middle table. I think -- (inaudible) --

QUESTIONER: Thanks. Dan Altman from NYU Stern School of Business, though I used to be in the British government working on drug regulation awhile back. I'm speaking to you from New York state, which is a state that has put a lot of people in prison for a long time for relatively minor drug offenses and where we also have rather widespread drug abuse, much of which is untreated. Does the public health approach that you have alluded to mean that we don't need any changes in laws because we're just going to eliminate the demand, and then the dealers will disappear as well? Or are there changes in laws, and if there are changes that you think are necessary, how do you promulgate those to the states and localities?

KERLIKOWSKE: Well, one of the thing that we try to do is to make sure that we don't parachute into some state and tell people what they need to do. We try to promulgate the information that's necessary for them.

And as you know, particularly over these last couple years and the changes in New York state with the changes in the Rockefeller laws, significant law changes have occurred. And it's a -- it's a combination of very conservative governors like Governor Deal in Georgia or Governor Kasich to governors in -- that would be seen as more liberal that have all looked at this drug issue and said, we need to make changes in how we deal with it. I think that's why we've seen such an increase and particular acceptance of drug courts that I know exist in New York and also the fact that drug treatment -- the combination of drug treatment that was made available.

And I agree with you, there should be more drug treatment available. the drug treatment that has been available is oftentimes leveraged with the criminal justice system, whether it's through drug courts or whether it's through the probation system.

So we've put out a lot of information, but it's clearly not our position to kind of dictate to the states about what they should do individually or how they should approach it. And I think they've been approaching it from a variety of ways that reduce incarceration, reduce prison costs but also really foster treatment and rehabilitation. And if you really -- what's interesting to me is to see the example of not only New York state, which has reduced its prison population, but the state of Texas, which is now touting its drug programs in -- within -- behind the walls as a reason for having less people in the state prison systems.

DEVINE: You had your hand up first.

QUESTIONER: Thank you. I'm Alan Hyman. Two drugs that are widely used for recreation are alcohol and nicotine. They're highly taxed, and most states depend on that revenue. Few people would want to go back to prohibition of alcohol, and few people are asking for prohibition of nicotine. What's fundamentally different about marijuana?

KERLIKOWSKE: So I think a couple of things that are important is, one, I -- in reading -- whether it's Daniel Okrent's book, "Last Call," probably the seminal piece on prohibition, it's important not to kind of put the -- and I think he even said this in an op-ed to The New York Times -- to say that the prohibition that existed around alcohol is similar to the prohibition -- calling it prohibition around marijuana. There's a lot about marijuana that we don't know. We know that the THC content or potency of marijuana has increased dramatically, particularly among people that are -- well, I'm 62 -- people that remember marijuana from my early generation to what the marijuana is that exists today.

The other part that goes around with the taxing and regulating and controlling is this: For example, in alcohol, for about every dollar that is collected in taxes, we -- all of us -- spend about $8.00 in public health and public safety costs. And we make more arrests in this country for the legal alcohol issues -- underage drinking, DWI, et cetera -- than we do for small amounts of marijuana.

So I think that I just -- I hate to coin the term and use "prohibition" as a result -- trying to tie it to marijuana. I'm not sure it particularly fits.

DEVINE: The fellow in the middle there. Yeah.

QUESTIONER: (Name inaudible) -- Strategic Partners. I have a question regarding South America. Bolivia, Brazil and the United States signed a trilateral agreement a little less that a year ago on interdiction, police training, et cetera. Last month the government of the United States decertified Bolivia on the grounds -- on various grounds, but one of them was increased hectarage of coca production, while the U.N. Office in Drugs and Crime indicated that there was a lessening of the hectarage.

How beneficial is this decertification in light of the trilateral agreement that was signed a little less than a year ago? Thank you.

KERLIKOWSKE: And what we're talking about here is something called the Majors List, which is a result of an act of law passed by Congress a number of years ago that requires that the president decertify a country as a result of whether or not they have taken adequate steps regarding drug production or drug transit.

The relationship with Bolivia has not been as strong, although we continue to work in a variety of ways with them regarding this. Peru has become the largest producer of coca, but President Humala has taken this issue on in significant ways in his first year in office. Bolivia has not shown that same level of resolve. It doesn't mean we won't continue to work with them.

The other point that you bring up, though, is the amount of hectares that are essentially eliminated as a result of some type of either manual eradication or in the past aerial eradication and how that's measured. And it becomes a very difficult issue because the United Nations publishes numbers and we publish numbers.

We actually believe that our methodology is a little more accurate than the United Nations numbers, and we look at not just hectares that have been eradicated, but also what's the production out of the field and what is the crop yield. And I think that we will continue to work closely with the U.N. so that our numbers actually can be more aligned.


QUESTIONER: Shannon O'Neil from the Council on Foreign Relations. I'd like to keep you in Latin America for one more question here, and the question is this. We've seen over the last year, especially, a rising very public frustration with the international drug control regime. We saw many Latin American presidents at the U.N. General Assembly a couple of weeks ago use their time to talk about this. And perhaps more important, I would say, for the United States is we saw three presidents -- and these are sitting presidents in office, not those that have retired to private life -- from Mexico, Guatemala and Colombia present a request to the United Nations to look at the current drug regime that we have internationally and to think about alternatives to it.

And so one is a question about that specific act and how the United States is viewing it. But two, I'd be interested in your thoughts about what this means for cooperation with our most vital partners who are really coming together and amplifying some frustration and -- as we think about this evolution of our cooperation with Mexico, Colombia especially, but the other countries, Guatemala and such -- how we see that developing, given we have this very public, increasingly amplified frustration?

KERLIKOWSKE: Sure. I think that this was raised quite directly previous to the summit of the Americas. And at the summit of the Americas, I think President Santos from Colombia stated -- and the OAS is now working on developing that study and that research -- but President Santos said, you know, it's important that we look at all of the ways that we're approaching drugs. And basically, it said there are those people that say everyone should be incarcerated; there are those that say that legalization, in fact, is an answer. And we all have a responsibility to look at what are the most effective methods of dealing with this. So I know that the OAS study is ongoing at this point. I think everyone will look forward to seeing the results of what the OAS produces as a result of this.

But I think it's important to also recognize and understand that every country has a consumption and drug use problem. It doesn't -- it isn't confined to just a large consumer nation. And if we look at the most recent press release from the government of Brazil, they talked about, according to a study that I have not seen but the press release cited, that Brazil has now become the number one consumer, not per capita, but the number one consumer of crack cocaine in the world.

So I think we really need to be concerned about approaching this issue holistically, particularly from a prevention standpoint, from an intervention standpoint -- when people are involved in drugs, how do you treat them and make sure that they get back into being the kind of person that they wanted to be before becoming addicted to drugs -- but that we also have to look at these criminal enterprises for exactly what they are, organized crime enterprises.

Thank you.

DEVINE: I think we have -- we've reached the witching hour. We're very religious here in finishing right on time at 2:00. But I think to close it out, if you have any comment that you'd like to sort of close out the session -- I think it's been very informative -- there is many, many questions here, and I'm sure there is a way to get to you through the staff. But if there is any sort of words of wisdom that you want to leave us with in addition to those that you've already imparted, it'd be great to finish it off.

KERLIKOWSKE: Good. Thank you. I wish I had words of wisdom. The older I get, not only am I not sure of what the answers are, I'm always not so sure of the questions. But -- and we would be happy to --

DEVINE: Well, what -- (chuckles) -- can I (take ?) the exception to that? (Laughter.)

KERLIKOWSKE: I would be happy to -- I would be happy to make sure that we receive the questions, and we'll do our very best to get the answers back to the wonderful audience that you have had.

So I think that what hasn't been recognized is that in the three years of this administration in particular, this third way, this holistic way of approaching the drug problem, not just from an interdiction or a criminal justice standpoint, but approaching it from much more of a public health and education standpoint, is really somewhat different. And it -- and it's very difficult to get that message out, particularly with all the things that are happening right now in the world and right now in the United States.

So I think that if you have the opportunity to take a look at the president's National Drug Control Strategy, you will find some significant changes in the way we are beginning to over these last three years approach the drug problem. And we hope that some of these most recent numbers that were just released will continue leading us to preventing young people from being involved, interdicting with people who do become involved in drugs and leveraging a lot of resources together that perhaps in the past did not work as closely on this issue as they should have.

So thank you all very, very much.

DEVINE: Thank you. Great pleasure. (Applause.)






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