ONDCP Blog

Guest Post: A Policy Focus on Recovery in New York

Posted by Lureen McNeil & Peter Gaumond on June 28, 2013 at 2:54 PM EDT

On June 4^th, Deputy Director Michael Botticelli joined public health officials in New York to discuss integrating a focus on recovery into alcohol and substance abuse treatment services.

The half-day conference, hosted by the State of New York Office of Alcoholism and Substance Abuse Services (OASAS), was led by Commissioner Arlene Gonzalez-Sanchez and attended widely by state and city public health experts, treatment providers and social workers.

Entitled “Recovery 2013: Charting the Future of Policy and Practice,” the event emerged from the state’s participation in the ONDCP ROSC Learning Community. With a current membership of 10 states and two local governments, the ONDCP ROSC Learning Community gives members access to expert presentations, group consultation, and opportunities for cross-jurisdictional sharing and collaboration. It receives ongoing support from the SAMHSA Addiction Technology Transfer Center (ATTC) Network Coordinating Office and from various regional ATTCs.

The conference raised awareness about the state’s ROSC efforts and helped expand their base of support. Mr. Botticelli spoke of the importance of developing recovery-oriented systems and services, which helps lay the groundwork for health reform implementation, and how states such as New York (who participates in the ONDCP ROSC Learning Community), are national leaders who serve as examples for other state and local governments.

The State of New York has been working on ROSC implementation for the past five years. To date, it has begun establishing recovery community centers, has instituted training for Recovery Coaches, and has taken significant strides in developing sustainable mechanisms for reimbursing peer-to-peer services provided in outpatient treatment settings. Since joining the ONDCP ROSC Learning Community in March 2012, the State of New York team has focused its participation on developing flexible funding mechanisms to develop, sustain, and integrate peer recovery support services.

With the implementation of the Affordable Care Act and the concurrent charge from New York Governor Andrew Cuomo to make sweeping changes to the structure of the State Medicaid system, New York State stands poised to make bold leaps toward a more recovery -oriented system of behavioral health care. Participating in the learning community gives the state a mechanism for better guiding its ongoing ROSC efforts.

Lureen McNeil is a Program Manager at the State of New York Office of Alcoholism and Substance Abuse Services (OASAS). Peter Gaumond is the Recovery Branch chief at ONDCP.

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Cross Post: Statement by HHS Secretary Kathleen Sebelius on Supreme Court Ruling on Defense of Marriage Act

Posted by Cross-posted from HHS Newsroom on June 27, 2013 at 10:35 AM EDT

Posted: June 26, 2013

Today’s Supreme Court decision finding the Defense of Marriage Act unconstitutional is a victory for equality, which is a core belief of this administration.

It is also a victory for families, especially those children whose parents’ legal same sex marriages can now be recognized under federal law.

As a result of today’s ruling, the federal government is no longer forced to discriminate against legally married same sex couples.

The Supreme Court’s decision on DOMA reaffirms the core belief that we are all created equal and must be treated as equal.

The Department of Health and Human Services will work with the Department of Justice to review all relevant federal statutes and ensure this decision is implemented swiftly and smoothly.

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Synthetic Drugs - An Emerging Global Threat

Posted by William R. Brownfield on June 26, 2013 at 4:28 PM EDT

Note: This is a cross-post from DipNote, the U.S. Department of State Official Blog. The original post can be found here.

"Bath salts, spice, and jewelry cleaner" – what sounds like a normal shopping list is actually a list of new and dangerous drugs known as new psychoactive substances (NPS), many of which are synthetic cannibanoids. In 2011, in the United States alone, an estimated 28,531 emergency room visits involved a synthetic cannabinoid product. Synthetic cannabinoids are substances that are designed to affect the body in a manner similar to marijuana, but that are not derived from the marijuana plant. However, the effects of these new substances can be severe and dangerous and may include hallucinations, vomiting, agitation, and elevated heart rate. While some of these substances are controlled, others are easily available to teens and young adults on the internet, in smoke shops, and even at gas stations.

The United States and the international community are increasingly concerned about this growing public health threat. Today, June 26, in commemoration of the International Day against Drug Abuse and Illicit Trafficking, the UN Office on Drugs and Crime (UNODC) is releasing the annual UN World Drug Report, underscoring the emergence of NPS in 70 of 80 countries that reported to UNODC.

While most markets for plant-based organic drugs such as cocaine and heroin are stable or declining, synthetic drug use is rising. Greater efforts are needed to educate people at home and around the world about the dangers of these synthetic drugs and also work with the international community to reduce their availability. Synthetic drugs are in many ways more difficult to counter than other drugs – they originate from a wider range of production zones than cocaine or heroin, they are less vulnerable to law enforcement intervention, and they are found in otherwise legal chemicals needed for legitimate industry. Synthetics manufacturers have also shown an ability to alter their chemical composition while retaining their psychoactive effects in order to skirt existing drug laws and put them on the market faster than they can be scheduled for control.

The United States is deeply committed to reducing drug abuse within our own borders, and we are also working with international partners to reduce the availability of illegal drugs and minimize the harm they cause around the world. In 2012, the United States passed domestic legislation to enhance law enforcement's ability to respond to NPS. Last year, the Bureau of International Narcotics and Law Enforcement Affairs (INL) provided funding to support the UNODC’s Global Synthetics Monitoring, Analysis Reporting, and Trends program, which tracks new synthetic drug production and trafficking trends and disseminates this information to governments around the globe.

Creating systems to limit the production and movement of these drugs are more vital than ever. At the same time, governments must engage with civil society to educate families and communities about the dangers of this new class of drugs.

Go to www.drugabuse.gov to learn more about this emerging threat.

William Brownfield serves as the Assistant Secretary for the Bureau of International Narcotics and Law Enforcement Affairs.

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Sesame Street, Incarceration and Drug Policy Reform

Posted by Cameron Hardesty on June 13, 2013 at 4:53 PM EDT

Yesterday, the White House hosted twelve Champions of Change, individuals who work to support children of incarcerated parents and their caregivers. Today over 2 million children have a parent who is incarcerated,^[i] and those honored yesterday work every day to bring stability and support to these young people and their families.

In conjunction with this event, Sesame Street released a toolkit for parents and caregivers of children who experience the incarceration of a loved one. The toolkit features videos, tips, activities, songs, and smartphone apps to help providers and caregivers support children struggling with the effects of a parent’s incarceration.

You can watch the video here.

To learn more about the President’s plan for drug policy reform, visit this page.

[i] http://www.osborneny.org/images/uploads/printMedia/Initiative%20CIP%20Stats_Fact%20Sheet.pdf

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Lowering Incarceration Rates, Honoring Children of Incarcerated Parents

Posted by Meredith DeFraites on June 12, 2013 at 12:26 PM EDT

Today, the White House honors twelve Champions of Change who are helping children of incarcerated parents and their caregivers. These heroes work every day to help families affected by incarceration.

The courageous work of these Champions of Change is complemented in government by an interagency group committed to identifying and eliminating legal obstacles faced by people reentering society after incarceration. This group, the Federal Interagency Reentry Council, was convened by the Attorney General 2 years ago and seeks to reduce barriers to jobs, housing, and education, with a special emphasis on the needs of veterans and women as they rejoin society after involvement with the criminal justice system.

The Council’s record includes:
- Training and collaboration. The National Institute of Corrections funded intensive technical assistance in six states for the Transition from Jail to Community Initiative, which advances collaboration between jails and communities to enhance public safety, reduce recidivism, and improve reintegration processes.
- Employment and legal aid. The Department of Labor and the Department of Justice issued grants for employment and to help pay for legal assistance for such actions as securing drivers’ licenses and expunging criminal records.
- A focus on veterans. The Department of Veterans Affairs (VA) is piloting the Veterans Reentry Search Service, a web-based system to allow court, jail, and prison staff identify veterans among their inmate or defendant populations—an important step toward linking justice-involved veterans with VA substance use, mental health, and other clinical services.
- Support for women. The Department of Labor funded grants to provide employment and support services to justice-involved females using a comprehensive care management strategy. The grants are now active in nine locations, with seven sites serving adults and two serving youth.
In conjunction with today’s Champions of Change event, the Reentry Council has published a new online resource to explain the Council’s work, outline its accomplishments, and share its plans for the future. To learn more about the Reentry Council, please visit this page. To view and join the conversation about today's Champions of Change, use the hashtag #WHChamps.

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Director Kerlikowske Delivers Keynote Remarks at NMPI Conference

Posted by ONDCP Staff on June 10, 2013 at 2:51 PM EDT

On May 7, ONDCP Director Gil Kerlikowske delivered keynote remarks at the annual Strategy Summit of the National Methamphetamine and Pharmaceuticals Initiative (NMPI) in Charleston, South Carolina. In his remarks, Director Kerlikowske highlighted the “Smart on Crime” approach to drug enforcement and recognized the important role law enforcement officers play in implementing a balanced drug control policy.

Following his remarks, the Director was presented with the IMPACT award in recognition of his commitment and leadership in reducing the diversion and abuse of prescription drugs and the production and trafficking of methamphetamine in the United States. The IMPACT Award is presented to individuals whose actions have resulted in a significant impact on the Nation’s methamphetamine or pharmaceutical abuse problems. Recipients are selected by the NMPI’s advisory board, which is composed of local, state, and Federal law enforcement officials and policy makers.

Over the course of 4 days, more than 250 attendees from across the United States, as well as delegations from Canada, Mexico, and China, met at the summit to share information, cultivate contacts with partners at the Federal, state, and local levels, and develop operational strategies and best practices critical to their efforts to seize and prevent clandestine methamphetamine laboratories and disrupt and prosecute prescription drug crimes.

Reflecting the Administration’s balanced approach to drug policy, speakers delivered presentations on such topics as the role of law enforcement and first responders in reversing opiate overdoses with naloxone, working within communities to prevent prescription drug abuse, and treating individuals suffering from addiction. Presenters also provided information on the latest trends in methamphetamine production and trafficking and prescription drug diversion.

The diverse group of attendees included law enforcement officers, public health officials, medical professionals, family welfare advocates, laboratory chemists, and policy makers. The range of expertise and experience created a vibrant environment for an informed discussion and a rich exchange of information about the prescription drug and methamphetamine threats facing the United States.

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Cross Post: Hepatitis C Infection Among Young Injection Drug Users: Addressing an Emerging Trend

Posted by Ronald Valdiserri, M.D., M.P.H., Deputy Assistant Secretary for Health, Infectious Diseases, and Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services on June 6, 2013 at 11:30 AM EDT

This is a cross-post from the AIDS.gov blog. The original post can be found here.
Dr. Ronald Valdiserri

In recent years, there has been an emerging epidemic of hepatitis C virus (HCV) infection among young injection drug users (IDU) in rural and suburban settings. Early this spring, the U.S. Department of Health and Human Services convened a multidisciplinary technical consultation to discuss the existing evidence and to identify and define priorities for the development of a public health response. Already working together to implement the Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis—which includes among its priorities “reducing viral hepatitis caused by drug use behaviors”—the Office of HIV/AIDS and Infectious Disease Policy, the National Institutes of Health, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration organized the consultation which brought together representatives of federal agencies, state health department officials, researchers, care providers, staff of community-based organizations, and other experts in the field. Over two days the participants explored factors fueling this epidemic and recommended priorities around epidemiology and surveillance initiatives, prevention and linkages to care interventions, and research questions designed to curb the rising rate of HCV among young persons who inject drugs (PWID) in the United States.

New HCV Infection Trend Among Young People Who Inject Drugs

Injection drug use is known to play a major role in HCV transmission. Surveillance data shared by Massachusetts in 2010 put a spotlight on an emerging HCV infection trend among young PWID. That year, the Massachusetts Department of Public Health analyzed chronic hepatitis C infection data and observed an increase of HCV among persons aged 15–24 between 2002 and 2009. The young people being reported were from all over the state, almost all outside of metropolitan Boston, primarily White, and equally male and female. In-depth interviews with a number of these HCV-positive young people uncovered that most were IDUs who had started opioid use by first misusing oral oxycodone around 1–1.5 years before transitioning to injecting heroin.

After the Massachusetts findings were published, other jurisdictions across the country, began to report similar findings: rising rates of hepatitis C infection among young injectors, both male and female, primarily White, found in suburban and rural settings, who started misusing prescription opioids (e.g., oxycodone) before transitioning to heroin injection.

Participants in the consultation shared that HCV transmission among young IDUs is highly efficient, with young injectors frequently acquiring HCV soon after they first begin to inject opioids. This indicates that the window for HCV prevention interventions targeting this population is narrow. In addition to drug use behaviors, other risk factors influence their risk of acquiring or transmitting HCV including homelessness and a lack of understanding about their risk of infection with HCV and how to prevent it.

The size of this population is significant. An analysis of data from the National Household Survey on Drug Abuse between 1979-2002 (now the National Survey on Drug Use and Health) estimated that 590,000 young adults aged 18–29 had ever injected drugs. As the surveys do not include institutionalized or homeless individuals, it is likely that these figures are underestimates. Among these young injectors, it is estimated that as many as 45% (265,000) are infected with HCV.

There is growing concern that these increases could begin to reverse the declines in overall HCV incidence and prevalence observed by the CDC over the past decade. It is clear that federal, state local and community partners need to take action if we are to mount a sound public health response.

Strategies to Address HCV Infection Among Young PWID

During the consultation, researchers, federal agency representatives, providers, and community leaders shared presentations on key facts about the epidemiology of HCV infection among this population, the state of current research, and examples of innovative community responses. The consultants engaged in robust, highly interactive discussions identifying successes, challenges, and gaps and proposing strategies to address the issues that emerged. A summary of the presentations and the groups’ recommendations are presented in a meeting summary report [PDF 4MB].

The consultation participants recommended several key public health actions including:
- Create community-led education and messaging strategies on hepatitis C risks, injection transmission risks (e.g., sharing drug preparation equipment in addition to sharing drug injection equipment), and HCV testing resources.
- Improve and increase infrastructure for HCV surveillance and data collection.
- Create age-appropriate (e.g., young adult) substance use and hepatitis C interventions and prevention strategies that are evidence based and effective.
- Expand both community-based and basic science research activities to better understand how to effectively address the emerging crisis of hepatitis C infection among young IDUs.
Discussions about this issue are ongoing among the participants and other federal and non-federal partners as we collaborate on ways to stem the tide of new HCV infections among young PWID and connect those already living with HCV to care and treatment for their infection and underlying drug use. With heightened awareness of this evolving epidemic and the attention and engagement of partners from across all sectors of society– including the voices of young people– we can make a positive difference in the lives of these young men and women.
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Guest post: Michael Banyard’s Story, Part 4 – Final Entry

Posted by Michael Banyard, Founder, Each1Reach1Teach1.org on June 3, 2013 at 3:27 PM EDT

In June 2012, National Drug Control Policy Director Gil Kerlikowske visited the Betty Ford Center, one of the Nation’s oldest and most recognized addiction treatment facilities. There he gave remarks to a crowd of leaders in the field of recovery. In the audience were two special guests—Michael Banyard and Federal District Court Judge Spencer Letts. In his remarks, Director Kerlikowske mentioned Banyard’s improbable—and inspirational—journey from crack cocaine dependence and homelessness, to prison, to a successful sentence appeal, to the chambers of a federal district court judge and completion of his GED.

Read Part 1, Part 2 and Part 3 of Michael Banyard’s story.

I went to the Los Angeles Dream Center. It was August 18, 2011, when I arrived, and at that time I was back on parole and also probation at the same time.

I committed myself to do 1 full year in the Discipleship Program, and after the first 30 days I knew I had never been anywhere like this. They not only gave discipline and spiritual structure, but also taught me how to build your character and learn the power of integrity. How to do what is right even when no one is looking!

I felt so strong about my opportunity of permanent change, that I told my roommates, "Before I graduate I will be off parole and probation." Today, I can say that dream came true. I discharged parole April 5th, 2012. My parole officer called and said I had done great and they were really proud of my accomplishments.

The very next month I went to court for a progress report as to my formal probation and the court was so pleased that at the end of the hearing I was given the opportunity to speak. I thanked the court for giving me the chance to change my life, and asked if I could be removed from formal probation. The court said I had a long past, but my accomplishments at the Dream Center had reach beyond what they expected, and granted my request. Since this was before the year was completed, I went back to court later on to show the court that I did not change from my positive path just because formal probation was removed. So, when the term of a year was reached I returned to court and I invited Judge Letts, so that I could thank both justices for not giving up on me, for if they had I would have probably been dead or back in prison for life.

After that court date, Judge Letts and I sat outside the Los Angeles Superior Court and shared a moment of bliss.

Judge Letts and Michael Banyard outside a State Court House after Michael was discharged from formal probation.

Kurt Streeter of the Los Angeles Times wrote a follow up story of how my life had change since I arrived at the Dream Center. Shortly following that, my mind was even blown more when I was invited to meet the Director of National Drug Control Policy.

Michael Banyard and Judge Letts were honored to meet the Director of Drug Policy.

Today, I am a very happy graduate of the Los Angeles Dream Center Discipleship Program.

Michael Banyard at Angelus Temple in Los Angeles, graduating from a 1 year Discipleship Program at the Dream Center.

I can say that never in my life have I ever volunteered to be inside a program or institutional setting, yet even though I graduated the Discipleship Program, I stayed on working as a Resident Advisory. I am able to serve the needs of the men who are within their first four months of the program, encouraging them as one who personally understands that change is possible.

Last year, I completed the Dream Center’s G.E.D. program, and am proud to report that I passed the G.E.D. exam in December 2012.

With the Dream Center, I share in the mission to "find needs and fill it, find hurts and heal it."

Michael Banyard remains at the Dream Center as a volunteer to encourage new intakes of the program as a Resident Advisory.

Michael Banyard is the founder of Each1Reach1Teach1, where he mentors the children of incarcerated parents.

He thanks the Office of the Director of Drug Policy for sharing his story. Michael passionately thanks Judge Letts for never giving up on him, and thanks Pastor Matthews of the Dream Center because his vision has changed many lives. But most of all, Michael thanks God for putting it all together.

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ADAM II Report and Alcohol

Posted by Rafael Lemaitre on May 28, 2013 at 5:57 PM EDT

Last week, we released the 2012 Arrestee Drug Abuse Monitoring Annual Report (ADAM II), a long running study that reveals the percentage of arrestees in certain U.S. cities/counties testing positive for at least one illegal drug at the time of arrest. Because of the significant impact on public health and safety (in 2007 alone, illegal drugs were responsible for over $193 billion in lost productivity, health, and criminal justice costs) this survey has long served as a vital asset for officials at both the local and national levels. Typically, however, the annual ADAM report does not include findings about alcohol use. Why? Here are three reasons:

1. Simply put, the nexus between alcohol use and crime is already well documented. You’d be hard pressed to find anyone – particularly in the criminal justice research community - who would dispute the long established link between the use of a widely available, legal drug like alcohol and crime. Moreover, there are already many other surveys that compare rates of legal drug use to illegal drug use - most notably the National Survey on Drug Use and Health (NSDUH), the Nation’s premiere general population survey. (Here’s a chart showing rates of legal drug use vs. illegal drug use using NSDUH data).

What’s harder to investigate, however, are emerging trends in illegal drug use – which fluctuate and shift more widely compared to alcohol - at the local level, and among a highly transient, often homeless criminal justice population. How does meth use among arrestees in Sacramento compare to Chicago? Is cocaine use falling or rising among arrestees in each of the five sites measured by ADAM II? How does opiate use among arrestees in Atlanta compare to New York? These are the types of questions ADAM II is designed to investigate.

2. The ADAM II study doesn’t test arrestees for alcohol in the first place. One of the primary characteristics that make the ADAM II survey unique is that it collects bioassay data (urinalysis) from arrestees within 48 hours of arrest (as opposed to larger surveys such as NSDUH that rely solely on a questionnaire). Since ADAM II only tests for certain illegal drugs (marijuana, cocaine, opiates, amphetamines/methamphetamine, Darvon, PCP, benzodiazepines, methadone, and barbiturates), there are no data on positive alcohol results to report in the study.

As part of the data collection process, some questions are asked about alcohol use, but since the focus of the annual report is on the drug test results, the findings from the alcohol questions are not included in the report. However, in keeping with the scientific principles of transparency and accessibility and Administration policy, ONDCP makes the complete ADAM II raw data file available to researchers so they can conduct their own analyses. These raw data are available for previous years of ADAM data collection through the University of Michigan’s Inter-University Consortium for Political and Social Research (ICPSR), a data warehouse used by many Federal agencies to make their data available to the research community. (Users must first register with the ICPSR and sign a user’s agreement, and more recent years data will be available there soon).

3. The primary focus of ONDCP is to reduce illegal drug use and its consequences. A component of the Executive Office of the President, ONDCP was created by the Anti-Drug Abuse Act of 1988 (you can read our Congressional authorization here). Accordingly, ONDCP’s primary mission has focused on efforts to reduce illicit drug use, manufacturing and trafficking, drug-related crime and violence, and drug-related health consequences.

As part of our commitment to science-based drug policy, we welcome conversation about our research. The ADAM II survey has been a valuable tool for our office, and we encourage anyone with an interest in its findings to take a look.

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New Arrestee Data Underscore Need for 21st Century Approach to Drug Policy Reform

Posted by R. Gil Kerlikowske on May 23, 2013 at 2:00 PM EDT

Today, I spoke at the Urban Institute to call for the expansion of criminal justice reforms aimed at addressing the underlying causes of criminal behavior in light of new data confirming the nexus between drug use and crime. The 2012 Arrestee Drug Abuse Monitoring Annual Report (ADAM II) shows that in five cities/counties, more than half of adult males arrested for crimes ranging from misdemeanors to felonies tested positive for at least one illegal drug. According to ADAM II, positive test results among arrestees ranged from 62 percent in Atlanta to 86 percent in Chicago.

Director Kerlikowske, Marc Mauer, Chief Thomas Manger and Nancy La Vigne at Urban Institute.

In 2004, according to the Bureau of Justice Statistics, 53 percent each of jail and state inmates and 46 percent of Federal inmates suffered from drug use abuse or dependence – and yet only 7 percent of jail inmates, 15 percent of state inmates, and 17 percent of Federal inmates received treatment.

These data show that reform is needed. A month ago, the Obama Administration released the 2013 National Drug Control Strategy (Strategy), the president’s plan for 21^st century drug policy reform based on scientific research about the nature of addiction. This plan reflects our understanding of addiction as chronic brain disease—one that can be prevented, treated, and from which people can recover.

The Strategy also supports a “smart on crime” approach to drug enforcement, protecting communities from domestic and international drug-related crime while diverting non-violent drug offenders into treatment instead of prison. As part of this approach, our plan highlights promising criminal justice reform, like drug courts and smart probation programs that reduce incarceration rates, along with community-based policing programs that break the cycle of drug use, crime, and incarceration while focusing limited enforcement resources on more serious offenses.

Far too often, addiction is at the root of what drives crime in our communities. To stop the revolving door of the criminal justice system in America, we must address not only serious criminal activities, but equally important, underlying substance use disorders. The ADAM II report confirms an urgent need to support policy reform outlined in the Obama Administration’s new drug policy strategy, which emphasizes prevention, treatment, and “smart on crime” policies that break the vicious cycle of drug use, crime, and incarceration in America.

To read the full 2012 Arrestee Drug Abuse Monitoring Annual Report (ADAM II) report, click here.

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