On April 11th, President Donald Trump named Tom Marino his new "drug czar." Marino is a three-term Republican member of the US House, representing the 10th district of Pennsylvania. Formally, Marino will be the Director of the White House Office of National Drug Control Policy (ONDCP). Effectively, the drug czar is an advisor to the president and the person who coordinates the many drug policy outposts in the federal government.
In addition to the usual tasks a drug czar must take up, Marino will be faced with an exploding opioid crisis in the US. For perspective, the CDC reported that in 2015 alone, more than 33,000 Americans died from opioid overdoses. That's more than twice the number of deaths of American servicemen during the deadliest year of the Vietnam War, 1968. Between 2014 and 2015, Marino's home state of Pennsylvania saw a 20.1 percent increase in overdoses—the 10th highest in the nation.
In response, the president established the "President's Commission on Combating Drug Addiction and the Opioid Crisis," which is chaired by New Jersey Governor Chris Christie and overseen by the president's son-in-law, Jared Kushner. Beyond navigating the bizarre leadership structure of this commission, Marino will need to work to maximize the impact of its findings and recommendations.
There will be significant expectations that this White House do something about opioids, and if confirmed, Tom Marino's actions will help determine how well we deal with this silent killer.
Many in the marijuana reform, drug treatment, and other drug policy communities are worried that Marino will run ONDCP like his predecessors: fixated on a "public safety" (read: brutal law enforcement) approach to the nation's drug issues rather than one that focuses on public health.
A good way for Tom Marino to outshine his predecessors is to focus less on the government's addiction to marijuana enforcement and more on how to deal with opioids. Here are a few ways to achieve that:
Be a populist, like your boss
Listening to the public is a good thing for a drug czar. Previous drug czars' efforts were not so much listening tours, but hearing tours—tours where officials would hear the public's words and not listen to the serious information they were being told.
The public isn't right about every issue or every detail of drug policy, public health, or public policy solutions. Yet the public is pretty good about knowing when there is a problem in their communities. While some officials in this administration are itching to crack down on state-legal, medical and adult-use marijuana industries, the public sees a bigger problem with opioids. In 2016 the Kaiser Family Foundation found that between 66 and 71 percent of Americans believed opioid abuse was an extremely serious or very serious problem in the US. Similarly, a 2016 Gallup poll showed that 44 percent of the public felt that prescription painkillers were a crisis or a very serious problem in their area, and 42 percent believed the same about heroin. Compare that with 23 percent of the public who felt the same about marijuana (legal or illicit) and the public is leading the drug policy horse to water.
Listen to science
This administration, when it comes to drug policy, has a tangential relationship with science, data analysis, and on-the-ground realities. Even though the federal government maintains bureaucratic barriers that make research on marijuana difficult, we have still learned volumes about that drug compared to what we knew 20 years ago, including information about dependence, dependence relative to other substances, medical efficacy, its effect on the human body, the so-called "gateway effect," etc. We have enormous evidence about how ineffective prison has been for treating users of all types of drugs. Scientific communities have been begging the government for decades to see drug abuse as a public health, rather than public safety, issue. As the coordinator for all US drug policy, it is incumbent upon the drug czar to update all government entities on the best science on marijuana, opioids, prescription drug abuse, mental health and addiction, public health, and public safety. Stop guessing and ask the experts.
Be cooperative, not divisive
A drug czar has to coordinate policy within the administration and with Congress with limited resources; that's no easy task. While the Attorney General and others in the administration may have the legal marijuana industry in their crosshairs, a drug czar should think about the rifts such a fight would generate. Governors of both parties in states that have legalized marijuana would react; many have already stated they will fight federal intervention. There would be opposition among bipartisan coalitions in Congress, making the effort more complicated and the oversight more onerous. On the other hand, a serious focus on opioids would help governors who are pleading with the federal government for assistance and would find bipartisan, bicameral support in Congress. These days, there is not much that unites across so many boundaries—the two parties, independents, the House, the Senate, governors, voters of both parties—but the need for serious action to combat the opioid epidemic does.
Be a leader in rhetoric
One way a drug czar can help advance drug policy in the US is to ensure all relevant agencies speak in one voice and that that voice speaks honestly. Luckily, the script is largely in place, and the drug czar just needs to change some of the words. Marino can simply borrow much of the Attorney General's rhetoric, simply substituting the word "marijuana" for "opioids," and he would have something accurate to say. It's shocking how accurate the language could be, in fact. See these quotes from Jeff Sessions:
I don't think America's going to be a better place if they sell marijuana at every corner grocery store.
Experts are telling me there's more violence around marijuana than one would think and there's big money involved.
Yes, the Attorney General has had some tough talk on opioids, recognizing the crisis they are creating in our communities. Unfortunately, the manner in which he talks about state-legal marijuana is often grossly inaccurate. But interestingly, it does reflect the many aspects of opioids in the US. Honesty and accuracy give legitimacy, and only officials with legitimacy will effectively address our nation's drug policy problems.
The government's fight against opioids will be a difficult one, and it won't be solved overnight. If confirmed, Mr. Marino should prioritize this deadly crisis among all relevant agencies and ensure government officials are well-informed and well-spoken on the issue. Some officials, obsessed with cracking down on state-legal marijuana industries, should also consider how legal pharmaceutical companies may be complicit in creating a drug crisis in this country. I'm not convinced the government's drug policy community can walk and chew gum at the same time. And if a drug czar needs to think about how to prioritize enforcement in the US, ask a simple question to governors, mayors, doctors, coroners, and the general public: Is it legal marijuana or opioids that pose a bigger threat to your community?" Then, simply proceed accordingly.
John Hudak is deputy director of the Center for Effective Public Management and a senior fellow in Governance Studies at the Brookings Institute. He's also the author of Marijuana: A Short History.
Update 5/4/17: Marino withdrew himself from consideration as Trump's drug czar, citing a critical illness in his family.
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