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ONDCP’S FISCAL YEAR 2011 NATIONAL DRUG

CONTROL BUDGET: ARE WE STILL FUNDING

THE WAR ON DRUGS?

HEARING

BEFORE THE

SUBCOMMITTEE ON DOMESTIC POLICY

OF THE

COMMITTEE ON OVERSIGHT

AND GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED ELEVENTH CONGRESS

SECOND SESSION

APRIL 14, 2010

Serial No. 111–137

Printed for the use of the Committee on Oversight and Government Reform

(

Available via the World Wide Web: http://www.fdsys.gov

http://www.oversight.house.gov

(II)

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM

EDOLPHUS TOWNS, New York, Chairman

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

JOHN F. TIERNEY, Massachusetts

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

JIM COOPER, Tennessee

GERALD E. CONNOLLY, Virginia

MIKE QUIGLEY, Illinois

MARCY KAPTUR, Ohio

ELEANOR HOLMES NORTON, District of

Columbia

PATRICK J. KENNEDY, Rhode Island

DANNY K. DAVIS, Illinois

CHRIS VAN HOLLEN, Maryland

HENRY CUELLAR, Texas

PAUL W. HODES, New Hampshire

CHRISTOPHER S. MURPHY, Connecticut

PETER WELCH, Vermont

BILL FOSTER, Illinois

JACKIE SPEIER, California

STEVE DRIEHAUS, Ohio

JUDY CHU, California

DARRELL E. ISSA, California

DAN BURTON, Indiana

JOHN L. MICA, Florida

MARK E. SOUDER, Indiana

JOHN J. DUNCAN, JR., Tennessee

MICHAEL R. TURNER, Ohio

LYNN A. WESTMORELAND, Georgia

PATRICK T. MCHENRY, North Carolina

BRIAN P. BILBRAY, California

JIM JORDAN, Ohio

JEFF FLAKE, Arizona

JEFF FORTENBERRY, Nebraska

JASON CHAFFETZ, Utah

AARON SCHOCK, Illinois

BLAINE LUETKEMEYER, Missouri

ANH ‘‘JOSEPH’’ CAO, Louisiana

RON STROMAN, Staff Director

MICHAEL MCCARTHY, Deputy Staff Director

CARLA HULTBERG, Chief Clerk

LARRY BRADY, Minority Staff Director

SUBCOMMITTEE ON DOMESTIC POLICY

DENNIS J. KUCINICH, Ohio, Chairman

ELIJAH E. CUMMINGS, Maryland

JOHN F. TIERNEY, Massachusetts

DIANE E. WATSON, California

JIM COOPER, Tennessee

PATRICK J. KENNEDY, Rhode Island

PETER WELCH, Vermont

BILL FOSTER, Illinois

MARCY KAPTUR, Ohio

JIM JORDAN, Ohio

MARK E. SOUDER, Indiana

DAN BURTON, Indiana

MICHAEL R. TURNER, Ohio

JEFF FORTENBERRY, Nebraska

AARON SCHOCK, Illinois

JARON R. BOURKE, Staff Director

(III)

C O N T E N T S

Page

Hearing held on April 14, 2010 .............................................................................. 1

Statement of:

Carnevale, John, president, Carnevale Associates, LLC; Ethan

Nadelmann, executive director, Drug Policy Alliance; Vanda FelbabBrown, fellow, the Brookings Institution; and Peter Reuter, professor,

School of Public Policy and Department of Criminology, University

of Maryland ................................................................................................... 41

Carnevale, John ......................................................................................... 41

Felbab-Brown, Vanda ................................................................................ 73

Nadelmann, Ethan .................................................................................... 64

Reuter, Peter .............................................................................................. 88

Kerlikowske, Gil, Director, Office of National Drug Control Policy ............. 8

Letters, statements, etc., submitted for the record by:

Carnevale, John, president, Carnevale Associates, LLC, prepared statement of ........................................................................................................... 44

Felbab-Brown, Vanda, fellow, the Brookings Institution, prepared statement of ........................................................................................................... 75

Kerlikowske, Gil, Director, Office of National Drug Control Policy, prepared statement of ........................................................................................ 11

Kucinich, Hon. Dennis J., a Representative in Congress from the State

of Ohio, prepared statement of .................................................................... 4

Nadelmann, Ethan, executive director, Drug Policy Alliance, prepared

statement of ................................................................................................... 66

Reuter, Peter, professor, School of Public Policy and Department of Criminology, University of Maryland:

Prepared statement of ............................................................................... 105

Prepared statement of Ms. Pacula ........................................................... 89

Watson, Hon. Diane E., a Representative in Congress from the State

of California, prepared statement of ........................................................... 119

(1)

ONDCP’S FISCAL YEAR 2011 NATIONAL DRUG

CONTROL BUDGET: ARE WE STILL FUNDING

THE WAR ON DRUGS?

WEDNESDAY, APRIL 14, 2010

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON DOMESTIC POLICY,

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM,

Washington, DC.

The subcommittee met, pursuant to notice, at 10 a.m., in room

2154, Rayburn House Office Building, Hon. Dennis J. Kucinich

(chairman of the subcommittee) presiding.

Present: Representatives Kucinich, Tierney, Foster, Jordan, and

Issa (ex officio).

Staff present: Jaron R. Bourke, staff director; Claire Coleman,

and Charles Honig, counsels; Jean Gosa, clerk; Leneal Scott, IT

specialist; Charisma Williams, staff assistant; Adam Fromm, minority chief clerk and Member liaison; Stephanie Genco, minority

press secretary and communication liaison; Ashley Callen, minority

counsel; and Molly Boyl, minority professional staff member.

Mr. KUCINICH. Thank you for being here. The committee will

come to order.

The Subcommittee on Domestic Policy of the Committee on Oversight and Government Reform is now in order. The hearing will examine the priorities and objectives of the Office of National Drug

Control Policy under the Obama administration and how those

goals are reflected in the 2011 Fiscal Year National Drug Control

Budget.

Without objection, the Chair and ranking minority member will

have 5 minutes to make opening statements, followed by opening

statements not to exceed 3 minutes by any other Member who

seeks recognition.

Without objection, Members and witnesses may have five legislative days to submit a written statement or extraneous materials for

the record.

We are here today to evaluate the Office of National Drug Control Policy’s 2011 budget, the first drug budget formed under the

Obama administration. President Obama and Director Kerlikowske

have said that the Nation’s drug policy should be guided by examining the evidence of what works. To that end, they have suggested

that drug abuse should be treated as a public health issue instead

of a criminal justice issue.

Director Kerlikowske has rightfully called for an end to the war

on drugs. This is an obviously important shift from the previous

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administration. The question to be addressed at this hearing today

is whether, despite this important rhetorical shift, the ONDCP is

in fact engaging in employing an honest assessment of what works

and what does not work in U.S. drug policy.

We will ask: Does the budget support programs of demonstrated

effectiveness for reducing drug use and its harmful health consequences here in the United States? Or does the budget continue

to fund a war on drugs that is unsupported by science and research?

It is unfortunate that ONDCP was not able to release this year’s

National Drug Control Strategy or budget summary prior to this

hearing. Not only have they missed by over 2 months the February

1st statutory deadline mandated by the 2006 reauthorization, but

it has frustrated the subcommittee’s ability to conduct oversight.

Without the strategy, we will have to speculate to some degree

about the administration’s approach from the budget highlights

and other drug control agency budget agency documents.

From the information available, it is clear that at least in some

areas, we are beginning to see drug policy decisions based on

science and evidence, instead of politics. This is especially true in

the area of treatment in international source country programs.

The increased funding for treatment programs and commitment to

funding addiction screening is falling short of the goal of providing

treatment for all who need it, and reflects the recognition that handling drug addiction as a medical problem is most effective.

On the international side, while the budget continues to drastically overspend on failed interdiction policies, at least we are finally seeing a shift in spending in source country programs, focusing less on the military side of drug enforcement and crop eradication, and more on providing assistance to strengthening the rule

of law, democratic institutions and addressing border security.

The budget proposes funds for new demand reduction programs

in source countries that have drug problems largely as a result of

supplying the United States with drugs. These are all positive

steps that support evidence-based and cost-effective drug policy.

But if the administration truly acknowledges the plethora of research demonstrating that treatment and evidence-based prevention are more effective at reducing drug use than law enforcement

interdiction and source country eradication, then why is our drug

budget still so lopsided in favor of less effective approaches?

If we compare the current budget request for supply side and demand side programming to the previous administration’s last drug

budget in 2009, the difference in spending for supply reduction in

the upcoming fiscal year is only one-half of 1 percent. The 2011

budget still spends at least two-thirds of the total drug budget on

supply reduction programs because the drug budget still fails to

comprehensively account for all Federal drug control expenditures

as required by the 2006 ONDCP Reauthorization Act. Despite the

subcommittee and congressionally ordered reviews and repeated

calls for ONDCP to follow the law, the misguided and unsupported

orientation to supply side efforts is actually more.

The drug budget as calculated now contains only those expenditures aimed at reducing drug use, rather than those associated

with the consequence of drug use. For example, the budget fails to

3

account for the billions of dollars a year spent on prosecuting and

incarcerating drug offenders. Congress has clearly spoken on this

issue and we hope that this administration will work quickly to reintroduce a budget methodology that actually communicates to

Congress and the public the levels of public spending on drug policy.

I am going to ask unanimous consent to just put the rest of my

statement in the record.

[The prepared statement of Hon. Dennis J. Kucinich follows:]

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Mr. KUCINICH. Mr. Jordan, you are recognized.

Mr. JORDAN. Thank you, Mr. Chairman.

It is good to have the Director with us again. I appreciate the Director’s response to a letter that many of us had sent to him and

the fairly detailed response that he sent back to us.

Mr. Kucinich, I want to thank you for holding this hearing.

Our Nation continues to face a drug problem that takes lives,

brings about violence and tears apart communities and families.

We need to take every opportunity and make every effort to eliminate this problem with an approach that focuses both on keeping

drugs from entering the country in the first place and curbing addiction here at home.

The Office of National Drug Control Policy has an extremely difficult task in coordinating many different agencies to address

issues at home and abroad. The ONDCP budget must strike a balance between funding programs to tackle both international and

domestic supply reduction, demand reduction at home, drug-related

violence along our borders and in our streets, addiction treatment

and health-related issues stemming from abuse of both illicit and

prescription drugs, and enforcement of our drug laws and punishment of those who are in violation.

Regional disparities mean different drugs are more readily available to be bought, sold and abused in different States, compounding

the challenge of creating one budget and one strategy for the entire

country.

For example, methamphetamines are a growing problem, especially in rural areas all over the country, and I have seen the detrimental effects of this drug in our home State of Ohio. My colleagues from districts along the southwest border have seen increases in spillover violence as Mexican drug cartels have become

more brazen and moved operations further north toward Texas,

New Mexico, Arizona and California.

The many domestic and international factors that contribute to

our drug problem necessitate a strategy that addresses both supply

and demand reduction initiatives, eradication of drug crops in

source countries, interdiction, domestic anti-drug campaigns and

treatment programs must all be a part of a successful national

strategy.

The last time Director Kerlikowske testified before this subcommittee, he had been on the job for only a few days. As a result

of our budget process, during his first year at ONDCP, the Director

operated largely under the framework of a budget and strategy prepared by the Bush administration. I especially look forward to

hearing about the Director’s experiences during his first year at

ONDCP and what his expectations are for the future of the Office

during the Obama administration, including what changes to the

budget he is seeking and how the national strategy will change to

reflect the goals of the current administration.

I am only sorry that we could not have postponed this hearing

until the ONDCP national strategy had been released, but hope

that we may have another opportunity to speak with the Director

once the strategy has been finalized.

With that, Mr. Chairman, I yield back the time.

Mr. KUCINICH. I thank Mr. Jordan.

8

Mr. Foster, do you have an opening statement?

Mr. FOSTER. I would just like to make one brief comment. When

you are optimizing a budget, it is very important to understand

what it is you are optimizing for. And I think that the starting

point for this discussion should be what is it that we are optimizing

for. It seems to me that it ought to be something like the number

of man years lost to drug abuse in this country. And then you can

look at the entire range of things that we spend money on and find

out which contributes most to that.

So I will be very interested in how you set up the framework for

optimizing all of our expenditures.

Thank you. I yield back.

Mr. KUCINICH. Thank you very much.

I want to introduce Mr. Kerlikowske, who is the sole witness on

the first panel. He is the Director of the Office of National Drug

Control Policy. In this capacity, Mr. Kerlikowske coordinates all aspects of Federal drug control programs and implementation of the

President’s national drug control strategy.

Mr. Kerlikowske brings nearly four decades of law enforcement

and drug policy experience to the position, most recently serving 9

years as chief of police for the Seattle Police Department. He also

served as Deputy Director for the U.S. Department of Justice Office

of Community Oriented Policing Services, and president of the

Major Cities Chiefs Association.

I want to thank you for appearing before the subcommittee

today. Mr. Kerlikowske, it is the policy of the Committee on Oversight and Government Reform to swear in all witnesses before they

testify. I would ask that you rise and raise your right hand.

[Witness sworn.]

Mr. KUCINICH. Thank you very much.

Let the record reflect that the witness answered in the affirmative.

Mr. Kerlikowske, I would ask that you give a brief summary of

your testimony and to keep the summary under 5 minutes in duration. Your complete written statement will be included in the

record of the hearing, and I ask that you begin.

I am just going to say that rather than to trouble future witnesses, staff should be instructed to make sure that every witness

is prepared to testify, including demonstrating to them the appropriate use of the microphone.

Thank you very much. You may proceed.

STATEMENT OF GIL KERLIKOWSKE, DIRECTOR, OFFICE OF

NATIONAL DRUG CONTROL POLICY

Mr. KERLIKOWSKE. Thank you, Mr. Chairman and Ranking Member Jordan for the opportunity to testify. And I am happy to return

back to the committee. I was only on the job a few days, and it has

been an exciting year, quite frankly.

I look forward to the discussion. I look forward to answering your

questions.

The Obama administration understands that addiction is a disease. Prevention, treatment and law enforcement must be included

as part of a comprehensive strategy to stop drug use, to get help

to those who need it, and to ensure public safety.

9

The public health consequences of drug use are enormous and

the public safety impact of drug use is equally dramatic. Drug

overdoses now outnumber gunshot deaths in America. They are

fast approaching motor vehicle crashes as the leading cause of accidental death.

Since I last appeared before the committee, I have been focused

on drawing attention to a series of problems. One in particular is

drugged driving. Results from the Monitoring the Future Study indicate that in 2008, more than 10 percent of high school seniors admitted to having driven a vehicle after smoking marijuana in the

2-weeks prior to the survey. This is a troubling statistic that is consistent with data from the Department of Transportation study

that was released in December last year.

I have also been focused on raising awareness about prescription

drug abuse. Prescription drug abuse harms the people who misuse

these pills, as well as those close to them. While we must ensure

access to medications that alleviate suffering, it is also vital that

we do all we can to curtail diversion and abuse of pharmaceuticals.

Moreover, between 1997 and 2007, treatment admissions for prescription painkillers increased more than 400 percent. These

issues, as well as a renewed focus on the importance and effectiveness of smart prevention, are reflected in the soon to be released

2010 National Drug Control Strategy. The inaugural strategy commits the Obama administration to reduce drug use and its consequences. It is based on common sense, sound science, and practical experience.

The President’s Fiscal Year 2011 National Drug Control Budget

lays the foundation for our efforts. It contains requests totaling

$151⁄2 billion, an increase of $521 million over the fiscal year 2010

enacted level. The resources are categorized around five major

functions: substance abuse prevention, substance abuse treatment,

domestic law enforcement, interdiction, and international partnerships. And overall, the budget request for prevention and treatment represents a 61⁄2 percent increase over fiscal year 2010 enacted level.

The budget also includes $151.3 million for the five priorities established by ONDCP and our Federal partner working together as

part of the Demand Reduction Interagency Work Group.

Let me summarize those five priorities: creating a national community-based prevention system to protect adolescents; training

and engaging the primary healthcare system to intervene in the

emerging cases of drug abuse; expanding and improving integrating addiction treatment into the Federal healthcare systems; developing safe and efficient ways to manage drug-related offenders; and

creating a community-based drug monitoring system.

However, our renewed focus on prevention and treatment does

not come at the expense of effective law enforcement. We are committed to a balanced approach that places as much emphasis on enforcement as it does on treatment and prevention. Over $3.9 billion

is included in the fiscal year 2011 budget request for domestic law

enforcement efforts, an increase of $73.8 million over the fiscal year

2010 level.

With the forthcoming strategy and added resources, we will take

a comprehensive and balanced approach, combining tough but fair

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enforcement with robust prevention and treatment efforts, and that

we will be successful in stemming both the demand for and supply

of illegal drugs in our country.

I look forward to continuing to work with the committee’s members to address these challenging and important issues. I recognize

that the many things ONDCP and my executive branch colleagues

want to accomplish would not be possible without the support of

the Members of Congress.

Thank you very much.

[The prepared statement of Mr. Kerlikowske follows:]

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Mr. KUCINICH. Thank you very much, Mr. Kerlikowske.

All of our witnesses who will address this committee today agree

that the previous administration’s supply side programs were not

effective in stopping supply or consumption of drugs in the United

States. Given the evidence, Mr. Kerlikowske, why does supply side

reduction programming continue to receive so much budget emphasis?

Mr. KERLIKOWSKE. I think that the supply side emphasis is important for a host of reasons, whether we talk about eradication,

whether we talk about our international partners and where drugs

are flowing, no longer America being just the sole point of destination. For example, cocaine. As America’s appetite has diminished

for cocaine, the appetite in the U.K. and Europe for cocaine increases.

So these supply side interdiction efforts, international partnerships, helping to reduce the use of drugs and the amount of drugs,

even in the most impoverished nations, as was highlighted in Sunday’s New York Times Magazine, are critically important and we

have to be a strong partner with them.

Mr. KUCINICH. Well, where is the evidence, though? I mean, describe to this committee specifically with statistics what evidence

you have that this approach has been effective? You get a lot of

money. You put more money in the budget. Tell me about the effectiveness. I want you to attest to the effectiveness of the last administration’s supply side programs.

Mr. KERLIKOWSKE. Colombia. I would cite Colombia. There is a

level of safety and security in the country. There is increased productivity among the citizens.

Mr. KUCINICH. That is anecdotal. Do you have any specific statistics that you can point to?

Mr. KERLIKOWSKE. I would tell you that everything I know after

four decades in law enforcement tells me that we have to have a

balanced approach.

Mr. KUCINICH. I appreciate your experience. You have served the

country well and you have served the city of Seattle. I am familiar

with your service there. Give me some numbers.

Mr. KERLIKOWSKE. I would give you the numbers that are probably most effective when it comes to the reduced amount of violence that has occurred in some of these other countries. For instance, Colombia. You certainly can’t cite Mexico at that point

when it is reduced levels of violence, but I think in the coming

years with the strategy that President Calderon has done and the

support of the U.S. Government, that you will see increased safety

and security. And that can be reflected in violent crime numbers

in that country also. I know the devastation that the drugs cause.

Mr. KUCINICH. In Mexico? Really?

Mr. KERLIKOWSKE. Yes.

Mr. KUCINICH. Tell me more.

Mr. KERLIKOWSKE. I have had in less than a year my third trip

to Mexico. I have had three and now soon to be followed by four,

trips to the southwest border. I think that they are making

progress in taking on these transnational organized crime and drug

cartels.

29

Mr. KUCINICH. So what parts of your budget are the most costeffective in reducing illicit drug use?

Mr. KERLIKOWSKE. I think that is the question that everyone

would like to see answered.

Mr. KUCINICH. That is what I am asking you, and you are the

Director. Do you want to give it a try?

Mr. KERLIKOWSKE. I certainly am happy to give it a try. I would

tell you that it is the money that goes into prevention and treatment, because we know that is effective. But I would also tell you

that it is extremely difficult, and I think that will be buttressed by

other witnesses, to get your head and your arms around what the

Federal drug budget is and what it means.

If people tell me that money that goes to law enforcement has

nothing to do with reducing demand, I would tell them they are

wrong, but that has been a debate that has gone on. Trying to segregate this drug budget into a supply only or demand only, and

which one is more effective, has stymied the economists and the researchers and the academics for many, many years, and continues

to do so, but we are making some progress at trying to refine better

measures.

Mr. KUCINICH. So can you tell the subcommittee what are the

most cost-effective approaches that you are using?

Mr. KERLIKOWSKE. The most cost-effective approaches would be

in prevention, and the most cost-effective approaches would be in

treatment.

Mr. KUCINICH. That is generally speaking, though. Can you be

specific about what your strategy is with respect to employing costeffective approaches?

Mr. KERLIKOWSKE. Sure. The cost-effective approach would be the $151 million that the President has requested to do something

called Prevention Prepared Communities.

Mr. KUCINICH. As compared to what?

Mr. KERLIKOWSKE. As compared to the Drug-Free Communities that we currently funded, about $125,000. Those are positive programs, but Prevention Prepared Communities are ones that have

greater amount, or will if they are enacted, will have greater

amounts of money going to communities using evidence-based,

science-based prevention programs. And for every dollar that we

can invest in prevention and who we can prevent from becoming

a drug addict or a user of drugs that causes a drain on society, and

a horrible problem to their family, that makes sense, Mr. Chairman.

Mr. KUCINICH. Thank you, Director.

The Chair recognizes Mr. Jordan for 5 minutes. You may proceed.

Mr. JORDAN. Thank you, Mr. Chairman.

Of your $400 million budget, what percentage, Director, is supply

oriented? What percentage is demand-oriented?

Mr. KERLIKOWSKE. I am happy to tell you.

Mr. JORDAN. You said both are important. Is it 50/50? But then

you also talked about prevention and treatment. Does it lean more

to that direction?

Mr. KERLIKOWSKE. It is much more on supply. The moneys are

much more on supply. But I would go back to that earlier stateVerDate 11-MAY-2000 13:52 Jun 09, 2011 Jkt 000000 PO 00000 Frm 00033 Fmt 6633 Sfmt 6633 C:\KATIES\DOCS\65125.TXT KATIE PsN: KATIE
30

ment that it is pretty hard to get your head around exactly what

the supply problem and what the supply amount is. But it does

lean more heavily toward the supply interdiction and enforcement.

Mr. JORDAN. OK. Let me ask just on the broad question, and you

can take as much time as you want, and I will try to make this

my only one, although we typically have a habit of interrupting you

as you go along.

Americans are concerned about drug use, drug abuse. They are

concerned about the link of the drug trade with gang activity, particularly folks in the Southwest, but I get these comments in Ohio

as well when I am out and about our District, the link with gang

activity, potentially terrorist activity, illegal immigration. Give this committee an idea of how your $400 million budget,

how you work with Justice, DEA, Border Patrol? Because again, I

also talk with a lot of folks back home who say, we spend money

on a lot of things. It seems like there is a lot of overlap in it.

How does it work? And with the other agencies who also have

a big say in that same kind of thing. Because as I talk to folks back

home, families and business owners, that is kind of their general

concern. When they think about the drug things they read about

in the paper and the things they see on their nightly news, that

seems to be their concern.

So tell me how that works and how it relates. And specifically,

I know staff has pointed out that the Justice Department is looking

at cutting the Southwest Border Prosecutor’s Initiative. So kind of

tie that in together if you can and I will attempt not to interrupt

you and let you talk.

Mr. KERLIKOWSKE. OK. We actually have an incredibly good

working relationship. There were agencies that had not been over

to ONDCP in a pretty good number of years, for instance, representatives from the Department of Education. We established

very quickly, and some of it went on clearly before I was even confirmed, we established an interagency work group, 135 other Federal partners, high level officials within the Department of Justice,

HHS, etc., to attack this stuff comprehensively and to look at it in

a very balanced way.

And bringing the Department of Justice, for instance, we meet

almost every month, bringing the Department of Justice, whether

it is DEA, the Department of Homeland Security groups that are

all affected. For instance, the example would be the Southwest Border Strategy. This is a strategy that encompasses all of these different activities and makes sure that everyone is playing well in

the sandbox, that people are cooperating, that people are supporting each other and that people aren’t just looking toward their own

very narrow lane.

And I have seen great success in the effect of attempting to and

working toward reducing the number of guns going into Mexico,

looking at bulk cash, but also the increases along the southwest

border where we have actually stopped more drugs from coming in.

As you know, we have a lot of other issues on our plate. Right

now, I think Governor Strickland has put together in Ohio a task

force on prescription drugs. We know that the amount of deaths in

this country is being spiked by prescription drugs. Those aren’t

being manufactured in another country. Those aren’t being smugVerDate 11-MAY-2000 13:52 Jun 09, 2011 Jkt 000000 PO 00000 Frm 00034 Fmt 6633 Sfmt 6633 C:\KATIES\DOCS\65125.TXT KATIE PsN: KATIE
31

gled in. We know that methamphetamine laboratory seizures have

increased, particularly in the last year. California is still the No.

1 preparer of methamphetamine. A lot of that is not being smuggled in from another country. It is being manufactured right here.

We have to reduce demand within the United States. We have

to prevent young people from doing this. And we have to make sure

that every dollar, every very important tax dollar that is spent is

used in the most effective manner.

And that is the terrific part of this is being able to bring all of

those equities together to say what is important, how do we do it,

and how do we make sure that we are not being redundant and

overlapping. And I think we are making some great progress.

Mr. JORDAN. Thank you.

Thank you, Mr. Chairman.

Mr. KUCINICH. Thank you very much, Mr. Jordan.

The Chair recognizes Mr. Foster. Thank you.

Mr. FOSTER. I wonder if you could help me at describing what

efforts have been made to quantify the relative cost-effectiveness of

the various anti-drug programs?

Mr. KERLIKOWSKE. One of the things that is in the strategy, and

there are certainly no secrets in the President’s strategy, and it

will be released very quickly. But one of the chapters deals with

the lack of adequate measures, numbers, metrics that have existed

and continue to exist; also, the timeliness of the information and

the data.

So we have convened several groups to take a look at that and

try and figure out some effective measures. We know, for instance,

one, the number of admissions to treatment centers, the number of

hospital emergency room admissions. We also know that some of

this data is woefully either inadequate or late getting there.

So we brought these folks together and we have asked them to

help us work together to design a series of measures that cut

across the medical community, the law enforcement community, for

instance, who comes into the different jails in this country and

what are the effects of drugs that they may be under? And these

are all going to be important measures.

Mr. FOSTER. All right. But is the intention to put in place something where you can say, OK, we can buy one more helicopter for

this country and it is going to result in this many fewer hospital

admissions? Or any attempt to try to track it all the way through?

Mr. KERLIKOWSKE. I think a lot smarter people than I have

worked hard at trying to do that, to say what is the most effective

use? Is it in the media campaign to keep young people? Is it in the

buy more aerial eradication in another country, etc.?

I think President Truman, when he talked about having all the

economists lined up end to end, said, wouldn’t that be a beautiful

sight? And I have had great difficulty understanding some of these

issues myself. We are working hard to try and do that. I doubt if

we will ever be to a point in this country where we can say that

X amount of money going here to this country will result in a safer

society within the United States. I just don’t think we will get

there. I think we will move closer, but we are not there.

Mr. FOSTER. But even a very imperfect analysis can catch an

error. If you are making a mistake by a factor of 10 in where you

32

put your money, then you don’t need a perfect analysis to identify

that you should shift your money.

Another area that concerns me is research and development and

the balance of effort. We are making tremendous progress in understanding the effects of drugs in the brain. And it is not at all

unthinkable that within 10, 20, 30 years, we will have medical

things that reverse addiction. And I think that this is obviously a

huge payoff R&D.

I was wondering, do you also balance the research and development? The two research and development things are, first off, biomedical R&D and the other one is advanced screening methods,

simply just to have cheaper ways to test more people for a wider

spectrum of drugs faster. When people are in programs, they are

supposed to be drug-free. If it was free to test them automatically

every 10 minutes, then that would actually make enforcement and

keeping them in the programs easier. And so those two technical

ways or other ways.

How do you balance the research and development?

Mr. KERLIKOWSKE. I will tell you that going back to the last part

of your question first, Screening Brief Intervention Referral to

Treatment [SBIRT]. It essentially teaches healthcare professionals

to ask all of their patients, regardless of what they are being treated for or talked about, to ask several questions about their alcohol

and their drug use. And that the answers to those questions can

actually lead to an early intervention, which is more effective and

less costly.

Eighty-five to 90 percent of the drug treatment research in the

world is done by the United States, and is done through the National Institute of Drug Abuse. We are strong supporters of NIDA

and the NIDA budget when it comes to this. That is why I think

the discussion about cocaine vaccine that is being looked at very

closely. The scans that have been done to show the effects of addiction on the brain, to actually show it as a disease, rather than a

moral failure has taken us a long way forward.

I think we also have a more important task, particularly in a role

that I get to play, because I am not a scientist. I am certainly not

an economist, but I get to tell people that addiction is a disease,

rather than a moral failure. And once we start looking at it and

rolling it into the primary healthcare, which President Obama has

done, I think we will make further progress.

Mr. FOSTER. OK. Thank you. My time is up.

Mr. KUCINICH. Thank you very much.

Mr. Issa.

Mr. ISSA. Thank you, Mr. Chairman. Thank you for holding this

important hearing.

I have to first start off by having an unusual one for the minority. I would like to thank you for a very detailed response you gave

our committee to a letter. I seldom get to do that. I seldom got to

do it in the last administration, so I do appreciate it.

I would like to go through quickly, some of which is from your

response. It is pretty obvious when you have a Member of Congress

who flies in and out of San Diego every week that I consider what

you are doing on the southwest border critical. I have with me Alan

33

Birsin and a number of other people who are daily in touch with

that.

And I think it is critical and I certainly would hope that this administration will give you the resources and coordination, obviously, with the Mexican government to have a Plan Colombia on

steroids, because I think otherwise the border violence that is spilling over in to San Diego, completely separate from the fundamental drug question, is going to represent a real threat to the security

of America.

And I think most people who don’t live near the border miss that

point, that drugs are just another name for the money that supports crime in a big way. Just as alcohol during Prohibition, it

wasn’t about the alcohol. It was about the organized crime that ultimately began threatening our country.

Your response on Afghanistan was good, but it wasn’t supported

by my trip there. I spent 8 days over Christmas going through

those poppy fields in western Afghanistan. Now, I didn’t go there

to see poppies, but you couldn’t miss them since it was reported by

the commanders on the ground, both British and Americans, that

there is no eradication program. There is no program for eradication. And it is only just happenstance that people are desperate

enough that they are growing wheat to feed their families, rather

than poppies in some cases.

I am pleased to say that the invasion that began, or the sequential group of invasions that began on some of the Taliban headquarters in that western region are likely to give us the ability to

control those areas. But having said that, I was in areas we did

control and controlled quite well, and we do nothing about eradication.

So I hope in your answer you will tell us the step where you believe we can do something in a country where we do not have the

support of the president, the government, or in some cases even regional leaders. It is very clear that Afghanistan has no intention

whatsoever of giving up this lucrative sideline that does not seem

to corrupt them as much as it corrupts all of Europe and of course

has a spillover effect here.

And I will tell you that when I met with the British general on

the ground, he was much more concerned about American policy

than I think we were.

I would like to have you answer, though, two additional areas

that you did not expect to hear from me. First of all, you mentioned

prescription drugs. It does appear as though the previous administration, and administrations going back a very long time, have

missed bringing to the Congress and to the U.S. attorneys real opportunities to take the abuse of, you mentioned meth, but I certainly would mention Oxycontin and lots of the other drugs of

choice, that are, in the case of Florida and a number of other areas,

there is very easy to find organized operations that appear not to

be treated as dangerously, they almost appear to be treated as

white collar. And you can rebut that, but that does seem to be a

lot of what we are seeing. And people are dying from drugs that

technically are completely controlled by us from their inception and

distribution and so on.

34

And last, one that I have never heard from your office before,

that I have a personal concern for, having served in California on

the Prison Industry Board, people do not come out of prison sober

from a drug standpoint because drugs are so available in our prisons. And I would ask you a rhetorical question: If you cannot have

a war on drug availability in Federal, State and county prisons and

have it won, then how can we expect to win anywhere else in any

other arena where the complete freedom of drugs is comparatively

obvious?

And that is really, you don’t have to comment on all of them, but

the last two I am particularly interested in.

Mr. KERLIKOWSKE. I just would make one quick comment on Afghanistan. I don’t think anybody feels comfortable seeing American

soldiers or the ISAF forces there among the poppy fields. I clearly

understand, and Ambassador Holbrooke has taken great pains to

explain to me the rationale and the reasons.

I think we will make progress in the future on that issue. I am

particularly heartened by the work we are doing with the Russian

FSKM, their Federal drug control, because it affects Russia far

more deeply than it affects us, and I think your point is excellent.

On the prescription drug issue, I don’t think it really has been

raised to the attention because we oftentimes think about prescription drugs as being safe. And yet young people, we know, abuse

these prescription drugs for exactly that reason, because they believe that they are safe, when in fact when they are misused, they

are quite deadly and quite addictive, and we know a lot of those

stories.

We are bringing this to the attention every day to people in every

possible way, including the media campaign which has been very

effective at educating adults about what is within their own medicine cabinets. I know Congress is working hard on take back programs—Congressman Stupak, Congressman Insley—on how to get

rid of these drugs that are existing in medicine cabinets in a safe

way that does not harm the environment, and we support those efforts very much.

On the prisoners, I think you are exactly right. As State budgets

decrease and more people are released, if these people went into

prison with a drug problem and they did not get treatment within

the walls, we should not be surprised when they are released back

into our communities that they are going to re-offend.

Mr. ISSA. My time is expired, but I just want to make sure I directed the question. It was about the fact that they are on drugs.

They have availability of drugs in prison. It is the absence of the

ability to have them simply withdraw for a period of 2, 5 or 10

years while they are in prison. I agree that we need treatment, but

it was actually that can we make prisons a drug-free environment.

Mr. KERLIKOWSKE. And I think among the correctional experts

that I have talked to, that whether it is cell phones, whether it is

drugs within prison, whether it is homemade alcohol, those are significant problems. I think there is some technology that the prison

systems are exploring to actually do a better job of doing that.

Mr. ISSA. Thank you.

Thank you, Mr. Chairman.

Mr. KUCINICH. I thank the gentleman.

35

Mr. Kerlikowske, at the U.N. Commission on Narcotics Drugs

Summit, you stated that, ‘‘The U.S. supports many specific interventions, such as medically assisted drug treatment, syringe exchange programs, and the use of detoxification and treatment services tailored to the needs of those suffering from the disease of addiction.’’

However, you stated that, ‘‘We do not use the phrase ‘harm reduction’ to describe our policies because we believe it creates unnecessary confusion and is too often misused to further policies and

ideologies that promote drug use.’’

Your testimony submitted to this subcommittee, while briefly acknowledging the spread of HIV from drug use, is silent on both syringe exchange programs that have shown positive results in limiting the spread of HIV, and the issue of harm reduction interventions generally.

Do you acknowledge that, whatever its title or characterization

you choose to use, that these interventions can be effective in reducing the spread of death and disease? Do you agree that we need

to fund more programs that help reduce death and disease? Does

the budget propose to fund any intervention programs that demonstrated positive results in reducing drug overdose deaths? Do you

have any plan for dealing with the overdose crisis and the HIV/

AIDS epidemic? And what is the basis for your belief that the term

harm reduction implies promotion of drug use? What about HIV,

Director?

Mr. KERLIKOWSKE. Your question about the overdoses and reducing that, I think that part of the answer was educating parents and

doing all of the work. That is the spike in treatment admissions.

That is the spike in people going to emergency rooms. And it is also

causing the spike of fatal overdoses.

We don’t use the term harm reduction because it is somewhat in

the eye of the beholder, the ear of the beholder, I guess.

Mr. KUCINICH. What is in your ear and your eye with respect to

that?

Mr. KERLIKOWSKE. I have heard people talk about harm reduction as if it is legalization. And I have heard people talk about it.

Mr. KUCINICH. Is that how you believe? Is that your interpretation?

Mr. KERLIKOWSKE. Personally, I don’t have any——

Mr. KUCINICH. You are the Director.

Mr. KERLIKOWSKE. No, I haven’t spent a lot of time thinking

about whether I should put a definition on it. Frankly, I don’t think

that is my——

Mr. KUCINICH. You haven’t really given it any thought at all?

Mr. KERLIKOWSKE. Frankly, I haven’t given much thought as to

what I should define it as because I don’t think I get to tell the

world that——

Mr. KUCINICH. Does that have any bearing on the way that you

look at managing this?

Mr. KERLIKOWSKE. I am sorry?

Mr. KUCINICH. Does that have any bearing on the way that you

look at syringe exchanges, for example?

Mr. KERLIKOWSKE. The term harm reduction doesn’t have any

bearing, but here is the way I look at the syringe exchange proVerDate 11-MAY-2000 13:52 Jun 09, 2011 Jkt 000000 PO 00000 Frm 00039 Fmt 6633 Sfmt 6633 C:\KATIES\DOCS\65125.TXT KATIE PsN: KATIE
36

grams. Whether I was in Seattle where they existed or when I was

the Police Chief in Buffalo where they existed, if they are part of

a comprehensive program to get people to, one, help reduce the

spread of hepatitis C, the spread of HIV, that reduction is important. But if they also serve as a gateway to people who are interested and want treatment and can use treatment, then I think it

can be quite effective.

Mr. KUCINICH. What about AIDS? What about HIV?

Mr. KERLIKOWSKE. On HIV/AIDS?

Mr. KUCINICH. How serious a matter is that? And how serious

to you take your policies with respect to being able to limit the

spread of HIV? Do you see any fit between that as a public health

issue and your responsibilities as Director?

Mr. KERLIKOWSKE. I do, and we work very closely with——

Mr. KUCINICH. Be specific in your response.

Mr. KERLIKOWSKE. We do, because as you know, this administration, working with Congress, relieved the Federal ban on needle exchange. But it is also part of our working with HHS to make sure

that these other incidents as a result of drug abuse and the use of

injectable drugs, that we look at that very carefully and work on

that.

Mr. KUCINICH. But tell me, though, help us out here. Help me

out, to understand specifically with respect to syringe exchange

programs and the connection between those exchanges and limiting

the spread of AIDS, what specifically are you doing to create conditions which will limit the spread of AIDS through your programs?

Where do you do it?

Mr. KERLIKOWSKE. Well, the Drug Free Communities Program,

which talks about and helps people prevent drug use, from a

particular——

Mr. KUCINICH. What is that? Is that a needle exchange? Is that

syringe exchange?

Mr. KERLIKOWSKE. No, we don’t—the Federal——

Mr. KUCINICH. You don’t believe in that, really, do you?

Mr. KERLIKOWSKE. We are not doing Federal funding.

Mr. KUCINICH. You don’t believe in syringe exchange?

Mr. KERLIKOWSKE. I supported needle exchanges in Buffalo. I

supported needle exchanges in Seattle. I think if they are part of

a comprehensive drug reduction effort, then they make a lot of

sense.

Mr. KUCINICH. OK. Thank you.

Mr. Jordan.

Mr. JORDAN. Thank you, Mr. Chairman.

Director, define for me what you view as your mission or your

goal? Is it the broad thing? We all understand to reduce drug use.

And this gets sort of back to my first question and your response.

Do you view it as we accomplish reduction in drug use by being the

coordinator, the facilitator of other agencies who are doing their

job?

Define in as specific way as you can how you view your mission,

your goal at the ONDCP, if I have my acronym right?

Mr. KERLIKOWSKE. Sure. I think that the mission is critical when

it comes to coordination of the——

37

Mr. JORDAN. Do you think that is your primary objective? Because you are like the grand coordinator for how we are going to

implement our drug policy.

Mr. KERLIKOWSKE. I never thought as the grand coordinator, but

yes.

Mr. JORDAN. OK.

Mr. KERLIKOWSKE. And I would tell you why it is important. In

2003, the British government did away with their so-called drug coordinator. In their most recent report from Parliament, they are

saying, my gosh, we should bring this back. It was a mistake to

have all of these different organizations within a government that

is much smaller than the United States, all of these different organizations working on drug policy, drug enforcement, drug treatment, etc., without somebody to oversee them and without somebody to coordinate their efforts.

We are much stronger when we work together and when we

break down the silos of communication that exist among treatment,

among prevention, and among law enforcement.

Mr. JORDAN. OK. Now, let me go back to a question that Ranking

Member Issa brought up specifically about individuals incarcerated

in our prisons. It would seem to me that if we took a tough approach, if we said there will be zero tolerance for inmates who are

getting access to drugs. I don’t know if that means super harsh

sentences for correction officers who are assisting or whatever. But

are you willing to say that should be a goal for you as coordinator

of our drug policy, that no inmate will be getting access to drugs,

at least in Federal prison?

I think the American people would expect that, frankly. Maybe

there are some who don’t understand and assume that is happening right now. So talk to me about that issue. I think it is a great

point that the ranking member brought up.

Mr. KERLIKOWSKE. I think it is an excellent point also because

what goes on in the prisons clearly will be outside, particularly as

inmate populations are reduced for a whole variety of reasons.

Working with other components about technology that can help to

detect the drugs within the prison walls, the National Institute of

Corrections, a number of other organizations have worked very

hard to do that.

It not only is for the safety of the people behind the walls, it is

also for the safety of the people that work there. But I think the

other more important part is that if they went into the prison with

a drug problem, they should be given access to treatment within

those walls.

Mr. JORDAN. I am not saying they shouldn’t, but they should not

be getting access to illegal substances while they are in prison, and

taxpayers, I mean, you talk about something they don’t like. There

are lot of things they don’t like about our government, but that is

certainly one of them. And it seems to me that should be something

we—I have been, back in my days in the State House, the State

Senate representing areas where we had State prisons, I have been

in those prisons. Most of the folks are in there because of a drug

problem, and the drug problem caused them to do some other

crime.

38

And so if we can’t get after that, I think as Representative Issa

pointed out, it is going to be tough to really get at the overall problem in the country.

Thank you, Mr. Chairman.

Mr. KUCINICH. Thank you very much.

Mr. Foster.

Mr. FOSTER. I guess maybe I am a little bit naive, but I am a

little bit less pessimistic on getting a rough estimate of the costeffectiveness of offshore supply interdiction. For example, when the

Taliban were in charge of Afghanistan, they had a bunch of bad

features, but one of their merits was in fact that I believe there

was a drop in the production of opium poppies. Is that correct?

Mr. KERLIKOWSKE. You are right.

Mr. FOSTER. And it was by more than a factor of two. It was a

big factor.

Mr. KERLIKOWSKE. It was almost to zero.

Mr. FOSTER. Almost zero. We have a calibration point. We can

see what the effect will be. Presumably, if you wipe out that source

of opium poppies, that will trigger an increase in the world price

of opium, that will trigger a drop in the demand in the United

States, and hopefully a measurable drop in the destruction of

human life in the United States.

So I believe we have a calibration data sample to know what

would happen if we could throw that switch the other way, get rid

of all opium poppies in Afghanistan. Are you familiar with the history of what drug consumption of relevant drugs happened during

the time when the opium poppy supply came and went, or disappeared and reappeared?

Mr. KERLIKOWSKE. I am. Almost no heroin that comes out of Afghanistan comes to the United States at all. And it has not, whether it is during the height of poppy production and heroin production in that country. Our source of heroin in the United States has

been Mexico.

Unfortunately, the source for Russia, the source for the U.K, the

source for Europe quite often is Afghanistan. And that is why we

really have to work very closely with international partners to stop

the flow coming out, to stop the production, to go after the labs, as

Ambassador Holbrooke has talked about. Those type of things.

Mr. FOSTER. Is there in fact a world price for this? Is this like

oil? We import almost no oil from Saudi Arabia, OK, but that

doesn’t mean that Saudi Arabian production isn’t very crucial to

the price that we pay for oil. And so is there in fact a pretty liquid

world market for drugs in various states of processing?

Mr. KERLIKOWSKE. Unfortunately, there is a pretty interesting

piece that the RAND Corp. had done a while back that shows that

you can have a fairly significant effort in reducing, and their study

was on precursor chemicals that were used to manufacture, I believe at that time it was methamphetamine.

After that significant reduction, the amount of availability of the

drug decreased. The price went up. It didn’t take long at all, unfortunately, for the market and the drug dealers to respond quickly.

So when Afghanistan went down in opium production, the area of

the Golden Triangle filled that void.

39

Mr. FOSTER. Now, doesn’t that really call into question putting

any money into getting rid of opium poppies in Afghanistan?

Mr. KERLIKOWSKE. I think what it calls into question is one or

two things. People that look at eradication as just a method of reducing the amount of drugs that may go somewhere else and don’t

see it as a part of rule of law—Colombia, again, is a good example,

using it for other reasons to increase democratic forces, to show the

fact that government can be effective and work and actually be

more productive.

Mr. FOSTER. OK. So economically, the tradeoff has nothing to do

with reducing the damage of drugs in the United States. If we were

successful at wiping out the opium poppies in Afghanistan, the anticipated effect on drug consumption in the United States would be

very small.

Mr. KERLIKOWSKE. It would be very small in Afghanistan because very little of the drugs ever come to the United States, about

3 percent.

Mr. FOSTER. But the world price effect could, in principle, make

a difference. But during the period when the Taliban suppressed it,

was there a noticeable rise in the world drug price or not?

Mr. KERLIKOWSKE. I don’t know the price issue. I do know that

people that needed heroin or were addicted to heroin could still get

heroin. There might have been a dip, but then when the production

in the Golden Triangle increased, it filled the void. And remember,

too, there is heroin that is produced out of Mexico.

Mr. FOSTER. Yes. All right. Thank you.

Mr. KERLIKOWSKE. I hope I didn’t wane on your optimism there.

Mr. FOSTER. No, no, no. I was optimistic in getting an estimate

of how cost-effective the intervention is, and you have been very

encouraging that the effectiveness seems to be near zero, according

to what you said, which is a very interesting thing from a policy

point of view.

Mr. KERLIKOWSKE. But there are a lot of other reasons for it.

Mr. FOSTER. That is right, but those should be done for internal

reasons on what we want to come out of Afghanistan, and not because we expect it will reduce the amount of human misery in the

United States.

OK. Thank you. I yield back.

Mr. KUCINICH. I want to commend the Representative on his line

of questioning and the importance of the discussion that you started. Thank you.

Mr. Kerlikowske, the subcommittee has literally dozens of questions, but in order to get to the next panel, in order to facilitate

movement of your business and important work today, we will submit those in writing and ask that you respond in writing to those

questions.

Mr. KERLIKOWSKE. I will.

Mr. KUCINICH. I appreciate you being here today. You have a

centrally important position with respect to drug policy for this

country, and for that matter, internationally. And so this is the

first of many hearings that we will be having. Because I know I

will see you again, I think that it is fair at this point to thank you

for being here and to bid you good day. Thanks for your appearance.

40

Mr. KERLIKOWSKE. Thank you.

Mr. KUCINICH. We will move to the second panel. While the second panel is getting in place, I am going to make the introductions.

First is Mr. John Carnevale. Mr. Carnevale is an internationally

recognized expert in the field of drug policy. He is president of

Carnevale Associates, a public policy firm. He served three administrations, four drug czars, and he directed the formulation of the

President’s National Drug Control Strategy, as well as the Federal

drug control budget.

He is recognized as a key architect of the performance measurement system which ONDCP has used to determine progress toward

national goals and objectives. He is credited with directing policy

research that shifted the primary focus of the Nation’s drug control

strategy from supply to demand reduction.

He received his Ph.D. in economics from the Maxwell School of

Syracuse University.

Ethan Nadelmann is executive director of the Drug Policy Alliance, which advocates for drug policies ground in science, health

and human rights. He received his B.A., J.D., and Ph.D. from Harvard; a master’s degree in international relations from the London

School of Economics. He taught politics and public affairs at

Princeton, where his speaking and writing on drug policy attracted

international attention.

In 1994, he founded the Lindeman Center, a drug policy institute

created with the philanthropic support of the Soros Foundation. In

2000, the growing Center merged with another organization to

form the Drug Policy Alliance and Drug Policy Alliance Network.

Dr. Vanda Felbab-Brown is a fellow in Foreign Policy and in 21st

Century Defense Initiatives at Brookings, where she focuses on

South Asia, the Andean region, Mexico and Somalia. She is an expert on international and internal conflict issues and management

including counterinsurgency and the interaction between illicit

economies and military conflict.

She is an adjunct professor in the Securities Studies Program,

School of Foreign Service at Georgetown. Prior to taking up her position at Brookings, she was assistant professor at Georgetown. A

frequent commentator in the media, she authored a forthcoming

book, ‘‘Shooting Up: Counterinsurgency and the War on Drugs.′′ I

look forward to reading that.

Professor Peter Reuter is testifying in place of Rosalie Pacula,

who is ill. Professor Reuter is professor in the School of Public Policy in the Department of Criminology at the University of Maryland. He served as editor of the Journal of Policy Analysis and

Management. He founded and directed RAND’s Drug Policy Research Center. He has written and coauthored numerous books and

articles on criminology, criminal justice, and drug policy. He is Director of the University’s program on the economics of crime and

justice policy.

Dr. Reuter received his Ph.D. in economics from Yale.

Thanks to all the witnesses for being here. It is the policy of the

Committee on Oversight and Government Reform to swear in all

witnesses before they testify. I would ask that you rise and raise

your right hands.

[Witnesses sworn.]

41

Mr. KUCINICH. Thank you very much. Let the record reflect that

each of the witnesses answered in the affirmative.

I would ask that each witness give an oral summary of his or her

testimony and to keep this summary under 5 minutes in duration.

Your complete written statement will be included in the hearing

record. When you speak, make sure that mic is close so we can

hear you.

Dr. Carnevale, let’s begin with you. You may proceed for 5 minutes.

STATEMENTS OF JOHN CARNEVALE, PRESIDENT, CARNEVALE

ASSOCIATES, LLC; ETHAN NADELMANN, EXECUTIVE DIRECTOR, DRUG POLICY ALLIANCE; VANDA FELBAB-BROWN, FELLOW, THE BROOKINGS INSTITUTION; AND PETER REUTER,

PROFESSOR, SCHOOL OF PUBLIC POLICY AND DEPARTMENT

OF CRIMINOLOGY, UNIVERSITY OF MARYLAND

STATEMENT OF JOHN CARNEVALE

Mr. CARNEVALE. Good morning, Mr. Chairman and members of

the committee. I want to thank you for this opportunity to submit

testimony regarding ONDCP’s proposed Federal drug control budget for fiscal year 2011.

Mr. KUCINICH. Bring the mic closer please.

Mr. CARNEVALE. Sure.

Mr. KUCINICH. Thank you.

Mr. CARNEVALE. Before I begin, I want to point out that ONDCP

awarded my company a contract to assist it in developing a performance reporting system for the strategy. I did confer with my

contracting officer about potential conflicts of interest related to my

testimony today. While I am restricted from discussing my company’s work, I am committed to discuss all of the matters of interest

to this committee.

I do want to make it clear that my testimony is entirely my own

and was not prepared on behalf of or with the consent of ONDCP.

So let me begin by highlighting what I see in the way of a new

approach to drug policy under the Obama administration. It appears to me that they want to move more toward the public health

model that focuses heavily on reducing our Nation’s demand for

drugs. I assume this means that the new strategy will strongly emphasis demand reduction and that supply reduction will no longer

be central to our Nation’s effort to reduce drug use.

With regard to the drug budget, if there is one thing I know it

is this, that no drug policy will succeed unless it has the resources

to implement it. My view is supported by the evidence handed to

us by the last administration. In looking at past budgets, we find

they emphasized funding for supply reduction as a means of reducing the demand for drugs.

This emphasis on supply reduction failed to produce results and

our Nation’s drug policy stalled because of it. For example, there

was no change in overall drug use from 2002 to 2008. It was 8 percent. The decline in youth drug use that started in the mid-1990’s

abruptly ended in 2004 and now shows signs that it may be increasing.

42

There was no change in the number of individuals who abuse or

are addicted to drugs over this period, and there was no shortage

of illicit drugs in the market.

With regard to the 2011 ONDCP budget, it does present a

change in resource priorities whereby treatment and prevention receive the largest percentage increases. While this is good news, I

do have some serious concerns and they are as follows. One, we

have a budget like those in the past days that continues to substantially over-allocate funds to where research says they are the

least effective: interdiction and source country programs.

Two, we have a budget that fails to present a consolidated picture of all Federal drug control spending. And three, we have a

budget that makes me wonder if what is being scored is new prevention resources is correct.

With regard to drug scoring issues, I just want to highlight a

couple of concerns quickly today. First, with regard to the issue of

the comprehensive accounting, I have done some analysis and I estimate that if we add back the $6 billion in resources to the budget

that is currently missing, we would find that only 24 percent of today’s total drug budget is for demand reduction and 76 percent is

for supply reduction.

Second, while the largest increase is proposed for prevention, the

increase does little to help us recover from years of cuts. Adding

up the cuts in the previous administration, including last year’s

$3.1 million cut for the Safe and Drug Free Schools Program, we

find that prevention is in the hole by a half billion dollars. The proposed $200 million increase in prevention in 2011 only partially

fills that hole.

Third, the request for prevention itself, the increase for one pro- gram, the successful Safe and Healthy Students Program of $283

million, is somewhat questionable. My analysis of that program

suggests that most of these funds will not be realized as prevention. The new program only says that schools may spend funds to

prevent and reduce substance abuse.

In reality, this program is about funding non-education strategies to improve school climate and to improve students’ health and

well being. If these funds are not realized for prevention, the proposed increase for 2011 essentially vanishes.

There are two other matters I would like to briefly discuss. Let

me start with healthcare reform. Under healthcare reform, along

with the new parity laws, coverage for substance abuse treatment

services is on the verge of a great expansion. One area to pay close

attention to is Medicaid. This doesn’t start until 2014, but starting

in 2014, State Medicaid programs will allow for care to all State

residents. This means that beginning in 2014, Medicaid resources

will help the drug budget become more demand reduction oriented.

But healthcare reform and parity will not benefit everybody

needing treatment. This means that we must not give up on existing programs that add to today’s treatment capacity, programs like

Access to Recovery and Substance Abuse Block Grant.

My last concern pertains to ONDCP’s budget formulation authority. ONDCP is required by law to make independent recommendations to the President that it determines as appropriate to enable

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ous, OMB has never liked this authority and there has been some

recent debate about whether ONDCP’s budget formulation responsibility should be continued.

If ONDCP loses its authority with regard to the budget formulation process, it will just become another policy shop. I hope this

subcommittee continues to strongly support the current budget formulation authority now afforded ONDCP.

I want to thank you, Mr. Chairman and members of the committee, for the opportunity to appear before you again today.

Thank you.

[The prepared statement of Mr. Carnevale follows:]

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Mr. KUCINICH. Thank you for your presence here.

Mr. Nadelmann, you may proceed.

STATEMENT OF ETHAN NADELMANN

Mr. NADELMANN. Thank you for the invitation to testify for this

committee.

Let me be frank about the perspective of myself and my organization, the Drug Policy Alliance. We regard the U.S. drug policy of

the last 30 years as a colossal failure and a gross violation of

human rights, as well as of common sense: increasing America’s incarcerated population to over 2 million people; possessing less than

5 percent of the world’s population, but almost 25 percent of the

world’s incarcerated population; increase in the number of people

incarcerated on drug charges from 50,000 in 1980 to half a million

today; arresting almost 2 million people a year; allowing hundreds

of thousands of people to die unnecessarily of HIV/AIDS when

proper interventions were available; allowing tens of thousands

each year to die of overdoses; allowing and continuing to tolerate

gross racial disproportionality in our policy.

All of those represent egregious violations of fundamental American values.

I am encouraged that the Obama administration and Congress

have taken some steps in the right direction over the past year.

The leadership of Speaker Pelosi and Congressmen Obey and

Serrano in moving forward on the syringe exchange, allowing Federal funding for syringe exchange was a notable step forward. The

leadership so far in the Senate and in the House on reducing the

crack-powder disparity has been important, and it has been important that it has had Republican cooperation as well.

I urge the House to pass the Senate legislation, the 18 to 1 reform, and then to move as quickly as possible to push toward 1 to

1 reform and other sentencing reform.

I am also encouraged at the movement on the part of the Obama

administration allowing States to move forward in the responsible

regulation of medical marijuana. The shame, of course, is that

ONDCP has been largely absent from these reforms. They have

made important steps in the right direction in terms of integrating

drug treatment into ordinary medical care and in terms of highlighting the problem of overdoses, but there are essentially four

fundamental problems with their current proposed strategy and

budget.

The first is the absence of any truly meaningful indicators of success or failure. The continuing obsession with how many people say

they have used an illicit drug in the past year or month seems to

me deeply misplaced. What we need to focus on instead are reductions in the death, disease, crime and suffering associated both

with drug misuse and with our drug prohibition policies. That is

the sort of restatement of policy objectives that ONDCP needs to

embrace or that Congress needs to mandate for them.

Second, we see no indication of a real shift from criminal justice

and repression to a true public health approach. What John

Carnevale just said about the Federal budget is more than true.

The fact that the Federal Bureau of Prisons, in which more than

half the Federal prison population are locked up on drug charges,

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is not even included in the drug war budget is just one indication

of that.

What you see, essentially, is no mention in Director

Kerlikowske’s statement about the importance of reducing the unnecessary incarceration of Americans for nonviolent drug offenses;

no mention of the need to reduce the 1.7 million drug arrests; no

mention, although to some extent responsive to Congressman Foster’s question, about the futility of supply reduction efforts and the

inevitability of push-down/pop-up dynamics in what is essentially

a global commodities market.

Third, the striking lack of innovation in what they propose to do

in the future. They essentially appear to be rearranging the chairs

on the Titanic. There is the rhetoric there, but not the reality. The

problem of overdose fatalities is properly noted, and Director

Kerlikowske has shown some leadership in highlighting that problem. But what is their solution? Just more attempts at futile supply reduction efforts.

Meanwhile, a potential answer in the form of the lock zone, a

heroin overdose antidote which is increasingly used in American

cities and abroad, is not given any mention or support. Thousands

of lives could be saved simply by increasing Federal support in this

area and by providing necessary leadership.

Look in Europe, look in Canada where innovative approaches to

prescribe pharmaceutical heroin to people who have failed in drugfree and methadone programs has abundant evidence recently confirmed in The New England Journal of Medicine, yet we don’t hear

those sorts of proposals.

The same thing with supervised injection facilities which are effective in reducing overdose fatalities, effective in reducing HIV

transmissions, effective in reducing public nuisance. Once again, no

mention of that either.

The only innovations are in trying to find new ways, new coercive approaches, new ways of using testing and repression to deal

with what Director Kerlikowske essentially acknowledges is a disease or a chronic condition. That does not seem to be a public

health approach.

Finally, there is no evidence of any desire or interest in a truly

independent assessment of American drug policy. You don’t see it

in the ONDCP recommendations. I urge this committee, I urge the

Congress to allocate funding so that the National Academy of

Sciences or some other independent body can undertake a truly

independent analysis so that we can at least head off in the right

direction in trying to reduce the problems both of drug misuse and

of drug prohibition in America and around the world.

Thank you.

[The prepared statement of Mr. Nadelmann follows:]

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Mr. KUCINICH. I thank the gentleman.

Ms. Felbab-Brown, you may proceed for 5 minutes.

STATEMENT OF VANDA FELBAB-BROWN

Ms. FELBAB-BROWN. Thank you, Mr. Chairman, for giving me

this opportunity to address the subcommittee on this important

issue. I will focus on international policies.

The drug trade poses multiple and serious threats, not only in

consuming countries, but also in source and transshipment countries, that range from serious threats to security, to the legal economy, to political and judicial processes.

At the same time, however, millions of people around the world,

large segments of population and entire communities depend on

the illegal drug trade for basic livelihood. Consequently, belligerent

groups that embrace the drug trade obtain not only large financial

profits, but political support.

Hence, how one manages, what kind of narcotics policies one

adopts is critical for stability and security and U.S. national security interests.

There can be hope that supply side policies will disrupt the global drug trade. However, in specific locales, supply side policies have

been effective in disrupting in a lasting way supply. There are two

basic models: the China model, a very brutal repression model; and

the Thailand model. The China model is deeply inconsistent with

U.S. values and interests. Consequently, we should adopt the Thailand-based alternative livelihoods model.

However, for the model to be effective, it needs to be conceived

of as a multi-faceted state-building process that focuses on

strengthening the bond between marginalized communities and the

state in a variety of ways. I am very encouraged how the Obama

administration has formulated the Merida Initiative toward such

an objective. That is a very important development even as the

funding is still limited.

I am also encouraged that the Obama administration is adopting

the right approach to sequencing eradication and alternative livelihoods in Afghanistan. I have some reservations about the Afghanistan policy, but the cornerstone of the strategy is very important.

For the alternative livelihoods approaches and state-building approaches, to be effective they need to be comprehensible, well-funded, long-lasting and specifically they cannot focus simply on chasing the replacement crop. Building effective law enforcement, building accessible judicial processes is as important as comprehensive

rural development.

It is also important to realize that if we succeed in the locale in

disrupting smuggling or supply, the smuggling or supply will shift

to other locations. Again, the Obama administration should be complimented for recognizing this with respect to Mexico and adopting

two new initiatives, the Central American Region Initiative and the

Caribbean Basin Security Initiative.

These efforts are funded in a very limited way, which is not necessarily inappropriate because we need to realize that State capacity, the level of corruption, the level of state development typically

hampers the productive capacity of states to productively absorb

money.

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Mr. KUCINICH. Would you repeat that? Just say that one more

time?

Ms. FELBAB-BROWN. Sure. The funding for the Central America

Initiative and Caribbean Initiative is very limited. However, that

is not necessarily inappropriate because we need to recognize that

there are limits on state capacity to absorb money productively if

the state faces critical institutional deficiencies.

We need to avoid situations of simply teaching traffickers how to

become more effective traffickers, as has been the unfortunate consequence of many of our policies.

I also want to commend the Obama administration on focusing

on demand reduction abroad, not just in the United States. Again,

the funding is limited for these programs, and critically, it is important to recognize that one shoe does not fit all. These approaches need to be very much tied to the local economic, political,

social conditions in the country.

With respect to Afghanistan, the overall strategy away from

eradication right now, the focus on interdiction and rural development is effective. I have concerns about focus on wheat in the rural

development program, and I have also concerns about the way

interdiction is being operationalized.

Mexico I think is a great change with limited funding. Nonetheless, again, that is not necessarily inappropriate. It is important to

focus the funding on demonstration areas and it is important to

recognize that the political and economic arrangements in local

countries, their social organizations, greatly limit the effectiveness

of policy, and the United States has very limited capacity, and in

the best of circumstances even the good cooperation with Mexico to

change these. And these social, political, economic arrangements

critically influence the effectiveness of counter-narcotics policies.

Great progress has been accomplished in Colombia, but much remains to be accomplished, both in the security sphere and in the

social sphere and in the counter-narcotics sphere. The elections in

May in Colombia present an opportunity to move toward a more

productive approach that focuses much more on socioeconomic programs and moves away from the very counterproductive zero-coca

policy.

[The prepared statement of Ms. Felbab-Brown follows:]

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Mr. KUCINICH. Thank you very much.

Professor Reuter, you may proceed for 5 minutes. Thank you.

STATEMENT OF PETER REUTER

Mr. REUTER. Thank you very much.

Mr. Chairman, I appreciate the opportunity to testify before you

today. I ask that the full statement of my colleague, Rosalie Pacula

of the RAND Corp., be incorporated into the record.

[The prepared statement of Ms. Pacula follows:]

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Mr. REUTER. I will focus today on two issues. The first, which

will take most of my testimony, is how drug courts should be developed so they can emerge from their essentially boutique status to

make an important contribution to reducing the Nation’s crime and

drug problems.

The second issue is a brief comment on whether supply programs

should be cut.

Director Kerlikowske, like his predecessors, has offered support

for the continued expansion of drug courts, though the funding offered by the administration’s budget is for a broader set of specialized courts. Drug courts are seen as a major innovation which, by

increasing the use of treatment rather than incarceration, lowers

the extent of drug-caused crime and drug consumption.

But despite the rapid expansion of the number of drug courts,

the number of defendants who pass through such programs remains small. After almost 20 years, with over 2,300 separate programs having been created, a 2008 study estimated that only

55,000 drug-involved defendants were processed in such courts in

the middle of the decade. The same study estimated that over 1

million drug-involved defendants entered the criminal justice system each year.

The small number of enrollees arises from several factors. For

example, many jurisdictions simply lack the administrative capacity to implement drug courts at scale. Over half of the drug courts

responding to one survey reported they just cannot accept more clients because of these capacity constraints. And as a result, there

are strong administrative and political incentives for drug courts to

cream-skim by serving relatively low-risk populations most likely

to achieve successful outcomes, rather than the populations who

would experience the greatest net reduction in criminal offending

from drug court interventions.

In addition, the eligibility criteria at the drug courts are highly

restrictive. They may be effective and even cost-effective serving

the specific clients they recruit, but the diverted offenders are at

low risk of going to prison or even jail following sentence in the absence of the drug court intervention.

My colleagues, Harold Pollack and Eric Sevigny in their forthcoming paper estimate that of those sentenced to prison or jail in

the early part of the last decade, fewer than 10 percent would be

eligible for drug courts that apply the usual criteria.

Given the limited capacity and relatively low-risk populations actually served, the currently deployed model of drug courts is unlikely to noticeably reduce the numbers incarcerated. In fact, most

drug courts routinely exclude most of the drug-using offenders. One

survey found that only 12 percent of drug courts accept clients with

any prior violent convictions. Individuals facing a drug charge,

even if the seller is drug-dependent, are excluded in most courts.

Other charges that routinely lead to exclusion include property

crimes commonly associated with drug use like theft, fraud and

prostitution.

These eligibility rules are likely to exclude most experienced

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erty and violent crimes and that many, perhaps most, have co-occurring disorders.

Can drug courts be effective in dealing with these harder clients?

Assessing the potential effect on program effectiveness of relaxing

eligibility requirements is a major research challenge. But unless

this is done, the courts are unlikely to make a major difference to

crime and drug use. They have to reach out to these other clients

with appropriate adaptations in services and monitoring.

Let me conclude with a comment on supply side programs. As a

number of others have said, the President’s budget leaves these

programs largely unscathed, despite a mounting unease that Federal enforcement effort has done little to help reduce drug use. Like

John Carnevale, I believe that some of these programs, particularly

in the interdiction area, should be cut. Congressman Foster asked

very perceptive questions about the eradication programs and the

evidence on the Afghan prohibition under the Taliban is it had

minimal effect on drug markets in the United States and modest

effects at most in Western Europe.

With interdiction, even large increases in the share of cocaine

seized in the last 10 years, has not led to reductions in availability

or in price. And there are sound analytic arguments as to why seizures are unlikely to make much difference to price or availability.

If my arguments for making such cuts lacks specificity, this reflects the simple lack of evaluations and research about the interdiction program. Despite annual expenditures of approximately $4

billion in fiscal year 2010, no agency involved has invested in systematic analysis of the effectiveness of the program as a whole or

of its components. Of if they have, the results have not been published.

Thus, one is forced to make judgments on the basis of gross data

that don’t allow for much nuance. This committee would do a considerable service if it authorized a rigorous external assessment of

the interdiction effort, after which one might be able to make a

more grounded statement about the value of continuing this level

of support and of what elements of the program, if any, are worth

retaining.

Thank you.

[The prepared statement of Mr. Reuter follows:]

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Mr. KUCINICH. Thank you very much, Professor, for your testimony.

I want to thank each of the witnesses for their presence here. I

would like any of you who would like to respond to this question

and observation to do so.

Director Kerlikowske testified earlier that wiping out all poppies

in Afghanistan would have very little effect on drug availability in

the United States, and he seemed to agree with Dr. Felbab-Brown’s

testimony that while eradication and interdiction has benefits, such

as weakening drug trafficking organizations and instilling democratic reforms, it has little effect on domestic supply and consumption. And I would like you to respond to Director Kerlikowske’s

comments and address whether given this limited effect on reducing drug availability in the United States, should these types of

international programs be considered as part of the Nation’s drug

policies and should these programs be funded.

So Mr. Carnevale, let’s start with you and go down the line if

anyone wants to comment.

Mr. CARNEVALE. I have pretty strong views about this topic. I

have been studying this for about 20 years and worked at ONDCP

and worked on drug budgets, and worked on two Andean strategies, one in the early 1990’s and the one that started actually in

1998, but became law in 2000.

I am quite convinced that spending money for eradication, especially aerial eradication, is not effective. I am quite convinced that

spending money on——

Mr. KUCINICH. Why not?

Mr. CARNEVALE. Because we have not seen any changes in potential cultivation. For example, in Colombia in this decade, ONDCP

when it was counting how much money we were spending on Plan

Colombia, reported from 2000 to 2005 that we had spent over $4

billion just on Plan Colombia. Over that same period, we saw cultivation increasing.

Mr. KUCINICH. Why is that? Explain to us how that happens.

Mr. CARNEVALE. Why that happened? Well, I think it is because

the money wasn’t being used effectively. Director Kerlikowske

talked about reductions in crime in Colombia, and in my mind, the

money was being used more for institution building, strengthening

the judicial system and so on. But the real point of that program

was to reduce the amount of drugs coming into the United States

from Colombia, and it had no effect on the amount of coca that was

being grown by the farmers, and that was the whole point.

So when I evaluate it with that outcome measure, I see no effect.

Mr. KUCINICH. Mr. Nadelmann.

Mr. NADELMANN. Yes. I think what we have to realize, looking

at this in the historical perspective, what you are essentially dealing with here with coca, with cocaine, heroin, opium, marijuana,

whatever, are essentially global commodity markets, very much

like coffee, sugar, tea, alcoholic beverages, precious metals, you

name it.

If one source is knocked out through eradication efforts or bad

weather or a blight or drought, some place else will pop up. And

this has been true for decades now. We cracked down on Turkey

in the early 1970’s under Nixon, and it popped up in Mexico, then

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it popped up in Southeast Asia, Southwest Asia. Same thing with

coca cocaine, cracking down on Bolivia and Peru, now popping up

in Colombia; marijuana the same thing.

It seems to me what is missing, essentially, is any sort of strategic analysis or strategic planning. If you accept the fact that these

drugs are going to be produced one way or another someplace in

the world, and that therefore you need to manage that to minimize

the harms associated with it, whether continuing with a prohibition policy or moving in the direction of regulation and decriminalization, that would be a strategic policy.

Note how Director Kerlikowske responded to your question about

Colombia and the efficacy. He pointed to some of the reductions in

violence in Colombia and some of the increases in security, nothing

really about a reduction of the significant flow of drugs; same thing

in the exchange over Afghanistan.

Mr. KUCINICH. Thank you.

Ms. Felbab-Brown.

Ms. FELBAB-BROWN. If the measure is reducing consumption,

supply side policies are not effective. However, I do believe there

is a very important role for supply side to manage the spillover effects such as fueling violence, fueling corruption of political processes, undermining of judicial systems, and devastating legal

economies or perpetuating marginalized populations and conditions

of poverty.

That is why I argue that both interdiction and eradication should

be reconceptualized as drug operations, but rather be part of statebuilding measures that seek to strengthen the bonds between

marginalized communities and states.

Mr. KUCINICH. Professor.

Mr. REUTER. The history of the last 20 years of the cocaine and

heroin trade are indicative of how much mobility there is in both

production and trafficking. If you stick with cocaine, Colombia was

a minor producer until the mid-1990’s. Peru was the largest one

and Bolivia was No. 3. Pressures on Peru and Bolivia, different

pressures, led to a shift to Colombia, in part spread by the fact that

Colombia had become so unstable it was not a very inviting environment.

And you can see similar changes in the patterns of trafficking

and production for heroin as well.

Much of what we do as deliberate policy has a perfectly predictable effect on changing the way trafficking occurs. So you push

down against the trade in South Florida in the early 1980’s and it

moved to Mexico. Was that desirable? If you are Mexican, the answer is clearly no. If you are Floridian, it is yes.

We can do a lot of that kind of thing. It is very uncomfortable

to make those decisions out in the public, but the evidence is really

striking that it is just moving the trade.

Mr. KUCINICH. Ms. Felbab-Brown, I note that you have a book

coming up.

Ms. FELBAB-BROWN. It is actually out already.

Mr. KUCINICH. Pardon?

Ms. FELBAB-BROWN. It is out.

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Mr. KUCINICH. It is out. OK, here is a chance to plug it. Do you

get into the U.S. presence in Afghanistan and the relationship between that and the so-called war on drugs?

Ms. FELBAB-BROWN. Very much so.

Mr. KUCINICH. And do you note that since the United States has

been present occupying in Afghanistan, has drug production gone

up or down?

Ms. FELBAB-BROWN. It has gone significantly up if one uses the

1-year that Taliban suppressed the poppy. However, if one uses the

history of all of the 1990’s, production has only slightly gone up

compared to what production was in the 1990’s. The Taliban suppressed for only 1 year and it was not sustainable.

Mr. KUCINICH. But how much has it gone up if you look at the

measure of an increase? Let’s say since the United States has been

there for now a period of several years, how much has it gone up,

like from baseline United States comes in to where we are now?

Ms. FELBAB-BROWN. Well, the baseline when the United States

came in came just after when Taliban suppressed, at which time

it was only a very few thousand hectares. Right now, the level of

cultivation is around 130,000 hectares. So the increase has been

significant, but that is a false baseline because it is not a sustainable baseline. If one looks at the 1990’s, we are higher, but not

very, very much higher than what it was in the 1990’s.

Mr. KUCINICH. What is the major drug export out of Afghanistan?

Ms. FELBAB-BROWN. Sorry, what is the major export?

Mr. KUCINICH. Export, which kind of drug are you talking about?

Ms. FELBAB-BROWN. It is more and more heroin. It used to be

opiates, more broadly frequently opium, but more and more it is

conversion into heroin.

Mr. KUCINICH. And what form is it in? I mean, how is it shipped?

What form is it moved in?

Ms. FELBAB-BROWN. It depends on what segments. Within much

of Afghanistan, it is still moved as opium bricks, but it is increasing with distribution of refining and movement of laboratories, so

there is more and more conversion on the farm and more and more

is moved in the form of heroin. Once it leaves the borders, it is usually in the form of heroin.

Mr. KUCINICH. Well, I think the American people would find it

difficult to believe that you could still have massive drug production going on in Afghanistan during a period of U.S. occupation.

How do you describe that?

Ms. FELBAB-BROWNS. There are several reasons. The fact is that

since the United States came into Afghanistan, structural drivers

of opium poppy have not been addressed. As I mentioned before,

the Taliban suppressed with the use of great military force, the repression against the population and production for 1 year. But even

the Taliban could not maintain it, and before the suppression of the

Taliban, production was rising.

Since then, there has been no addressing of security conditions

that give rise to poppy cultivation or the structural economic drivers that drive poppy cultivation. It is only now that since the

Obama administration has come to office, it has indicated it will

focus on addressing these structural drivers, but we have to see

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that will in fact take place. Now resolving the security situation,

we will not be able to address even the economic drivers.

Let me also point out that Afghanistan is a very unique case

since between one-third and one-half of the country’s GDP depends

on opium poppy or illicit drugs. We have not seen that anywhere

in the history of the modern drug trade.

Mr. KUCINICH. Well, what was the amount that you say is exported now?

Ms. FELBAB-BROWN. The amount of heroin being exported?

Mr. KUCINICH. Yes.

Ms. FELBAB-BROWN. Well, I don’t know the heroin numbers, but

the opium numbers are about 6,000 metric tons of opium.

Mr. KUCINICH. Six thousand metric tons.

Ms. FELBAB-BROWN. Which is about twice as much as we believe

is the global consumption, but these numbers are——

Mr. KUCINICH. What would that look like in terms of would that

fill this room or more or what?

Ms. FELBAB-BROWN. I cannot really say. It would be a lot, probably.

Mr. KUCINICH. Hold on a minute. I will come to you in a minute.

How do they get this out? The United States controls the air. The

United States has border presence. How do they get this out?

Ms. FELBAB-BROWN. Well, the United States does not control

much of the territory. The borders are very long and very porous.

You could ask a similar question of how does tremendous amount

of drugs enter the United States.

Mr. KUCINICH. Who is moving these drugs out of Afghanistan? Is

it al Qaeda?

Ms. FELBAB-BROWN. It is very diverse. It is crime organizations

in Afghanistan.

Mr. KUCINICH. It is not the Taliban, though, right?

Ms. FELBAB-BROWN. Some of it is the Taliban, but far from all

of it is the Taliban.

Mr. KUCINICH. So the Taliban is involved in the drug traffic as

well?

Ms. FELBAB-BROWN. Very much so, very deeply, as it was in the

1990’s.

Mr. KUCINICH. And so is Al Qaeda involved in the drug trafficking?

Ms. FELBAB-BROWN. There is a big controversy surrounding that.

All the evidence indicates only very tangential links. And certainly

in the early 1990’s, Al Qaeda took a decision not to participate in

the drug trade, even as the Taliban was deeply involved. It is not

clear that decision still holds.

Mr. KUCINICH. Do you in your book do you cover the possibility

of the government of Afghanistan and officials within the Afghan

government being involved in the drug trade?

Ms. FELBAB-BROWN. Yes, there is very strong evidence that from

the lowest levels to very high levels, officials of the Afghan government, officials of the Afghan National Police, especially, are deeply

involved in aspects of the drug trade and drug cultivation, which

is not surprising given that half of the country’s GDP comes from

drugs. Consequently, political arrangements are very much linked

to the opium trade.

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Mr. KUCINICH. So is Afghanistan fairly, then, described as a

narco-state, given the fact that they are producing all these drugs

and depend on it for——

Ms. FELBAB-BROWN. I don’t like to use such labels. I don’t think

it is useful for policy. I don’t think there are any definitions. But

certainly, the intensity of the problem is far greater than we have

seen anywhere in the world since World War II.

Mr. KUCINICH. What should the United States be doing in Afghanistan with respect to dealing with this tremendous outflow of

drugs during the time that the United States has a presence there?

What should we be doing?

Ms. FELBAB-BROWN. The No. 1 factor is to establish security.

Without establishing security, no counter-narcotics policy, whether

it is eradication or rural development, will be effective. Once security is established, or as security is being established, then the

focus needs to be on building a state that is capacious and that is

also accountable to its people.

Mr. KUCINICH. But if there is a state that depends on its income

for this drug production, what hope is there that any kind of security would eradicate the drug——

Ms. FELBAB-BROWN. Security is the necessary requisite, but it is

not sufficient. The other component then needs to be building state

that can generate legal livelihoods, that can assist in generating

legal livelihoods, and that can also generate access to justice and

have effective law enforcement. This is inevitably a very long-term

process. Given the scale of institutional underdevelopment in Afghanistan and the scale of the drug problem, there can be no hope

that it can be accomplished——

Mr. KUCINICH. How many years has Afghanistan been a significant international player in the production of drugs, whether we

are talking about opium or heroin?

Ms. FELBAB-BROWN. Since the mid-1990’s, it is the No. 1 country

in the world.

Mr. KUCINICH. OK.

Mr. Nadelmann, you had something you wanted to say?

Mr. NADELMANN. Yes. I just wanted to try to put this in some

historical perspective, because while Afghanistan is in some respects unique, as Vanda mentioned, there have been hearings in

the past that focused on Burma as producing 80 percent, or Turkey

or Mexico or Colombia, what have you. And so it could well be the

case that in 10 or 15 or 20 years, Afghanistan is a non-issue and

it is now someplace in Africa or elsewhere in Central Asia or back

elsewhere.

I think it is important to realize this. If the United States or anybody, or the mullahs, could suddenly wave a wand and, poof, no

more opium or heroin coming out of Afghanistan, what would be

the implications for the American drug problem, the global drug

problem, for security? You know that so long as there is a demand,

there will be a supply. You know that if Afghanistan was taken

out, it would emerge back in the northwest frontier of Pakistan,

back in Burma, back closer to U.S. borders.

Peter Reuter mentioned this as well. We don’t know where, and

it could well be that the disruptive implications in terms of U.S.

economic and security interests and in terms of the economic and

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human rights interests of others would be even worse, would be

even more badly impaired.

So I think that the answer with Afghanistan is not to focus on

reducing the supply of opium from Afghanistan. It is to focus, as

Vanda suggested, on ensuring the stability of Afghanistan and

looking at it from the perspective of Afghan security, NATO and

U.S. interests.

We can talk all we want, of course, about economic development

being the answer to reducing drug supplies, but America is one of

the most economically developed countries in the world and that

hasn’t stopped us from being a major producer of marijuana and

methamphetamine and a host of other illicit drugs as well.

Mr. KUCINICH. Why is there such a demand? What is your opinion or considered opinion on why there is such a high demand for

drugs in this country, let’s say?

Mr. NADELMANN. We are not that dramatically off from other

countries. We have somewhat higher rates of use than, for example, European countries, but Pakistan and Iran have a higher per

capita use of opium and heroin than does the United States. And

some European countries use higher rates as well.

Let’s face it, there has never been a drug-free society in human

history, except maybe the Eskimos because they couldn’t grow anything. But apart from them, there has never really been one. There

is never going to be one. There is going to be consumption of alcohol, tobacco products, caffeinated beverages, you name it.

The real question in the long term is not how do we keep trying

to build a moat between all these drugs and ourselves or our children. The real question is how do we come up with sensible ways

of learning how to live with this reality so that we reduce the negative consequences of drug use and of our prohibitionist policies as

much as possible.

Mr. KUCINICH. In your testimony, what you have said is that

there has been a failure to adequately evaluate drug policies as to

how they can meet the challenge of drug use.

Mr. NADELMANN. Yes. Harm reduction refers on the one hand to

needle exchange programs. Harm reduction can be simply defined

as those policies and interventions that seek to reduce the negative

consequences of drug use by and among those people who are unable or unwilling to stop today.

But you can also define harm reduction in policy terms, as those

that seek to reduce the negative consequences of drug use and the

negative consequences of our drug policies. That is where I think

the criteria need to go. That is where I would encourage this committee to push or mandate that ONDCP and the Obama administration move in that direction.

Mr. KUCINICH. I thought it was very interesting when Mr.

Kerlikowske would not want to get into a description of harm reduction. I wonder what the AMA would say to that, since essentially the father of medicine’s first rule is do no harm.

Mr. NADELMANN. Yes, that is exactly right. It is interesting. In

the Commission on Narcotic Drugs and the international channels,

the Europeans sort of hear Director Kerlikowske say this and they

sort of roll their eyes. They think it is foolish. But it is not just the

Europeans.

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I was in Kuala Lumpur, Malaysia 2 years ago listening to a

speech by the deputy drug czar of Malaysia. They have very harsh

policies. And he said we have three components of our national

drug control strategies: supply reduction, demand reduction, and

harm reduction.

Now, if you could have people both in Europe, but also people in

Asia who are saying this thing, I am baffled at why ONDCP is unable to use this language. Note, by the way, that the deputy drug

czar, Tom McLellan, did begin to embrace the language of harm reduction some months ago, but appears to have been repudiated in

the interim.

Mr. KUCINICH. Dr. Carnevale, why do you believe that the administration’s rhetoric about moving to a public health model view

of drug control has not been matched with changing funding priorities? For example, is it attributable to a lack of authority of

ONDCP or a lag time in getting the right people in place? Do you

believe with ONDCP’s current structure and current political climate that they have the institutional and political wherewithal to

change drug budget policies and priorities?

Mr. CARNEVALE. That is a very good question. Let me start by

saying quite frankly when I saw the budget that did come out, I

was really surprised that we did not see large increases in demand

reduction and very large cuts and decreases in supply reduction.

And I was hoping that would happen.

With regard to ONDCP’s authorities, it does have the legal authorities to shape a budget, make recommendations independent of

the OMB, directly to the President. And my sense is that in the

new administration, when the Director came on board, there was

a reshuffling of the deck chairs. And the loss of Cabinet status, to

me, is one issue that I think is playing into this.

Second, I think the fiscal climate, from what I can hear from my

friends at OMB, if I can call them friends given the disappointment

I have with the budget, is that this simply was not a lot of money,

but I kept saying that is no excuse for not cutting ineffective programs on the supply side.

I do think, though, ONDCP has the authorities. The issue is

whether it uses them effectively. And I am at this point hopeful

that at least the Director can do something more positive to shift

resources.

Mr. KUCINICH. Then let me ask you, and I would like each of the

panelists to respond to this question. Looking forward to the reauthorization of the ONDCP, what institutional changes do you believe should be made to ensure that it has the authority to truly

affect policy formulation and spending? What would you recommend? Let’s start with Mr. Carnevale and go down.

Mr. CARNEVALE. One of the concerns I have is the structure of

the agency itself is now flawed. It was built and designed back in

1988. The Congress designed an agency to fight a cocaine problem,

stopping drugs from coming into the United States. The Reagan administration budget then had a budget that was close to 80 percent

focus on supply reduction because it viewed cocaine as the problem

in America.

We have an Office of Demand Reduction, Supply Reduction, and

there was an Office of State and Local Affairs that was designed

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or intended to help spread that policy to State and local governments, so it would truly be a national drug control policy.

The current structure with the Office of Supply Reduction I think

needs to be changed. It continues to dominate the scene in terms

of what is going on with the drug budget inappropriately. And I

think if we are moving more toward a public health model, we

should consider that structure and design.

It doesn’t make sense to me that we have five political Senateconfirmed appointees in an agency of about 100 people, one for

each of these areas—demand, supply, State and local, and of

course, the Director. I would reconsider that, and I would want

supply reduction programs maybe to be viewed more of a program

office, not headed up with such a high level official.

Mr. KUCINICH. Mr. Nadelmann.

Mr. NADELMANN. Yes, I would take one lesson for ONDCP from

the United Nations Office of Drugs and Crime, the UNODC, which

has not been notably successful in its work, but to the extent it has

been, it is because it developed its own branch for harm reduction.

The most dynamic and successful aspect of UNODC has been

that branch, and I would encourage ONDCP to create the position

of a Deputy Director for Harm Reduction. It is not sufficient to simply rely on people, for example the two very talented former New

York City Health Commissioners who now chair the CDC and

FDA, Peggy Hamburg and Tom Frieden. There needs to be more

of a dedicated presence within ONDCP.

I also think that, second, building in a capacity for independent

evaluation, as well as some element to try to push forward on independent strategic thinking that has been notably absent, not just

for ONDCP, but to my knowledge also within the State Department, within the defense community and within the intelligence

community.

There needs to be an element within the U.S. Government, and

it might appropriately be situated within ONDCP so long as it is

to some extent politically independent, to encourage more strategic

thinking about policy options.

Mr. KUCINICH. Thank you.

Ms. Felbab-Brown.

Ms. FELBAB-BROWN. If ONDCP is to remain in the role of being

the national agency on counter-narcotics policy, it needs to not only

have the standing comprehensive approach domestically but also

internationally. Consequently, interagency working groups need to

be mandated in the manner of the Director’s choice, including Defense, State, Justice, etc., all the other agencies so that policy is set

on the basis of what truly is in the U.S. national interest and

would recognize the effects on communities and States abroad.

I would also stress Dr. Nadelmann’s line that this committee,

more broadly Congress should mandate that considering unintended consequences, secondary effects be part of regular policy

process on which ONDCP and other agencies report.

Mr. REUTER. The premise of your question is that ONDCP should

be reauthorized, and I would hope that you would examine that

premise before moving ahead.

This is a problem which was acute in the late 1980’s and is now

not acute. It is a substantial, but routinized problem. If it is to be

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continued, then I do think that the questions that the committee

members posed today to Director Kerlikowske were very much

about cost-effectiveness and in general assessing programs that are

being carried out.

ONDCP is uniquely placed to do that. Dividing an office, as it is

now, into supply reduction and demand reduction creates units

that are rather defensive about their domains. There is an Office

of the Chief Scientist, CTAC, which in principle could take on this

evaluation responsibility and I would hope that you would

strengthen its authorities and give it a clearer mandate to do just

that.

Mr. KUCINICH. I want to thank each one of the witnesses for

their presence before this subcommittee. There has been some very

positive testimony and some suggestions that this subcommittee

will act on, including exploring the necessity of an independent

analysis of the drug policies.

As we move into the reauthorization, we certainly need to be able

to determine the question of efficacy and effectiveness. You have

raised some very important questions. This has been one of the

best panels testifying on an issue that has some overarching importance in so many areas of the American economy and society.

So I appreciate your presence here. I would ask you to be responsive to any followup questions that Members may have in writing,

and we will certainly keep all of you posted on the future hearings

which we will have. This subcommittee does have legislative authority in this area and we are going to be taking very seriously

our responsibility with respect to the reauthorization.

I am Dennis Kucinich, Chair of the Domestic Policy Subcommittee of the Committee on Government Oversight and Reform. Today’s hearing has been ‘‘ONDCP’s Fiscal Year 2011 National Drug

Control Budget: Are We Still Funding the War on Drugs?’’

We have had a distinguished panel, the first panel and the second panel. I want to thank all of the individuals here for participating, and the subcommittee will continue our work in this area.

Now, this hearing stands adjourned. Thank you.

[Whereupon, at 11:40 a.m., the subcommittee was adjourned.]

[The prepared statement of Hon. Diane E. Watson follows:]

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