The Last Drug Czar?

The mixed record of Obama's outgoing drug chief.

It might as well have been a lifetime ago when Gil Kerlikowske began his job as the nation's top drug official back in 2009.

When President Obama appointed him to be director of the Office of National Drug Control Policy — a position known as the "drug czar" — only a dozen-plus states had legalized medical marijuana; a poll showing a minority of Americans support legalization could still be considered "record breaking;" and the disparity in sentences for users of crack and users of cocaine was still 100-1. The idea that two states would soon fully legalize the recreational use of marijuana seemed absurd.

Kerlikowske was fresh off a gig as police chief in Seattle, a city known for experimenting with progressive drug programs, giving reformers some hope and drug warriors some heartburn. But after a tenure that proved to be relatively conventional, Kerlikowske has been tapped to head Customs and Border Protection, and is expected to be replaced by someone who could represent a sea change in federal drug policy.

When Kerlikowske was first appointed, reformers hoped it signaled a shift from the typical federal approach emphasizing arrest and prosecution to a more modern one, centered around education and prevention. It was a notion Kerlikowske had paid considerable lip service to, promising in his first interview as drug czar to end the "war on drugs" and, later, to promote public health solutions and a "21st century" approach.

People on the enforcement side of things worried that would come at the expense of law enforcement. As it turns out, they needn't have worried.

"He's been an extremely valuable partner and someone we could reliably expect to work with us, cooperate with us, and apprise us of where the administration was headed," said Jim Pasko, executive director of the Fraternal Order of Police, the nation's largest law-enforcement labor organization. "We were very happy with him."

The White House budget for 2014 devotes 57 percent of drug-control spending to punishment and interdiction while just 43 percent went to treatment and prevention. Kerlikowske has noted such numbers increased treatment and prevention funding from previous years, and there's some truth to that. But look a little further back, and you'll see ONDCP is just now bringing this ratio into line with about where George W. Bush had it in fiscal year 2004.

Marijuana Majority spokesman Tom Angell was underwhelmed by what Kerlikowske billed as progress. "If the administration really believes drug abuse is a health issue that we can't arrest our way out of, they need to put their money where their mouth is and stop emphasizing devoting so many resources to the same old failed 'lock 'em up' policies," Angell said. "It's quite disconcerting that spending for the Bureau of Prisons is going up at a time when the attorney general of the United States says we are incarcerating far too many people for far too long at too great a cost."

It's not just Kerlikowske's record on marijuana that reformers take issue with. The number of overdose deaths from heroin has increased dramatically in recent years, growing 45 percent between 2006 and 2010, according to ONDCP. The uptick in deaths has been shown to be correlated with the the recent crackdown on prescription drugs. Kerlikowske has admitted that heroin "was not on the radar screen" during most of Obama's first term, according to The Washington Post, and that he "didn't do everything I should have" to raise awareness of the problem.

Kevin Sabet, a former ONDCP officer who now runs the anti-legalization group Smart Approaches to Marijuana, doesn't hold Kerlikowske responsible for that. "No one can possibly blame the office for devoting so many resources — so quickly — to reducing the prescription-pill epidemic," he said in an email. "Action was swift and certain, as it had to be. Is the current surge in heroin addiction a result of a crackdown on pills? I don't know, but no one can blame someone for taking action on a horrible public-health crisis."

Bill Piper, director of national affairs for Drug Policy Alliance, a pro-reform group in Washington, sees Kerlikowske's record as mixed. "It's interesting because traditionally drug czars have been propagandists for the federal war on drugs" he said. "Since the creation of ONDCP, they've largely been cheerleaders for the drug war; they've put politics over science; they've opposed reform; and stifled debate. Drug czar John Walters, who was Bush's drug czar, once compared drug users to terrorists."

By contrast, Piper called Kerlikowske's approach "a refreshing change." He supported the Obama administration's reform agenda around crack sentencing reform and overdose prevention, as well as syringe-exchange programs. He also helped to change some of the rhetoric around the issues, constantly saying that drug reform should be treated as a health issue instead of a criminal-justice issue.

"All of that is good," Piper said. "But his rhetoric hasn't always matched up with his actions. This is especially the case with marijuana."

Sabet blames environmental factors for any shortcomings. "Gil Kerlikowske was one of the most effective drug czars, working in one of the most difficult environments a drug-control director has ever had to work in," he said. "He was the head of drug policy in a White House largely agnostic about today's great drug-policy debates, and that makes it difficult."

Some drug reformers speculate the White House moved Kerlikowske because he's out of step with the trend toward liberalization of marijuana, noting his outspoken opposition to a California referendum that would have legalized the drug in 2010. "It makes me wonder if that's why he left," Piper said.

A background in law enforcement, or a hawkish political career, used to be an unwritten requirement for assuming the position of drug czar. Now, for the first time, we're seeing something different.

Kerlikowske's interim replacement, acting director Michael Botticelli, hails from a background in public health and has even received service awards for promoting recovery addiction. Botticelli, who served as Kerlikowske's deputy at ONDCP, is the former director of the Massachusetts Substance Abuse Services Bureau, where he expanded treatment and recovery services and helped establish early intervention treatment programs for adolescents. It's unclear whether he'll be formally nominated by the Obama administration, and even more unclear that he could clear a Senate vote. But if he is chosen, it would mark the first time in history someone with a background in promoting addiction recovery became the nation's top drug official — since he's in charge now, it already does.

"It's still an open question on where he's going to be on marijuana," said Drug Policy Alliance's Piper. "We hope that he's evidence-based on that, but it's nice to see someone at the helm who has a health background instead of a law-enforcement background. We're hoping to be able to work with him where there's common ground."