A New Direction On Drugs
Top drug official Michael Botticelli says the old war on drugs is all wrong, and wants to refocus the country’s drug policy
After forty years and a trillion dollars, the nation has little to show for its war on drugs. Prisons are beyond crowded and there’s a new outbreak in the heroin epidemic. If it’s time for a change, it would be hard to find a leader more different than Michael Botticelli. The president’s new Director of National Drug Control Policy isn’t a cop. He’s lucky he didn’t go to jail himself. And we knew that things had changed the first time we used the nickname that comes with his job, the “drug czar.”
Michael Botticelli: It’s actually a title that I don’t like.
Scott Pelley: Why?
Michael Botticelli: Because I think it connotes this old “war on drugs” focus to the work that we do. It portrays that we are clinging to kind of failed policies and failed practices in the past.
Scott Pelley: Are you saying that the way we have waged the war on drugs for more than 40 years has been all wrong?
Michael Botticelli: It has been all wrong.
Blunt force didn’t knock out the drug epidemic. 21 million Americans are addicted to drugs or alcohol. And half of all federal inmates are in for drug crimes.
Michael Botticelli: We can’t arrest and incarcerate addiction out of people. Not only do I think it’s really inhumane, but it’s ineffective and it cost us billions upon billions of dollars to keep doing this.
Scott Pelley: So what have we learned?
Michael Botticelli: We’ve learned addiction is a brain disease. This is not a moral failing. This is not about bad people who are choosing to continue to use drugs because they lack willpower. You know, we don’t expect people with cancer just to stop having cancer.
Scott Pelley: Aren’t they doing it to themselves? Isn’t a heroin addict making that choice?
Michael Botticelli: Of course not. You know, the hallmark of addiction is that it changes your brain chemistry. It actually affects that part of your brain that’s responsible for judgment.
“We can’t arrest and incarcerate addiction out of people. Not only do I think it’s really inhumane, but it’s ineffective and it cost us billions upon billions of dollars to keep doing this.”
That is the essence of Michael Botticelli’s approach — addicts should be patients, not prisoners. He did it in Massachusetts as Director of Substance Abuse Services. There, his initiatives included a high school for teens in recovery and expanding drug courts, like this one in Washington D.C., where offenders can choose treatment over jail. And the charges can be dropped.
Scott Pelley: You know that there are people watching this interview and they’re saying to themselves, “Oh, great. He wants to open the jails and let the drug addicts out.”
Scott Pelley: I think we have to base our policy on scientific understanding. You know, and we’ve had really great models and evaluated models to show that we can simultaneously divert people away from our criminal justice system without an increase in crime. And it actually reduces crime.
Botticelli pursues reform with the passion of the converted because he, himself, is recovering from addiction. Back in 1988, he was a university administrator, whose car slammed into a truck. Botticelli was drunk, in truth, he’d been drunk for years.
Scott Pelley: Did you love drinking?
Michael Botticelli: I would say that I probably had an unhealthy love affair with drinking. You know, I grew up as this kind of insecure kid, you know, kind of making my way. And, you know, drinking took all of that away, you know? People drink and do drugs for a reason. ‘Cause it makes them feel good, you know — until it doesn’t anymore.
Scott Pelley: Is it true that after the accident you woke up handcuffed to a gurney?
Michael Botticelli: I did. I did. And, you know, you think to yourself, “how did I get to this point, you know, in my life?”
That point included imminent eviction from his apartment because the booze had washed away all the money.
Michael Botticelli: A very wise judge said to me, “Michael, you have two options. You can either get care for your drinking problem. Or we can continue with criminal proceedings.”
Scott Pelley: It was at that point that you walked into this church and went to the 12-step meeting down in the basement?
Michael Botticelli: Yeah, I did.
Scott Pelley: What was that first meeting like?
Michael Botticelli: It’s hard for me to talk about this. And not from a sense of sadness. From a sense of tremendous gratitude. This was the first time that I raised my hand and said that I was an alcoholic and that I had a problem. And what the miraculous thing about that movement is that people rally around you in ways, you know, addiction is such an isolating incident in your life. You feel alone. And, you know, when you admit, when you come into a fellowship like this and people just surround you and say, “We will help you, that you’re not alone, that we’ve been through it before, and you will get through it,” just gives you such great hope.
He’s been alcohol free for 27 years. Today he oversees a $26 billion budget across 16 government agencies. Just over half of the money goes to drug enforcement.
Scott Pelley: What do you say to those who argue, and there are many, that if you lock down the southern border, you solve the drug problem?
Michael Botticelli: I think it’s overly simplistic to say that any one single strategy is going to really change the focus and change the trajectory of drug use.
For example, he says, the heroin crisis was created here at home.
Michael Botticelli: We know one of the drivers of heroin has been the misuse of pain medication. If we’re gonna deal with heroin and heroin use in the United States, we really have to focus on reducing the magnitude of the prescription drug use issue.
Many pain drugs are opioids, like heroin. And the number of opioid prescriptions has risen from 76 million in 1991 to 207 million today.
Michael Botticelli: We have a medical community that gets little training on pain, gets little training on addiction, and quite honestly has been promoting and continues to promote the overprescribing of these pain medications.
Some are born addicted. We met Botticelli at Massachusetts General where Dr. Leslie Kerzner, weans infants off of opioids.
Dr. Leslie Kerzner: I’m just going to give him this little bit of morphine right in his cheek.
In the last decade, the number of expectant mothers on opioids has increased five fold.
Dr. Leslie Kerzner: If they don’t get the treatment, they could have a seizure. And that’s what we really worry about.
Scott Pelley: But how does a person who is addicted to prescription pain medication find themselves on heroin?
Michael Botticelli: Prescription drugs and heroin act in very similar ways on the brain. // And, you know, unfortunately, heroin, because of its widespread availability is a lot cheaper on the streets of Boston and many places around this country.
Scott Pelley: Heroin is cheaper than prescription painkillers?
Michael Botticelli: It is. So a bag of heroin could be as cheap as $5, $10.
More than 120 Americans die of drug overdoses each day. That is more than car wrecks or gun violence. To save lives, Botticelli started an experiment in 2010 with the Quincy, Massachusetts police. Lieutenant Patrick Glynn is head of narcotics.
Patrick Glynn: When someone dies of an overdose the community becomes very, very small. Everyone knows each other, even in a large city as ours. Just recently in the past four to six months some of our officers have lost children.
Scott Pelley: In a city of about 100,000 people, did I just understand you to say that some of your officers have lost children to drug overdoses?
Patrick Glynn: Yes.
Scott Pelley: How many?
Patrick Glynn: Two did. Two– they– two of them lost sons.
Scott Pelley: In what period of time?
Patrick Glynn: Within the last six months.
Botticelli helped arm every Quincy officer with Naloxone, a nasal spray antidote for overdose. Lt. Glynn saw it work on an unconscious addict.
Patrick Glynn: Within about 45 seconds to a minute, they started to move around, their eyes fluttered, and they began to sit up and speak.
Scott Pelley: Must have looked like a miracle?
Patrick Glynn: It’s surreal.
And they got to the victim in time due to a controversial innovation called the “Good Samaritan Law.”
Scott Pelley: One of the changes that came under Botticelli’s administration was that someone involved in drugs, if there was an overdose, they could call 911. And they would not be arrested for having drugs on the premises.
Patrick Glynn: Correct.
Scott Pelley: What difference did that make?
Patrick Glynn: That opened the floodgates of people calling 911.
Today, 32 states have a similar 911 law and Naloxone is carried by more than 800 police departments.
In Massachusetts, Botticelli helped make treating addiction routine healthcare. So patients can get their opioid treatments now in a doctor’s office.
[Dr. Samet: Things have been going really well for you. We’ll figure out the path you can walk down to stay in recovery.]
And today, the Affordable Care Act requires most insurance companies to cover addiction treatment.
Michael Botticelli: I often say that substance use is one of the last diseases where we’d let people reach their most acute phase of this disorder before we offer them intervention. You’ve heard the phrase “hitting bottom.” Well, we don’t say that with any other disorder. So the medical community has a key role to play in terms of doing a better job of identifying people in the early stages of their disease, in doing a better job at treating people who have this disorder.
Notice that word: “disorder,” Botticelli prefers it to “addiction.” He wants to lift the stigma by changing the language as he did this past October in a rally on the National Mall.
[Michael Botticelli at rally: We must choose to come out in the light and be treated with dignity and respect. So let’s stop whispering about this disease.]
Botticelli sees a model for the change in attitude in the gay rights movement, which he has also lived. He’s been with his husband, David Wells, more than 20 years.
Scott Pelley: At what point were you comfortable talking about being a gay man?
Michael Botticelli: Before I was comfortable talking about being an alcoholic.
Scott Pelley: The alcoholism was harder?
Michael Botticelli: You know, even kind of feeling that moment of hesitation about saying that I’m in recovery and not about being a gay man shows to me that we still have more work to do to really de-stigmatize addiction.
But it’s addiction to legal drugs, alcohol and tobacco that kill the most Americans, over half a million a year. Botticelli does not believe in adding another drug to that cocktail with the legalization of marijuana.
Scott Pelley: You’re not a fan?
Michael Botticelli: I’m not a fan. What we’ve seen quite honestly is a dramatic decrease in the perception of risk among youth around occasional marijuana use. And they are getting the message that because it’s legal, that it is, there’s no harm associated with it. So, we know that about one in nine people who use marijuana become addicted to marijuana. It’s been associated with poor academic performance, in exacerbating mental health conditions linked to lower IQ.
Botticelli worries the marijuana industry is quickly adapting “big tobacco’s” playbook.
In the 90s tobacco companies appealed to kids with flavored cigarettes and Joe Camel. Today, the nearly $3 billion marijuana industry promotes sweetened edibles and “buddie,” a mascot for legalization.
Scott Pelley: You are never gonna be able to talk all the states out of the tax revenue that will come from a burgeoning marijuana industry. It will just be too seductive.
Michael Boticelli: You know, that’s quite honestly my fear. Is that states are going to become dependent on the revenue.
Scott Pelley: It becomes a co-dependency?
Michael Botticelli: It becomes an addiction to, unfortunately, a tax revenue that’s often based on bad public health policy.
As for his own recovery, Botticelli says it gets easier. Though he still attends those 12-step meetings that he called ‘miraculous.’
Scott Pelley: There are people watching this interview right now who are addicted to drugs, are alcoholics. And they cannot stop. And to them, you say what?
Michael Botticelli: That there’s help. That there’s hope. That there is treatment available. If I, in some small way can help people to see that there is this huge, incredible life on the other side of addiction, you know, I will feel accomplished in my job.
Douglas Lee Thompson