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Will Godfrey Will Godfrey

US Drug Czar Opens National Harm Reduction Conference in Unprecedented Move

Michael Botticelli’s presence in Baltimore indicates the softening of government attitudes to harm reduction—and wins him a standing ovation.

40 Substance

“It really is no coincidence that I’m here,” declared Michael Botticelli, the US drug czar, at the opening of the 10th National Harm Reduction Conference this morning in Baltimore. Although his speech, which won him a standing ovation from the hundreds of delegates, stuck to politically safer topics, his very involvement represents an unprecedented endorsement of the harm reduction movement by the federal government.

“I hope that my presence here reflects the Obama administration’s commitment to continuing drug policy reform,” said Botticelli, whose official title is acting director of the Office of National Drug Control Policy (ONDCP). He spoke of a desire to ensure that “federal policy reflects the needs of people on the ground,” and also expressed the hope that his working relationship with the Harm Reduction Coalition will “continue to grow.”

The policy details of his speech, showcasing the government’s progressive credentials, covered improvements in the areas of sentencing reform (“behind a rap sheet there is a real person, often struggling with a substance abuse disorder, who needs treatment”); the prevention of nonmedical prescription drug use and overdose, including naloxone distribution and Good Samaritan laws; and medication-assisted treatment (MAT, including methadone and buprenorphine).

His endorsement of the latter was notably ringing: MAT “should be recognized as a standard of care for opioid addiction,” he said, and denied to no one. MAT “can mean the difference between hope or despair, or between life and death,” he continued. “To put it simply, people maintained on medication-assisted treatment don’t die.”

His humble, friendly tone went down well, as did interspersing his speech with inspiring stories of people he has met whose lives have been transformed thanks to health improvements facilitated by better policy.

There had previously been some “whispers” from within the harm reduction community, organizers say, that the conference was “selling out” by inviting Botticelli.

But Botticelli predictably sidestepped several elephants in the room. He celebrated the reduction of the sentencing disparity between crack and powder cocaine, an area, he acknowledged, that “disproportionately affects people of color,” without addressing how that disparity should be eliminated. He “recognized” the importance of syringe exchange programs, despite the continuing ban on federal funding for them, but avoided mentioning supervised injection facilities, which have proved successful by every valid measure in Europe and Canada, yet remain illegal in the US. And he made no mention of drug decriminalization or legalization, despite the damage prohibition and mass incarceration do to the very people the harm reduction movement works to help.

There had previously been some “whispers” from within the harm reduction community, organizers say, that the conference was “selling out” by inviting Botticelli. But any suspicions that his welcome from people who have personally been victimized by US drug policy might be less than warm were instantly allayed. His introduction from Daniel Raymond, the Harm Reduction Coalition’s policy director, helped. He told the crowd that a more politically cautious acting drug czar—Botticelli’s appointment in the permanent role still needs to be confirmed by the Senate after his nomination by the president—would have stayed away: “You’re here to give Michael his marching orders, because he’s open for business.”

Raymond also reminded us of Botticelli’s harm reduction track record, which includes spells at the HIV/AIDS and Substance Abuse departments in Massachusetts, where he worked to increase the availability of naloxone and buprenorphine.

Botticelli acknowledged that there is much room for improvement in federal policy. “As a person in recovery,” he said, “I’ve learned that patience is essential. We must meet people where they are and help more people on a path to better health. We must do better…let’s work together to help people live safer and healthier lives. Thank you for the work that you do, and let’s get to work.”

“About six years ago, we wouldn’t get to meet with the ONDCP,” reflected Allan Clear, the Harm Reduction Coalition’s executive director, afterwards. Back then, he went to Vienna to meet US representatives to the UN because he couldn’t get access to representatives of the federal government back home. There, he was informed that the then-drug czar, Gil Kerlikowske, “doesn’t like harm reduction,” Clear recalled. “That’s how far we’ve come in the last six years.”

Will Godfrey is the editor-in-chief of Substance.com.