NPR Interview with ONDCP Deputy Director

Jan 19 2010 Published by under Drug Abuse Science, Public Health

Deputy Director of the ONDCP A. Thomas McLellan, Ph.D. [ PubMed ] being interviewed on Here & Now from WBUR.
[ Notes on McLellan's appointment at Terra Sigillata and The Discovering Alcoholic. ]
He was talking about stigma, the addition of prevention, intervention, treatment and recovery to the traditional ONDCP focus on interdiction.
"addiction is an illness"
"drugs that have the greatest harm are those that have the greatest availability"
" [use of] prescription opiates has gone up more than 1,000 percent over past 10 yrs...led to record numbers of overdose deaths... 2nd only to automobile deaths"
same genetics, relapse rate as other chronic illnesses but we treat it differently. "imagine if we treated hypertension that way...."
(on proper treatment, early intervention at primary medical care level) "It's not more money, it's less money"
(on anti-drug abuse vaccines) "I think they will be miracles" [DM- Hmmmm....]
[h/t: Occasional commenter SurgPA]

8 responses so far

  • WMDKitty says:

    "drugs that have the greatest harm are those that have the greatest availability"
    Actually, what's doing the greatest harm is the current prohibition. If drugs were made available safely -- i.e. measured dose, pure product (not laced with god-knows-what), medical supervision during (and 15 minutes after) use, clean needles -- the associated crime, disease, and death rates would go down sharply. It's the only sane way to deal with the drug "problem" we have in America.
    Prohibition just doesn't work.

  • namnezia says:

    Actually, what's doing the greatest harm is the current prohibition...It's the only sane way to deal with the drug "problem" we have in America.

    Maybe that's true for treating people currently addicted to drugs. How about for preventing new people from getting addicted? It seems that wider availability will result in greater addiction.

  • Cashmoney says:

    Yeah that'll solve the problem of addiction, for sure Wmdk.

  • Lamar says:

    DM-I'd be interested in hearing your opinion on the vaccine craze, which has actually been around for a while now. I've seen the idea described anywhere from being a miracle cure to a classic example of a politically-trendy cart leading a really bad science horse.

  • SurgPA says:

    @WMDKitty - Sorry, no, listen to the interview; the link is above. The prevalence of use/abuse/dependence on tobacco, alcohol and prescription opiates far outstrips that of the illegal drugs. Tobacco use is directly linked to heart disease, lung cancer, COPD, peripheral vascular disease among others. Alcohol use: liver disease and a host of drug interactions ("what, you drink 3-4 drinks per day? Maybe that's why your beta blocker/statin/coumadin/etc... dose isn't working as it should.") Both are legal, widely available. From the perspective of burden to the health system and financial cost to us all, these two are the dominant players (due at least in part to relative prevalence of use.) Also in the top 5 is prescription opiates, chiefly oxycodone in its various formulations. Pure product, measured dose, but legal (with prescription) and widely available. And increasingly a significant problem of abuse and dependency ("second only to automobile deaths.") Even if I concede, for the sake of argument, that there would be some level of public health/health-cost benefit by legalizing pot/coke/ex/your-drug-of-choice, the benefit of legalization pales in comparison to the benefit of more successfully addressing dependence on and abuse of alcohol/tobacco/prescription opiates.
    The interview was quite good; I encourage you to listen. At first glance it seems like a significant departure from previous administrations' approaches to this issue. I'll be interested to see how it plays out.

  • k8 says:

    This appointment has made me very happy. However, I am very skeptical of the anti-abuse vaccines.

  • Klem says:

    McLellan says (7:58) "Prescription opiates are the second leading cause of accidental death, second only to automobile accidents."
    I tried to find some evidence for this claim.
    The CDC reported in 2009 on 2006 death statistics (2006 is the latest year available), including a detailed report on opiate analgesic deaths. (Media stories on this data compare opioid deaths and automobile accidents, so these CDC reports seem to be what McLellan is talking about.)
    Drug-induced deaths (includes suicides and prescribed drugs), total 38,396
    * Opioid analgesics (not heroin), 13,755
    * Heroin, approx 2000
    * Unspecified drug (could be opioids or others), 8,200
    Alcohol-induced deaths (not injury or drunk driving), total 22,073
    Motor vehicle traffic, total 43,664
    Firearm injury (mainly suicide and homicide), total 30,896
    Falls, total 21,647
    * Unintentional falls 20824
    Suicide (includes intentional drug overdose), total 33,300
    So 13755 confirmed prescription opioid deaths in 2006, that includes suicides and medical errors or patient confusion, and most prescription opioid deaths involved other drugs in addition (benzodiazepines, etc). Total deaths from prescription opioids in 2006 were less than alcohol-induced deaths or deaths from accidental falls.

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