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Federal drug czar Barry McCaffrey praised the American Academy of Addiction Psychiatry (AAAP) for helping to educate the public that addiction is a treatable disorder and for standing with his office in opposing state initiatives aimed at legalizing medical use of marijuana.
McCaffrey is director of the Office of National Drug Control Policy (ONDCP), the federal office that coordinates drug policy. McCaffrey made his remarks in the keynote address at the AAAP annual meeting in San Antonio, Tex., in December.
In his speech, McCaffrey also praised AAAP members, noting that "as psychiatrists specializing in addiction, you are uniquely positioned to treat patients with co-occurring mental health and substance-abuse disorders."
McCaffrey cited a variety of statistics on illegal drug use to illustrate the costs it imposes on society, stressing the importance of "protecting the citizens of this nation from the scourge of illegal drugs."
Psychiatrists, by training, have the skills to diagnose and treat addicted patients and have a key role in educating the public about the importance of treatment, McCaffrey said. Treatment capacity should be increased, he asserted. The Clinton Administration’s 1997 National Drug Control Strategy asked for $4.9 billion for treatment and prevention, of which $3 billion was for treatment alone, McCaffrey observed. The need is urgent, he added. For example, only 115,000 of an estimated 600,000 heroin addicts receive methadone at this time. He called on AAAP to help revise the current "cumbersome" regulatory approach that restricts use of methadone for addiction treatment.
McCaffrey contended that those who support a philosophy of "harm reduction" aimed at stressing treatment over punishment and those who support medical use of marijuana "ultimately seek the legalization of all drugs, which the vast majority of Americans wisely oppose." Marinol - a synthetic version of one of marijuana’s active constituents - is "the real medical marijuana," McCaffrey asserted. "The so-called medical marijuana movement can be seen as a stalking horse for the legalization of all drugs," he contended.
Needle exchange, which has been shown in repeated studies to reduce the spread of the HIV virus, is "a Band-Aid in place of treatment," McCaffrey said. Both medical marijuana and needle exchange are "peripheral issues in a country that hasn’t gotten serious yet about prevention and treatment programs," he added.
Incoming AAAP President Thomas Kosten, M.D., who serves as a consultant to APA’s Council on Addiction Psychiatry, spoke with Psychiatric News about McCaffrey’s speech.
McCaffrey’s message, said Kostin, was "that psychiatrists and [other] physicians need to get more in front of the media, so the debate is not always between legalizers of drugs and the law-and-order police," said Kosten. "We need to get into that debate in order to emphasize the harm caused by these drugs and how we have effective treatments that can help."
Although there has been some dissent within AAAP over the organization’s stance on medical marijuana and needle exchange, most members agree with McCaffrey, Kosten said.
"Different organizations are going to have a different focus," Kosten noted. "Our major concerns are around abuse of drugs. And that enters into the area of needle exchange and the area of medical marijuana. As far as AAAP is concerned, both of those issues are distractions from the issue of withdrawal of dollars from treatment."
Kosten added, however, that AAAP is "a diverse organization of 1,000 physicians," and not all its members agree.
AAAP founder and past president Richard Frances, M.D., agreed with Kosten that most AAAP members are concerned about the attention paid to the medical marijuana issue. He said he would not encourage a patient to use marijuana and favors additional research on the issue. But Frances said he was worried about threats from the federal Drug Enforcement Administration to discipline California physicians for recommending marijuana to patients despite the fact that voters approved an initiative in 1996 permitting California doctors to recommend it and patients to use it without fear of prosecution.
"Doctors should not be caught in a cross-fire between federal and state law," Frances commented. He noted that a similar paradox now exists in Oregon, where physicians are allowed under state law to prescribe lethal doses of barbiturates to help a patient commit suicide, despite the fact that doing so violates the federal Controlled Substances Act. That law allows prescribing of controlled drugs only for legitimate therapeutic reasons. But what is or is not legitimate is at issue in both cases.
AAAP President-elect Stephen L. Dilts, M.D., said he does not blame patients and their advocates for their passion on needle exchange and medical marijuana. Dilts, however, would like to see "less passion" and more research on marijuana, which, he said, should be easy to conduct.
"In terms of the doctor-patient relationship, I feel an obligation to recommend something that has firm science," Dilts commented. "As a medical community, we should be lobbying hard to get the government to do what needs to be done."