Q and A With A. Thomas McLellan
A. Thomas McLellan is the deputy director of the Office of National Drug Control Policy and serves as the primary advisor to the director on a broad range of drug control issues and assists in the formulation and implementation of the president's National Drug Control Strategy.
He responded to questions from State Legislatures about a range of issues involving drug control policy.
State Legislatures: Drug abuse prevention has been a top stated priority of Office of National Drug Control Policy. What key advice would you give state policymakers about addiction and addiction prevention?
A. Thomas McLellan: We want to prevent drug use and its consequences, in addition to preventing addiction. Relatively small numbers of people are addicted, but much larger numbers of people who are not technically addicted nonetheless use drugs at frequencies and amounts that create pain, tragedy and enormous monetary and social costs.
We think communities are the logical venues for evidence based prevention efforts that will have to be coordinated across multiple sectors of influence such as parents, schools, healthcare, business and law enforcement. We think the federal and state governments should train and equip communities to take responsibility for preventing their local drug problems. There are proven ways of helping communities organize, learn what they need to know, shop wisely for effective interventions and measure their own progress as they go. If we help communities, we will ultimately reduce the state and national drug problem.
SL: Prescription drug abuse is a growing problem and challenge. What strategies would you suggest to states?
McLellan: Strategies include: (1) Train doctors and clinicians on proper prescribing of medications that have abuse potential, like opioids, stimulants and tranquilizers; (2) Develop coordination between physicians and pharmacists to reduce diversion and “doctor-shopping”; (3) Increase programs to foster safe disposal or return of unused medications; (4) Train patients in their responsibilities for using and securing prescription drugs; (5) Implement modern prescription drug monitoring programs; (6) Set up a substance abuse treatment hotline; and (7) Encourage lockboxes or portable child-proof senior-friendly medication storage and dispensing units. We should also examine models such as New York’s secure prescription pads system.
SL: The drug using offender is a significant and costly problem for states. How can states intervene effectively with this population of drug abusers?
McLellan: States have several opportunities and mechanisms to refer offenders with substance abuse problems to treatment. Alternatives to incarceration, such as drug courts, are one of many proven combinations of treatment and monitoring with sanctions that reduce drug use, prevent crime, and save taxpayer dollars. With more than 2,300 drug courts operational today, approximately 120,000 Americans annually receive the help they need to break the cycle of addiction.
Problem-solving court programs are also successfully confronting emerging issues for our nation. For example, Veteran’s Treatment Courts are adapting to the needs of our heroes from the armed services, who sometimes have difficulty adjusting to civilian life or coping with combat-related stress, and may become involved with the justice system. Many communities have also used the drug court model to address juvenile drug abuse, child abuse and neglect, impaired driving, mental illness, homelessness, domestic violence, and other pressing community problems. Re-entry Drug Courts are assisting individuals leaving our Nation’s jails and prisons to succeed on parole and avoid a recurrence of crime and drug abuse.
Community courts have also shown to be effective. These are neighborhood-focused courts that integrate the criminal justice system with therapeutic treatment in order to stop the revolving door of recidivism to bring about fundamental life changes that address local problems and misdemeanor offenses such as drug possession, shoplifting, vandalism and assault.
Treatment is not always necessary, even for drug-involved offenders. Simple drug testing with rapid, certain but modest sanctions has shown positive results (e.g., Hawaii’s Project HOPE). Potentially, similar results may also be accomplished administratively, if probation and parole agencies are given limited authority to impose brief sanctions such as short stints of incarceration. These initiatives have the potential to sharply reduce drug use, crime, and probation revocation, in addition to being able to distinguish those who truly need drug treatment from those who can be induced to stop their drug use through other means.
Finally, in the past few years, collaborative efforts, such as the Justice Reinvestment Strategy aim to reduce spending on corrections, increase public safety, and prime neighborhoods for re-entry. Several states are designing policies to manage the growth of the corrections system, improve the accountability and integration of resources concentrated in particular communities, and reinvest a portion of the savings generated from these efforts to make communities receiving the majority of people released from prison safer, stronger, and healthier.
SL: Having recently come to ONDCP from the private-sector field of addiction research, what opportunities and challenges are you most eager to approach as deputy director at the White House Office of National Drug Control Policy?
McLellan: I am particularly proud of the work done over the past eight months by our Interagency Work Group. In a period where Americans have seen so much partisan bickering and so little action at the congressional level, I am very happy to report that at the federal agency level, people from 35 federal agencies have collaborated closely to develop innovative and evidence based initiatives to prevent, intervene early, expand treatment and promote recovery from drug abuse. These ideas are both exciting and practical and I look forward to helping implement them with the continued help of the Interagency Group.