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(YASUYOSHI CHIBA/AFP/Getty Images)

Drug Use and Drug Spending: How the Washington Post and the President Get It Wrong

David W. Murray

Washington Post reporter Christopher Ingraham writes about the drug issue during the Obama Administration, referencing both drug use data and the drug budget (“The White House is Spending Billions to Combat Drugs. But Drug Use Keeps Rising” August 30). Somehow, he manages to mislead both on the data and the budget.

His measure of drug use is the National Household Survey on Drug Use and Health (NSDUH), run annually by the Department of Health and Human Services. The most recent data available end in 2012. It is curious that he chose to write about this now, since the release of updated information in the 2014 NSDUH report is imminent.

Further, Ingraham inexplicably examines trends since 2003. This is an even odder choice, because the 2003 data derive from the beginning of the George W. Bush Administration’s first term, while the current White House began setting drug policy in 2009. A more relevant measure of the Obama Administration’s performance is surely the period from 2009 until the present.

Further, Ingraham chooses the largest NSDUH drug use category of all Americans 12 and older, rather than the youth measure (12-17) or the young adult measure (18-25). That choice matters, because it is in those two youth categories where the real action is; that is, changes in youth rates are the real places where policy impact can be seen.

Nonetheless, we read of the Obama Administration’s goal of reduction in the past month use of “any illicit” drug of 15 percent between 2010 and 2015. This is the measure of accountability the Obama Administration set for itself under the President’s Office of National Drug Control Policy (ONDCP).

But when Ingraham presents the actual data he describes only “a one percentage point” rise by 2012 (8.2 percent to 9.2 percent). The effect of this characterization is to distract us from just how poor the performance has been. In fact, the difference between 2003 rates of use and 2012 rates of use is a rise of 12 percent.

Were the more policy-pertinent period of 2008 to 2012 used to measure performance, cast in the same terms as the goal of 15 percent reduction, we find instead a 13.6 percent increase. The gap between the goal and the reality matters; with nearly 24 million Americans being current users of illicit drugs, the difference is nearly 7 million people.

Still, that increase does fit the theme of the headline; drug use is going the wrong way, while the ONDCP budget is said to be increasing. But the overall trajectory of that relationship is masked by the way the data are presented. During the Bush Administrations, drug use went down.

The decrease was quite dramatic in the more consequential categories of youth. In fact, the Monitoring the Future school surveys of teens during that period show as much as a 25 percent reduction in marijuana use, with a 24 percent reduction in the current use of “any illicit” drug.

The school surveys are validated by similar declines found in the NSDUH youth cohort and in the Youth Risk Behavioral Survey (YRBS) conducted by the Centers for Disease Control and Prevention.

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The previous steep downturns in youth use coincide with the Administrations of Reagan and George H. W. Bush, respectively. The overall message is, to evaluate drug policies in terms of their budgetary effectiveness, it is imperative to recognize that those policies shift between Administrations; some are strikingly successful, some not so.

Now to the budget issues. We read that the ONDCP budget has risen (again, from 2003) from $17 billion to $25 billion, a 48 percent increase. But the heart of Ingraham’s critique is in how the budget dollars are broken down.

Spending on treatment is said to have doubled, even though prevention has declined. Hence, to Ingraham’s apparent applause, “demand-side” programs have been (somewhat) supported, while “supply-side” programs (international programs, interdiction, law enforcement) have been weakened. The relative spending proportion (60 for supply, 40 for demand) is a favorite scorecard of critics of drug policy, but it is itself not always a clear distinction. If the budget is spent on prison construction, that must represent “supply-side” law enforcement. Unless there are drug treatment programs in those prisons; then it’s suddenly “demand-side.”

And who has considered the impact of reducing international programs for geographic areas like Central America, with the subsequent disaster of refugees, the surge of drug smuggling across the border, and then the dramatic increase in supply and demand for a drug like heroin in the U.S. Northeast? The categories are better seen as in reality part of an integrated strategy.

But that’s not the worst of it. Ingraham fundamentally misunderstands the nature of the drug budget. ONDCP does not receive, or spend, either $17 billion, or $25 billion. Those are dollars appropriated for agencies like the Department of Justice, of State, and of Health and Human Services. They are the ones who receive and spend the money, for prisons, for treatment, or for international law enforcement training.

ONDCP’s role is only two things. They issue grants of the appropriated money, for example, for Drug Free Communities (about $90 million dollars a year) or for the High Intensity Drug Trafficking Areas, which are law enforcement fusion centers of state, local, and federal officials scattered throughout the country. The HIDTAs receive about $230 million per year. The rest of the billions and billions?

ONDCP never gets it; they merely “certify” that certain federal programs with a “drug-control nexus” have requested funds consistent with the Administration’s drug policy—the dollars are allocated and spent by other Cabinet agencies. ONDCP can issue budget guidance for how they would like those “drug control nexus” dollars to be spent, but the actual impact, both during negotiations with the Office of Management and Budget and in the actual distribution by the interagency, is a function of the effectiveness of the ONDCP Director. It is the effectiveness of his National Drug Control Strategy that is the major variable, as well as the presence in the White House of drug policy champions for what becomes the President’s strategic road-map.

(There are grounds for saying that the influence of ONDCP in this interagency spending process has never been lower than it is under the Obama Administration, for lack of strategic vision, of effective leadership, and most of all, because it now represents a President for whom the drug issue is at best an unpleasant inconvenience, and whose first act was to delete ONDCP from Cabinet status.)

Finally, there’s always a bit of a shell game going on with the actual appropriations, in terms of what gets counted as falling within the drug control nexus. For instance, the “doubling” of treatment dollars is in some sense illusory. Actual treatment money appropriated for treatment block-grants to be allocated to the states has not grown at all; in fact, it is danger of shrinking.

But the Obama Administration determined that it would count as within the “drug control nexus” dollars that the potential and estimated impact of the Affordable Care Act might have on Medicare and Medicaid spending for drug treatment. Whether such dollars will ever actually materialize is, at best, up for grabs, and dependent on the fate of the ACA. Currently, it is no more than a future promise, about as solid as the other ACA promises.

Nonetheless, this Administration continues to announce the dramatic increases in treatment and prevention, as though they represented a fundamental shift away from Bush Administration policies. Self-serving rhetoric aside, this is untrue. The Bush Administration strategy and budget were as committed to the public health dimensions of the drug problem as the current one,

The only difference in actual practice is that the Bush Administration did not abandon international allies, undermine interdiction assets on the high seas, or neglect our borders.

For all its rhetoric, the Obama Administration is at risk, in its sixth year, of delivering on neither side of the strategic equation.

Meanwhile, drug use rises – steeply. The issuance soon of the NSDUH data for 2013 could be telling.

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