Michael Botticelli is a recovering alcoholic, a former Massachusetts resident and Director of Substance Abuse Services in the state. And in March 2014, Botticelli became Director of National Drug Control Policy, a position that has sometimes been referred to as the nation's "drug czar." (But he doesn't like that title.)
Botticelli joined Boston Public Radio to talk about what initiatives his office is pursuing, the downgrading of low-level drug use as a law enforcement priority, and how we can better treat addicts by putting them in recovery programs instead of prison.
Questions below are paraphrased; Botticelli's answers are edited where noted [...].
Do you believe you have an edge for this job given your background — that you're an alcoholic, that you've abused drugs and alcohol, and have been through recovery?
I do believe so, but I do believe it's indicative of where we are with drug policy in the United States. [...] We know arrests and incarceration for people with addictive disorders [don't work]. Both my personal and professional background [helped, having] also serving in a public health policy for many years. [...] I have really been astounded [...] as I travel the county and I talk to law enforcement officials. [...] You will hear them echo the same sentiment.
Do you think Pres. Obama is also in a unique position, having not only used drugs in the past and publicly admitted to it?
I think more importantly it shapes his overall agenda, that we can't use our criminal justice system as a vehicle to [...] perpetuate this mass-incarceration. And quite frankly, the disproportionality that we have in our criminal justice system, [we need to] support the health and safety of the people in the United States.
Can we use the model of the LGBT movement to help shore up support and awareness for the addict community?
The recovery movement can talk about how we de-stigmatize people with addiction. [There was] a fundamental belief that if people knew someone who was gay, that they were more likely to support them, and that the same was true for people with addictive disorders. [...] This is an issue that affects other people, that it's not me, that these are just morally flawed people. [We can] showcase people in recovery as a way to de-stigmatize this highly-stigmatized disorder. [...] Only about 19 percent of people who need treatment in the United States get care and access.
What are the biggest impediments to getting treatment?
One of the biggest factors that I hear time and time again is stigma. Addicts are ashamed to tell their employers, they're ashamed to tell their friends.
One of the biggest factors that I hear time and time again [...] is stigma. They're ashamed to tell their employers, they're ashamed to tell their friends.
And that was your experience as an alcoholic?
I knew that I had a problem with alcohol, I knew that I had to stop, but I was significantly worried that people would think it's stupid. [...] So, this is really where we're trying to focus on the fact that this is a disease, this is not a moral failing.
Do you get a kick out of being called the nation's 'drug czar?'
I actually don't like it, because I think it connotes, you know, this kind of war-on-drugs mentality that people had. This was a term that was coined way back when, you know so, for me it's an easy way to explain my title because it's so tremendously long, but I actually don't like the title.
We're hearing more about doctors being part of the prescription-drug problem here in Massachusetts as well as other states. Is your office focusing on that, too?
They got pain medication when they didn't want it, they got more of it than they needed to, and that they weren't appropriately monitored on these medications.
So, for instance, people get mega-doses of pain meds for losing one wisdom tooth.
You get a 30-day supply, maybe you need three. You put the rest in the medicine cabinet, and that's where it gets diverted. One of the top priorities of our office [...] is, continue to support an increase state and local resources for appropriate treatment capacity. [...] Those public health approaches under the Obama administration are at the highest level that they've been.
We're seeing a lot of movement from states on medical marijuana, as well as full recreational marijuana legalization. Where does your office stand on this?
I think everyone would agree that there needs to be enhanced research, particularly at the federal level to really look at valid conditions for which the components of marijuana might be effective. I think it's been a fair criticism of this administration that we haven't really supported [that]. We actually just removed what many people saw as a barrier to good academic research on marijuana. We had an additional review process that we actually just did away with. [...] We really have a lack of scientific understanding about what conditions do well with what components. So, we need to make sure that we're using the scientific process. [But] smoking medication is not a good medication delivery device.
But you're not in favor of full legalization for recreation marijuana?
What we're in favor of is good, scientifically-based research.
Has the administration said whether it will or will not stand in the way of medical marijuana dispensaries?
Our administration has remained opposed to the legalization of recreational marijuana because it will have a deleterious effect on the youth of this country
I think we need to separate medical marijuana versus legal marijuana. I think our administration has remained opposed to the legalization of recreational marijuana [because it] will have a deleterious effect on the youth of this country. [...] We know that marijuana is addictive, that about one in nine people go on to develop addictive disorder, that it has a dramatic effect on youth development.
But isn't alcohol just as addictive as marijuana, if not worse? What about tobacco? A recent youth health survey found that legalization in Washington didn't have an effect on youth usage levels of marijuana.
I think that argument kind of falls apart — that we can regulate marijuana and not have a significant impact on the youth of this country. [...] We have I think — myself and many other public health experts feel like we have — this kind of industry that's using some of the same tactics that the tobacco industry used to use in terms of marketing marijuana to youth. [They're] using kind of comic book characters on edibles and candy. [...] I think there is a significant cause for concern.
If eight of nine people don't get addicted, and most people who use marijuana go on to hold jobs and pay taxes, does it make sense that the government still criminalizes it?
The Department of Justice has issued clear guidelines that we are not using our limited federal resources to go after people who are low-level [users]. We want to continue to focus on criminal justice reform. [...] What we are proposing is a more balanced approach that will continue to focus on criminal justice reform.
Are you a big House of Cards fan? We want to know your reaction to the character of Doug Stamper, Francis Underwood's right-hand man who battles addiction on the show.
I have a number of reactions. [...] It's, you know, kind of tragic watching him struggle, but I also see some of the things that he has done, and to kind of question how much of a focus on his own recovery he is taking. [...] I wouldn't quite say that Doug Stamper is in recovery.
You had a great two-and-a-half minute video on the Washington Post site recorded on Newbury Street, talking about when you first went into treatment.
It was a 12-step meeting that was for the LGBT community.
Do you pinch yourself thinking how far you've come?
I've been given an incredible opportunity here in terms of where I came from, where I think I was on that night that I walked into that meeting. All I wanted to do was make the pain go away. [...] My story is not unique, and there are millions of people who got access to treatment.