July 10, 2025 • 25 mins
America stands at a crossroads in our battle against addiction, facing the deadliest drug crisis in our nation’s history. With over 100,000 overdose deaths annually, the devastation is undeniable—but so are the solutions. In this special episode, you’ll get an exclusive first look into Kevin’s groundbreaking new book, One Nation Under the Influence.
Kevin reveals how proven prevention strategies could slash regular drug use by two-thirds and highlights innovative criminal justice programs like Hawaii’s Project HOPE, which has successfully reduced methamphetamine use by 70%. He explores lessons from America’s dramatic reduction in cigarette smoking and Portugal’s compassionate yet accountable drug policy, illustrating how strategic public policies, social shifts, and accountability can transform addiction outcomes.
This episode tackles the harmful false dichotomies holding back progress—treatment vs. harm reduction, criminalization vs. legalization, moral failing vs. medical condition—and demonstrates how embracing comprehensive, evidence-based strategies can create real change. The solutions exist; what’s needed now is the courage to implement them. Join us for this critical conversation about how America can finally turn the tide against addiction.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Yes or no?
Do you believe nicotine is notaddictive?
I believe nicotine is notaddictive.
Yes, congressman, cigarettesand nicotine clearly do not meet
the classic definitions ofaddiction.
I don't believe that nicotinefor our products are addictive.
I believe nicotine is notaddictive.
So if you think about where weare in North America when it
(00:21):
comes to drug overdoses, we'reexperiencing the worst drug
problem in our history.
We have over 100,000 people ayear dying comes to drug
overdoses.
We're experiencing the worstdrug problem in our history.
We have over 100,000 people ayear dying from fatal drug
overdoses.
But that's not the end of thestory.
For every one person that dies,there are five to six people
that have a non-fatal overdose,that might be suffering from
disability as a result of thatoverdose, and every time that
(00:42):
happens, families, individuals,communities, children are all
affected by it.
So it goes way beyond thenumbers of just deadly drug
overdoses.
This is a bigger problem thanwe can imagine and you know I
was personally a bit distraughtwith some of the solutions that
I put forward about how to fixwhat's happening.
(01:02):
A lot of these solutions are oldsolutions that have actually
been tried before, and that'spart of the reason I wanted to
write the book to talk aboutwhat hasn't worked, but also
talk about those beacons oflight around the world and
throughout America that actuallydo work if we take them to
scale, and so talk to us aboutsome of those amazing solutions
that you found in the course ofyour work that maybe you want to
highlight.
Yeah, I mean, I was able totravel to so many different
(01:24):
parts of the country and againaround the world, whether it was
Portugal or what was happeningin Canada.
But you know, right here in theUnited States, we have
prevention strategies that areactually reducing regular drug
use by over two thirds becauseof a comprehensive approach that
they're taking.
We have strategies in thecriminal justice system that are
working, because 70 percent ofthose in the criminal justice
(01:45):
system today have a drug problem.
It's not that they're therebecause of a drug crime, but
it's, you know, their drugaddiction or drug use is fueling
crimes, and so, while they'rein criminal justice custody,
this is a great opportunity foractually us to intervene as a
society to help them, help ourcommunities, and so, for example
, in Hawaii, project Hope, whichwas pioneered by a judge, steve
(02:07):
Alm, uses testing and sanctions, but not severe sanctions, just
swift and certain sanctions tochange behavior.
This has been done in SouthDakota, where they had a huge
alcohol problem.
It's been adapted there totheir 24-7 program.
That program has been adaptedeven in London, england, where
they're using a lot of thoseprinciples to reduce addiction
(02:30):
and reduce the consequences.
So there is a lot that'sworking out there.
It's just really up to us towant to implement them at a wide
scale.
So why do you think now is thecritical moment for this book to
come out and provide this pathforward?
Well, I think we're seeingpeople sometimes out of you know
, real desperation.
Look, search for quick answers,and those quick answers are
(02:50):
usually not solutions to thisproblem.
So you look at a place likeOregon.
Oregon was targeted by the druglegalization movement as a
place to kind of experiment withthe policies that they've been
pushing for many years, and theyput a ballot initiative down in
2020 that they sold astreatment over incarceration,
and you know who would voteagainst that.
(03:10):
We all want people to be, youknow, get treatment that they
need if they're addicted, and sothat initiative passed.
But the fine print wasimportant to read because there
actually wasn't any treatmentgiven.
There was barely any treatmentgiven.
It was really up to theindividual to say, okay, I'm
ready to look for treatment.
And that's one of the big mythsthat this book is trying to
sort of bust through is that youalways have to be sort of ready
(03:33):
for treatment or you alwayshave to want treatment in order
to get it.
We actually know that there areways to persuade people who
don't want it to actually go getit and they will get help.
And in Oregon, what happened wasthey voted for this initiative
and, you know, drug use andaddiction skyrocketed, crime
went up, neighborhood disorder,and it actually in a matter of
two to three short years, itturned that entire state against
(03:55):
what they had just voted for.
And they actually went aheadand repealed that law in Oregon,
which was.
You know, if you would havetold people that a year before,
they would have said you'recrazy.
This is now the law of the land.
But they repealed that lawbecause it was driving overdoses
up, it was driving crime up, itwas one of the main drivers for
public disorder.
(04:16):
And again, it was centeredaround this idea that if we just
let you know, people that areaddicted to drugs decide when
they want to finish using willbe OK.
The reality is.
You know, drugs are verypleasurable.
They latch onto pleasurecenters in the brain and it's
kind of not.
If you think about that,actually it's not so strange
(04:37):
that people won't want to stop.
It feels good.
Why would you?
And so we have to think aboutas a society how do we get
people that actually feel likethey're doing great when their
life is crumbling around them?
How do we get them to realizethat they do need to get that
help?
So the book goes through how wecan do that and the policies
that surround that.
Something pretty special aboutthe book is that you interviewed
every living US drug czar.
(04:58):
Can you talk more about that?
I was lucky enough in this bookto interview almost all of the
living former drug czars, thedirectors of national drug
control policy, and you know Iserved for three of them in the
Clinton, bush and Obamaadministration, but I hadn't
talked to some of them in awhile, so it was really nice to
catch up.
Jerry Jaffe was really thefirst White House drug czar, a
(05:21):
pretty much moderate to liberalDemocrat who was actually
appointed by Richard Nixon tobecome drug czar and pioneered
methadone methadone maintenancefor heroin users.
At the time in the 70s, the USwas going through an
unprecedented heroin epidemicwhich, you know, by the way,
looks like tiny against what'swhat we're currently going
through with fentanyl, but atthe time it was obviously a very
(05:41):
big deal and was causing a lotof crime in Washington and
beyond.
But at the time it wasobviously a very big deal, it
was causing a lot of crime inWashington and beyond, and you
know, talking to him about howto talk about this to both
Republican and Democraticlawmakers and how to make sense
of it and how to push evidencebased policy, was really eye
opening.
I was also able to talk toPeter Bourne who recently passed
(06:04):
away, but while I was writingthe book was still very cogent
and we had a couple of greatconversations who was Jimmy
Carter's drug czar, who actuallyresigned in disgrace, but was
actually a very intelligent manwho even himself sort of noted
that the current drive forlegalizing drugs was was, you
know, too overboard even for histaste.
And he was a guy whoessentially advocated for
cocaine legalization when he wasin office and just before he
(06:27):
took office for President Carter.
He was a good friend ofPresident Carter's and so that
was.
That was really interesting.
And then to hear you knowsomeone like Bill Bennett who
has made a lot of headlines,that sort of pretty well known
to the American people, but talkabout some intimate moments on
Air Force One with PresidentBush and the discussions that
they had with the White Housechief of staff at the time was,
I think, a window into thepolicymaking in this area, which
(06:50):
I think is just as important,frankly, as sort of having a
good idea, because a good ideais only as good as if you can
actually get it through Congressand the president to implement
it.
So that was a really excitingpart of the journey of this book
was being able to sit down withthem.
It was quite an honor.
Talk to me about you know whatthis book is trying to advocate
(07:12):
for.
What is the call to action fromthis book?
Yeah, so this book is not meantto be a collection just of
statistics.
You can go to the CDC or atleast used to be able to go to
the CDC website for that or youknow, it's not just a collection
of facts that you can findonline.
It's really meant to first ofall humanize the issue.
I was able to interview andtalk with people you know who've
(07:32):
been greatly affected byaddiction, whether it's folks on
the border working on thisissue at our southern border,
whether it was people, parentswho have struggled with this
with their kids or themselves,whether it was, you know,
lawmakers who have been tryingto do the right thing.
So it was meant to also sort ofchronicle their stories and
make sure that they were heard.
(07:54):
But it was also really meant tobe a call to action, this idea
that you know it's not rocketscience to figure out how to
reduce drug use and itsconsequences.
We're sometimes so overwhelmedwith these crazy facts that are
coming out, which are true,about the level of record level
of fatal overdoses that we'reexperiencing both in the U?
S and Canada and beyond.
(08:14):
It can feel so overwhelming,it's so large, and part of what
this book tried to do was pointout the things that are working
and talk about how we could.
If we could only bring them toscale and implement them in a
widespread fashion, we couldactually make a difference.
Because, again, it's not rocketscience about what's what's
(08:36):
worked.
The greatest public healthvictory of our time is has been
the reduction of cigarettesmoking and the reduction of
tobacco-related illness anddeath that we've experienced
over the last 50 years.
That wasn't because some newpotion was created in a lab that
we finally created.
It wasn't the kind of thingwhere we had the vaccine for
(08:57):
polio.
It wasn't like that.
It was a combination of publicpolicies and public attitudes
that changed, and having thecourage to implement them on a
wide scale.
Having the courage to tell theairlines we're not going to
allow smoking sections inairlines anymore.
It doesn't matter if you thinkyou're going to lose business.
By the way they gave business.
They didn't lose business atthe time.
They thought they would loseGoing to the restaurants and
(09:18):
saying we're not going to havesmoking or non-smoking sections
anymore.
Schools we're going to teach,you know, drug-free education,
not how to smoke safely or whereto smoke you know, as long as
it's not around other people,that's okay, or whatever it was
done, we did so in a reallycomprehensive way with our
public policy, where weessentially said we're not going
to tolerate smoking anymore,but if you have a smoking
(09:39):
problem, we're going to get youhelp and we're going to look at
it with compassion.
But we're also not going to letthe tobacco industry get away
with lies and to see just tomake a buck.
We can actually learn from thatexample, and so I know not in
the most comprehensive way MaybeI would have wanted to, but I I
go into a little bit at least Idon't think I gave it full,
really what it deserves.
(10:00):
But I go into a little bitabout what we can learn from the
fact that we've had such amassive reduction in cigarette
use and tobacco-related illness,how that can inform these other
addictive drugs that we'redealing with, because at the end
of the day, our brains don'tknow whether a drug is illegal
or legal.
It just knows that if it likesit or not.
And tobacco is almost just aslikable as heroin and fentanyl.
(10:21):
So we can learn a lot from that.
And there are other things wecan learn from.
We can learn from othercountries as well.
There's a lot of misinformationaround Portugal, for example.
Portugal has always been set upas the poster child for sort of
lax drug policy or druglegalization.
And what I did in this bookactually going to Lisbon and
talking with the Portuguese drugczar one of the first things
(10:42):
he's told me is you know, kevin,please tell people.
We have not legalized drugs.
We are not a haven for drug use.
We don't tolerate drug use.
What we tolerate are people whouse drugs because we try and
get them help and we have anaccountability system to get
them that help.
It's not perfect.
They're the first to admit thatit's been a mixed, they've had
mixed results.
It hasn't been this, you know,perfect utopia Sometimes I think
(11:05):
it's been written about, butit's the principles of
accountability and compassionthat actually seem to be, you
know, seem to work, and, bycontrast, you go to a place like
British Columbia where they'renow just beginning to learn that
you know, 25 years of simplysaying we want to make drug use
safer is not going to actuallyfulfill its objective and it's
(11:27):
not going to save lives.
So the book tried to look at,sort of look at those places
beyond our borders to try andinform what we can do here.
So doing this work was notsomething that I, you know,
envisioned.
When I was 14 years old and Istarted volunteering for an
anti-drug coalition, which isactually how I started in this
field, I had aspirations likeany kid to be a professional
(11:49):
sports player or to be able.
I really wanted to be a lawyer,a judge.
I had sort of seen that Issuesof human rights really touched
on me because of religiouspersecution in my parents'
native country.
And so if you were to tell me,you know, 30 years later, you
know, that 15-year-old that Iwould be, you know, writing and
(12:10):
making a living out of doingdrug policy, I wouldn't really
be able to grasp or understandthat.
But I was really lucky to meetmentors at a very young age that
guided me and I somehow figuredout, you know, I guess in my
early 20s that you know, maybe Ican actually make a living
doing something I love which isto think and talk and implement
(12:31):
around this issue of drug policyand addiction.
And so, you know, I rememberpassing out, you know, the NIDA
brain cards on ecstasy when Iwas a college sophomore at
Berkeley, and passing out thesebrain cards and showed what your
brain actually looked like ondrugs.
And that was something that Iwanted, that I wanted to do.
I mean, it was something on aFriday and Saturday night that I
(12:53):
felt was just in some ways mycalling.
But I didn't quite understandthat even then, that it would be
sort of something that I'd bedoing every day, would be sort
of something that I'd be doingevery day.
So I feel incredibly lucky tobe, I feel like one of the few
people to be doing somethingthat I love and I can, you know,
make a living out of doing that.
But when it comes to your sounddrug policy, what do you see a
(13:17):
measurable difference or anydifference between when you
first started and now?
Has the fight become more orless different?
I think this issue has become alot more complex.
It's actually become,unfortunately, a lot more
confused as well.
You know, you see people againdesperate for answers and I can
understand that desperation whenthey're seeing that we were
(13:41):
supposed to eliminate drug useby 1995, according to
congressional and UN mandates.
Clearly that hasn't happenedand in many indications it's
gotten worse.
So I can understand why peoplewould be desperate for answers.
That desperation sometimes hasturned into opportunity for
people who want to profit off ofaddiction to say that nothing
will work and therefore we needto teach kids how to use drugs
(14:03):
safely.
To, you know, use cocaine andmethamphetamine safely.
We need to, you know, be just.
You know, if a drug user wantsto use and they're using, we
should be okay with that.
Only when they say they'reusing, we should be OK with that
.
Only when they say they'reready is maybe we would offer
treatment.
Then these are becoming moremainstream quote unquote
solutions.
And you know, in that way thisissue has become a lot more
(14:25):
difficult because, you know,there are there are I've met and
I've met several parents whohave lost kids to drugs that
genuinely feel we shouldlegalize drugs because if we had
done that, there would havebeen a purity and maybe a
warning label the governmentwould have mandated and then
their kid wouldn't have used.
(14:48):
You know, I don't think we canever underestimate addiction for
profit in our country, whetherit's with regards to sugary
sodas or cigarettes or, one day,heroin or cocaine, currently,
marijuana.
I think that the forces outthere of, you know, sort of
(15:09):
greed are so strong that theirability to manipulate has been
shown time and time again and Ithink in some ways this book is
a real warning about that.
What are some of the biggestmisconceptions?
(15:29):
Misconceptions See you up here.
Yeah, we're going to do this.
I've been up, thank you, it'shot, I know it's hot, I know
it's very hot.
It's 83.
Okay, what are some of thebiggest misconceptions of
legalizing?
The lesson of the sequel,technically, you mentioned about
(15:51):
the moms.
Yeah, I think that we look andsee all the violence that's
happening in our southern borderand the violence of the
international drug cartels andwhat you know, the Chinese
governments in India and others,how they're manipulating, you
know, foreign trade and howthey're manipulating financial
currency, monetary markets inorder to cyber issues, in order
(16:11):
to, you know, traffic drugsmarkets in order to cyber issues
, in order to traffic drugs.
And I think it's easy to thinkthat if we just legalized drugs
we'd have no cartels, we'd haveno underground market.
You look at alcohol.
We have a very limitedunderground market for alcohol,
so why couldn't drugs follow thesame suit?
I think the reality is that thatthinking and understanding
doesn't really grasp the depthof the reach of these current
(16:35):
criminal organizations.
It goes way beyond legal drugs.
Sure, if you were able to trulytake fentanyl away, would it
cripple them?
Yeah, would it destroy them?
I don't think so and I thinkthey would be easily able to
adapt.
To adapt Because, if you looknow, one of the top sources of
income for Colombian drugcartels isn't cocaine, which is,
(16:56):
you know, grown, you know, bythe, you know like, like weed in
Colombia, but it's actuallylogging and mining which are
legal.
If you look at the undergroundcigarette market in high taxed
countries, where they really taxcigarettes as a best practice
to reduce cigarette use.
There are's a multi-billiondollar underground market.
If you look at again where thesecriminal organizations are,
(17:18):
they're in the business of humantrafficking.
They're in the business ofmoney laundering.
They're in the business of allkinds of businesses.
Drugs are one of them, true,but they're not going to be
going away and the only waywe're going to be able to
actually get rid of them is afundamental change, especially
in countries whose institutionsbasically have completely failed
(17:40):
and where we essentially havefailed narco states.
I think we have more failednarco states than we actually
acknowledge and we don'tacknowledge them for political
purposes.
But the reality is, if you lookat some of these countries,
they are hanging on a thread andbasically surviving with the
full consent of theseunderground actors and the
(18:01):
government working together, andthat's not a conspiracy theory.
I'm not a conspiracy theoristat all, but when you look at
what's happening in a lot ofthese countries, that some of
these drugs are being grown andtransited through, it's a
complete breakdown of theinstitutions in those countries.
I think the discourse andtherefore the ability to come to
some real solutions have beencompletely crippled in our field
(18:24):
because we've gotten caught upin some of these false
dichotomies that really preventus from thinking creatively
about how to actually make goodchange on the issue.
For example, treatment versusharm reduction.
We're sort of presented withthis idea that you either have
to make drug use safer andtolerate it, or you have to
treat it.
And then the reality is, wewant to see harm reduction and
(18:47):
we're you know, I think that youknow, I would say that harm
reduction can be an extremelyuseful tool, but it's a useful
tool as an outreach tool whoseultimate goal has to be recovery
, and so, if you think about itthat way, it actually goes hand
in hand with drug treatment,because drug treatment is
supposed to be leading torecovery as well.
So, you know, I see these twothings as able to work together,
(19:08):
and I think sometimes, you know, people with not the best
motives have really pitted themagainst each other to try and
have one try and sound sort ofhumane and evidence-based in
this case harm reduction and theother sound, you know, inhumane
and and you know not somethingthat we've not not compassionate
, when in reality there'snothing more compassionate than
(19:28):
recovery.
So to me that doesn't makesense.
There's a false dichotomybetween criminalization and
legalization.
People say we're either goingto criminalize people with drug
use, who use drugs and theyshould be put in prison, or we
should be legalizing it, and thereality is we don't want to do
either of those things.
Now, often when you're using,you might commit a crime.
(19:50):
That's a separate issue.
So that's another falsedichotomy I think we've been
caught up in the other falsedichotomy a lot is is addiction
or drug use a moral issue or isit a medical issue?
And in reality it's a little bitof each, frankly.
I mean we can't say that alldrug use and addiction is devoid
entirely of a moral choice andof morality.
(20:11):
Entirely of a moral choice andof morality, I mean there is
morality that comes into it.
At the same time, it's clearlyalso a medical issue, but it's
not a medical addiction in myview, in the same way as maybe
other medical conditions,because of one reason, and that
(20:32):
reason is accountability goes along way in reversing this
disease.
That is not the same with,let's say, another brain disease
like Alzheimer's, where if youwere to tell an Alzheimer's
patient, you know, if you don'tremember my name tomorrow, you
know I'm not going to dosomething that you like.
(20:52):
Or if you do remember my nametomorrow, I'm going to give you
a $50 gift card.
Alzheimer's is not going torespond to that.
People with Alzheimer's Whereaspeople with addictions we have
seen through evidence withregards to methamphetamine users
, even with evidence withregards to heroin users, that
accountability is actually ahuge part of so many people
(21:13):
overcoming their addiction.
You know, one of the interviewsI was able to do was with the
former drug czar under thesecond half of the Obama
administration, michaelBotticelli.
Michael Botticelli was thefirst drug czar in recovery.
He was the first one toemphasize you know version of
harm reduction in recovery.
He was certainly not seen as aneoconservative on drug issues
very far apart maybe fromsomeone like Bill Bennett but at
(21:35):
the end of the day he's beenvery open in public to say that
the reason he's in recoverytoday is because of the time he
was arrested for drunk driving.
The handcuffs that went on himfor drunk driving was the reason
, was sort of the kick in thebutt that he needed to actually
realize that his life was not asput together as he was telling
himself it was.
Now, this isn't to say that wewant people to get arrested so
(21:57):
that they finally realize theyhave a problem.
We definitely don't want thatto happen, we want that to be
the last resort.
But what it teaches us is thatwhen there is some kind of
accountability often by anexternal actor, maybe an
employer, if it's not long-term,maybe a parent, maybe a best
friend or a sibling when thathappens more often than not,
that can be a positive.
(22:18):
It can be turning to somethingvery positive to allow that
person to change.
Obviously, what we don't wantis to handcuff people who are
using drugs and then throw themin prison for long sentences and
just sort of imagine thatthey're going to somehow get
miraculously better.
That's not what we're talkingabout.
But if we can think about theaccountability mechanism and
(22:39):
what that means from a policypoint of view, we can go a long
way.
And so when I was able to talkto Judge Steve Allman in Hawaii
about his probation program thathas reduced methamphetamine use
by prisoners by more than 70%people that were totally
non-responsive to treatment,non-responsive to any outreach
efforts, but actually had acredible threat hanging over
their head nine times out of 10,that thread never had to be
(23:01):
carried out, which obviously isthe best kind of thread, one
that you never have to carry out.
And so if we can learn fromthese kinds of principles and
implement them in a, you know,on a wide scale.
We can, you know, make hugeinroads on this issue.
So I think we can neverunderestimate the power of, you
know, people who want to makemoney off of addiction with, you
(23:24):
know, inventing some new reasonabout why they should.
I mean, you know, 20 years agoit was medical marijuana, now
it's medical psychedelics.
We've heard about medicalheroin.
You know, there's never goingto be, or at least I think no
time soon is there going to bean end to those that want to
exploit those with addiction forpersonal gain.
I mean, this started from ourcountry's founding.
(23:46):
This started with alcohol, itstarted with tobacco, it's now
happening with marijuana, it'shappening with psychedelics, on
and on.
And what's the future in this?
I think we have to embrace bothsort of modern technology and
there are modern medicationsthat are absolutely in line with
a recovery-oriented approach tothis issue but also remember
(24:06):
that sort of the biggest modernmiracle is something that was
pioneered 80 years ago andthat's the 12 steps, that's the
recovery programs that we havemillions, tens of millions of
people who have considered thisthe thing that saved their life,
and I don't know of anymedication in our field.
That's done.
That that doesn't mean thereisn't room for medication,
because we're only now adoptingthem.
There's still stigma aroundmedication.
(24:27):
There's still stigma aroundpeople getting help and talking
about this issue, just likethere is with mental illness.
So we have to mature, you know,in our understanding of this as,
again, not another falsedichotomy of medication versus
not medication, or treatmentversus harm reduction, or
criminalization versuslegalization.
We need to throw thosedichotomies out, moving forward
(24:49):
and understand that it trulywill take a comprehensive
approach, with prevention, Ithink, at the cornerstone,
because if we can preventsomebody from using drugs by age
21, they are unlikely ever touse drugs and ever to be
addicted.
That's a remarkable statisticthat I don't think a lot of
people really grasp andunderstand.
So if that is a guidingprinciple, if we can get
(25:10):
treatment to everyone who wantsit, and if we can convince 50%
of people who don't want it thatthey should get treatment, the
difference that we will make istremendous.
I want to especially thankeverybody who reviewed early
drafts of the book, includingLuke Niferatos, charles Lehman,
(25:32):
john Coleman, bertha Madras, bobDuPont.
I want to thank people whohelped me think through some of
these concepts Keith Humphreys,sally Sattel and many more that
I know I'm forgetting.
Yes or no?
Do you believe nicotine is notaddictive?
I believe nicotine is notaddictive.
Yes, congressman, cigarettesand nicotine clearly do not meet
the classic definitions ofaddiction.
I don't believe that nicotinefor our products are addictive.
I believe nicotine is notaddictive.
So if you think about where weare in North America when it
(00:21):
comes to drug overdoses, we'reexperiencing the worst drug
problem in our history.
We have over 100,000 people ayear dying comes to drug
overdoses.
We're experiencing the worstdrug problem in our history.
We have over 100,000 people ayear dying from fatal drug
overdoses.
But that's not the end of thestory.
For every one person that dies,there are five to six people
that have a non-fatal overdose,that might be suffering from
disability as a result of thatoverdose, and every time that
(00:42):
happens, families, individuals,communities, children are all
affected by it.
So it goes way beyond thenumbers of just deadly drug
overdoses.
This is a bigger problem thanwe can imagine and you know I
was personally a bit distraughtwith some of the solutions that
I put forward about how to fixwhat's happening.
(01:02):
A lot of these solutions are oldsolutions that have actually
been tried before, and that'spart of the reason I wanted to
write the book to talk aboutwhat hasn't worked, but also
talk about those beacons oflight around the world and
throughout America that actuallydo work if we take them to
scale, and so talk to us aboutsome of those amazing solutions
that you found in the course ofyour work that maybe you want to
highlight.
Yeah, I mean, I was able totravel to so many different
(01:24):
parts of the country and againaround the world, whether it was
Portugal or what was happeningin Canada.
But you know, right here in theUnited States, we have
prevention strategies that areactually reducing regular drug
use by over two thirds becauseof a comprehensive approach that
they're taking.
We have strategies in thecriminal justice system that are
working, because 70 percent ofthose in the criminal justice
(01:45):
system today have a drug problem.
It's not that they're therebecause of a drug crime, but
it's, you know, their drugaddiction or drug use is fueling
crimes, and so, while they'rein criminal justice custody,
this is a great opportunity foractually us to intervene as a
society to help them, help ourcommunities, and so, for example
, in Hawaii, project Hope, whichwas pioneered by a judge, steve
(02:07):
Alm, uses testing and sanctions, but not severe sanctions, just
swift and certain sanctions tochange behavior.
This has been done in SouthDakota, where they had a huge
alcohol problem.
It's been adapted there totheir 24-7 program.
That program has been adaptedeven in London, england, where
they're using a lot of thoseprinciples to reduce addiction
(02:30):
and reduce the consequences.
So there is a lot that'sworking out there.
It's just really up to us towant to implement them at a wide
scale.
So why do you think now is thecritical moment for this book to
come out and provide this pathforward?
Well, I think we're seeingpeople sometimes out of you know
, real desperation.
Look, search for quick answers,and those quick answers are
(02:50):
usually not solutions to thisproblem.
So you look at a place likeOregon.
Oregon was targeted by the druglegalization movement as a
place to kind of experiment withthe policies that they've been
pushing for many years, and theyput a ballot initiative down in
2020 that they sold astreatment over incarceration,
and you know who would voteagainst that.
(03:10):
We all want people to be, youknow, get treatment that they
need if they're addicted, and sothat initiative passed.
But the fine print wasimportant to read because there
actually wasn't any treatmentgiven.
There was barely any treatmentgiven.
It was really up to theindividual to say, okay, I'm
ready to look for treatment.
And that's one of the big mythsthat this book is trying to
sort of bust through is that youalways have to be sort of ready
(03:33):
for treatment or you alwayshave to want treatment in order
to get it.
We actually know that there areways to persuade people who
don't want it to actually go getit and they will get help.
And in Oregon, what happened wasthey voted for this initiative
and, you know, drug use andaddiction skyrocketed, crime
went up, neighborhood disorder,and it actually in a matter of
two to three short years, itturned that entire state against
(03:55):
what they had just voted for.
And they actually went aheadand repealed that law in Oregon,
which was.
You know, if you would havetold people that a year before,
they would have said you'recrazy.
This is now the law of the land.
But they repealed that lawbecause it was driving overdoses
up, it was driving crime up, itwas one of the main drivers for
public disorder.
(04:16):
And again, it was centeredaround this idea that if we just
let you know, people that areaddicted to drugs decide when
they want to finish using willbe OK.
The reality is.
You know, drugs are verypleasurable.
They latch onto pleasurecenters in the brain and it's
kind of not.
If you think about that,actually it's not so strange
(04:37):
that people won't want to stop.
It feels good.
Why would you?
And so we have to think aboutas a society how do we get
people that actually feel likethey're doing great when their
life is crumbling around them?
How do we get them to realizethat they do need to get that
help?
So the book goes through how wecan do that and the policies
that surround that.
Something pretty special aboutthe book is that you interviewed
every living US drug czar.
(04:58):
Can you talk more about that?
I was lucky enough in this bookto interview almost all of the
living former drug czars, thedirectors of national drug
control policy, and you know Iserved for three of them in the
Clinton, bush and Obamaadministration, but I hadn't
talked to some of them in awhile, so it was really nice to
catch up.
Jerry Jaffe was really thefirst White House drug czar, a
(05:21):
pretty much moderate to liberalDemocrat who was actually
appointed by Richard Nixon tobecome drug czar and pioneered
methadone methadone maintenancefor heroin users.
At the time in the 70s, the USwas going through an
unprecedented heroin epidemicwhich, you know, by the way,
looks like tiny against what'swhat we're currently going
through with fentanyl, but atthe time it was obviously a very
(05:41):
big deal and was causing a lotof crime in Washington and
beyond.
But at the time it wasobviously a very big deal, it
was causing a lot of crime inWashington and beyond, and you
know, talking to him about howto talk about this to both
Republican and Democraticlawmakers and how to make sense
of it and how to push evidencebased policy, was really eye
opening.
I was also able to talk toPeter Bourne who recently passed
(06:04):
away, but while I was writingthe book was still very cogent
and we had a couple of greatconversations who was Jimmy
Carter's drug czar, who actuallyresigned in disgrace, but was
actually a very intelligent manwho even himself sort of noted
that the current drive forlegalizing drugs was was, you
know, too overboard even for histaste.
And he was a guy whoessentially advocated for
cocaine legalization when he wasin office and just before he
(06:27):
took office for President Carter.
He was a good friend ofPresident Carter's and so that
was.
That was really interesting.
And then to hear you knowsomeone like Bill Bennett who
has made a lot of headlines,that sort of pretty well known
to the American people, but talkabout some intimate moments on
Air Force One with PresidentBush and the discussions that
they had with the White Housechief of staff at the time was,
I think, a window into thepolicymaking in this area, which
(06:50):
I think is just as important,frankly, as sort of having a
good idea, because a good ideais only as good as if you can
actually get it through Congressand the president to implement
it.
So that was a really excitingpart of the journey of this book
was being able to sit down withthem.
It was quite an honor.
Talk to me about you know whatthis book is trying to advocate
(07:12):
for.
What is the call to action fromthis book?
Yeah, so this book is not meantto be a collection just of
statistics.
You can go to the CDC or atleast used to be able to go to
the CDC website for that or youknow, it's not just a collection
of facts that you can findonline.
It's really meant to first ofall humanize the issue.
I was able to interview andtalk with people you know who've
(07:32):
been greatly affected byaddiction, whether it's folks on
the border working on thisissue at our southern border,
whether it was people, parentswho have struggled with this
with their kids or themselves,whether it was, you know,
lawmakers who have been tryingto do the right thing.
So it was meant to also sort ofchronicle their stories and
make sure that they were heard.
(07:54):
But it was also really meant tobe a call to action, this idea
that you know it's not rocketscience to figure out how to
reduce drug use and itsconsequences.
We're sometimes so overwhelmedwith these crazy facts that are
coming out, which are true,about the level of record level
of fatal overdoses that we'reexperiencing both in the U?
S and Canada and beyond.
(08:14):
It can feel so overwhelming,it's so large, and part of what
this book tried to do was pointout the things that are working
and talk about how we could.
If we could only bring them toscale and implement them in a
widespread fashion, we couldactually make a difference.
Because, again, it's not rocketscience about what's what's
(08:36):
worked.
The greatest public healthvictory of our time is has been
the reduction of cigarettesmoking and the reduction of
tobacco-related illness anddeath that we've experienced
over the last 50 years.
That wasn't because some newpotion was created in a lab that
we finally created.
It wasn't the kind of thingwhere we had the vaccine for
(08:57):
polio.
It wasn't like that.
It was a combination of publicpolicies and public attitudes
that changed, and having thecourage to implement them on a
wide scale.
Having the courage to tell theairlines we're not going to
allow smoking sections inairlines anymore.
It doesn't matter if you thinkyou're going to lose business.
By the way they gave business.
They didn't lose business atthe time.
They thought they would loseGoing to the restaurants and
(09:18):
saying we're not going to havesmoking or non-smoking sections
anymore.
Schools we're going to teach,you know, drug-free education,
not how to smoke safely or whereto smoke you know, as long as
it's not around other people,that's okay, or whatever it was
done, we did so in a reallycomprehensive way with our
public policy, where weessentially said we're not going
to tolerate smoking anymore,but if you have a smoking
(09:39):
problem, we're going to get youhelp and we're going to look at
it with compassion.
But we're also not going to letthe tobacco industry get away
with lies and to see just tomake a buck.
We can actually learn from thatexample, and so I know not in
the most comprehensive way MaybeI would have wanted to, but I I
go into a little bit at least Idon't think I gave it full,
really what it deserves.
(10:00):
But I go into a little bitabout what we can learn from the
fact that we've had such amassive reduction in cigarette
use and tobacco-related illness,how that can inform these other
addictive drugs that we'redealing with, because at the end
of the day, our brains don'tknow whether a drug is illegal
or legal.
It just knows that if it likesit or not.
And tobacco is almost just aslikable as heroin and fentanyl.
(10:21):
So we can learn a lot from that.
And there are other things wecan learn from.
We can learn from othercountries as well.
There's a lot of misinformationaround Portugal, for example.
Portugal has always been set upas the poster child for sort of
lax drug policy or druglegalization.
And what I did in this bookactually going to Lisbon and
talking with the Portuguese drugczar one of the first things
(10:42):
he's told me is you know, kevin,please tell people.
We have not legalized drugs.
We are not a haven for drug use.
We don't tolerate drug use.
What we tolerate are people whouse drugs because we try and
get them help and we have anaccountability system to get
them that help.
It's not perfect.
They're the first to admit thatit's been a mixed, they've had
mixed results.
It hasn't been this, you know,perfect utopia Sometimes I think
(11:05):
it's been written about, butit's the principles of
accountability and compassionthat actually seem to be, you
know, seem to work, and, bycontrast, you go to a place like
British Columbia where they'renow just beginning to learn that
you know, 25 years of simplysaying we want to make drug use
safer is not going to actuallyfulfill its objective and it's
(11:27):
not going to save lives.
So the book tried to look at,sort of look at those places
beyond our borders to try andinform what we can do here.
So doing this work was notsomething that I, you know,
envisioned.
When I was 14 years old and Istarted volunteering for an
anti-drug coalition, which isactually how I started in this
field, I had aspirations likeany kid to be a professional
(11:49):
sports player or to be able.
I really wanted to be a lawyer,a judge.
I had sort of seen that Issuesof human rights really touched
on me because of religiouspersecution in my parents'
native country.
And so if you were to tell me,you know, 30 years later, you
know, that 15-year-old that Iwould be, you know, writing and
(12:10):
making a living out of doingdrug policy, I wouldn't really
be able to grasp or understandthat.
But I was really lucky to meetmentors at a very young age that
guided me and I somehow figuredout, you know, I guess in my
early 20s that you know, maybe Ican actually make a living
doing something I love which isto think and talk and implement
(12:31):
around this issue of drug policyand addiction.
And so, you know, I rememberpassing out, you know, the NIDA
brain cards on ecstasy when Iwas a college sophomore at
Berkeley, and passing out thesebrain cards and showed what your
brain actually looked like ondrugs.
And that was something that Iwanted, that I wanted to do.
I mean, it was something on aFriday and Saturday night that I
(12:53):
felt was just in some ways mycalling.
But I didn't quite understandthat even then, that it would be
sort of something that I'd bedoing every day, would be sort
of something that I'd be doingevery day.
So I feel incredibly lucky tobe, I feel like one of the few
people to be doing somethingthat I love and I can, you know,
make a living out of doing that.
But when it comes to your sounddrug policy, what do you see a
(13:17):
measurable difference or anydifference between when you
first started and now?
Has the fight become more orless different?
I think this issue has become alot more complex.
It's actually become,unfortunately, a lot more
confused as well.
You know, you see people againdesperate for answers and I can
understand that desperation whenthey're seeing that we were
(13:41):
supposed to eliminate drug useby 1995, according to
congressional and UN mandates.
Clearly that hasn't happenedand in many indications it's
gotten worse.
So I can understand why peoplewould be desperate for answers.
That desperation sometimes hasturned into opportunity for
people who want to profit off ofaddiction to say that nothing
will work and therefore we needto teach kids how to use drugs
(14:03):
safely.
To, you know, use cocaine andmethamphetamine safely.
We need to, you know, be just.
You know, if a drug user wantsto use and they're using, we
should be okay with that.
Only when they say they'reusing, we should be OK with that
.
Only when they say they'reready is maybe we would offer
treatment.
Then these are becoming moremainstream quote unquote
solutions.
And you know, in that way thisissue has become a lot more
(14:25):
difficult because, you know,there are there are I've met and
I've met several parents whohave lost kids to drugs that
genuinely feel we shouldlegalize drugs because if we had
done that, there would havebeen a purity and maybe a
warning label the governmentwould have mandated and then
their kid wouldn't have used.
(14:48):
You know, I don't think we canever underestimate addiction for
profit in our country, whetherit's with regards to sugary
sodas or cigarettes or, one day,heroin or cocaine, currently,
marijuana.
I think that the forces outthere of, you know, sort of
(15:09):
greed are so strong that theirability to manipulate has been
shown time and time again and Ithink in some ways this book is
a real warning about that.
What are some of the biggestmisconceptions?
(15:29):
Misconceptions See you up here.
Yeah, we're going to do this.
I've been up, thank you, it'shot, I know it's hot, I know
it's very hot.
It's 83.
Okay, what are some of thebiggest misconceptions of
legalizing?
The lesson of the sequel,technically, you mentioned about
(15:51):
the moms.
Yeah, I think that we look andsee all the violence that's
happening in our southern borderand the violence of the
international drug cartels andwhat you know, the Chinese
governments in India and others,how they're manipulating, you
know, foreign trade and howthey're manipulating financial
currency, monetary markets inorder to cyber issues, in order
(16:11):
to, you know, traffic drugsmarkets in order to cyber issues
, in order to traffic drugs.
And I think it's easy to thinkthat if we just legalized drugs
we'd have no cartels, we'd haveno underground market.
You look at alcohol.
We have a very limitedunderground market for alcohol,
so why couldn't drugs follow thesame suit?
I think the reality is that thatthinking and understanding
doesn't really grasp the depthof the reach of these current
(16:35):
criminal organizations.
It goes way beyond legal drugs.
Sure, if you were able to trulytake fentanyl away, would it
cripple them?
Yeah, would it destroy them?
I don't think so and I thinkthey would be easily able to
adapt.
To adapt Because, if you looknow, one of the top sources of
income for Colombian drugcartels isn't cocaine, which is,
(16:56):
you know, grown, you know, bythe, you know like, like weed in
Colombia, but it's actuallylogging and mining which are
legal.
If you look at the undergroundcigarette market in high taxed
countries, where they really taxcigarettes as a best practice
to reduce cigarette use.
There are's a multi-billiondollar underground market.
If you look at again where thesecriminal organizations are,
(17:18):
they're in the business of humantrafficking.
They're in the business ofmoney laundering.
They're in the business of allkinds of businesses.
Drugs are one of them, true,but they're not going to be
going away and the only waywe're going to be able to
actually get rid of them is afundamental change, especially
in countries whose institutionsbasically have completely failed
(17:40):
and where we essentially havefailed narco states.
I think we have more failednarco states than we actually
acknowledge and we don'tacknowledge them for political
purposes.
But the reality is, if you lookat some of these countries,
they are hanging on a thread andbasically surviving with the
full consent of theseunderground actors and the
(18:01):
government working together, andthat's not a conspiracy theory.
I'm not a conspiracy theoristat all, but when you look at
what's happening in a lot ofthese countries, that some of
these drugs are being grown andtransited through, it's a
complete breakdown of theinstitutions in those countries.
I think the discourse andtherefore the ability to come to
some real solutions have beencompletely crippled in our field
(18:24):
because we've gotten caught upin some of these false
dichotomies that really preventus from thinking creatively
about how to actually make goodchange on the issue.
For example, treatment versusharm reduction.
We're sort of presented withthis idea that you either have
to make drug use safer andtolerate it, or you have to
treat it.
And then the reality is, wewant to see harm reduction and
(18:47):
we're you know, I think that youknow, I would say that harm
reduction can be an extremelyuseful tool, but it's a useful
tool as an outreach tool whoseultimate goal has to be recovery
, and so, if you think about itthat way, it actually goes hand
in hand with drug treatment,because drug treatment is
supposed to be leading torecovery as well.
So, you know, I see these twothings as able to work together,
(19:08):
and I think sometimes, you know, people with not the best
motives have really pitted themagainst each other to try and
have one try and sound sort ofhumane and evidence-based in
this case harm reduction and theother sound, you know, inhumane
and and you know not somethingthat we've not not compassionate
, when in reality there'snothing more compassionate than
(19:28):
recovery.
So to me that doesn't makesense.
There's a false dichotomybetween criminalization and
legalization.
People say we're either goingto criminalize people with drug
use, who use drugs and theyshould be put in prison, or we
should be legalizing it, and thereality is we don't want to do
either of those things.
Now, often when you're using,you might commit a crime.
(19:50):
That's a separate issue.
So that's another falsedichotomy I think we've been
caught up in the other falsedichotomy a lot is is addiction
or drug use a moral issue or isit a medical issue?
And in reality it's a little bitof each, frankly.
I mean we can't say that alldrug use and addiction is devoid
entirely of a moral choice andof morality.
(20:11):
Entirely of a moral choice andof morality, I mean there is
morality that comes into it.
At the same time, it's clearlyalso a medical issue, but it's
not a medical addiction in myview, in the same way as maybe
other medical conditions,because of one reason, and that
(20:32):
reason is accountability goes along way in reversing this
disease.
That is not the same with,let's say, another brain disease
like Alzheimer's, where if youwere to tell an Alzheimer's
patient, you know, if you don'tremember my name tomorrow, you
know I'm not going to dosomething that you like.
(20:52):
Or if you do remember my nametomorrow, I'm going to give you
a $50 gift card.
Alzheimer's is not going torespond to that.
People with Alzheimer's Whereaspeople with addictions we have
seen through evidence withregards to methamphetamine users
, even with evidence withregards to heroin users, that
accountability is actually ahuge part of so many people
(21:13):
overcoming their addiction.
You know, one of the interviewsI was able to do was with the
former drug czar under thesecond half of the Obama
administration, michaelBotticelli.
Michael Botticelli was thefirst drug czar in recovery.
He was the first one toemphasize you know version of
harm reduction in recovery.
He was certainly not seen as aneoconservative on drug issues
very far apart maybe fromsomeone like Bill Bennett but at
(21:35):
the end of the day he's beenvery open in public to say that
the reason he's in recoverytoday is because of the time he
was arrested for drunk driving.
The handcuffs that went on himfor drunk driving was the reason
, was sort of the kick in thebutt that he needed to actually
realize that his life was not asput together as he was telling
himself it was.
Now, this isn't to say that wewant people to get arrested so
(21:57):
that they finally realize theyhave a problem.
We definitely don't want thatto happen, we want that to be
the last resort.
But what it teaches us is thatwhen there is some kind of
accountability often by anexternal actor, maybe an
employer, if it's not long-term,maybe a parent, maybe a best
friend or a sibling when thathappens more often than not,
that can be a positive.
(22:18):
It can be turning to somethingvery positive to allow that
person to change.
Obviously, what we don't wantis to handcuff people who are
using drugs and then throw themin prison for long sentences and
just sort of imagine thatthey're going to somehow get
miraculously better.
That's not what we're talkingabout.
But if we can think about theaccountability mechanism and
(22:39):
what that means from a policypoint of view, we can go a long
way.
And so when I was able to talkto Judge Steve Allman in Hawaii
about his probation program thathas reduced methamphetamine use
by prisoners by more than 70%people that were totally
non-responsive to treatment,non-responsive to any outreach
efforts, but actually had acredible threat hanging over
their head nine times out of 10,that thread never had to be
(23:01):
carried out, which obviously isthe best kind of thread, one
that you never have to carry out.
And so if we can learn fromthese kinds of principles and
implement them in a, you know,on a wide scale.
We can, you know, make hugeinroads on this issue.
So I think we can neverunderestimate the power of, you
know, people who want to makemoney off of addiction with, you
(23:24):
know, inventing some new reasonabout why they should.
I mean, you know, 20 years agoit was medical marijuana, now
it's medical psychedelics.
We've heard about medicalheroin.
You know, there's never goingto be, or at least I think no
time soon is there going to bean end to those that want to
exploit those with addiction forpersonal gain.
I mean, this started from ourcountry's founding.
(23:46):
This started with alcohol, itstarted with tobacco, it's now
happening with marijuana, it'shappening with psychedelics, on
and on.
And what's the future in this?
I think we have to embrace bothsort of modern technology and
there are modern medicationsthat are absolutely in line with
a recovery-oriented approach tothis issue but also remember
(24:06):
that sort of the biggest modernmiracle is something that was
pioneered 80 years ago andthat's the 12 steps, that's the
recovery programs that we havemillions, tens of millions of
people who have considered thisthe thing that saved their life,
and I don't know of anymedication in our field.
That's done.
That that doesn't mean thereisn't room for medication,
because we're only now adoptingthem.
There's still stigma aroundmedication.
(24:27):
There's still stigma aroundpeople getting help and talking
about this issue, just likethere is with mental illness.
So we have to mature, you know,in our understanding of this as,
again, not another falsedichotomy of medication versus
not medication, or treatmentversus harm reduction, or
criminalization versuslegalization.
We need to throw thosedichotomies out, moving forward
(24:49):
and understand that it trulywill take a comprehensive
approach, with prevention, Ithink, at the cornerstone,
because if we can preventsomebody from using drugs by age
21, they are unlikely ever touse drugs and ever to be
addicted.
That's a remarkable statisticthat I don't think a lot of
people really grasp andunderstand.
So if that is a guidingprinciple, if we can get
(25:10):
treatment to everyone who wantsit, and if we can convince 50%
of people who don't want it thatthey should get treatment, the
difference that we will make istremendous.
I want to especially thankeverybody who reviewed early
drafts of the book, includingLuke Niferatos, charles Lehman,
(25:32):
john Coleman, bertha Madras, bobDuPont.
I want to thank people whohelped me think through some of
these concepts Keith Humphreys,sally Sattel and many more that
I know I'm forgetting.
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