The Drug Report
The Drug Report
SNEAK PEEK: Kevin Talks About His New Book Here First
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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Yes or no? Do you believe nicotine is not addictive? I believe nicotine is not addictive. Yes, congressman, cigarettes and nicotine clearly do not meet the classic definitions of addiction. I don't believe that nicotine for our products are addictive. I believe nicotine is not addictive.
Speaker 1:So if you think about where we are in North America when it comes to drug overdoses, we're experiencing the worst drug problem in our history. We have over 100,000 people a year dying comes to drug overdoses. We're experiencing the worst drug problem in our history. We have over 100,000 people a year dying from fatal drug overdoses. But that's not the end of the story. 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 that overdose, and every time that happens, families, individuals, communities, children are all affected by it. So it goes way beyond the numbers of just deadly drug overdoses. This is a bigger problem than we can imagine and you know I was personally a bit distraught with some of the solutions that I put forward about how to fix what's happening.
Speaker 1:A lot of these solutions are old solutions that have actually been tried before, and that's part of the reason I wanted to write the book to talk about what hasn't worked, but also talk about those beacons of light around the world and throughout America that actually do work if we take them to scale, and so talk to us about some of those amazing solutions that you found in the course of your work that maybe you want to highlight. Yeah, I mean, I was able to travel to so many different parts of the country and again around the world, whether it was Portugal or what was happening in Canada. But you know, right here in the United States, we have prevention strategies that are actually reducing regular drug use by over two thirds because of a comprehensive approach that they're taking. We have strategies in the criminal justice system that are working, because 70 percent of those in the criminal justice system today have a drug problem. It's not that they're there because of a drug crime, but it's, you know, their drug addiction or drug use is fueling crimes, and so, while they're in criminal justice custody, this is a great opportunity for actually us to intervene as a society to help them, help our communities, and so, for example, in Hawaii, project Hope, which was pioneered by a judge, steve Alm, uses testing and sanctions, but not severe sanctions, just swift and certain sanctions to change behavior. This has been done in South Dakota, where they had a huge alcohol problem. It's been adapted there to their 24-7 program. That program has been adapted even in London, england, where they're using a lot of those principles to reduce addiction and reduce the consequences. So there is a lot that's working out there. It's just really up to us to want to implement them at a wide scale.
Speaker 1:So why do you think now is the critical moment for this book to come out and provide this path forward? Well, I think we're seeing people sometimes out of you know, real desperation. Look, search for quick answers, and those quick answers are usually not solutions to this problem. So you look at a place like Oregon. Oregon was targeted by the drug legalization movement as a place to kind of experiment with the policies that they've been pushing for many years, and they put a ballot initiative down in 2020 that they sold as treatment over incarceration, and you know who would vote against that. We all want people to be, you know, get treatment that they need if they're addicted, and so that initiative passed. But the fine print was important to read because there actually wasn't any treatment given. There was barely any treatment given. It was really up to the individual to say, okay, I'm ready to look for treatment. And that's one of the big myths that this book is trying to sort of bust through is that you always have to be sort of ready for treatment or you always have to want treatment in order to get it. We actually know that there are ways to persuade people who don't want it to actually go get it and they will get help.
Speaker 1:And in Oregon, what happened was they voted for this initiative and, you know, drug use and addiction skyrocketed, crime went up, neighborhood disorder, and it actually in a matter of two to three short years, it turned that entire state against what they had just voted for. And they actually went ahead and repealed that law in Oregon, which was. You know, if you would have told people that a year before, they would have said you're crazy. This is now the law of the land. But they repealed that law because it was driving overdoses up, it was driving crime up, it was one of the main drivers for public disorder.
Speaker 1:And again, it was centered around this idea that if we just let you know, people that are addicted to drugs decide when they want to finish using will be OK. The reality is. You know, drugs are very pleasurable. They latch onto pleasure centers in the brain and it's kind of not. If you think about that, actually it's not so strange that people won't want to stop. It feels good. Why would you? And so we have to think about as a society how do we get people that actually feel like they're doing great when their life is crumbling around them? How do we get them to realize that they do need to get that help? So the book goes through how we can do that and the policies that surround that.
Speaker 1:Something pretty special about the book is that you interviewed every living US drug czar. Can you talk more about that? I was lucky enough in this book to interview almost all of the living former drug czars, the directors of national drug control policy, and you know I served for three of them in the Clinton, bush and Obama administration, but I hadn't talked to some of them in a while, so it was really nice to catch up. Jerry Jaffe was really the first White House drug czar, a pretty much moderate to liberal Democrat who was actually appointed by Richard Nixon to become drug czar and pioneered methadone methadone maintenance for heroin users.
Speaker 1:At the time in the 70s, the US was going through an unprecedented heroin epidemic which, you know, by the way, looks like tiny against what's what we're currently going through with fentanyl, but at the time it was obviously a very big deal and was causing a lot of crime in Washington and beyond. But at the time it was obviously a very big deal, it was causing a lot of crime in Washington and beyond, and you know, talking to him about how to talk about this to both Republican and Democratic lawmakers and how to make sense of it and how to push evidence based policy, was really eye opening. I was also able to talk to Peter Bourne who recently passed away, but while I was writing the book was still very cogent and we had a couple of great conversations who was Jimmy Carter's drug czar, who actually resigned in disgrace, but was actually a very intelligent man who even himself sort of noted that the current drive for legalizing drugs was was, you know, too overboard even for his taste. And he was a guy who essentially advocated for cocaine legalization when he was in office and just before he took office for President Carter. He was a good friend of President Carter's and so that was. That was really interesting. And then to hear you know someone like Bill Bennett who has made a lot of headlines, that sort of pretty well known to the American people, but talk about some intimate moments on Air Force One with President Bush and the discussions that they had with the White House chief of staff at the time was, I think, a window into the policymaking in this area, which I think is just as important, frankly, as sort of having a good idea, because a good idea is only as good as if you can actually get it through Congress and the president to implement it. So that was a really exciting part of the journey of this book was being able to sit down with them. It was quite an honor.
Speaker 1:Talk to me about you know what this book is trying to advocate for. What is the call to action from this book? Yeah, so this book is not meant to be a collection just of statistics. You can go to the CDC or at least used to be able to go to the CDC website for that or you know, it's not just a collection of facts that you can find online. It's really meant to first of all humanize the issue. I was able to interview and talk with people you know who've been greatly affected by addiction, whether it's folks on the border working on this issue at our southern border, whether it was people, parents who have struggled with this with their kids or themselves, whether it was, you know, lawmakers who have been trying to do the right thing. So it was meant to also sort of chronicle their stories and make sure that they were heard.
Speaker 1:But it was also really meant to be a call to action, this idea that you know it's not rocket science to figure out how to reduce drug use and its consequences. We're sometimes so overwhelmed with these crazy facts that are coming out, which are true, about the level of record level of fatal overdoses that we're experiencing both in the U? S and Canada and beyond. It can feel so overwhelming, it's so large, and part of what this book tried to do was point out the things that are working and talk about how we could. If we could only bring them to scale and implement them in a widespread fashion, we could actually make a difference. Because, again, it's not rocket science about what's what's worked.
Speaker 1:The greatest public health victory of our time is has been the reduction of cigarette smoking and the reduction of tobacco-related illness and death that we've experienced over the last 50 years. That wasn't because some new potion was created in a lab that we finally created. It wasn't the kind of thing where we had the vaccine for polio. It wasn't like that. It was a combination of public policies and public attitudes that changed, and having the courage to implement them on a wide scale. Having the courage to tell the airlines we're not going to allow smoking sections in airlines anymore. It doesn't matter if you think you're going to lose business. By the way they gave business. They didn't lose business at the time. They thought they would lose Going to the restaurants and saying we're not going to have smoking or non-smoking sections anymore.
Speaker 1:Schools we're going to teach, you know, drug-free education, not how to smoke safely or where to 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 really comprehensive way with our public policy, where we essentially said we're not going to tolerate smoking anymore, but if you have a smoking problem, we're going to get you help and we're going to look at it with compassion. But we're also not going to let the tobacco industry get away with lies and to see just to make a buck. We can actually learn from that example, and so I know not in the most comprehensive way Maybe I would have wanted to, but I I go into a little bit at least I don't think I gave it full, really what it deserves. But I go into a little bit about what we can learn from the fact that we've had such a massive reduction in cigarette use and tobacco-related illness, how that can inform these other addictive drugs that we're dealing with, because at the end of the day, our brains don't know whether a drug is illegal or legal. It just knows that if it likes it or not. And tobacco is almost just as likable as heroin and fentanyl. So we can learn a lot from that. And there are other things we can learn from. We can learn from other countries as well.
Speaker 1:There's a lot of misinformation around Portugal, for example. Portugal has always been set up as the poster child for sort of lax drug policy or drug legalization. And what I did in this book actually going to Lisbon and talking with the Portuguese drug czar one of the first things 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 who use drugs because we try and get them help and we have an accountability system to get them that help. It's not perfect. They're the first to admit that it's been a mixed, they've had mixed results. It hasn't been this, you know, perfect utopia Sometimes I think it's been written about, but it's the principles of accountability and compassion that actually seem to be, you know, seem to work, and, by contrast, you go to a place like British Columbia where they're now just beginning to learn that you know, 25 years of simply saying we want to make drug use safer is not going to actually fulfill its objective and it's not going to save lives. So the book tried to look at, sort of look at those places beyond our borders to try and inform what we can do here.
Speaker 1:So doing this work was not something that I, you know, envisioned. When I was 14 years old and I started volunteering for an anti-drug coalition, which is actually how I started in this field, I had aspirations like any kid to be a professional sports player or to be able. I really wanted to be a lawyer, a judge. I had sort of seen that Issues of human rights really touched on me because of religious persecution 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 I would be, you know, writing and making a living out of doing drug policy, I wouldn't really be able to grasp or understand that. But I was really lucky to meet mentors at a very young age that guided me and I somehow figured out, you know, I guess in my early 20s that you know, maybe I can actually make a living doing something I love which is to think and talk and implement around this issue of drug policy and addiction. And so, you know, I remember passing out, you know, the NIDA brain cards on ecstasy when I was a college sophomore at Berkeley, and passing out these brain cards and showed what your brain actually looked like on drugs. And that was something that I wanted, that I wanted to do. I mean, it was something on a Friday and Saturday night that I felt was just in some ways my calling. But I didn't quite understand that even then, that it would be sort of something that I'd be doing every day, would be sort of something that I'd be doing every day. So I feel incredibly lucky to be, I feel like one of the few people to be doing something that I love and I can, you know, make a living out of doing that.
Speaker 1:But when it comes to your sound drug policy, what do you see a measurable difference or any difference between when you first started and now? Has the fight become more or less different? I think this issue has become a lot more complex. It's actually become, unfortunately, a lot more confused as well. You know, you see people again desperate for answers and I can understand that desperation when they're seeing that we were supposed to eliminate drug use by 1995, according to congressional and UN mandates. Clearly that hasn't happened and in many indications it's gotten worse. So I can understand why people would be desperate for answers.
Speaker 1:That desperation sometimes has turned into opportunity for people who want to profit off of addiction to say that nothing will work and therefore we need to teach kids how to use drugs safely. To, you know, use cocaine and methamphetamine safely. We need to, you know, be just. You know, if a drug user wants to use and they're using, we should be okay with that. Only when they say they're using, we should be OK with that. Only when they say they're ready is maybe we would offer treatment. Then these are becoming more mainstream quote unquote solutions. And you know, in that way this issue has become a lot more difficult because, you know, there are there are I've met and I've met several parents who have lost kids to drugs that genuinely feel we should legalize drugs because if we had done that, there would have been a purity and maybe a warning label the government would have mandated and then their kid wouldn't have used. You know, I don't think we can ever underestimate addiction for profit in our country, whether it's with regards to sugary sodas or cigarettes or, one day, heroin or cocaine, currently, marijuana. I think that the forces out there of, you know, sort of greed are so strong that their ability to manipulate has been shown time and time again and I think in some ways this book is a real warning about that.
Speaker 1:What are some of the biggest misconceptions? Misconceptions See you up here. Yeah, we're going to do this. I've been up, thank you, it's hot, I know it's hot, I know it's very hot. It's 83.
Speaker 1:Okay, what are some of the biggest misconceptions of legalizing? The lesson of the sequel, technically, you mentioned about the moms. Yeah, I think that we look and see all the violence that's happening in our southern border and the violence of the international drug cartels and what you know, the Chinese governments in India and others, how they're manipulating, you know, foreign trade and how they're manipulating financial currency, monetary markets in order to cyber issues, in order to, you know, traffic drugs markets in order to cyber issues, in order to traffic drugs. And I think it's easy to think that if we just legalized drugs we'd have no cartels, we'd have no underground market. You look at alcohol. We have a very limited underground market for alcohol, so why couldn't drugs follow the same suit?
Speaker 1:I think the reality is that that thinking and understanding doesn't really grasp the depth of the reach of these current criminal organizations. It goes way beyond legal drugs. Sure, if you were able to truly take fentanyl away, would it cripple them? Yeah, would it destroy them? I don't think so and I think they would be easily able to adapt. To adapt Because, if you look now, one of the top sources of income for Colombian drug cartels isn't cocaine, which is, you know, grown, you know, by the, you know like, like weed in Colombia, but it's actually logging and mining which are legal. If you look at the underground cigarette market in high taxed countries, where they really tax cigarettes as a best practice to reduce cigarette use. There are's a multi-billion dollar underground market.
Speaker 1:If you look at again where these criminal organizations are, they're in the business of human trafficking. They're in the business of money laundering. They're in the business of all kinds of businesses. Drugs are one of them, true, but they're not going to be going away and the only way we're going to be able to actually get rid of them is a fundamental change, especially in countries whose institutions basically have completely failed and where we essentially have failed narco states. I think we have more failed narco states than we actually acknowledge and we don't acknowledge them for political purposes. But the reality is, if you look at some of these countries, they are hanging on a thread and basically surviving with the full consent of these underground actors and the government working together, and that's not a conspiracy theory. I'm not a conspiracy theorist at all, but when you look at what's happening in a lot of these countries, that some of these drugs are being grown and transited through, it's a complete breakdown of the institutions in those countries.
Speaker 1:I think the discourse and therefore the ability to come to some real solutions have been completely crippled in our field because we've gotten caught up in some of these false dichotomies that really prevent us from thinking creatively about how to actually make good change on the issue. For example, treatment versus harm reduction. We're sort of presented with this idea that you either have to make drug use safer and tolerate it, or you have to treat it. And then the reality is, we want to see harm reduction and we're you know, I think that you know, I would say that harm reduction can be an extremely useful tool, but it's a useful tool as an outreach tool whose ultimate goal has to be recovery, and so, if you think about it that way, it actually goes hand in hand with drug treatment, because drug treatment is supposed to be leading to recovery as well. So, you know, I see these two things as able to work together, and I think sometimes, you know, people with not the best motives have really pitted them against each other to try and have one try and sound sort of humane and evidence-based in this case harm reduction and the other sound, you know, inhumane and and you know not something that we've not not compassionate, when in reality there's nothing more compassionate than recovery. So to me that doesn't make sense.
Speaker 1:There's a false dichotomy between criminalization and legalization. People say we're either going to criminalize people with drug use, who use drugs and they should be put in prison, or we should be legalizing it, and the reality is we don't want to do either of those things. Now, often when you're using, you might commit a crime. That's a separate issue. So that's another false dichotomy I think we've been caught up in the other false dichotomy a lot is is addiction or drug use a moral issue or is it a medical issue?
Speaker 1:And in reality it's a little bit of each, frankly. I mean we can't say that all drug use and addiction is devoid entirely of a moral choice and of morality. Entirely of a moral choice and of morality, I mean there is morality that comes into it. At the same time, it's clearly also a medical issue, but it's not a medical addiction in my view, in the same way as maybe other medical conditions, because of one reason, and that reason is accountability goes a long way in reversing this disease. That is not the same with, let's say, another brain disease like Alzheimer's, where if you were to tell an Alzheimer's patient, you know, if you don't remember my name tomorrow, you know I'm not going to do something that you like. Or if you do remember my name tomorrow, I'm going to give you a $50 gift card. Alzheimer's is not going to respond to that. People with Alzheimer's Whereas people with addictions we have seen through evidence with regards to methamphetamine users, even with evidence with regards to heroin users, that accountability is actually a huge part of so many people overcoming their addiction.
Speaker 1:You know, one of the interviews I was able to do was with the former drug czar under the second half of the Obama administration, michael Botticelli. Michael Botticelli was the first drug czar in recovery. He was the first one to emphasize you know version of harm reduction in recovery. He was certainly not seen as a neoconservative on drug issues very far apart maybe from someone like Bill Bennett but at the end of the day he's been very open in public to say that the reason he's in recovery today is because of the time he was arrested for drunk driving. The handcuffs that went on him for drunk driving was the reason, was sort of the kick in the butt that he needed to actually realize that his life was not as put together as he was telling himself it was.
Speaker 1:Now, this isn't to say that we want people to get arrested so that they finally realize they have a problem. We definitely don't want that to happen, we want that to be the last resort. But what it teaches us is that when there is some kind of accountability often by an external actor, maybe an employer, if it's not long-term, maybe a parent, maybe a best friend or a sibling when that happens more often than not, that can be a positive. It can be turning to something very positive to allow that person to change. Obviously, what we don't want is to handcuff people who are using drugs and then throw them in prison for long sentences and just sort of imagine that they're going to somehow get miraculously better. That's not what we're talking about. But if we can think about the accountability mechanism and what that means from a policy point of view, we can go a long way. And so when I was able to talk to Judge Steve Allman in Hawaii about his probation program that has 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 a credible threat hanging over their head nine times out of 10, that thread never had to be carried out, which obviously is the best kind of thread, one that you never have to carry out. And so if we can learn from these kinds of principles and implement them in a, you know, on a wide scale. We can, you know, make huge inroads on this issue.
Speaker 1:So I think we can never underestimate the power of, you know, people who want to make money off of addiction with, you know, inventing some new reason about why they should. I mean, you know, 20 years ago it was medical marijuana, now it's medical psychedelics. We've heard about medical heroin. You know, there's never going to be, or at least I think no time soon is there going to be an end to those that want to exploit those with addiction for personal gain. I mean, this started from our country's founding. This started with alcohol, it started with tobacco, it's now happening with marijuana, it's happening with psychedelics, on and on. And what's the future in this?
Speaker 1:I think we have to embrace both sort of modern technology and there are modern medications that are absolutely in line with a recovery-oriented approach to this issue but also remember that sort of the biggest modern miracle is something that was pioneered 80 years ago and that's the 12 steps, that's the recovery programs that we have millions, tens of millions of people who have considered this the thing that saved their life, and I don't know of any medication in our field. That's done. That that doesn't mean there isn't room for medication, because we're only now adopting them. There's still stigma around medication. There's still stigma around people getting help and talking about this issue, just like there is with mental illness.
Speaker 1:So we have to mature, you know, in our understanding of this as, again, not another false dichotomy of medication versus not medication, or treatment versus harm reduction, or criminalization versus legalization. We need to throw those dichotomies out, moving forward and understand that it truly will take a comprehensive approach, with prevention, I think, at the cornerstone, because if we can prevent somebody from using drugs by age 21, they are unlikely ever to use drugs and ever to be addicted. That's a remarkable statistic that I don't think a lot of people really grasp and understand. So if that is a guiding principle, if we can get treatment to everyone who wants it, and if we can convince 50% of people who don't want it that they should get treatment, the difference that we will make is tremendous. I want to especially thank everybody who reviewed early drafts of the book, including Luke Niferatos, charles Lehman, john Coleman, bertha Madras, bob DuPont. I want to thank people who helped me think through some of these concepts Keith Humphreys, sally Sattel and many more that I know I'm forgetting.