After months of meetings among law enforcement officials, public health officials, and treatment and prevention specialists, the state of Kentucky unveiled the outlines of its new drug strategy last week. While there is much talk of new efficiencies in treatment and prevention and rationalizing existing drug policy, there is little in the new Kentucky drug strategy that will bring cheer to drug reformers. Experts and activists who spoke with DRCNet about the new drug strategy suggested that it suffered from lack of inclusion, especially of the subjects of the policy -- drug users -- and from a lack of imagination.
In a 480-page report issued August 26, the Kentucky Drug Summit, as the process of creating a new drug strategy is known, called for a number of recommendations for immediate executive action, including:
Kentucky Gov. Ernie Fletcher has already begun moving on the Summit recommendations. At an August 26 press conference, Gov. Fletcher announced he was creating a new Office of Drug Control and named Sylvia Lovely, executive director of the Kentucky League of Cities, as temporary head of the office. Fletcher said he was appointing Lovely, who has no experience in drug policy, because the first task of the new Office of Drug Control is essentially bureaucratic reorganization.
"It's probably best at this point not to have somebody with an expertise, perhaps, in drug and substance abuse policy, which I'm not an expert in that area," Lovely said, "but really someone who can help coordinate substance abuse agencies and problems."
And Fletcher was right on-message from the get-go, getting the word "epidemic" out before the public from the beginning. "What has been done in this state to address this issue in the past has not produced the necessary results," Fletcher said. "It is not enough for us to be tough on the substance abuse problem. We must become effective. We have to realize that this is greater than a law enforcement problem," Fletcher said. "We're going to treat it like an epidemic with an effective method of enforcement, treatment and education. This is the beginning, I think, of one of the most progressive initiatives to fight drugs in the country," Fletcher said.
Some begged to differ. "In terms of structure and approach, this looks like the mirror image of what they are doing in Washington with the Office of National Drug Control Policy," said Thomas Nicholson, professor of public health at the University of Western Kentucky, who has published extensively on public health and drug policy. "They are just repeating the same old drug war mantra," he told DRCNet. "They talk about treatment, and they try to gloss it up and make it look like something new, but the drug war just keeps going."
They did things a bit differently in Vancouver, British Columbia, when that city crafted its drug strategy known as the Four Pillars -- prevention, treatment, law enforcement, and harm reduction -- in 2001. For starters, city officials there specifically included both drug user views and harm reduction practices in the mix from the beginning. "The Four Pillars plan is still unfolding," said Zarina Mulla, social planner for the city's Four Pillar's office. "Part of that is talking to the many diverse communities within the city, and drug users are very much a part of that dialog," she told DRCNet. "We have a very active drug users group, the Vancouver Area Network of Drug Users (http://www.vandu.org), as well as an aboriginal drug users' group, so yes, there has been quite a bit of involvement of drug users in this process," she explained. "We think it is crucial to include the voice of the drug user because they know from experience and they have things to say about which people in the policy field have very little understanding."
The police have come around on harm reduction programs, said Mulla. "We have a safe injection site operating here, and we could not do it without the cooperation of the police. And what is happening is that the police we work with see this is working, and now they are recommending a safe injection site to the people in Victoria [the provincial capital and second largest city] because it makes a lot of sense. It takes addicts off the street, provides them with clean equipment, puts users in touch with social services, reduces overdoses, and generally reduces harm."
So, how do drug users get involved in helping to set policy? "We pretty much forced our way in," laughed Anne Livingston, director of the Vancouver drug user group VANDU. "If we knew there was a meeting going on, we showed up. If there was a neighborhood consultation, we were there. At every opportunity, we would brief our people beforehand on what were the issues and who were the players, then we would go as a group," she told DRCNet. Now organized drug users are some of the most civically involved citizens in Vancouver, said Livingston. "We would show up at meetings, and people would complain that we were there," she said. "Drug users are viewed as criminals and bums; they have terrible social status problems. But eventually those same people who complained came to admire us in a way because we were involved and because we were empowering people. There is a lot of cheap talk about empowerment, but this is the real thing."
"Drug users are seen as bad people," concurred Nicholson. "The state views them as the problem and doesn't want their input, and they don't want to talk about harm reduction. There are lots of things we can do to mitigate the harms of drug abuse and the harms of the drug war, but in the current political environment, both here in Kentucky and in Washington, DC, they don't want to hear it," he said. "For people who are really dependent on drugs, it's a chronic, relapsing disorder, like diabetes," said Nicholson. "It needs to be managed and dealt with, but they want a law enforcement approach. There is no real empathy for people with a substance abuse problem."
"To try to create a drug strategy without involving drug users will only make matters worse," said Livingston. "Part of the reason drug policy is such a mess now is because no one ever thought to talk to drug users. You wouldn't try to set policy on women's issues without inviting women to participate, and you wouldn't meet about black problems without having black people."
DRCNet made repeated attempts to speak with Summit staff assistant David Hobson or Public Information Officer Jamie Neal about including drug users or harm reduction concepts in the drug strategy, but neither responded.
The full 480-page report is available at http://www.kydrugsummit.ky.gov online.