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A drug czar who knows addiction firsthand

    Michael Botticelli, deputy director, Office of National Drug Control Policy, listens while testifying on Capitol Hill in Washington on Feb. 4, 2014 before the House Government Operations subcommittee hearing to examine the administration's marijuana policy.

BALTIMORE » Six recovering substance abusers sat in an inner-city treatment center, sharing their stories. When Michael’s turn came around, he spoke of his former drug of choice, alcohol, and mentioned the night years ago when he drove drunk on the Massachusetts Turnpike, caused an accident and was arrested before passing out.

Michael then pulled out a picture of a friend’s brother who recently died from mixing prescription painkillers with alcohol. He described his grief and visceral connection with the struggles of substance abusers in recovery.

"You are my people," he said, wiping one eye.

Catharsis is common in treatment centers, but Michael is not the typical former substance abuser: He is Michael Botticelli, the director of the White House Office of National Drug Control Policy, informally known as the drug czar. Botticelli is the first person in substance-abuse recovery to hold the position.

His history, far from the liability it once may have been, is considered evidence that the government is moving toward addressing drug abuse more through healing than handcuffs.

"Every other drug czar has had a military, political or police background," said Tom McLellan, a founder of the Treatment Research Institute in Philadelphia and an expert in substance abuse. "Nothing against them, but it’s time to have that new perspective, and Michael brings it. He is the living example of what should be an expectable result of treatment – recovery."

Botticelli’s agency, created during the Reagan administration’s war-on-drugs initiatives, devises and controls the budget for national drug policies. It assists the State Department and Drug Enforcement Administration in dealing with governments of countries from which drugs are exported – such as Mexico, India and China – and works with domestic health and law enforcement officials on strategies to stem the supply and abuse of drugs, from heroin to prescription opioids.

Heroin abuse and deaths in the U.S. have risen drastically in recent years, particularly among the middle class and in rural communities. About 23,000 Americans died from overdoses of prescription painkillers and tranquilizers in 2013 -vroughly double the total of a decade earlier, according to the National Institute on Drug Abuse. Other federal data shows that in 2013, 1.8 million people ages 12 or older received treatment at a facility for abuse of either alcohol or drugs.

Botticelli lived it himself: In 1988, after being arrested on charges of causing an accident while driving drunk on the Massachusetts Turnpike, he woke up the next morning handcuffed to a hospital bed. (He had previously used marijuana a few times, as well as cocaine, he said, "on a somewhat occasional basis.") He spent four months in a court-mandated outpatient treatment program for alcohol abuse, and soon left his job as an administrator at Brandeis University to work at a substance-abuse treatment center.

Botticelli, 57, has remained abstinent for 26 years, his only synapse-soothing substance being an occasional cigarette. He even refused a prescription for opioid painkillers after a significant medical procedure for fear they might awaken addictive behavior.

Raised in Waterford, New York, outside Albany, Botticelli directed the Bureau of Substance Abuse Services in Massachusetts for 10 years before joining the Office of National Drug Control Policy in November 2012 as deputy director under Gil Kerlikowske, a former Seattle chief of police. Kerlikowske left the position last year to become commissioner of Customs and Border Protection, leaving Botticelli to succeed him.

John P. Walters, who served as the agency’s director from 2001 to 2009 under President George W. Bush, said he supported Botticelli’s focus on improving treatment for abusers but expressed concern that it might distract from efforts to keep illicit substances like heroin and methamphetamine from entering the country. He criticized the Obama administration for removing the director from the cabinet in 2009, and said Botticelli would need to enlist more support from the DEA, the FBI and the State Department to negotiate with foreign governments.

"Yes, we need to make treatment resources available to more people, but our goal is not to just treat victims but deal with supply reduction in a way that gets foreign countries and governments involved," said Walters, the chief operating officer of the Hudson Institute, a think tank.

Botticelli said he embraced his office’s more traditional charges, like combating the flow of heroin across the U.S. border with Mexico. (This role explains his round-the-clock protection by U.S. marshals.) Yet some of his primary objectives do not attempt to stem substance abuse – they accede to its reality.

He wants police officers nationwide to be trained to use naloxone, a nasal spray or injection that can almost instantly resuscitate people who overdose on opiates; better education for prescribers of painkillers and other drugs so that they can recognize signs of abuse or addiction; and the distribution of clean syringes for intravenous drug users to stem the spread of infectious diseases like HIV and hepatitis C.

"Locking people up for minor drug offenses, and especially people with substance-use disorders, is not the answer," Botticelli said. "It’s cruel. It’s costly. And it doesn’t make the public any safer."

Botticelli said that as the social stigma associated with drug abuse dissuaded people from seeking treatment, the substance-abuse field should take cues from the gay rights movement. He lived that, too – he is gay and married his partner in Massachusetts in 2009.

"I almost found it easier to come out as being a gay man than a person in recovery," Botticelli said. "We’re doing an amazing job decreasing the shame and stigma surrounding gay folks. There is a playbook for this."

Regarding the issue of medical marijuana, which 23 states and the District of Columbia have authorized despite its federal ban, Botticelli has said he opposes the legalization of cannabis unless it is formally approved by the Food and Drug Administration. Even if Botticelli had mixed feelings, the statute that created his agency, in 1988, specifically forbids the office to support legalizing any substance classified in Schedule I by the Drug Enforcement Administration.

Reporting primarily to Denis McDonough, the White House chief of staff, Botticelli splits time between his Washington office and touring the country visiting treatment centers, making speeches and consulting with local officials on how to improve services for those with substance abuse disorders. In late March, he went to Baltimore – sometimes called the heroin capital of America – for a typical tour.

Botticelli stopped first at Reach, an outpatient treatment facility that serves primarily patients covered by Medicaid. When he sat down with five adults recovering from abuse of various substances – heroin, alcohol, painkillers, marijuana – they were reticent about sharing their experiences and opinions. Only after an awkward 10 seconds did he say with a smile, "OK, I’ll start," detailing his own abuse history and allowing the others to open up.

"It means a lot to know there’s somebody who understands," said Ashley Grimes, 22, who is in her second year of recovery from heroin abuse. "He’s walked in the shoes we’ve walked."

After Botticelli spent an hour with doctors at the Johns Hopkins Center for Substance Abuse Treatment and Research, he rode with a police officer from Anne Arundel County, Nick Tackett, who used naloxone to save the lives of two people who had overdosed on heroin.

"You’re doing something that police don’t normally do – administering a drug," Tackett said as they passed an abandoned one-car garage in which one of the overdoses occurred. "And two or three minutes later the person’s alive."

As heartened as Botticelli was at that story, on the way home he shared a more somber one. Last year, he heard about a Virginia man whose 23-year-old son died in his arms from a heroin overdose. Botticelli invited the grieving father to lunch in the West Wing, where the father lamented that the death was his responsibility.

"It isn’t your responsibility," Botticelli responded. "It’s my responsibility."

Alan Schwarz, New York Times

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