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Welcome to Washington D.C. and thank you very much Mr. Ethwan for the introduction.
I hope you enjoy the weather, it's just a little humour on our part.
I couldn't be more delighted to be here and to be with you this morning
than to talk about President Obama's drug control strategy.
We're greatly appreciative of the invitation to be here,
not only from the International Aid Society and amfAR,
but for all of you and the chance to have a bit of a conversation,
and we have several staff members that'll be here throughout the day,
and so I think if there is follow-up information
we would be delighted to participate and to be of some help.
Neither this meeting, nor the International AIDS conference which is so historic,
that will follow this here in Washington,
would occur in this city without President Obama's leadership.
He corrected the policy restrictions
that banned individuals with *** to travel to the United States.
He could not make it more clear that he has an administration
that relies on science rather than dogma to inform policy.
To some of you in the audience,
I may look like an unexpected messenger.
A police chief who delivers a message about addiction as a disease
and treatment and prevention and healthcare as the primary tools
and not about the criminal justice system or a war on drugs.
But frankly, my colleagues for many years have had very much the same position
and have repeatedly talked about that.
After I had this position and talked with the Wall Street Journal
about ending the war on drugs and not calling it that,
that it was really a terrible misnomer to use War on Drugs as an analogy
for what is truly a public health issue.
I was asked, "Well, what about the members of Congress,
aren't they going to see you as being soft on drugs and soft on crime?"
But I think after thirty-seven years in law enforcement
it's just a little hard to paint me as soft on drugs or soft on crime.
But we know we needed to be much smarter about the way we addressed this issue.
And I came actually into this, into the ***/AIDS world
with a much better and fuller understanding of this problem
than I did with the science around the disease of addiction
and the understanding of treatment.
When I was brand new and being tested police chief in Florida,
in a place called Fort Pearce,
which as some of you may know, had for many years,
one of the highest per capita infection rates in the country,
in a fairly small community.
I had a young officer who was ***/AIDS positive
and as he became less healthy and weaker
and this was 1992, so long before lots of drugs and treatment,
as he became less healthy and weaker, I assigned him to the front desk
and after he would get off his shift I noticed that the people that replaced him
were taking windex and alcohol and squirting it over
everything and wiping everything down,
and I really realized that the people in that department
didn't have an understanding of what this was.
And so we brought in experts,
back then the experts were not as many and not as knowledgeable certainly as today
but we did huge training sessions for all of the people involved
to help understand what this disease is and what the disease was
and that wiping everything down with alcohol and treating him as
an infectious individual made absolutely no sense.
And you would think that sometimes police officers who are very brave
and carry firearms
would be more knowledgeable and become better understanding.
But I think the fault was that we didn't spend the time
giving them the education and the information about this.
And then my wife did some real ground-breaking work
in this area also, with the sheriff in San Francisco many many years ago
in talking about people who were incarcerated and were also *** positive,
and how corrections officers and others should better understand it.
So I really had a much fuller understanding of this issue
and couldn't be more pleased and more proud to see how far all of us have come
in treatment, in recognition, and I think this issue of the twin epidemics of
IV drug use and *** is particularly important, that we address that.
While over the years here in this country, and certainly in some others,
our drug policy has just lurched back and forth
between people who say, "Look, everybody needs to be arrested and incarcerated
and that will solve the drug problem" and other people who say, "Well look, if we just legalise drugs that will solve the problem".
We don't think that either approach makes a lot of sense quite frankly.
Spending more money for prisons and enforcement increases arrests
and seizures but it isn't going to solve the problem.
And for my colleagues in this room, and one of them the Assistant Chief
Jim Pugel from the Seattle Police Department, who will be speaking to you later,
often talk about, "we are not going to arrest our way out of our drug problem."
We don't believe that either of these approaches is humane, compassionate, realistic,
and we don't believe either approach is grounded in science.
And neither acknowledges the complexity of our nation's drug problem.
"War On Drugs" is a great bumper sticker, I mean it really fits well on the back of the car.
Unfortunately it isn't a solution to a really very very complex problem.
That's why our national drug control strategy,
President Obama's National Drug Control Strategy,
actually pursues a third way.
The twenty-first century approach to drug policy is this third way.
It's progressive, it's innovative, it's evidence-based
and we really believe that it paves the way forward,
not only for the United States, but we think it can be quite helpful in other
places around the world.
And we have done an awful lot of work with counterparts in other countries.
The health consequences of drug use are many,
today the drug-induced deaths are the number one cause of injury death,
we have more deaths from drug abuse than from car crashes or gunshot wounds.
Injection drug use is a well-known route of transmission
of blood-borne infections, particularly *** and Hepatitis B and C,
and in addition the use of illicit drugs is associated with increased rates of TB and STDs.
The facts underscore the need for this different approach
and one that treats drug addiction as a disease and promotes interventions
through a public health system.
Despite the fact that drugs and crime are intimately linked,
we know that arrest is not the answer.
We're taking action to reform public health and safety systems
so that we can learn to recognise the signs of addiction
and act before substance use disorder becomes chronic.
And we know that our screening brief intervention referral to treatment programs
in bringing to drug use issue into primary care
rather than set it aside as a silo
is also a better answer.
Reforming drug policy takes time.
We've made progress and over the past three years
we've spent over thirty billion dollars to support drug prevention
and treatment programs.
That's more than we spend on federal law enforcement.
Recognising that drug use is a public health issue, last year the
Obama administration released its first ever national prevention strategy,
which calls for eliminating health disparities and increasing education.
And then, it's important for us to remove the stigma associated with drug addiction
and to support the millions of Americans in recovery.
And so, in September, when we have recovery walks all over this country
from small communities to very large cities,
tens of thousands of people who are in recovery
and are able to be back doing the things in life that they want to be able to do,
we support them, and we've worked very hard to
remove a number of stigmas around recovery.
And to break the cycle of crime and drug use
we tried to divert non-violent drug offenders into treatment
instead of jail through our drug court programs.
There are 2600 drug courts in the United States.
They divert over 120,000 people annually
into treatment and help to remove also any criminal justice stigma
that was associated with their early intervention.
And, believe me, I'm a big supporter of the
criminal justice system as being a part of the solution
and understanding it.
It just shouldn't be the only solution.
And finally, the Affordable Care Act for the first time makes
drug treatment a require benefit for all Americans
who suffer from substance use disorders.
And this way, our third way approach, to drug policy
supports the admininstration's policies on *** prevention and treatment.
So we've made significant progress on reducing the number of
new *** infections among injection drug users,
and their *** partners.
And the Centre for Disease Control and Prevention
estimates that injection drug users represents nine percent
of new *** infections in 2009, and about seventeen percent of
those living with AIDS in 2008.
One in five of the estimated 1.2 million individuals
in the United States who are *** positive
are unaware of their infection.
So it's imperative that we enhance efforts
to make *** screening, and then the linkage to care,
for those infected to be much more readily available
and particularly among the most affected groups.
Well, we work closely with the Office of National AIDS Policy in the White House
and the Department of Health and Human Services,
and we were involved in the development and
implementation of the National AIDS Strategy
that was released in 2011.
It's a collaborative process and we were able to ensure
compatible goals and actions in our respective national strategies.
Let me give you a couple of examples,
National ***/AIDS Strategy recommends coupling
*** screening with substance abuse treatment programs,
and that's a key step in the nation's effort to prevent
the spread of *** in communities where it's most heavily concentrated.
And advances in rapid *** testing technology
allow for *** testing to be offered in a wider variety of settings,
including substance abuse treatment programs,
as well as in correctional settings.
And it's particularly meaningful,
because approximately fourteen percent of all people
living in the United States with *** in 2006
were released from a correctional facility that year.
And in addition to the disproportionate rates of ***,
inmates have a high prevalence for other infectious diseases,
substance use and mental illness.
I often used to say that it should come as no surprise
to elected officials when someone is released
from prison and hasn't gotten the treatment
or the care or the support that they needed
to be able to re-enter society, that they turn around
and re-offend and go back through the criminal justice system.
And yet, I've seen now, very positively,
a number of governors in a number of our states,
which is in the United States where most of the
criminal justice work actually gets accomplished,
make changes in their budgets to provide these
kinds of services behind the walls
but more importantly, to help people re-enter society
in a way that isn't going to lead to recidivism.
Furthermore, the vast majority of inmates that are
going to be released after incarceration back
into the community, the number of sentences has been reduced,
and, in fact, we were able to, under President Obama's leadership,
reduce the minimum mandatory sentencing around crack and
powder *** which had existed for some time
and both President Clinton and President Bush had attempted to reduce,
but in a bipartisan effort and with the
leadership of the President
that was the first minimum mandatory sentence
program that has been reduced in the last four decades.
However, we fully also support the interventions that were listed
in the PEPFAR Technical Guide
for countries and strategies for a comprehensive
approach to *** prevention, treatment and care for injection drug users.
And that guide focuses on three central elements:
the community based outreach programs;
sterile needle and syringe programs;
and drug treatment, including medication assisted treatment.
Let me take a moment to clarify that policy on needle exchange.
In December of '09, President Obama
signed the 2010 Labour, Health and Education Appropriations Bill into law
and he ended the long-standing ban on federal funding
for needle exchange programs.
And in the administration's inaugural
National Drug Control Strategy in 2010,
we made specific reference to the importance of informing
public health systems on implementing
needle exchange programs as part of a comprehensive
strategy to reduce *** transmission among
injection drug users.
In my experience as a Police Chief both in Buffalo, but also in Seattle,
with needle exchange programs could not have been... and was more positive.
The needle exchange programs were partners,
they helped in neighbourhoods,
they helped people,
they helped people get into care that perhaps
without those programs normally
might have continued not getting into treatment programs.
So, I think, among my colleagues, we were strong supporters of this.
And, as you know, though Congress reinstated the ban on the use of federal funds
for needle exchange programs that are conducted in the United States.
And before I conclude, just let me stress
the United States condemns the Human Rights violations
that are passed onto drug users
and they have raised concerns,
and we have raised concerns,
about the practices that we consider human rights violations.
For example, mandatory labour is not a
preferred treatment for drug addiction,
and we have made that voice known.
Our concerns are based on the absence of due process,
ineffective practices, reported levels of abuse in facilities,
that only contribute to malnutrition,
other diseases and things that actually can be prevented.
And where countries continue to engage in
human rights abuses of drug users
and/or refuse to adopt effective programs,
we're going to continue to work with them,
while reaching out to the civil society and the
non-governmental entities to ensure that people
get access to services.
I was just recently in a country two weeks ago
in which a very high-ranking official said
"Consumption in our country is a minor concern",
and I had just finished leaving a treatment centre
where I met with a number of women who were
in drug treatment and I thought
"You really probably are not getting out
to see the effects and the devastation that
drug use can have, even in countries that are
particularly poor."
Well, our objective in every country, in which PEPFAR works
is to save lives by keeping ***-infected
drug users healthy so that they can live to
benefit from effective treatment, and
preventing every new infection that we can,
and promoting an inclusive approach to service delivery
that has to be respectful of human rights.
Respect for human rights in the elimination
of stigma and the discrimination are
key priorities in the United States.
And in many countries legal regulatory and policy reforms
are needed to ensure an environment that is
created, that supports prevention treatment and care.
And in other countries, the issue may be a
need for greater coordination between public health
and public safety officials.
We've never seen better cooperation than what
this terrible economy has wrought here in this country.
There were perhaps groups that did not
collaborate, did not coordinate, did not
work together, in a variety of governmental systems
that because of the issues around budget,
and the very tight austere budget process
that we're all engaged in, are coming together
and joining hands and working together to be
supportive.
Finally, the stigma around the discrimination
remains a challenge everywhere,
and training and capacity-building need to
take place to combat them.
I've travelled for well over three years on
behalf of this administration, and I've met
people all over the world, but particularly
here in the United States, that are in recovery
and that are doing an absolutely marvelous job of
being back, taking care of their families,
and back in their neighbourhoods.
And I do, and the people in my office do,
everything we can, not only to support them,
but to tell people in this country that people
can recover from drug addiction.
And, it wasn't that long ago, that methamphetamine was considered,
that once you were addicted to methamphetamine,
you could never recover.
Well, I've met literally hundreds and hundreds
of people that have completely and fully recovered.
We're committed to supporting a balanced
public health and a safety approach to
reducing drug use and the consequences.
We absolutely applaud the work of the
International Aid Society and amfAR to
promote these policy discussions, because
that's the way forward.
And it's only by cooperation and understanding
each other's viewpoints that we will make progress.
We hope we will come out of today's meeting
and this week's conference with a renewed
understanding that the debate around *** and
intravenous drug use is not a zero-sum game
between public health and public safety interests.
But it is rather a critical convergence between the two.
Thank you for the invitation and thank you for allowing me to be here today.