Dr. Nadelmann means it. Photo via

By Will Godfrey

06/30/13

Maybe a little bit of rock star has rubbed off on Ethan Nadelmann, the executive director of the Drug Policy Alliance, after his recent profile in Rolling Stone. Due to address a conference at NYU, where, the program promises, he will “take us around the world in 20 minutes,” Nadelmann shows up with seconds to spare, clutching a Coke Zero and a stick of gum. He hits the rostrum without breaking stride and delivers, notes-free, an adrenaline-pumped rundown of the harms of drug prohibition and the emergence of alternatives in Latin America, Europe and the US that has the respectful crowd of social work educators whooping in appreciation.

Nadelmann, 56, has been a drug policy reform activist for decades, from his teaching and research at Princeton in the ‘80s and early ‘90s to his founding in 1994 of the Lindesmith Center—a think tank funded by George Soros, which Nadelman merged with another group to form theDrug Policy Alliance in 2000. He’s widely considered the most influential advocate in this field, and his efforts bore their most spectacular fruit to-date last November, when Colorado and Washington voted to legalize marijuana.

“The most pernicious and powerful opponents we have are the DAs. Their bloated power in American society is the single most dynamic element driving the drug war today.”

Pot hogs headlines, but Nadelmann stresses that most DPA efforts focus elsewhere. Pushing harm reduction in the broadest sense—everything from Good Samaritan laws to combat overdose, needle exchange and naloxone distribution to ending mandatory minimum drug sentences and ultimately drug decriminalization—is their overarching theme. In a later session at the NYU conference, Nadelmann details how harm reduction boosts public health and breaks stigma; he wraps up with a glowing endorsement of heroin maintenance programs.

In person Nadelmann, who has a PhD in political science from Harvard, a master’s in international relations from the London School of Economics and a New Yawk accent, combines an engaging passion for his subject with a professorial grasp of it, frequently citing studies to support his points. Later on, as we finish our interview on a bench in Washington Square Park, whiffs of second-hand marijuana smoke drift by, forestalling any temptation to stray off-topic.

A ballot initiative, you say, is what you do when you think people are already on your side. But as you waited for the Colorado and Washington results to come in last November, how confident were you really, given that you were trying to do something unprecedented?

I did not think, just a few months in advance, that we would win both. Certainly not by those margins, where we got roughly 55% of the vote. It was only in the final week that we began to see polling and early voting in these states—in Colorado, we were deeply involved in the drafting and then in the ground game; in Washington, we were slightly involved in the drafting but deeply involved in the fundraising—and to sense that we were ahead. Even then, I didn’t quite believe it.

You know, we had a little wave of momentum in the late ‘90s, and then with Bush/Cheney and 9/11, especially, we got pushed back. Now this acceleration of support for legalizing marijuana has caught me, and almost everybody else, by surprise.

Where in the US do you think we’ll next see marijuana legalized?

I’m wondering whether Oregon has a shot to move forward in 2014; there the legislature can put an initiative on the ballot, so I think there’s a chance. There’s some possibility around Alaska in 2014. I’m curious about Washington, DC, and whether the city council, where views have really evolved, might be willing to do something. California, we’re looking at 2016. And states like Arizona or Missouri might pop through.

Rolling Stone calls you “The Real Drug Czar.” What’s your assessment of Gil Kerlikowske and the Obama administration?

I was hopeful with Gil Kerlikowske. He had been the police chief of Seattle, and they have Hempfest. He had gone to Vancouver, looked inside a safe-injection site and written a fair-minded memo. I met him as soon as he was appointed, and he was very friendly. But now on the marijuana issue he appears to be mimicking the verbiage of his predecessors. It’s almost like he was captured by the people who pursue this absurd line of thinking. In that respect, it’s a good sign that responsibility for marijuana policy appears to have been shifted to the justice department, which has to pursue a much more pragmatic policy.

I was pleasantly surprised during the first 18 months of Obama’s administration. He made three commitments when he was running for president. One was that he would pull back on federal enforcement on medical marijuana in the states that had made it legal. The second was that he would approve federal funding for needle exchange programs. And the third was that he would push to roll back the mandatory minimum crack penalties. You know that 100-to-one issue? [the former sentencing disparity between crack and powder cocaine]

Now it’s “only” 18-to-one, right?

Yeah. He made good on all three commitments. On medical marijuana, they put out the Ogden Memo in ‘09, which was cautious, but emboldened some of the state governments. On needle exchange, they did not lead, but he did approve it. [Congress reinstated the federal funding ban in 2011.] And on the crack/powder issue, they actually did lead, and pushed on one-to-one.

Unfortunately, they kind of peaked. Once the Republicans took over the House, it made it much more difficult, having some of the most reactionary Republicans in charge of these committees, so I can only blame the Obama administration so far.

Kerlikowske, after being very leery of the overdose issue, is now providing some leadership on that. But they’re using our rhetoric about a public health approach, about reducing incarceration, and the budgets, the policies, don’t match the rhetoric. The stigmas associated with addiction; the criminalization of pregnant women who test positive for drugs; legislation to roll back further mandatory minimums—he’s just not present on that stuff. I see him trying to claim the mantle of public health. But you can’t do that if you’re not willing to talk about the kinds of innovations we see in Europe, if you continually insist on the criminalization of drug possession.

You don’t just preach to the choir like at NYU today; you go and speak to people who oppose your goals. Where have you experienced the most hostility?  

The people most hostile to my goals typically don’t invite me to speak—especially in the law enforcement world. Questioning that approach raises existential issues for them. When you’re spending your life enforcing these laws and you want to go home at night and look your kid in the eye and say, “Daddy’s doing good,” to have to step back and say, “Maybe Daddy’s job is no different than the prohibition agents during the alcohol Prohibition”—it’s a hard thing. I’m sensitive to that.

The tragedy is the so-called “blue wall of silence.” I mean, this is a powerful issue right now. I’m one of the leaders of this movement. You’d think these guys would want to hear it from the horse’s mouth. I think a lot of them are afraid that if they invited me to speak, their members might be persuaded. The only silver lining on perceiving their fear of debate is that it lets me know how incredibly vulnerable they feel about what they’re trying to defend. They know deep down—the smarter ones—that they can’t win, that there’s something flawed in their way of thinking.

Who do you see as your most formidable opponents?  

The most pernicious and powerful opponents we have are the prosecutors and the DAs. Where we’re trying to get a Good Samaritan law passed, trying to get needle exchange laws through, expand access to methadone, they’re the ones standing in the way. Their bloated power in American society and the extent to which they are unaccountable, and only care about their own self-empowerment—that is the single most dynamic element driving the drug war today. It’s not about money. This is about power. The power to run for higher office. The power in squeezing some poor guy arrested for drug possession or low-level selling into making a deal and avoiding a massive sentence.

I am continually stunned by the lack of humanity and the disrespect for science and public health that I see in that world. It is pathetic and they need to be held accountable. When DAs engage in behavior that results in the deaths of large numbers of people, they are never sanctioned. They deserve to be. The only saving grace is the growing number of people in that world who are beginning to break off: David Soares, the DA of Albany County, and some others.

Where around the world have you been most inspired by drug policy reforms?

My first trip to Switzerland was 1992, and they just had approved proceeding with the heroin maintenance thing. I used to go the Netherlands in the late ‘80s, early ‘90s, to see what they were doing. I went to Portugal more recently, and to Vancouver—as an advisor, as well as to learn and ally with them. The European approach has always been a major inspiration. When I created the Lindesmith Center in ’94, one of the ways I defined our mission was to educate Americans about the lessons and benefits of foreign approaches.

You’ve criticized America’s “pig-headedness” against harm reduction approaches that work elsewhere. Has the relative dominance of the abstinence-based 12-step movement in the US been part of the reason that harm reduction has been less welcome here?

I don’t have a simple answer. We were one of the only countries in the western world to prohibit alcohol. That attitude, the abstinence-only approach, preceded AA. Our instinctive reliance on criminalization is not inherent to AA. That really grew up in an American frame: Nixon’s war on drugs, the way race issues played out in this country, the private prison industry.

The 12-step model has been problematic, I think, in two areas. The first is the way the criminal justice system and the for-profit drug treatment industry tried to capitalize. When you marry the 12-step abstinence-only approach with a criminal justice approach, when falling off the wagon has a criminal sanction attached, you can’t just take one step at a time, and it’s awfully hard to build peer groups based on trust. All these for-profit 28-day programs—many ended up doing relatively little good, at a tremendous cost.

Where the 12-step thing has the most to own up to is its role in impeding harm reduction interventions to stem the spread of HIV/AIDS. Why was it that Australia and England and the Netherlands were able to stop the spread, and keep the number for injecting drug users under 5-10%, and the US was not? It’s that notion—that abstinence is the only permissible approach, that we are not going to “enable” a junkie by giving him a clean needle. There has to be a kind of owning up to that role in hundreds of thousands of people dying unnecessarily, even as people in recovery play a greater and greater role in drug policy reform.

But there can be a natural fit between 12-step recovery and your goals?  

Yes. The 12 Steps and harm reduction share some things: The notion of one step at a time, one day at a time; the importance of peer groups; the important role that dignity plays. This is why I admireHoward Josepher—he has both harm reduction and recovery programs. Some of the most significant leaders of the harm reduction movement are in 12-step programs. They say, “I have hit a point where I realize I cannot drink or use drugs; the 12-step approach worked for me,” but they’ve also seen many people where it did not work. They realized they needed a fallback strategy, and therefore see 12-step and harm reduction as complementary. On my board, on my staff, in the drug policy reform movement, one of the most dynamic and fast-growing elements is people in recovery.

Some feel they can’t support decriminalization or legalization because of awful personal experiences with drugs. What would you say to that?  

Firstly, marijuana prohibition in the US has almost entirely failed to make marijuana less available to young people. There are three national surveys in which young people say it’s easier to buy marijuana than alcohol. For anybody who is in recovery and used marijuana at some point, the prohibition laws failed to make it unavailable to them. What makes them think it’s going to be any better in the future, to persist with this policy?

The experience of the Netherlands is that the percentage of young people who use cannabis and then go on to try other drugs is less than in the US. The Dutch, I think reasonably, explain that as being a result of having separated the cannabis market from other drug markets. Drug dealers in the Netherlands are less likely to carry marijuana than other drugs, whereas in the US, they’re more likely to carry marijuana and other substances. Much of what accounts for the gateway theory is having a supply that sells multiple substances.

What about the decriminalization of other drugs?  

Drug addiction can be a terrible thing—but so can arrest and incarceration. We have to focus on reducing both the risks and harms of addiction and the risks and harms of incarceration.

With respect to the decriminalization of all drug possession, which we sometimes call the “Portugal model”—they did not eliminate criminal sanctions but they basically stopped putting anybody who was in possession in jail, or penalizing them through the criminal justice system. If you look at the evidencefrom Portugal, drug use went a little up in some groups and down in some others, but basically remained constant. But HIV, Hep C, drug arrests, criminality, all the negative consequences of drug use and addiction went down. The decriminalization of drug possession appears to have no impacton the number of people who use drugs. What it does do is remove obstacles to treating addiction as a health issue, reduce arrests, reduce the money spent on criminal justice.

You’re open about your own drug use: You’re a longstanding but occasional marijuana user; you’ve used cocaine but aren’t a fan. You seem much more enthusiastic about psychedelics. What did you mean when you told Rolling Stone that psychedelics are wasted on the young?

Oftentimes when you talk to younger people who’ve done psychedelics, it’s all about the bright lights and colors and the funny sensations—and that’s fine. Most of them do it and it’s fun; maybe they learn something from it, some of them get hurt by doing it stupidly. I’ve not been a frequent psychedelics user. I’ve tried a variety of them. I think it’s a good thing to do once a year, so long as one doesn’t have issues with mental health.

Why do you think it’s a good thing to do once a year?  

Psychedelics are a powerful and effective way of asking deeper questions about one’s life. I grew up the son of a rabbi but I’m not an advocate for organized religion—but there’s a spiritual element to this. There are traditions of prayer and fasting and chanting. Other people do it through psychological counseling. I think that continuing to challenge oneself becomes more difficult as one gets older. Trying to stir up the emotional sediment that one acquires is a good thing.

My occasional use of psilocybin mushrooms—I’ve derived not just wonderful experiences, and occasionally gone to some dark places. But I also had some intellectual and emotional insights that I value decades afterwards. Having once done it in the context of the Santo Daime ceremony—you know, the Brazilian ayahuasca-based church—people who had been through serious trauma, violence, loss, it was about coming to grips with that. The recent research, done in government-funded studies with very rigorous research models, shows profound benefits when psychedelics are done in a responsible way.

You have a 24-year-old daughter; what have you told her about drugs?  

The thing I’ve always stressed with my daughter was to keep the bottom line focused on safety. I don’t have an ideological viewpoint vis-à-vis adolescents and drugs. I’m not a proponent of drug use; I’m perfectly happy with people who want to be what they regard as entirely sober or straight. My view to marijuana and other drugs was similar to my view about alcohol, which is, if you’re going to do it, do it responsibly. I’d rather you wait till you got older; take care.

Like many people my age, I was less concerned about marijuana being used occasionally in late adolescence, but radically opposed to cigarettes…I hate cigarettes. My dad died at the age of 58 and his cigarette addiction may well have played a role. I think that adolescents that choose to use cigarettes in the face of all the evidence, that’s an indication that they’re willing to take risks that I think are not acceptable. Whereas young people who choose to drink occasionally, or to smoke marijuana—or even, depending on the age, do something like use MDMA—are actually being much more intelligent about the relative risks.

“We need to accept that there is going to be a small percentage of people who are determined to get their drug of choice. Heroin, cocaine, whatever. And for those people, we need to find a way to allow them legal access to the substance they want.”

How could better policies have reduced the huge US toll from Rx opioid overdoses?

One of my frustrations is that DPA is now devoting as much staff time and almost as many resources to overdose prevention as to marijuana reform, but all the media attention focuses on marijuana. We are playing a role of national leadership in passing Good Samaritan laws. We’ve led efforts in New York, California, New Mexico, Colorado and been deeply involved in Vermont and a host of other states. In New Jersey, we got that through and Governor Christie vetoed it—then we came back, mobilized parents and city councils and finally got Christie to realize he made a mistake. It’s a personal passion—probably more of my staff at DPA are passionate on the naloxone issue than on marijuana.

The shame is, the knee-jerk response, at least until recently, is: Crack down—crack down on pill mills, crack down on doctors. So much focus is on the supply side, in the absence of any significant evidence that that’s the most important place to focus. Meanwhile, you have this in-your-face evidence that naloxone—making it liberally available, making people aware of it—saves lives.

The DPA is a broad church, ranging from all-out libertarians to doubtful drug warriors, and you say you don’t need to fight over what the ultimate objectives are…  

There’s all sorts. People who want to roll back the drug war, get rid of mandatory minimums, harm reduction focus, decriminalization of possession—there’s still so much work to be done to get to that point that the internal disputes over what the ultimate policy should be are really just intellectual ones.

Does that mean you can’t tell me what you want the ultimate goal to be?

I’m somewhat bounded in terms of representing DPA. But on the marijuana issue, I’m not fighting for the Marlborization or Budweiseration of marijuana. My focus is very much to legislate a responsible public health approach.

The DPA website talks about giving people sovereignty over their own bodies. Is there any way to do that without legalizing all drugs?

There’s a fundamental distinction between saying we’re no longer going to criminalize people, and saying we are going to legalize the availability. We don’t have a position for or against the broader legalization of drugs other than cannabis. And that split between people who favor broader legalization and those who favor a more public health, harm reduction approach is in the DNA of Drug Policy Alliance.

Might it be argued that the concept of decriminalized drugs—as opposed to legalized—is a fudge? You won’t be prosecuted for drug use, but in order to obtain those drugs, you’ll still have to employ the services of someone who is breaking the law?  

You can call it fudge, or you can call it incremental steps! Thinking in politically realistic terms: People ask, Is there a slippery slope from marijuana legalization to the legalization of other drugs? The answer seems pretty clearly, No—whether you like it or not. There’s two pieces of evidence: One is the Netherlands, where you’ve had majority or close to majority support for the legal regulation of cannabis for a long time, but you don’t see support for legalizing other drugs. The second is the American opinion polls. You see the rapid increase in support for legalizing marijuana, but when you ask people about legalizing other drugs, it hovers in that 10-15% level.

But those who advocate outright for legalization serve very important roles. The government, the drug czars, have an interest in conflating the harms of drugs and the harms of prohibitionist policies. One service of legalization advocacy is to put right up front: Here are the harms that flow from treating this as an illegal market—the crime, the corruption, the black market, the incarceration and human rights violations, the environmental harms of spraying crops in Latin America, even the fact that drugs are much more dangerous, adulterated, unregulated.

Another value of legalization advocacy is that it requires people to think hard about what is it they’re really afraid of. That’s a hard question. To what extent are our fears real, and to what extent are they phantoms? Asking people what it is they fear is also about highlighting how we see some of these drugs—heroin, cocaine, meth—as so much more dangerous than alcohol and cigarettes…

Like the somewhat spurious distinction between “hard” and “soft” drugs.

Exactly. Those things don’t conform much with the available scientific evidence or the consensus conclusions of nationally appointed commissions of experts. The legalization advocacy is about a provocation to think afresh, instead of some belief that we’re all going to be selling crack cocaine in the stores the way we do Marlboro today. Some people advocate that; libertarians will. DPA does not—it’s about getting people to think hard about that, and to challenge their assumptions.

You often sound as if you’re primarily a pragmatist, looking to do what helps, rather than basing what you do primarily on ideology. Is that fair?

Yes and no. My mission, and that of my organization, is to reduce the harms of drugs—death, disease, crime, suffering—and to reduce the harms of our prohibitionist policies. The optimal drug control policy is the one which most effectively balances those two objectives. So in that sense, it’s very pragmatic. Most DPA resources are devoted to incremental reforms, which accomplish some good: Pass a needle exchange program, you reduce HIV/AIDS; get naloxone or Good Samaritan, you save lives; pass medical marijuana and patients get the chance to not be treated as criminals.

But each one of these steps is also part of a broader vision. Needle exchange is not just about reducing HIV/AIDS; it’s about redefining injection drug users, from criminals to be persecuted to potential partners in a public health campaign. Medical marijuana is about saying that the first people who deserve not to be criminalized are people who use it as medicine, but it also helps to transform the discussion around marijuana regulation.

I define myself first and foremost as a human rights activist, who happens to be focusing in this area of human rights violations. That drives me, gives me the passion—but I’m not typically putting human rights arguments out there, because that’s not what the public is open to. The public wants to hear about reducing disease, reducing fiscal costs of the drug war, better utilization of scarce criminal justice resources. So I am essentially an idealist, but the work is realistic and pragmatic.

You’ve been on this road for a long time. How do you assess your progress?

Obviously marijuana reform in the US, where we now have 18 going on 20 states that have legalized medical marijuana, one and a half to two million legal medical marijuana patients—that’s remarkable. And Washington and Colorado are almost certainly just the first two of many.

The other incredible breakthrough is the evolution in elite opinion in Latin America. Beginning with the Latin American commission on drugs and democracy in 2009, with former presidents and Nobel Prize winners. And then the presidents calling for open debate. And more recently this OAS report last month, coming up with four scenarios of how drug policy might evolve, one of which was marijuana legalization. This is the first time any multilateral organization has considered marijuana legalization, harm reduction and decriminalization on an equal footing with a drug-war strategy. What the OAS did would have been inconceivable three years ago. Having sitting presidents talking how Santos in Colombia and Molina in Guatemala and Mujica in Uruguay are, is extraordinary. I’m grateful to have been in a position of advising and publicizing with these various commissions. Last year I had one-on-one meetings with Presidents Calderon and Molina and Santos to talk about this.

How do you see your mission evolving in the years ahead?

For DPA, something which is going to become a much greater priority is the decriminalization of drug possession, making a serious commitment to treating drug addiction as a health issue, the way we treat cigarette or (mostly) alcohol addiction. Of the 1.5 million or more Americans arrested for drug charges last year, something like three quarters were for possession only. The negative consequences—for public and personal health, the criminal justice costs—are our major priority.

Down the road, I think ultimately we need to accept that there is always going to be a small percentage of people who are absolutely determined to get their drug of choice. Heroin, cocaine, whatever. And for those people: Offer them treatment; offer them counseling; offer them help. But ultimately, we need to find a way to allow them legal access to the substance they want. It’s looking at what the Europeans and Canadians have been doing with heroin maintenance and finding a way to scale that that does not present greater threats to public health and safety. In the long run, a decade from now, that’s going to be the major challenge.

Will Godfrey is the Editor-in-Chief of The Fix.