Why do we talk about a "Drug Czar?"

Jaffey, Bennett, Kerlikowske, Botticelli: Our official and unofficial czars

The other day one of our interns asked me where we came up with the term “drug czar,” and I shrugged and said I imagined it was a relic of the 70s when we first declared a national War on Drugs and needed some iron fists to fight it.

It was silly to answer off the cuff because even as I was answering, he was googling and explaining that actually, the use of “czar” to refer to executive branch officials goes back to Franklin Roosevelt. In fact, America has had lots of czars: a transportation czar, a shipping czar, a synthetic rubber czar. And that Joe Biden actually coined the term “drug czar.”

“Really, Joe Biden?” I said.

To back up a bit, “drug czar” is a colloquial term for the Director of the Office of National Drug Control Policy (ONDCP), a position in the Obama administration that until recently was filled by R. Gil Kerlikowske and is now held by Acting Director Michael Botticelli.

The ONDCP is the policy and coordinating arm of the federal government’s drug control efforts. Although the ONDCP operates its own programs (Drug Free Communities Support, High Intensity Drug Trafficking Areas), its major function is to make sure that federal agencies and departments are all swimming in the same direction and not duplicating efforts with regard to drug use and its harms.

There are a lot of cooks in this particular kitchen, which makes the ONDCP’s job complicated.

Every year, the ONDCP signs off on portions of many, many agency budgets that somehow pertain to substance use. In addition to the Departments of Justice and Health and Human Services (where the largest expenditures were authorized), in 2013, the ONDCP also approved dollars spent by the Forest Service and the Bureau of Land Management (e.g. to disrupt marijuana cultivation), the IRS (e.g. to investigate drug-related money laundering), and Job Corps and the Federal Aviation Administration (e.g. to provide drug testing and education for employees), among others.

So it makes sense that the head of the ONDCP would earn the title of “drug czar,” since according to linguist Ben Zimmer, czars are “those interagency point people charged with cutting through red tape to coordinate policy,” and the ONDCP was designed to do just that.

Joe Biden: “One person to call the shots”

William Bennett, shortly before his appointment to the ONDCP
Photo: Wikimedia Commons

In 1982, when then-Senator Biden first coined the term “drug czar,” we didn’t have one. He was pointing out that drug reduction efforts in the U.S. needed someone to coordinate efforts between state departments and agencies, “one person to call the shots.”

At the time, the War on Drugs was just heating up. In calling for a drug czar, Biden was responding to President Reagan’s new ”bold, confident plan to intensify the war on narcotics,” which involved sending teams of FBI agents, DEA agents, and federal prosecutors to eight major cities in the U.S. to “concentrate on intensive, long-range investigations of organized drug trafficking.”

He didn’t get his wish until six years later, when the passage of the Anti-Drug Abuse Act of 1988 created the ONDCP with a cabinet-level director. Our first drug czar, William Bennett was (and is) a wholehearted proponent of the War on Drugs.

Retrospectively, many have referred to Dr. Jerome Jaffey as America’s first drug czar, appointed in 1971 by President Nixon to what was then called the Special Action Office for Drug Abuse Prevention. Since the Roosevelt era, political “czars” in the U.S. have been almost always appointed by the president, often on an ad hoc (as-needed) basis, to focus on a particular issue. That’s an apt description of Jaffey’s role.

And by many measures, Jaffey was an exemplary czar: he identified the need for a drug strategy that cut across agencies, set up methadone clinics all over the country, established the National Survey on Household Drug Use and Health (NSDUH) and the Drug Abuse Warning Network (DAWN), and the earliest drug courts. He led a complex overhaul of our country’s response to drugs and drug use, focusing particularly on demand reduction.

Do we have a drug czar today?

As an ad hoc appointee to create new infrastructure and articulate priorities, Jaffey fit the bill of a “czar.” But what good is the “drug czar” analogy today?

The Director of the ONDCP is not an ad-hoc appointee charged with creating sweeping reform to our national response to substance use and its harms. While the Obama Administration has committed to a “balanced approach” and reduced interdiction spending in favor of prevention and treatment, these changes have been incremental.

And as an analogy, “drug czar” seems too entangled with the War on Drugs. Like the “War on Drugs,” it draws on the wrong model of substance use and addiction, conceptualizing “drugs” as a time-limited issue in need of ad hoc solutions.

If, indeed, substance use-related problems could be solved by appointing a czar or a task force, declaring a war, or even passing a legislative package, our job at IRETA would be done. But substance use and associated problems are embedded in individual and community health. This is why Kerlikowske tossed the term “War on Drugs” in 2009 when he joined the ONDCP, explaining:

“Regardless of how you try to explain to people it’s a ‘war on drugs’ or a ‘war on a product,’ people see a war as a war on them,” he said. “We’re not at war with people in this country.”

Although “drug czar” won’t die quickly because it’s the kind of term the media loves–it condenses “bureaucratic mouthfuls” and fits nicely into headlines–the ONDCP itself seems to be moving decisively away from analogies rooted in dictatorship and war. The replacement of Kerlikowske by Acting Director Botticelli means that the leader of the ONDCP is, for the first time, a representative of the public health community and specifically an advocate for addiction recovery.

How will Botticelli feel about being called the “drug czar?”

To my knowledge, he hasn’t weighed in on the matter publicly, but it seems unlikely to be the sort of title he’d embrace. I had the privilege of listening to his opening plenary speech at the American Association for the Treatment of Opioid Dependence (AATOD) conference last November, where he told the audience he had just celebrated 25 years in long-term recovery.

He said he’d been hesitant to share his anniversary publicly because he didn’t want to hog the limelight with his personal story, but that he did it to reduce stigma and offer hope to people seeking recovery, sounding not remotely like a czar leading a war against drugs and the people who use them.