Comment: The following Editorial reports two separate events. One, the
formation of The Physician Leadership Group on Drug Policy represents a
signal achievement by David Lewis and his associates. Dr. Lundberg, author
of the editorial is a member of that group. The other is an overdue, but
nevertheless remarkable act of responsibility by the AMA itself. I've
altered the format of the original article by separately listing each group
of physicians after the section of the report which deals with them. Tom
O'Connell

New Winds Blowing for American Drug Policies

On July 8, 1997, a starstudded group of American physicians (the
selfnamed "Physician Leadership on National Drug Policy") met at the New
York Academy of Medicine in New York City. Organized by David C. Lewis, MD,
chaired by June E. Osborn, MD, facilitated by Kenneth I. Shine, MD, and
funded by grants from the MacArthur Foundation and the Open Society
Institute, this group of physicians (listed at the end of this Editorial)
met to discuss our largely failing US national policy on illicit drugs and
to ponder new approaches.

Believed to be the first such group of highly placed US physicians to so
meet on this subject in this century, the physicians actively debated the
many aspects of this complex and difficult problem. The group agreed on the
following:

Consensus Statement Physician Leadership on National Drug Policy

Addiction to illegal drugs is a major national problem that creates
impaired health, harmful behaviors, and major economic and social burdens.
Addiction to illegal drugs is a chronic illness. Addiction treatment
requires continuity of care, including acute and followup care strategies,
management of any relapses, and satisfactory outcome measurements.

We are impressed by the growing body of evidence that enhanced medical and
public health approaches are the most effective method of reducing harmful
use of illegal drugs. These approaches offer great opportunities to
decrease the burden on individuals and communities, particularly when they
are integrated into multidisciplinary and collaborative approaches. The
current emphasison use of the criminal justice system and interdiction to
reduce illegal drug use and the harmful effects of illegal drugsis not
adequate to address these problems.

The abuse of tobacco and alcohol is also a critically important national
problem. We strongly support efforts to reduce tobacco use, including
changes in the regulatory environment and tax policy. Abuse of alcohol
causes a substantial burden of disease and antisocial behavior that
requires vigorous, widely accessible treatment and prevention programs.
Despite the gravity of problems caused by tobacco and alcohol, we are
focusing our attention on illicit drugs because of the need for a
fundamental shift in policy. As physicians, we believe that:

* It is time for a new emphasis in our national drug policy by
substantially refocusing our investment in the prevention and treatment of
harmful drug use. This requires reallocating resources toward drug
treatment and prevention, utilizing criminal justice procedures that are
shown to be effective in reducing supply and demand, and reducing the
disabling regulation of addiction treatment programs.

* Concerted efforts to eliminate the stigma associated with the diagnosis
and treatment of drug problems are essential. Substance abuse should be
accorded parity with other chronic, relapsing conditions insofar as access
to care, treatment benefits, and clinical outcomes are concerned.

* Physicians and all other health professionals have a major responsibility
to train themselves and their students to be clinically competent in this
area.

* Communitybased health partnerships are essential to solve these problems.

* New research opportunities produced by advances in the understanding of
the biological and behavioral aspects of drugs and addiction, as well as
research on the outcomes of prevention and treatment programs, should be
exploited by expanding investments in research and training.

During the next year, Physician Leadership on National Drug Policy will
review the evidence to identify and recommend medical and public health
approaches that are likely to be more costeffective, in both human and
economic terms. We shall also encourage our respective professional
organizations to endorse and implement these policies.

The group agreed to think, study, consult, and commission, research papers
on the spectrum of intervention opportunities dealing with illicit drug use
and with harm reduction strategies from both the supply and demand sides,
recognizing the complex texture of pragmatic realities, political
imperatives, and moral feelings that permeate this field. The group plans
to meet again in summer 1998 to assess progress and hopes then to make
major national drug policy recommendations based on scientific evidence.

Physician Leadership on National Drug Policy group: Errol R. Alden, M D,
Jeremiah A. Barondess, MD, Floyd E. Bloom, MD, Thomas F. Boat, MD, Edward
N. Brandt, Jr, MD, PhD, Lonnie R. Bristow, MD, Christine K. Cassel, MD,
Linda Hawes Clever, MD, George D. Comerci, MD, Richard S. Corlin, MD, James
E. Dalen, MD, Catherine D. DeAngelis, MD, Spencer Foreman, MD Willard
Gaylin, MD, H. Jack Geiger, MD, Alfred Gelhorn, MD, David S. Greer, MD,
Howard H. Hiatt, MD, Jerome P. Kassirer, MD, David A. Kessler, MD, Philip
R. Lee, MD, David C. Lewis, MD (project director), George D. Lundberg, MD,
Joseph B. Martin, MD, PhD, Antonia C. Novello, MD, MPH, Claude H. Organ,
Jr, MD June E. Osborn MD (chair), Robert G. Petersdorf, MD, P. Preston
Reynolds, MD, PhD, Frederick C. Robbins, MD, Allan Rosenfield, MD, Stephen
C. Scheiber, MD, Seymour I. Schwartz, MD, Harold Sox, MD, Robert D. Sparks,
MD, Louis W. Sullivan, MD, Allan Tasmam MD, and Donald D. Trunkey, MD.

Council on Scientific Affairs Recommendations

On a separate but related front, the House of Delegates ot the American
Meclical Association (AMA) approved the following recommenclations of the
Council on Scientific Affairs (members are listed at the end of this
Editorial) on June 25, 1997, making them AMA policy:

1. That the AMA encourage national policymakers to pursue an approach to
the problem of drug abuse aimed at preventing the initiation of drug use,
aiding those who wish to cease drug use, and diminishing the adverse
consequences of drug use.

2. That the AMA encourage policymakers to recognize the importance of
screening for alcohol and other drug use in a variety of settings, and to
broaden their concept of addiction tl eatment to embrace a continuum of
modalities and goals, including appropriate measures of harm reduction,
which can be made available and accessible to enhance positive treatment
outcomes for patients and society.

3. That the AMA encourage the expansion of opioid maintenance programs so
that opioid maintenance therapy can be available for any individual who
applies and for whom the treatment is suitable. Training must be available
so that an adequate number of physicians are prepared to provide treatment.
Program regulations should be strengthened so that treatment is driven by
patient needs, medical judgment, and drug rehabilitation concerns.
Treatment goals should acknowledge the benefits of abstinence from drug use
or degrees of relative drug use reduction.

4. That the AMA encourage the extensive application of needle and syringe
exchange and distribution programs and the modification of r estrictive
laws and regulations concerning the sale and possession of needles and
syringes to maximize the availability of sterile syringes and needles,
while ensuring continued reimbursement for medically necessary needles and
syringes. The need for such programs and mod)fication of laws and
regulations is urgent, considering/he contribution of injecting druguse to
the epidemic of human immunodeficiency virus infection.

5. That the AMA encourage the undertaking of comprehensive research into
the potential effects, both positive and adverse, of relaxing existing drug
prohibitions and controls and that, until the findings of such research can
be adequately assessed, the AMA reeffirm its opposition to drug
legalization, with a report back on the status of such research at the
interim meeting of 1998.

6. That the AMA initiate and support legislation revoking the 1988 federal
ban on funding for needle exchange programs for injecting drug users.

7. That the AMA strongly encourage state medical associations to initiate
state legislation modifying drug paraphernalia laws so that injection drug
users can purchase and possess needles and syringes without a prescription.

Pretty remarkable events, independent but less than 1 month apart. After a
while, despite entrenched ideology, intelligent and concerned people can
lead toward new thinking on seemingly insoluble problems. Let us all hope
that the new solutions proposed can be more effective than the old for the
health of our people.

Council on Scientific Affairs: Roy D. Altman, MD, Rebeeca Bezman (student),
Ronald M. Davis, MD, Scott D. Deitchman, MD, MPH, Myron Genel, MD, John P.
Howe 111, MD, Mitchell S. Karlan, MD (chair), Nancy H. Nielsen, MD, PhD,
Joseph A. Riggs, MD, Priscilla J. Shanetz, MD, MPH (resident), Michael A.
Williams, MD, and Donald C. Young, MD.

George D. Lundberg, MD

Dr Lundberg is the Editor of JAMA
Reprints: George D Lundberg, MD, JAMA, 515 N State St. Chicago, IL 60610
(email: George_Lundberg@amaassn org)