Unveiling his final National Drug Control Strategy, President George Bush cited a long-term decline in adolescent use of illicit drugs and stressed the need for more action to reduce prescription drug abuse and crack down on Internet pharmacies. But critics said Bush's success claims are overblown and that the White House's Office of National Drug Control Policy (ONDCP) lacks credibility and -- increasingly -- relevance.

Drug czar and ONDCP director John Walters said that President Bush's goal of reducing youth drug use by 25 percent over five years has nearly been achieved, with use of illicit drugs down 24 percent among adolescents since 2001. However, while reported use of marijuana, ecstasy and methamphetamine have declined sharply, misuse of prescription medications has risen.

"Our drug control strategy will continue all three elements of this successful approach," including law enforcement, prevention and treatment, said Bush on March 1. "It will also target a growing problem -- the abuse of prescription drugs by youth."

"Prescription drug abuse is an area of serious concern, and we are now focusing our nation's supply, demand, and prevention policies with the goal of seeing the same reductions that we have achieved for illegal 'street' drugs," said Walters, who noted that the National Youth Anti-Drug Media Campaign, previously focused largely on marijuana use, is now being used to educate parents about prescription-drug abuse as well.

Both Walters and Bush called on Congress to pass legislation cracking down on online pharmacies and beefing up requirements that prescribing doctors first examine their patients in person. "It describes what a legitimate relationship, medical relationship is for the purposes of writing prescriptions of these controlled substances," Walters said of the legislation.

Walters also hailed the expansion of federally funded student drug-testing programs to 80 school districts nationally; increased screening, brief interventions, and referral to treatment (SBIRT) programs in healthcare settings; and the Access to Recovery treatment voucher program, which he said has resulted in 190,000 people with addiction getting services.

Some Prongs Longer than Others

Walters and Bush focused many of their comments on drug-use trends and demand-reduction efforts, but critics contend that the administration's repeated reference to a balanced three-pronged antidrug strategy is a fallacy.

"The Strategy in its current form is neither balanced nor cost-effective," said Rosalie Liccardo Pacula of the RAND Corporation, who testified on antidrug priorities before a hearing of the House Domestic Policy Subcommittee of the Oversight and Government Reform Committee on March 12.

Pacula estimated that domestic law enforcement, interdiction, and international programs represent more than 65 percent of the administration's FY2009 anti-drug budget request. "Moreover, the ONDCP budget continues to omit large items from the enforcement side of the budget, namely the cost of prosecuting and incarcerating drug offenders in the federal system, which may well add as much as $5 billion to total expenditures," she said.

Pacula added that the administration continued to fund enforcement programs that "have no scientific support showing that they impact drug use," such as payments to the Colombian government intended to increase the cost of producing cocaine and paying Afghan farmers to grow crops other than opium poppies. She also criticized ONDCP's failure to take a leading role in promoting effective school-based prevention curricula and instead focusing its prevention efforts on the National Youth Anti-Drug Media Campaign -- a "well-documented failure."

"By cutting the budget for programs lacking scientific support or strong analytic arguments and reallocating those funds to program areas that are known to be effective, the nation will have a much better chance of successfully reducing substance abuse," said Pacula.

All About the Kids?

Both Pacula and former ONDCP staffer John Carnevale, who helped develop the annual drug-control strategies under three different "drug czars," criticized ONDCP for focusing its drug strategy and claims of success on a narrow interpretation of youth drug use trends while giving short shrift to adult use, which has not declined at all during the Bush administration.

"ONDCP is not serving the nation's interest in addressing the drug problem," said Carnevale. "It has ignored many of its legal responsibilities to address the drug-control problem and, most seriously, it is now misinforming the nation about its overall progress in reducing drug use."

Carnevale disputed the administration's claim that the nation has reached a turning point in the war on drugs, contending that ONDCP has overstated reductions in youth drug use. "Regardless of when they first initiate into drug use, about 50 percent of youth report having tried an illicit substance by the time they complete high school," he said, a figure that has changed little since 1995. "In other words, while initiation into drug use seems to be somehow delayed, our nation has achieved no progress in reducing illicit drug use by the time youth graduate from high school."

ONDCP's Future Role

Criticism of the imbalanced budget for drug demand and supply reduction has been around almost as long as ONDCP itself, but Carnevale said that widespread skepticism about the agency's reporting and effectiveness has put ONDCP's future in doubt.

"Congress intended ONDCP to be truly nonpartisan and to formulate policy based on evidence and to measure the progress of that policy using a performance-measurement system" that has since been abandoned, said Carnevale. As a result, the agency has failed to live up to its statutory requirements to provide a comprehensive accounting of national drug-control spending, and also has fallen short on the tasks of coordinating policy across the federal bureaucracy, establishing comprehensive and measurable policy goals and objectives, and promoting knowledge dissemination.

"As a result of these failures, ONDCP is no longer seen as a serious player in the drug issue," Carnevale told Congress. "It has become just another federal agencies involved in some aspects of drug policy, but its vital leadership role has been misplaced.

Experts still see a role for a reformed ONDCP, however. "Given that the federal government funds the bulk of prevention programs delivered within the states, ONDCP as the coordinating agency for all federal agencies and departments is in the most advantageous position to lead the prevention system toward the adoption of scientifically proven programs that would be effective at combating the initiation of methamphetamine and prescription drugs as well as marijuana and other drugs," said Pacula.

ONDCP has taken a positive leadership role in overcoming barriers to addiction treatment by supporting SBIRT programs, added Pacula, but the agency could do far more, including supporting parity legislation, she said.

"ONDCP must return to being a policy office, one that administers very few drug-control programs that so often interfere with its original policy mission," such as the Drug-Free Communities program, said Carnevale. "It must develop policies based on what the research tells us is effective in reducing demand and its damaging consequences. It must coordinate and propose to Congress on behalf of the administration a budget that logically implements the evidence-based policy."