Prevention Profiles: Take Five - James W. Carroll (Director of the Office of National Drug Control Policy)

Rich Lucey: Hi, this is Rich Lucey with Drug Enforcement Administrations' Community Outreach and Prevention Support Section and welcome to this episode of our podcast series "Prevention Profiles: Take Five."
 
Very excited about today's podcast and our guest James Carroll.
 
He's the Director of the Office of National Drug Control Policy.
 
And before I get talking with Director Carroll, let me tell you a little bit about him.
 
The Honorable James W. Carroll is Director of National Drug Control Policy in the Executive Office of the President.
 
He was unanimously confirmed by the United States Senate on January 2, 2019 and sworn in on January 31 of 2019.
 
Mr. Carroll previously served as the Acting Director and Deputy Director from February of 2018 to January 2019.
 
Prior to joining the Office of National Drug Control Policy, Mr. Carroll served as Assistant to the President and Deputy Chief of Staff at the White House.
 
Previously in the administration, Mr. Carroll served as General Counsel of the Office of Management and Budget and as Deputy Assistant and Senior Counsel to the President.
 
Mr. Carroll began his career as a State Prosecutor in Virginia after earning his bachelor's degree from the University of Virginia and his J.D. from the George Mason University School of Law.
 
With that, Dr. Carroll, welcome to the podcast.
 

James Carroll: Rich, I'm real excited to be here.
 
Thank you and thank Drug Enforcement Administration for having us.
 

Lucey: Absolutely.
 
So the typical format for our podcast series is a series of five questions that I will pose to you.
 
But before I get into the five questions, would you mind telling us a little bit about ONDCP, its role and your role as the Director?
 
 
Carroll: So my role as Director is also more commonly known as the U.S. Drug Czar.
 
And it's our responsibility here at the White House to oversee the almost 40 billion dollars the U.S. government is spending tackling this issue.
 
And for your listeners who are affiliated with DEA, we oversee the entire budget of DEA as an example.
 
And our National Drug Control strategy here at the White House is really focused on three issues.
 
It's eradicating drugs.
 
It's keeping drugs out of the United States, keeping traffickers in jail, and obviously that is one of the primary goals of the DEA.
 
So it's a great opportunity to partner with DEA as well as our state and local law enforcement to keep drugs off the streets.
 
The other important thing that we're doing here is the oversight of treatment and getting help to those people that are suffering from an addiction.
 
In the last two years under this President we have 20% more people than ever before getting treatment.
 
It's turning their lives around.
 
It's making them productive citizens, terrific parents, children, and so it's a great opportunity to get them back in.
 
And then, Rich, I'm real excited to be with you today to talk about the third step of prevention, of making sure that more people don't go down this path and start an addiction.
 
And so it's a great opportunity to be with you and talk about the important message that you're spreading.
 
Lucey: Absolutely and we're thrilled to have you as our guest on the podcast.
 
And for our listeners, as Director Carroll was saying, I think when people think of which agencies are touching the drug issue, they think of DEA, SAMHSA, NIDA, NIAAA, but really there are other agencies that you might not be thinking of like Homeland Security, Customs and Border Patrol.
Carroll: Department of Agriculture, Department of Interior.
 
It really is a whole government approach and it's a dozen different departments, agencies, Department of Defense.
 
So many different groups are involved in this, keeping the homeland safe.
 
And that is at the end of the day that is what we need to do is we need to save lives, and we do that by having a strong country dedicated to these people that are suffering from addiction, being compassionate with them, making sure that they understand that there's help out there and not letting more people go down this path.
 
Lucey: Absolutely.
 
Well, I'm going to delve into the first of our five questions which has to do with one of, I would arguably say one of the ONDCP's flagship programs, the Drug-Free Community Support Program.
 
In the most recent evaluation of the DFC program reported decreases in alcohol, tobacco, marijuana, prescription drug misuse by middle and high school students, and that's really good news.
 
But we know from research that the 18-25 age group have some of the highest rates of drug use if you look at the national survey on drug use and health, the Monitoring the Future study.
 
So I have a two-part question to start.
 
How might colleges and universities benefit from being involved in their local  DFC's current efforts?
 
 And then second, might there be potential for the DFC program to expand to also include young adults in general, college students in particular?
 
 
Carroll: Well, you can appreciate, Rich, we have to follow the mandate that Congress gave us.
 
And what they have said is they want this Drug-Free Community Program to really target kids in high school and younger to make sure they don't go down this path.
 
You have to start young.
 
If we waited until they were in college, we're waiting too late.
 
So we start at a young age.
 
We fund almost 800 across the country, all 50 states, our territories, spreading the message about the dangers of drug use.
 
But what's great is so many of these kids graduate from high school.
 
They have experience in a Drug-Free Community Program.
 
The go to college and they participate.
 
They start.
 
They star in some of the prevention programs on campus, taking the program with them, taking what they've learned and making sure that they're spreading the message.
 
So if we had more money, we would love to be able to be on college campuses to support some of their efforts.
 
We do in other ways but not through the Drug-Free Community Program.
 

Lucey: I know from my previous role working for Fran Harding at CSAP before I came to DEA that there were colleges and universities who actually were heavily involved in their local DFC.
 
And as you've said, we're starting early because we know that research tells us early onset, we need to target that.
 
And I think we are making a difference with that foundation because we know in college the alcohol misuse issue is really going down which is good.
 
I'll get into some other drugs that are not so good at the moment.
 
But yeah, I definitely understand why the need to target the middle schoolers particularly and then high schoolers and on up.
 

Carroll: I mean working for Fran you understand.
 
Fran is terrific.
 
She understands this message.
 
I know you do as well.
 
And that's why it is so important.
 
I was with a group of middle school students yesterday in New Hampshire and hearing about the Drug-Free Community Programs up there.
 
In New Hampshire alone we have twelve different programs covering almost the entire state.
 
And they really work, and the statistics show it.
 
What we know is that since 2005 about 49% of Americans have lived in a Drug-Free Community Program.
 
And now under President Trump we have more Drug-Free Community Programs than ever before.
 
But obviously if we can get more funding from Congress; we're working with them now to try to expand this program.
 
We're out in rural areas and we're in some urban areas.
 
We've got to be able to cover everything in between.
 
It's an opportunity for kids to get excited about this.
 
They work well together.
 
And it's not parent led.
 
It's not teacher led.
 
It's really student led, which really makes it more effective.
 
On the prevention side, they're going to listen to their peers more than they're going to listen to an adult.
 
 
Lucey: Absolutely.
 
 
Carroll: And that's why having kids out there spreading the message is just fantastic.
 
 
Lucey: So for our listeners, especially those of you working on colleges and universities, we often have a phrase "to invite yourself to the table".
 
And educational institutions, colleges, fit within that.
 
They are a required sector, one of the twelve of DFC.
 
So if you want to find out more or find out a way to get involved, they should, you know, contact ONDCP.
Carroll: Right, they can go on our website and we can put them in touch, and you can find them.
 
Like I said there are 786 of these programs across the country, and so it's a great opportunity to be involved in something that's really meaningful, that's really lifesaving work.
Lucey: Absolutely.
 
So I'm going to pivot now to I mentioned we were seeing good declines in alcohol misuse among college students.
 
Marijuana is a different story.
 
The recent Monitoring the Future study shows that college students' use of marijuana is at its highest level seen in the past 35 years.
 
The same study also shows that vaping of marijuana and of nicotine each doubled for college students between 2017 and 2018.
 
So with what we know about drug abuse research on the developing brain, and I know the U.S.
 
Surgeon General recently came out with an advisory on marijuana use and the developing brain.
 
What would you say is the primary takeaway for colleges and universities as they work to prevent marijuana use among college students?
 
 
Carroll: It's important to know that the marijuana that's out there today is not the marijuana that existed 20 years ago or even 10 years ago.
 
The amount of THC, the chemical in marijuana that makes you high, has doubled, tripled since it was in the past.
 
And in the edibles it's even higher.
 
And now of course what we're seeing is vaping.
 
And as of now I believe there have been 13 confirmed deaths from vaping.
 
And from reading the news, it seems that the vast majority of those involved the vaping of THC.
 
And so that's very concerning.
 
What it shows is that we're working together closely with DEA to make sure there's more research being done.
 
The DEA has made a lot of strides in opening up research, making sure that we understand the negative impacts as well as if there are any health benefits to a derivative of marijuana.
 
We've seen that already.
 
Last year the first derivative of marijuana was approved by FDA for epilepsy in kids.
 
But it's done in a regulated manner.
 
They control the dosage and there's no THC.
 
But it's a drug that works for epilepsy.
 
More research will find other impacts of marijuana use.
 
But in the meantime let's listen to the Surgeon General.
 
Let's be very careful with this product.
 
And it seems to be sadly fatal in many instances now across the country.


Lucey: Absolutely.
 
I'm glad you reiterate the point about the THC content because it's exponentially larger now than it was even five, six, seven years ago.
 
It's doubled.
 
It's tripled.
 
I've always been very concerned about the edibles because they're so unregulated it seems.
 
And people will pop a gummy bear or two, and they're not getting high, and all of a sudden they're taking three or four or five more thinking that's going to make it happen quicker.
 
The next thing you know there is an overdose or there is a severe adverse effect because of this.
 
 
Carroll: Yeah, and it's really; you know, you talked about a gummy bear and I'm glad you said that, Rich, because some of the edibles really look like candy.
 
And you have to worry about the marketing, who's the target audience for gummy bears.
 
And you have to think it's not a fully grown adult.
 
And so that's very concerning.
 
We don't know the other makeup of these edibles, what's in there.
 
Again the research the DEA is leading on those to find out the exact composition and the long-term health impacts is crucial.
 
And Acting Administrator Dillon is really committed to saving lives, making sure the people understand this, and I applaud him.
 
And God bless the men and women of the DEA who are working so hard to save American lives.


Lucey: Yes, absolutely.
 
And you know, it isn't really just the edibles.
 
I know that when I toured Colorado when they first passed their legislation, I mean there's everything from creams to patches to everything you can put on your body.
 
And I was concerned about how that affects the drug-free workplace.
 
Like for example, I mean you can't see.
 
Somebody's not smoking a joint.
 
I mean that's the issue.
 
They're ingesting it in some other way.
 
That has an impact.
 
It must have an impact on workplace issues.


Carroll: It does, and in some of these areas what we're seeing is data that suggests workplace injuries are up.
 
Now correlation doesn't always equal causation, but obviously when you look at the emergency room visits going up, car accidents going up, workplace injuries going up, you have to wonder what really are the impacts.
 
And so that's why it's crucial we know exactly what's going on.
 
People make educated, well reasoned decisions and we find out what exactly they need to know.


Lucey: I didn't have this prepared but I do want to plug ONDCP's HIDTA, the High Intensity Drug Trafficking Areas.
 
For our listeners, if you haven't seen it, every year the Rocky Mountain HIDTA comes out with an annual report that looks at the impact of legalization of marijuana in the state of Colorado.
 
And it's a fascinating report.
 
Every year it comes out, and it gets exactly what you're talking about between the car crashes and the ER visits and things like that.


Carroll: And also it's really sad.
 
I was with Acting Administrator Dillon and we went out to the Sierra Nevada National Park.
 
It's gorgeous, this beautiful, pristine area.
 
People are illegally growing marijuana there.
 
These are drug traffickers.
 
This isn't, you know, a leftover hippie from the 1970's.
 
These are drug trafficking organizations from Mexico growing marijuana illegally, using pesticides and herbicides that are completely banned in the U.S.
 
Administrator Dillon and I were only allowed so close to these plants because the poison on these things is so deadly.
 
And people are consuming marijuana thinking, oh, this is, you know, it's an all-natural organic product, and it's not.
 
And then sadly what we also know is that in some situations we're really worried that fentanyl, the deadly drug that it can just be a few grams, has been sprayed on marijuana, sprayed on, you know, on pot and it's being consumed by people unknowingly.
 
And this is done intentionally by some of these drug trafficking organizations to get people hooked.
 
These people are, they're buying it on the street.
 
They're buying it in communities even where it's legal.
 
We have not eliminated the black market in areas where it's been legalized.
 
And these people are trying something they don't even know how deadly it can be.
 
And that's why the work of the DEA, the work of our office, Department of Education, so many agencies are out there trying desperately to educate people.
 
This is no longer; you know back, Rich, when we were growing up, you used to hear about people saying, oh, I experimented with "X", with something.
 
Experimentation is over.
 
We cannot take that chance.
 
If you're in college, if you're in high school, anywhere in between, anywhere on that spectrum, one pill can kill.
 
You can try something once at a party and consume it, and you're dead.
 
And this is what's happening.
 
People are dying in back rooms.
 
They're dying in parties.
 
They're dying everywhere because there's no more experimentation.
 
We don't know what's out there.
 
We have to stop it.
 
We've got to get the message out.
 
And that's why, Rich, what you're doing is just so vitally important, and it's such a great treat to be on with you.


Lucey: Thank you.
 
You mentioned that the one pill can kill, and I think that one of the messages that we at DEA have been trying to promote to elementary, high and college students is you don't know what you're putting in your system anymore.
 
I mean between the clandestine pills, the pill presses and fentanyl showing up, you just have no idea what you're putting in, including vaping, the issue of what's going on in those delivery systems, as I call them.


Carroll: Yeah, and we're seeing a lot of illegal, illicit vaping cartridges that are for sale that aren't done in a regulated, you know, factory.
 
And really people don't know at all what they're, what they're getting when they insert that cartridge.


Lucey: So I'll move on to our third question.
 
I mentioned DFC being a flagship of ONDCP, and I think one of the other foundational pieces of ONDCP is the National Drug Control Strategy.
 
And earlier this year ONDCP released the 2019 strategy.
 
I of course know what's in it from my work here as a federal employee.
 
But what would you like our listeners to know about how colleges and universities might see themselves in the strategy?
 
 Where would they fit?
 
 
Carroll: They fit in a couple places.
 
One is so many of these college campuses now have collegiate recovery programs.
 
I've been out there.
 
You mentioned Colorado.
 
I've been to a college campus in Colorado, I guess back in the spring.
 
And I've been on many college campuses where they have these CRP's, Collegiate Recovery Programs, and it's bringing kids in who maybe in high school had an addiction.
 
They stepped out of the school environment for a year or two.
 
They got their life back together.
 
They're in long-term recovery.
 
Colleges are admitting them.
 
They're taking them in, but they're also providing that structure, that warm supportive environment to say, hey, we know that you had a couple years that were rough.
 
We want you to be in college.
 
We want to help you.
 
We want to make sure that you graduate and get meaningful life skills and move on.
 
And it's phenomenal being with these Collegiate Recovery Programs across the country, seeing what they're doing out there.
 
And so that's one of the things that is critical that people understand.
 
And it sort of speaks to the larger issue of stigma, of people who have an addiction do not have a moral failure.
 
They have become addicted to something, sometimes through no fault of their own, through a prescription or taking, you know, a pill they didn't realize that was so addictive.
 
And so by putting our arm around them and saying we're going to help you through, that's one of the great things that is needed, and we talked about that in the National Drug Control Strategy.
 
And then of course like we talked about the message of prevention as well and making sure that college campuses are drug-free areas where it's not prevalent.
 
But by the same token, more and more places understand that if they encounter someone who is in possession of a drug that putting them in jail; the DEA knows this and you all have been talking about this for years, that possession of a drug does not mean you should go to jail.
 
If you have an addiction, you need treatment.
 
You need help.
 
And so when you're caught in a minor, nonviolent possession charge, it's getting people into diversion courts.
 
It's getting them the help they need, getting them in front of a judge who understands that treatment is a long-term process.
 
But we have a goal to get them in there and so the last thing we want is to have people who have the medical condition of addiction in a jail cell.
 
That's not productive for them.
 
The DEA knows that.
 
We know that.
 
And that's really why we're very supportive here.
 
We make a huge financial investment on establishing diversion courts across the country.
 
Again more money than even before under President Trump for these diversion courts to keep people who have an addiction, is to keep them out of jail.
 
And so going to the diversion courts.
 
And Rich, I'd love to go with you sometime to one of these diversion courts and see a graduation of these people who are now successfully into recovery.
 
They're not going to jail for a minor offense.
 
And I tell you it's just incredibly moving.
 
We'll both have tears streaming down our eyes.
Lucey: Absolutely, yes.
 
I love the image that you just portrayed of the college putting their arms around the student.
 
I've been in this drug abuse prevention field for a bunch of years.
 
And it used to be, and we still say it to a degree, but a student who might have to leave school because of a substance use disorder or they're just seen; it's having a negative impact on their life.
 
Then they come back to campus where the culture has not changed.
 
It's a very dangerous environment if you will for someone who is dealing with an addiction or somewhere along the continuum along those lines, and the aftercare (that's what we used to call it) was sometimes nonexistent.
 
And some of these students would come back to school and end up right in the same boat they were earlier because they didn't have a formal CRP like they did or other formal mechanisms to really support the student with their, as you called it, as it rightfully is called a medical condition.


Carroll: And some colleges now have Safe and Sober living, dorms where the use of alcohol, use of drugs are simply not tolerated whatsoever.
 
So it's a much safer environment, especially for these kids that are coming back to school.
 
So they're coming back in an environment where there is more safety and where there are peers to help them, that if they're feeling weak one day, if they feel like they're going to succumb and relapse that there's people around them to put their arm around them and say we're going to help you.
 
There's a saying that there's two relapses.
 
The first one is when you decide to use again, and the second relapse is when you actually do.
 
If you're around people who are peers, they'll recognize that you have made the mental decision I'm going to go back.
 
And that's when a peer can step in and say, look, I see where you're going.
 
I know where you're headed.
 
Please don't do it.
 
Let's go together.
 
Let's talk this through.
 
Let's work this out.
 
And so we have to catch them before they make that next step.
 
And so that's why it's really so important.
 
And just like you said, if one of these kids is missing a semester because of a medical condition; you know, I had one of my family members had their appendix taken out.
 
One of my nephews had their appendix taken out and missed a semester of college and came back to school, and the teachers helped him get back on track.


Lucey: Wouldn't think twice about it.


Carroll: No! And that's the way we need to think about this is to say, hey, we're so glad you're back.
 
What can we do to support you?
 
Let's get you on track to graduate and let's put this behind you.


Lucey: Absolutely.
 
So a little bit earlier in the podcast I had mentioned a drug-free workplace, but I'd like to talk to you a bit about the workforce issues.
 
It seems like, so 29 years.
 
I've been in this field now for 29 years.
 
I think we're experiencing some challenges sustaining the workforce to respond to current and emerging drug issues.
 
We've talked about it for awhile that it seems like we're aging out.
 
And do we have the people coming in that need to be coming in in the prevention field, the treatment field, the recovery field who are trained properly also to do this work?
 
 So what are you recommendations with regard to getting young people excited about careers in prevention?
 
 
Carroll: First off, the fact that they can even have a career in addiction now is a wonderful thing.
 
Colleges now have degree programs for people in addiction.
 
Medical schools have specialties in addiction medicine.
 
And so there's really a wide range of services available for people to go and help others, and it's fantastic.
 
From ONDCP there are many fellowships that we support in other government agencies where loan repayment programs, where if you go to work as an addiction counselor helping people, it's like working in some of the other programs where we'll help you with student loan repayments because you're giving back to the community.
 
You're giving back to areas that need it.
 
And same thing for people in higher education on the medical side, fellowships where they're getting grants to go into addiction medicine.
 
And they're going back into communities sometimes that really don't have the medical professionals in that community to be able to do it.
 
There's new technology that's also sort of exciting, such things as telemedicine.
 
So some of these folks that are going to go into this field can do so sitting over a laptop with a monitor and treating folks in a completely different area where, maybe a rural area where they don't have access to transportation.
 
There aren't professionals around to get help.
 
And so it really is an exciting field, and it's growing.
 
And that's a great thing.
 
I mean it's sort of sad that we need them, but the wonderful part is, like I said, we have 20% more people going into treatment.
 
This is a great field to get into.
 
And the fact that we have more people going into this field shows that they're passionate about it as well.
Lucey: And that's the key word.
 
That's always been the key word for me is passion.
 
No matter what field you're in, you've got to have the passion for what you're doing in order to do it effectively I think.
 
 
Carroll: And you know that's true whether you're a peer recovery specialist or whether you're a physician.
 
This is some of the most rewarding work that is out there.
 
You are truly helping another person, and another person who is really struggling, another person whose family might be separated from support from there or the community has seen them gone through the system, cycle through over and over again, and you're reaching out.
 
You're touching them in ways that no one else can.
 
And these people that do it every day, these are special people.
 
I'm blessed to be able to work with some of them here who make sure at the federal level we're doing it but also, and Rich, you're out there.
 
I travel the country and you meet some of these people that are out there, and you meet some of the people that they're helping, and you realize this is why we do it.
 
This is why the DEA is out there.
 
This is why ONDCP is out here.
 
The President is committed to it.
 
Administrator Dillon is committed to it, and I'm committed to it.
 
 
Lucey: Well, we appreciate that and all of the support.
 
As you said, I think that sometimes if we're presented with somebody before us who is struggling, you don't know if in their minds you might be their last hope.
 
 
Carroll: That's right.
 
You might be their last one.
 
That's a great way to say it.
 
If we're going to be moral human beings, we have to care for another person as we find them.
 
Accept them for who they are.
 
Wrap them up and say we're here to help.
 
You're passionate about this too, Rich.
 
I can tell.


Lucey: Yes, I am.
 
So as we wrap up the podcast with our fifth question, as I typically do with our guests, and give you the opportunity, what would you say to encourage the professionals who are working to prevent drug abuse among college students as well as the students themselves who are listening to this podcast?
 
 
Carroll: Be strong.
 
You can do this.
 
God bless you.
 
We're all praying for you.
 
We need you to be successful.
 
We need you to spread the gospel of the truth that's out there and recognize that the good that you are doing is going to pay dividends not just now but I truly believe in generations to come.
 
We're going to turn this around.
 
Rich, you mentioned that you've been doing this for 29 years.
 
How appropriate.
 
We are now; we just announced a few months ago for the first time in 29 years we have reduced the number of Americans that are dying from a drug overdose.
 
So in three decades we've now, for the first time, reduced the number of Americans who are dying.
 
Still way too many are.
 
We can't declare success by any stretch.
 
But what I hope and pray is it shows that there are so many dedicated people out there across the board from law enforcement to prevention specialists, to treatment, to peer recovery, to employers who are hiring people who are in recovery.
 
I really believe that we're beginning to see the fruits of the hard work that so many people have done.
 
So thank you for what you have done.


Lucey: Well, I appreciate the advice to be strong.
 
So for our listeners, I know sometimes working on college campuses you may feel isolated or that you're the only person working on this issue and it gets kind of depressing at times.
 
Know that you're not.
 
You've got a lot of support among your colleagues at other colleges around the country and at the state level and here at the federal level.
 
I know certainly for DEA and ONDCP we're here to do what we can.


Carroll: Absolutely.
 
And if you're in college and you want an internship, apply for internships here at the White House at ONDCP.
 
I know DEA has internships.
 
And so there's a lot of opportunities to work at a national level to help as well.


Lucey: That's a great note to end on.
 
So Director Carroll, thank you so much for joining us.
 
It's been a pleasure.


Carroll: Thank you, Rich.


Lucey: And to our listeners, we appreciate you tuning in to this episode of "Prevention Profiles: Take Five".
 
With that I'm going to wish you a great day and thanks again for listening.