On October 1, just one month before Californians voted on Proposition 19, Sasha Abramsky spoke by phone with Gil Kerlikowske, director of the Office of National Drug Control Policy, about prospects for drug reform in America. Below is an edited transcript of the discussion. Click here to listen to a podcast of the full conversation.

America has obviously been fighting a war on drugs for close to forty years at this point. What do you see as being that war’s major successes—it’s D-Day landings, if you like—and what do you see as being its signal failures?

It’s easier to start with its signal failure. And that is to categorize the drug problem in the United States and the world as a war. As you’ve seen over the forty years we’ve had lots of different discussions around the term "war." War usually has a specific enemy, oftentimes fairly easily identifiable, and there’s an outcome—a win or a loss. And all of those things do not apply very well to the complexity of the drug problem. But there are some wins in some areas outside of the war analogy. The work the United States has done over the years in Colombia and the reduction of its coca crops, improvement in personal safety and the security of the government, and reductions in opium—poppy cultivation. The other win to bring to your attention—even though it was a simple phrase—"Just say no," under Nancy Reagan. Successive administrations have recognized the issue of the drug problem.

So even though you don’t like the phrasing, there was a public service in pushing it to the fore of the public discourse?

Yes. I think what we’ve seen over the years has been the drug problem is often something of a hidden problem or thought to be among minorities or among minority communities or the economically deprived. Now we talk about this problem much more publicly than we ever have. It’s important for any administration, regardless of party, to recognize the problems drugs cause among young people, the workforce, schools, in healthcare.

From the beginnings of the war on drugs, one of the consequences has been a greater proportion of criminal justice spending going toward drug interdiction and so on. On balance, has the country gotten bang for its buck?

It is misleading to characterize the drug efforts of the government—local, state and federal—with some type of definition of where the money is going. That’s incredibly simplistic and has done a disservice to the discussion. When it comes to "Should we be spending more money on prevention and treatment?" the answer is yes. It shouldn’t be an either/or, to take away money from interdiction or some other part. Part of the president’s strategy is, it really is comprehensive, and it doesn’t restrict collaboration or say law enforcement stays over here, prevention is over there, treatment is over there. These things should work in concert, be supportive of each other and be understanding of each others’ roles and missions and how they can help each other.

Obviously the drug issue transcends domestic issues. There’s a lot of concern at the moment that Mexico has become something of a narco-state and is at risk of becoming something of a failed state. How does that complicate US discussion of drugs and how to minimize the impact of drugs? Is it now more of a foreign policy conundrum than a domestic one?

I disagree that either it’s becoming or has any potential to become a narco-state or has any potential to become a failed state. After my four trips and multiple meetings here in the US with Mexican officials, and my seven trips to the southwest corner, I just disagree vehemently with either part of the last two statements.

Well then, let’s take it back a bit: if not a failed state, at least one bedeviled with extraordinarily high levels of violence associated with drug trafficking and money around drugs.

The extraordinary levels of violence are absolutely correct; and there is a drug nexus we have clearly seen in the last several years. The organized criminal cartels are becoming much more involved in other crimes in addition to drug trafficking. It’s a foreign policy issue as much as it is a law enforcement issue. But it’s also—I just came back from Lisbon—it’s also clearly a global issue.

There’s a lot of discussion among opinion-makers, the media and the general public about the spiraling cost domestically and overseas, about the way the war on drugs and drug policy has played out in recent years. And there’s a lot of evidence the political attitudes around the war on drugs are changing. We see that with medical marijuana laws, in California the significant support for Prop 19. Senator Webb is quite cynical about much of the drug policy. Where will American discourse on drugs head in coming years?

The president’s strategy that just came out in May is a very balanced and comprehensive strategy. I do not underestimate people’s frustrations or strong feelings about a lack of success in the war on drugs, whether in the US or worldwide. It’s been going on forty-five years, yet people still know their child can get drugs in high school, that their neighborhood has drug dealing, or they have a friend or neighbor or co-worker impacted by drugs. Where we have so clearly failed is not helping people understand there are very cost-effective, basic ways of working through prevention, understanding treatment can be effective and it’s half the cost of incarceration. We don’t have to throw up our hands as a nation and say the war on drugs has failed and therefore we have to go for legalization. We should look at these other prevention and treatment issues.

So is that where you see the direction of drug policy heading, as more of a medicalized issue defined in terms of treatment instead of punishment?

I do. There’s the president’s budget request for additional funding for prevention—science-based, evidence-based practices, additional funds for treatment. Talking about addiction as a disease. Recognizing in the new healthcare law that treatment for drug dependence and addiction is a part of primary healthcare. We’re making healthcare a huge issue [re drugs] when in the past it was seen as a criminal justice issue. It’s about being smart on drugs.

Let me continue on the political theme. What happens if Prop 19 passes in California in November, and then other states—Colorado, Oregon, Washington, say—what happens if a handful of states walk away from a central tenet of federal drug policy? Does it set up a constitutional crisis or something approaching that if states start taxing and regulating narcotic substances that at a federal level are still considered illegal?

Proposition 19 doesn’t say the state will tax and regulate and control; it says it will give authority to cities or counties if they wish to exercise that authority—and that’s if it passes. Now, on the constitutional issues, those are questions that are clearly best delivered to the Department of Justice. The other part is that no country has legalized drugs. And I think that countries throughout the world recognize drugs can be quite dangerous and have terrible effects on their populations, and there are important and necessary efforts to regulate them. Arresting people for violations around drugs is not in many cases the smartest way to deal with the disease of addiction.

But what happens if California becomes the first state in the world to try to create a legalized market for marijuana?

I wouldn’t speculate what would happen if Prop 19 passes. But I would go back to the original point the Justice Department has made, is it is still a violation of federal law.

If Prop 19 becomes a footnote at some point, there’s still this much broader issue of the redefining of drugs more as a public health crisis than a criminal justice issue, especially when it comes to lower-end users, the lower parts of the drug economy. That’s a linguistic shift, but it’s also a huge psychological shift, because for a generation a large part of the public has been conditioned to think the only way to fight drugs is through the criminal justice system. How do you bring conservative critics or commentators along for the ride on this reform journey?

There are conservative critics who were mostly my colleagues for many years, who are already there. They recognize, and will clearly tell you, whether they’re police chiefs or narcotics detectives, that merely trying to make arrests, make seizures, trying to incarcerate, is not a particularly smart way of addressing the drug problem here in the United States. Every state is looking at how to reduce their prison population, their criminal justice costs, and at the same time keep their communities safe. If there are ways like the Hope Project, in Hawaii, the Drug Market Initiative in Michigan and Seattle and Providence and a dozen other cities that can be used in a smart way to keep communities safe and reduce costs, I think a lot of folks are already there.

What about conservative critics in the political realm?

Well, you saw Bill Bennett, the first drug czar, supporting the drug policy this administration released. I’ve heard from former Attorney General Ed Meese, and others, that looking at this policy is smart. I’ve also been up on Capitol Hill, speaking with a number of incumbent members and staff members who see this policy as being a smart way to go after the drug problem.

You said this is partly because a lot of states can’t afford to keep the prison systems at the level they’re at. In an era of fiscal austerity, can localities afford to keep in place busting- at-the-seams jails and can states afford prison systems of the scale and cost they’ve grown accustomed to over the past thirty years? And if they can’t, how can the federal government help them scale back their criminal justice infrastructure while keeping the public safe?

You’re right. We’ve seen over the last three or so fiscal years that prisons that had been planned to be built are no longer being built, that jails and prisons have reduced space, that several states, whether Texas or New York, have reduced prison space. So the down cycle in prison population has already started. The federal government can be helpful in providing the evidence based and rigorously evaluated programs—whether it’s in technology or treatment programs—that can help to address the drug problem.

What are some of the programs that you think are particularly effective nationally, or internationally, and how can they become more a part of the everyday functioning of the criminal justice system?

Just like all systems and all bureaucracies, the criminal justice system can move slowly. But things I’ve seen that have proved effective include drug courts—they started with one twenty years ago; there’re now around 2,500 around the country. And Mexico just opened their first drug court, in Monterrey. Members of the Russian Duma and the Russian government were here and toured the drug courts in New York, Miami and Washington, DC. Intensive supervision of people who have been arrested and are out on bond, or are on parole or probation. Those efforts include drug testing, because if those folks are not on drugs, more than likely they won’t be involved in other crimes. Then the Drug Market Initiative being tested in about a dozen cities, being led by John Jay College, is worth looking at, although that is still to be evaluated. It’s an interesting process of using the police and a prosecutor; we all know that in most states drug crimes are handled with diversion programs—a person is arrested; the judge will say, As long as you complete a treatment program or you stay on your best behavior, we’ll do away with the file and the sentence. This [the Drug Market Initiative] is actually a pre-arrest diversion. Rather than arrest someone physically, photograph them, fingerprint them and take them out of their neighborhood in the back seat of a police car, they are asked to come to a voluntary meeting, in the evening, in the police department. And the prosecutor and the police department show the evidence about what they have been doing and ask them to make a choice about whether they’d like to get help or whether they should end up being prosecuted. This helps, because quite often when a person gets an arrest record, a downward spiral, particularly for a minority kid, has already started. They get a letter from the prosecutor and the police chief; their family comes in with them, they’re shown the evidence of what they’ve been doing—which is oftentimes low-level neighborhood drug dealing—then they can go and an assessment can be made; because they may have a drug problem themselves; they may need education; they may need help in vocational, etc. And they also have the power of their relatives asking and supporting them to make the right decision. So much of that is the power, the authority, not just of the criminal justice system but of the family and the neighborhood to say, Please get on the right track. One other issue: there’s a lot of success dealing with crack cocaine in the US. It was mostly a phenomenon in the African-American community, and it has been significantly reduced. That is the power of neighborhoods and families and education about the dangers of crack and the problems that crack causes as much as any governmental intervention.

As you expand these sorts of programs, in some ways you get not just the peripheral reform but you get to a fundamental reform of what the criminal justice system looks like. Over the years I’ve spoken to a number of criminal justice reformers who say the goal is to reduce drug usage and criminal activity to the point at which people involved in criminal justice put themselves out of business. That’s obviously rather utopian, but on a more realistic level, what is your measure of success?

We have set a measure of success as the number of deaths. Deaths as a result of drugs eclipse gunshot deaths in the United States; in seventeen states they eclipse car crash deaths. This is a huge issue about people dying, and the driving force in that is prescription drugs. Prescription drugs, which are not coming across the border but coming out of medicine cabinets, need a lot of attention. Reducing the number of people who have to come into emergency rooms as a result of drugs is important. It’s not only very high; it’s very costly. The last number, from 2007, was 38,000 deaths.

How else do you measure success?

The number of young people that engage, or utilize, or initiate in drug use. We’ve set some pretty ambitious goals over the next five years. That’ll be important. Then, of course, there are the other, more intangible things, because the drug issue is so intertwined with dropout rates from school, healthcare costs and a prepared and educated workforce.

You’ve obviously been in this job for a while now, you’ll be in it a while still to come. What legacy do you hope to leave after your time at the ONDCP is over?

I’m more concerned with how we should leave this country—making people more aware of the drug problem issue. The drug issue has been around a long time, so it’s hard to get it to the attention of the public—so looking at ways to get it to the attention of the public, not just through traditional media but through social media. The signature issues that I have put on my plate for us to deal with over these several years are the prescription drug problem, drugged driving—people behind the wheel with drugs in their system—and bringing to people’s attention that prevention programs can actually work and prevent kids from ever becoming involved with drugs.

I wonder, if you fast-forward 100 or 200 years and you think of a group of historians looking back on late twentieth-century American policies, how do you think they’ll interpret the late-twentieth-century drug wars and the huge increases in imprisonment that came about at least in part because of those drug wars?

That’s a fantastic question. I just finished Daniel Okrent’s book on Prohibition. I think if I was going to put myself 100 or 200 years in the future, and I look at what will come about as a result of medicines and technology—right now there are experimentations going on for vaccinations for cocaine—people can be vaccinated against becoming a cocaine user. So I think that there will be a lot of medical processes involved. I think that as we face more difficult economic times that they will go back and look at this time and say that perhaps part of the driving force of the change to looking at this as a public health problem was also economic—which is very much analogous to Prohibition.

Do you think they’ll understand our motivations? Because obviously sometimes we look at the past and think, What on earth would drive a group of otherwise sensible legislators to approve this policy? I wonder if a lot of the drug policies you inherited and you’re trying to shift public policy around—the Rockefeller drug laws, for example—do you think generations from now, people will just have an absolute problem understanding our motivations?

We’re a country that has a greater imprisonment rate than any other country in the world. Greater imprisonment per capita than Russia. We’ll probably begin to understand that because of this high imprisonment rate and the great deal of punitiveness that we have enforced, people will look at this drug issue and see that as more people speak out—I was in Philadelphia Saturday with 11,000 people marching who were in recovery from drugs—they’ll recognize it more as a public health problem. And more importantly that people can overcome this, that they can go back to being productive, tax-paying people who take care of their family if the government works to put things in place with the same level of enthusiasm as we did when we said we just need to incarcerate more people. Police chiefs don’t talk about a war on drugs; they say we can’t arrest our way out of the problem.

That leads to my wrap-up question: I started off talking about a war on drugs that, linguistically at least, takes off in the 1970s with Nixon and Rockefeller’s language, at a federal and state level, around how to approach drugs. And obviously we’re now at a moment where fewer people at a public policy level are using the military language to define and explain this problem. When do you think the war on drugs came to a close?

I’d love to say it was when I did an interview with the Wall Street Journal the first month I was in office. But it takes much longer to change a mindset. I’ve heard it being referred to in the foreign press more as the war on drugs than it is anymore in the American press. It’ll take a while to not only convince ourselves that this isn’t the best way to deal with the problem, but it will take longer to convince our foreign counterparts that we are being smarter about how we approach the drug problem. It could be a decade before we are looking at this in the comprehensive, smart, sensible way, that this balanced approach is taking us. I would say, in my meeting with federal law enforcement officials, that they never really talked about it or saw it particularly as a war. Certainly we battle with criminal elements. But when it comes to the entire issue around substance abuse, professionals view it with the complexity that it is, which is both public safety and public health.