SELF-ASSESSMENT OF THE CZARS:

According to "CESAR Fax" of Dec 4 2006 (vol 15, issue 48), seven of the eleven men (!) who've served as "drug czar" since the federal govt created that position in 1971 met to "reflect" on the effectiveness of their efforts and
policies. The "...general sense [was] that the national policies that have been pursued during the past 35 years have succeeded in contaning illegal drug use to levels far lower than those of alcohol and tobacco use..." In what must rank among the all-time under-statements of reporting, "CESAR Fax" states, "There was no enthusiasm at the meeting for legalizing drugs . . . " A few observations:

Keeping use of drugs like heroin and cocaine below that of tobacco and alcohol is hardly a high standard to which to aspire, and hardly an "achievement" that merits pride. What country - regardless of policies and practices - can't make the same claim regarding relative use patterns among these substances?

Secondly, many countries - including the US - have markedly reduced the use of the notoriously harmful drug nicotine, in its various forms, even though its legal status has not been changed.

Whatever the pros and cons of alcohol prohibition and its subsequent repeal, no one has suggested that sale, possession and use of this (also exceedingly harmful) drug once again be made illegal.

It's always kind of nice to note that "the level of civility and mutual respect at the meeting was striking." But there's a decided downside to all that harmony and good will: it does not bode well for a change in direction of a course that for three and one-half decades, under the aegis of this group of men, has cost hundreds of billions of dollars and destroyed the lives of tens of millions of Americans - none of which has prevented the purity and availability of illicit drugs from reaching historical highs, and prices record lows.

And yet, it's possible to end on a somewhat positive note. Credit where credit is due: whatever the former czars may - perhaps - have been smoking at their meeting, they did have enough reality-testing capacity to acknowledge "there was no self-satisfied sense that the nation had 'won' the war on drugs." They certainly didn't have to go too far out on a limb on that one!

As always, different views are welcomed and will be posted. And for those who really want to pursue the views of the former czars in vastly greater detail, "CESAR Fax" states that "The unedited 6 DVD set of the ... meeting is now available for $95, including shipping."

LIFTING BUPRENORPHINE LIMITS: What will it mean?

It's expected that a congressional bill to raise per-physician limit on number of buprenorphine patients from 30 to 100 will be lifted shortly. The question is: what impact will it have? If anyone has data oin the impact of lifting the (seemingly more important) per-GROUP limit a few years ago, those data have received little if any attention. The need for office-based practitioners to keep records and monitor the number of individuals treated with a particular medication and scrupulously avoid exceeding a legal limit seems likely to continue damping enthusiasm to "get invlved." We'll see - assuming anyone follows and publicizes the experience this time around. One can only applaud anything that offers a glimmer of hope of getting more help to those who want and need it and might benefit from it.