On April 21, 2022, the Biden administration unveiled the President’s National Drug Control Strategy, its first comprehensive drug policy to Congress, strengthening our national focus on actions to get people into care, reduce overall loss of life, and utilize new strategies to combat drug traffickers’ supply and profits, all while making improvements to the datasets that inform all of the above policies.
This will be the first national-level plan that lays out a significant focus on harm reduction as part of its two-pronged approach, which, combined with a clear commitment to supporting access to addiction treatment and rehab facilities, lays the groundwork for a promising and compassionate shift in the way the US approaches drug policy.
The Strategy was submitted at a critical moment – during the pandemic when drug overdose-related deaths have spiked to new highs with almost 107,000 cumulative fatalities counted in the past 12 months.
Meeting People Where They Are: Person-focused and Evidence-based Strategies
The new presidential Strategy does not lay out directives for penalizing people suffering from substance use disorders (SUDs). Instead, it looks at ways to meet people “where they are” and get them connected to care and services.
1. Removing Treatment Barriers to the Most At-Risk
Treatment saves lives, and with the new Strategy, federal policy is adapting to address the existing barriers to treatment as critical factors driving our rising overdose fatalities. This policy will endeavor to extend treatment access to the people who are at the greatest risk of overdose, hoping to relieve the devastating loss of life. This will include:
- Unhoused populations
- Incarcerated individuals
- Other justice-impacted persons and people in re-entry to society
- Syringe users
Dr. Rahul Gupta, the head of the Office of National Drug Control Policy and the first physician to ever hold this position, is spearheading this approach. Compassionate and practical, he put it simply: “Everyone who wants treatment should be able to get it.”
2. Expanding Harm Reduction
One of the most profound paradigm shifts directed by the Strategy is the introduction of a national focus on harm reduction (HR). In their frequently cited 2017 article Harm Reduction Principles for Healthcare Settings, Hawk et al define HR as “interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely.”
While they may not directly treat addiction or discourage addictive behaviors, these policies build trust between government agencies and people who suffer in isolation from addiction, providing life-saving care to people who are not yet ready to receive treatment. Interventions mentioned in the Strategy include:
- Expanding distribution and administration of naloxone
- Improving access to drug test strips
- Developing the nation’s syringe service (syringe exchange) programs
Similar dual focuses on harm reduction and treatment access have seen success in addressing addiction epidemics in the past decades in Portugal, the Netherlands, and Switzerland.
In the US, this policy will be integrated with the existing federal system of care, but the Strategy is also calling for a collaborative approach to HR, including calls for changes to state laws and cooperation between federal, state, and local governments.
3. Better Data, Better Policy
In line with the Biden Administration’s commitment to evidence-based policy, as outlined by the Presidential Memorandum on scientific integrity and evidence-based policymaking, the Strategy calls for efforts to invest in and improve the current research technologies that are used to inform public health policy relating to addiction.
Emphasis is placed on updating our existing data collection systems and introducing new ones for underexplored factors related to our national drug use data set, including non-fatal overdoses. The guiding belief is that more informed research, policy, and drug intervention practice will follow with better data.
Drug Profits and Drug Trafficking: Addressing the Epidemic at its Source
The Strategy will take an offensive stance against transnational criminal organizations (TCOs) that produce and transport illicit drugs into US borders, specifically by obstructing and disrupting the financial activities of these organizations, working domestically and internationally to reduce supply, and implementing new border strategies.
1. Hitting them Where it Hurts: Financial Disruption
While drug trafficking remains profitable, it is hard to stop, but the Strategy calls for a new set of coordinated actions that aim for the root: profits and proceeds.
While historically, the main method TCOs use to move money garnered from the illicit drug trade was bulk cash smuggling, they are expanding their financial toolkits to include:
- virtual assets,
- darknet markets,
- mirror transfers,
- trade-based money laundering,
- Black-Market Peso Exchanges.
The Strategy is set on employing and developing all of our available tools and systems usable, to research and obstruct the financial networks that fund drug trafficking to the US.
2. Domestic and International Collaboration to Reduce Supply
The Strategy has come out with several policies that aim to reduce the supply of illicit drugs that are available to be transported and consumed within our borders, both to limit access and to protect more Americans from criminal and risky exploitation in the drug trafficking supply chain.
What does that mean? The interventions include improvements to the way we assess existing supply reduction initiatives, strengthen our precious foreign partnerships that work to disrupt drug production and work together within multilateral organizations to fight our shared battle against synthetic drug production and trafficking.
Border policy is, of course, a critical part of this. Actions at the border can counter trade financing but they can also disrupt physical supply chains and routes to aggressively counter the criminal networks that introduce addiction and its harm to the US.
Shifting Times and Paradigms
The 2022 President’s National Drug Control Strategy may come to mark a key turning point in the long history of the way the US conceptualizes and addresses its persistent drug addiction and overdose pandemic. Past presidential strategies have often centered on punitive disincentives for individuals, but despite our commitment to justice-based strategies, our overdoses and overdose casualties have continued to grow.
Although there is no one-size-fits-all approach to drug policy, the revived interest directed at harm reduction and treatment in the new set of directives echoes successful legislation in other countries. Studies suggest that once you have a population living with substance use disorders, treatment is the best tool to employ in giving people their lives back, and harm reduction goes a great way towards reducing devastation to those same lives in the meantime.