For the first time in history, the U.S. National Drug Control Strategy includes support for harm reduction – drug overdose prevention and health interventions that save lives. This is a major step forward in preventing fatal drug overdoses, which topped 100,000 last year. The Office of National Drug Control Policy’s (ONDCP) important shift to emphasize public health approaches to drug use and addiction to drugs and alcohol includes these advances:  

  • Expanding harm reduction services. This will save lives, and it’s encouraging to see the Biden Administation supporting long-standing community-driven efforts to prevent fatal drug overdoses and disease transmission among people who use drugs. Expanding access to overdose prevention medications including  naloxone and drug testing strips, as well as syringe services programs are essential. We encourage the Administration to continue prioritizing all harm reduction efforts as a critical piece of U.S. drug policy.  

  • Focusing on prevention and early intervention. The strategy promotes youth prevention efforts, and importantly outlines the essential role schools play in making sure youth have the services they need when they need them. This is crucial because youth overdose deaths and suicide have been on the rise for years, both increasing by nearly 60 percent in the last decade.Adolescence is a critical time for preventing and treating mental illness and substance use disorders, and youth are more likely to access services and complete treatment in schools. Youth are our future, and this investment is commendable.  

  • Making substance use disorders treatment easier to access. The strategy also focuses on eliminating barriers to addiction treatment and making medications like buprenorphine easier to access. This will be essential for promoting health equity, as research demonstrates substance use disorders treatment inequities by race/ethnicity and payment method. We applaud ONDCP’s commitment to meet people where they are, reduce stigma toward people who use drugs, increase the addiction treatment workforce, and promote coordinated health services such as those offered through Certified Community Behavioral Health Clinics (CCBHCs). We need this so more of the 41 million people with substance use disorders can get treatment. 

  • Increasing recovery support services. ONDCP includes strong support for recovery support services including recovery housing, recovery community organizations, recovery high schools, and peer-led organizations, which provide essential non-clinical health and community resources for people with substance use disorders. Rooted in the philosophies of shared lived experiences and mutual respect, peer recovery support services providers play an essential role in helping people with addiction access the health and community supports they need to stay healthy. Also promising is ONDCP’s support for designated funding for recovery support services, in line with the President’s budget for the Substance Abuse and Mental Health Services Administration (SAMHSA).  

Less promisingly, the strategy also dedicates significant resources toward drug supply reduction, border control, drug trafficking, criminal justice interventions, and other punitive/law enforcement driven approaches to drug policy. While there are political reasons to highlight these areas, we are troubled by the increase in funds, since major aspects of these strategies are rooted in systemic racism, as ONDCP itself recognizes: “Arrest and incarceration for crimes related to substance use and possession disproportionately impact Black, Indigenous and People of Color (BIPOC) and other historically marginalized communities. In fact, Black persons are nearly five times more likely to be incarcerated for drug possession than white persons.” 

To save more lives, we need even bigger investments in health and community services for prevention, harm reduction, treatment and recovery as well as initiatives to address social and economic factors underlying drug use and substance use disorders. Investment should target communities facing the greatest inequities, especially those harmed by the War on Drugs, and use of funds should be directed by those communities. Investment should also prioritize services provided by those with behavioral health expertise, including lived experience, over those provided by law enforcement, as part of bigger efforts to decriminalize the illness of addiction.  

We join the Administration in envisioning a better future. In our vision, addiction is prevented and everyone has what they need to be healthy and thrive, including a health system rooted in race equity and health justice.