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21 Apr 2022 | Commentary

Biden’s New Drug Control Strategy: Long Overdue Focus on Harm Reduction and Other Takeaways

The Biden administration’s first full-fledged national drug control strategy was released today with the country in the midst of a drug overdose crisis of unprecedented severity, with more than 106,000 fatalities in the past 12 months alone.

The 152-page document, which was submitted to Congress, details the administration’s proposals to address the nation’s drug problems by enhancing drug treatment, investing in harm reduction, tackling drug trafficking, and improving data collection and evaluation.

Below are five initial takeaways from President Biden’s first drug control strategy:

An overdue start on modernizing U.S. drug policies to support public health

In his March 2022 State of the Union address, President Biden urged Congress to unite around the steps urgently needed to respond to the daily tragedies of drug-related suffering and death in communities across the nation.

The strategy released today makes a start on that response, especially by focusing on ensuring access to treatment for substance use disorders and highlighting the crucial role of harm reduction services.

Even so, when measured against the scale of the nation’s overdose problems and the urgency of the needs, Biden’s new plan appears quite timid.

The first U.S. strategy to include a chapter on harm reduction

By embracing harm reduction services—including life-savers such as overdose reversal sprays, drug testing strips, and low-threshold treatments, Biden’s first strategy marks a major step forward from those issued by Democratic and Republican administrations over the past three decades.

The plan’s recognition and adoption of syringe service programs (SSPs) is an especially significant step as part of the administration’s strategy for U.S. drug policy. As the strategy notes, SSPs and other harm reduction services “will save lives, improve health, and likely have a favorable economic benefit to society.”

The Biden administration deserves great credit for at last acknowledging and supporting the critical role of harm reduction—all the more so because at least some Republican lawmakers are likely to vilify Biden for doing so, including by singling out harm reduction services for demagoguery and scare tactics.

At the same time, it is important to realize that the new strategy’s inclusion of harm reduction—as welcome as it is—represents only a small step toward the scale of the investments needed to support a wider range of risk-reduction services, such as supervised injection sites.

Noteworthy advances risk being undercut by the continuation of approaches that have already failed

The Biden plan’s positive innovations regarding investment in treatment and harm reduction strategies risk being undermined by a continued commitment to the kinds of policies that have exacerbated the present crisis and that continue to absorb the lion’s share of resources, namely, drug criminalization at home and wildly exaggerated expectations for what can be achieved through supply control efforts abroad.

Indeed, in a phrase that could have been plucked from virtually any previous U.S. drug strategy, the Biden plan “directs agencies to work with partner governments in drug-producing and transit countries to prevent illicit drugs from ever reaching our border.” Perennially a U.S. goal but never close to being achieved, recycling such language now only perpetuates the unfounded belief that decisive responses to U.S. drug problems can be achieved by controlling supply overseas.

Highlights targeting financial profits to disrupt international drug trafficking

Prioritizing enforcement that focuses on the profits that flow to the higher echelons of trafficking networks makes more sense than attacking the subsistence livelihoods of farmers. Still, expectations for the kind of impact that can be achieved by targeting finances and profits should be tempered.

In a globalized, densely interconnected world, continued demand for drugs under conditions of prohibition creates enormous incentives for suppliers willing to face the enforcement risks to reap the potential monetary profits. Under these conditions, it is unrealistic to expect swift or decisive blows against the illegal drug trade, and even less likely that such blows would translate into sustainable impacts on supply and U.S. drug availability.

The stark limits of what can be achieved through supply control under the prevailing prohibitionist framework underscore the urgency of addressing the immediate needs through interventions that deliver direct and positive life-saving impacts, especially scaled-up treatment and harm reduction services.

Invites a fresh look at traditional drug policy data

For decades, the U.S. has heavily relied on indicators such as quantities of drugs seized and crops eradicated in countries such as Colombia and Mexico to assess progress in curtailing drug supply and availability.

Yet despite decades of huge U.S. investment in interdiction and eradication operations, illegal drug production, supply and availability appear to be greater in magnitude and toxicity than ever before.

Biden’s new approach acknowledges the need to consider “the full range of trends and activities, including consumption patterns, drug use consequences, prevention, harm reduction, treatment, recovery, drug production, transportation and distribution by drug trafficking organizations, and many more” as the basis for effective policy-making.

A clear-eyed examination of the data used to measure the country’s drug-related problems and assess the effectiveness of U.S. drug policies is long overdue. The question goes to the heart of policy making: how do we know if our investments are achieving our objectives? Especially in the realm of drug supply control, a fresh look at the indicators is a crucial step for reassessing strategy.

Now Congress needs to act

At a time when giant strides forward in drug policy innovation are urgently needed, Biden’s new plan offers baby steps, but at least steps in the right direction.

With lives in the balance every hour of every day, Congress should move quickly and in a bipartisan manner to ensure robust long-term funding for the core of Biden’s Strategy—centering on treatment and harm reduction.

And Congress should take up the challenge of assessing whether the U.S.’s traditional drug policy data collections are up to the task of supporting life-saving strategies, or have instead become disconnected from real-world outcomes.