At a time when overdose deaths, driven primarily by illicitly manufactured synthetic drugs, have reached a record high, the Biden-Harris Administration has significantly expanded access to evidence-based prevention, treatment, harm reduction, and recovery support services, as well as taken action to reduce the supply of illicit drugs like fentanyl.
In April, President Biden sent his inaugural National Drug Control Strategy to Congress. The Strategy delivers on the call to action in President Biden’s Unity Agenda for a whole-of-government approach to beat the overdose epidemic.
To support these efforts, President Biden’s FY 2023 budget request to Congress calls for a historic investment of $42.5 billion for National Drug Control Program agencies, a $3.2 billion increase over the FY 2022 continuing resolution level. The largest increases in funding are for critical public health interventions to expand research, prevention, treatment, harm reduction, and recovery support services, with targeted investments to meet the needs of populations at greatest risk for overdose and substance use disorder, as well as significant investments in reducing the supply of illicit substances.
The work moving forward will follow key actions the Biden-Harris Administration has taken to address addiction and the overdose epidemic since January 2021:
- In 2021, the White House Office of National Drug Control Policy (ONDCP) announced that a total of 745 community coalitions in all 50 states received over $93 million through Drug Free Communities program grants. This represents the largest single-year investment in the program’s history. In 2022, ONDCP announced approximately $81 million for 645 local coalitions across the country as part of the DFC Support Program Continuation Grant Awards.
- ONDCP announced the Biden-Harris Administration’s plan to address methamphetamine and its impact on public health and safety.
- The Department of Health and Human Services (HHS) released a new Overdose Prevention Strategy that supports substance use prevention by expanding research of new and improved prevention efforts, investing in community resources to help prevent harms related to substance use, increasing access to high-quality pain management to reduce preventable suffering, and promoting responsible prescription of opioid medications to protect patient safety.
- The Centers for Disease Control and Prevention (CDC), launched four complementary education campaigns that provide information about the prevalence and dangers of fentanyl, the risks and consequences of mixing drugs, the life-saving power of naloxone, and the importance of reducing stigma around drug use to support treatment and recovery.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) oversaw a three-fold increase in primary substance use prevention funding in 2021, the largest investment in primary prevention in history. Increases in funding for the Substance Abuse Prevention and Treatment Block Grant (SABG) provided states and territories an additional $630 million in funding to support primary prevention efforts.
- SAMHSA supported 743 community primary prevention grants in 2021 totaling over $182 million, including grants to Tribes and local community substance use prevention coalitions to address community prevention priorities.
- The National Institutes of Health (NIH) and National Institute on Drug Abuse (NIDA), supported more than 85 new studies to inform, develop, and/or test prevention interventions in different populations and settings to prevent drug use, overdose, or other harms of drug use such as HIV and neonatal opioid withdrawal syndrome.
- The Food and Drug Administration (FDA) worked to improve prescribing for pain management:
- FDA announced open periods for applications to support the development of evidence-based, clinical practice guidelines for management of post-operative pain in obstetric patients who have undergone surgery, as well as safe tapering of benzodiazepines.
- FDA published a draft guidance for industry, Development of Non-Opioid Analgesics for Acute Pain, which is intended to provide recommendations to companies developing non-opioid analgesics for acute pain lasting up to 30 days.
- FDA collaborated with the Duke-Margolis Center for Health Policy to hold two-day public workshops soliciting feedback on the role of prescriber education under a Risk Evaluation and Mitigation Strategy (REMS) and re-examining the need for mandatory education for prescribing opioids.
- The Drug Enforcement Administration (DEA) issued its first national public safety alert in six years and launched the “One Pill Can Kill” public awareness campaign to raise awareness of the dangers of fake prescription pills laced with fentanyl.
- DEA released details on the use of social media by criminal drug networks to market and sell deadly fake pills to teenagers and young adults. DEA publicly released known emojis and code words that are used to facilitate drug trafficking on social media to help inform the public of this growing threat.
- In August 2022, the U.S. Department of Education and ONDCP kicked off the first in a three-part program aimed at preventing youth substance use to improve student mental health and learning, titled, Transforming Youth Together: Understanding the Connection between Substance Use, Mental Health, and Student Learning – Part 1: What the Data Tells Us. This event explored what data on youth substance use and mental health tells us and how it can inform student support systems.
- The American Rescue Plan included $30 million in grants for harm reduction services—a historic amount that will enhance interventions like syringe services programs (SSPs) through a grant operated by SAMHSA at HHS.
- ONDCP released model laws for states to help expand access to naloxone and SSPs.
- ONDCP co-hosted a two-day National Harm Reduction Summit with SAMHSA and CDC, which convened a diverse group of partners and experts from local, tribal, state, and federal governments and non-government organizations, including representatives from the fields of harm reduction, substance use prevention, treatment, recovery, and criminal justice to develop a framework of harm reduction for SAMHSA to help inform its policies, programs, and practices.
- The HHS Overdose Prevention Strategy promoted harm reduction for the first time by increasing the availability and access to high-quality harm reduction services, decreasing negative effects of substance use, and reducing stigma related to substance use and overdose.
- SAMHSA’s Center for Substance Abuse and Prevention (CSAP) supported the distribution of more than 178,000 naloxone kits, which were used to help more than 62,000 people experiencing an overdose. SAMHSA’s naloxone training and distribution programs were provided to more than 100 communities, totaling more than $50 million.
- CDC and SAMHSA announced that federal funding may now be used to purchase fentanyl test strips in an effort to help curb the dramatic spike in drug overdose deaths.
- CDC worked to identify and document novel, innovative, and emerging harm reduction strategies implemented as a result of the COVID-19 pandemic and to fund promising strategies for ensuring or increasing access to services during COVID-19.
- CDC and SAMSHA established a $3 million partnership to leverage CDC’s National Harm Reduction Technical Assistance Center to support implementation of effective, evidence-based harm reduction programs, practices, and policies in diverse settings and decrease health disparities.
- Through the NIH HEAL Initiative®, NIDA is establishing a $21 million harm reduction research network to increase understanding of the effectiveness, implementation, and impact of existing and new harm reduction practices to address the ongoing opioid epidemic and substance use disorder more broadly, and reduce associated harms including infection transmission. Additionally, NIH and NIDA supported at least six new studies related to harm reduction, and the most recent projects aim to reduce smoking among people with opioid use disorder; reduce risk for HIV, HCV, and overdose; and address intersectional stigma as a barrier to harm reduction. They also supported more than 90 new projects to inform, develop, and/or test pharmacological and non-pharmacological treatments for substance use disorders and related conditions, with several clinical trials currently in development.
- FDA approved several naloxone products in the past year, including a higher-dose (5 mg) naloxone injection as an additional option to treat opioid overdose, a second generic naloxone intranasal spray, and a naloxone auto-injector product indicated for military usage and chemical incident response.
Treatment and Recovery
- The American Rescue Plan invested more than $5 billion to enable HHS to expand access to vital mental health and substance use disorder services. This included more than $3 billion for states and territories through SAMHSA’s Substance Abuse Prevention and Treatment Block Grant (SABG) Program. This included $1.65 billion announced in March 2021 and $1.5 billion announced May 2021. The SABG allows states and territories to plan, implement, and evaluate activities to prevent, treat, and help more people recover from substance use disorder.
- ONDCP announced the release of a model law for state legislatures that would help ensure opioid litigation settlement funds are directed to addressing addiction and the overdose epidemic in impacted communities and with public accountability.
- ONDCP hosted more than 300 state, local, and Tribal leaders from all 50 States, Washington, D.C., American Samoa, Virgin Islands, Puerto Rico, and the Northern Mariana Islands for a virtual convening entitled “Opioid Litigation Settlement: Using Evidence to Lead Action.” At the convening, government officials, researchers, and experts discussed how State, local, and Tribal governments can use evidence and data to guide decisions about how funds from opioid litigation can be spent to address addiction and the overdose epidemic, while advancing equity.
- ONDCP, in partnership with CDC, announced $3 million in funding through the Combating Overdose Through Community-Level Intervention (COCLI) initiative to invest in supporting innovative and scalable solutions developed by local governments, public and private universities, advocacy organizations, and nonprofits that are working to prevent drug overdoses in communities across the country.
- ONDCP announced the release of the Model Law Enforcement and Other First Responders Deflection Act, a resource for states that encourages the development and use of deflection programs across the country.
- ONDCP announced the release of the Telehealth and Substance Use Disorder Services in the Era of Covid-19: Review and Recommendations.
- The HHS Overdose Prevention Strategy prioritized advancing evidence-based treatment by making treatment easy to get, delivering health care and support services in a seamless and coordinated way, and implementing new and improved models of care that appeal to and help those who need them. It also aimed to improve recovery support by developing different types of support throughout the lifespan, increasing the quality of services, supporting the recovery workforce, and expanding access to ongoing, affordable, and effective recovery support services.
- HHS released the Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder, which exempt eligible health care providers from federal certification requirements related to training, counseling and other ancillary services that are part of the process for obtaining a waiver to treat up to 30 patients with buprenorphine. This action expands access to evidence-based treatment by removing a critical barrier to buprenorphine prescribing.
- HHS, through SAMHSA, announced the extension of the methadone take-home flexibilities for one year, effective upon the eventual expiration of the COVID-19 Public Health Emergency. The flexibility promotes individualized, recovery-oriented care by allowing greater access for people who reside farther away from opioid treatment programs (OTPs) or who lack reliable transportation.
- In 2021, SAMHSA announced the establishment of its Office of Recovery, within the Office of the Assistant Secretary for Mental Health and Substance Use, to advance the agency’s commitment to, and support of, recovery for all Americans. It will prioritize the role of peer support workers in using their lived experiences in recovery to help others to start and sustain their own journeys. The Office sponsored a Recovery Summit in August 2022 that centered participants’ lived experiences in a convening to identify themes for new directions for SAMHSA’s recovery-related efforts in the 21st century.
- CDC partnered with the National Association of County and City Health Officials (NACCHO) on a project to investigate the literature available on health inequities in substance use disorder treatment and services, as well as tools and resources which could provide guidance for health departments on addressing drug overdose through the use of a health equity lens.
- CDC expanded its investment in Public Health Analysts participating in ONDCP’s High Intensity Drug Trafficking Areas (HIDTA) program’s Overdose Response Strategy. This collaboration is helping communities reduce fatal and non-fatal drug overdoses by connecting public health and public safety agencies, sharing information, and supporting evidence-based interventions. CDC is funding public health analysts in all 50 states, DC, the US Virgin Islands, and Puerto Rico.
- CDC has provided over $300 million per year through Overdose Data to Action to support 47 states, Washington, DC, 2 territories and 16 high burden cities and counties in collecting high quality, comprehensive, and timely data on non-fatal and fatal overdoses and in using those data to inform prevention and response efforts, such as ensuring people are connected with the care they need; supporting health care providers and systems with overdose response efforts; and developing partnerships with public safety and first responders to improve data sharing and response.
- Research Recovery Network of researchers, payors, providers, and people in recovery to develop infrastructure to advance the science of long-term recovery. NIH also supported research on novel treatment strategies for addiction, including new treatment tools and strategies to improve engagement and retention in care, and implementation of evidence-based practices in healthcare, community, and justice settings. Further, NIH is conducting research to identify evidence-based best practices for recovery support services and strategies to sustain these services in communities and justice settings.
- HHS, through the Centers for Medicare & Medicaid Services (CMS), released an updated version of Medicaid’s Substance Use Disorder Data Book to help policymakers, researchers and other stakeholders understand more about the impact of substance use disorders.
- CMS also proposed to increase Medicare payment rates to OTPs in order to better reflect costs of counseling services, and also proposed that Medicare pay for buprenorphine initiation through telehealth (rather than just in person) to improve access to care.
- Since January 2021, CMS has approved, renewed, or amended 15 state section 1115 Medicaid demonstrations: 11 that include comprehensive care delivery for people with substance use disorders, and 4 that include comprehensive care delivery for people with serious mental illness.
- CMS approved contingency management (CM) as an approach to substance use disorders in California’s Medicaid program, for a pilot program in Drug Medi-Cal Organized Delivery System counties to provide care to people with stimulant use disorders, and is working with additional states that are also exploring using CM.
- CMS released guidance and planning grants to states to support the implementation of community-based mobile crisis intervention services through the American Rescue Plan Act, including for substance use disorder crises.
- CMS proposed changes to strengthen the Medicare behavioral health workforce so practitioners can practice to the full extent of their license, and proposed an exception to supervision requirements for services furnished, allowing marriage and family therapists, licensed professional counselors, and others to furnish behavioral health services under “general,” rather than “direct” supervision. CMS also proposed to pay psychologists and social workers to help manage behavioral health needs – including for substance use disorder care – as part of the primary care team, because sometimes it can be easier for people to get care through their primary care practitioner.
- Health Resources and Services Administration (HRSA), through the Federal Office of Rural Health Policy, invested $105 million in community-based grants and technical assistance through its Rural Communities Opioid Response Program in FY 2021, which supports prevention, treatment, and recovery efforts in rural communities. Additional awards are forthcoming in FY 2022.
- In FY 2021, HRSA invested $26.4 million in direct service awards through the Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program to participants working in communities with an overdose rate higher than the national average or in a designated mental health professional shortage area. FY 2022 awards are forthcoming.
- HRSA-funded health centers have been important partners in helping to prevent and address the increase in substance use disorder across the country. Health centers provided substance use disorder services to 286,000 patients in 2021. More than 184,000 health center patients received medication-assisted treatment (MAT), a 29% increase from 2019 to 2021. Approximately 17,000 health center providers were eligible to prescribe MAT in 2021—an increase of nearly 137% from 2019 to 2021.
- The Department of Justice’s (DOJ) Office of Justice Programs (OJP) announced the Bureau of Justice Assistance (BJA) is providing $94 million to adult reentry and recidivism reduction programs, including $29.6 million for substance use disorder treatment.
- DEA revised existing regulations for OTPs to allow the operation of a mobile component. This rule change will help provide treatment to rural and other underserved communities, including incarcerated individuals.
- In response to the COVID-19 public health emergency, DEA implemented temporary guidance allowing medication-assisted treatment to be prescribed by telemedicine. DEA plans to initiate rulemaking to consider making those flexibilities permanent.
- DEA announced the opportunity for DEA-registered practitioners or hospitals and clinics to request an exception allowing them to dispense a three-day supply of medication to treat patients experiencing acute opioid withdrawal symptoms.
- President Biden announced two Executive Orders to counter transnational criminal organizations and illicit drug trafficking, first by formally establishing the U.S. Council on Transnational Organized Crime, and second, by modernizing and expanding the U.S. Government’s ability to target drug trafficking organizations, their enablers, and financial facilitators through sanctions and other related actions.
- At the request of the United States, and with the recommendation of the International Narcotics Control Board, the UN Commission on Narcotic Drugs’ (CND) Member States voted unanimously to take international action and control the acquisition, production, and export of three precursors used to manufacture illicit fentanyl and its analogues.
- The Biden-Harris Administration announced a new United States-Mexico Bicentennial Framework for Security, Public Health, and Safe Communities that addresses multiple factors fueling the opioid epidemic and aims to protect the American people by investing in public health, preventing transborder crime, and pursuing criminal networks.
- ONDCP, DEA, and the Department of State (DOS) led the submission of a proposal to the United Nations (UN) to internationally list new precursor chemicals being utilized by illicit drug producers.
- ONDCP released a new, holistic U.S.-Colombia counternarcotics strategy developed by the Counternarcotics Working Group between the United States and Colombian governments that broadens focus to include specific actions on rural security and development, environmental protection, and supply reduction.
- ONDCP announced $275 million for the High Intensity Drug Trafficking Areas (HIDTA) Program and announced the addition of six counties to the ONDCP-funded HIDTA program. These counties, located in California, Illinois, Kentucky, and Pennsylvania, will receive support for regional law enforcement efforts to disrupt and dismantle drug trafficking organizations.
- ONDCP and CDC provided funding for the nationwide expansion of the HIDTA Overdose Response Strategy to all 50 states, Puerto Rico, the U.S. Virgin Islands, and the District of Columbia. The Strategy brings together drug intelligence officers and public health analysts at the local and regional level to share information and develop evidence-based intervention and support services that reduce overdoses.
- ONDCP, HHS, and DOJ presented to Congress the Biden-Harris Administration’s recommendations for a long-term, consensus approach to reduce the supply and availability of illicitly manufactured fentanyl-related substances (FRS), while safeguarding against racial disparities in prosecution and sentencing and reducing barriers to scientific research for all Schedule I substances.
- FDA and DEA partnered to issue first-of-their-kind joint warning letters to operators of two websites illegally selling Schedule II stimulants, including amphetamine drug products marketed as Adderall.
- DEA coordinated nationwide enforcement operations to rid American communities of significant quantities of fake prescription pills laced with deadly fentanyl.
- DEA initiated a data-driven, intelligence-led approach to identify hot spots of drug-related violence and overdose deaths in order to devote law enforcement resources to places they can have the most impact. DEA, working in partnership with its fellow federal, state and local law enforcement agencies, mapped the threats and initiated enforcement operations against dangerous drug networks in 34 locations across 23 states in the initial phase of Operation Overdrive.
- DEA seized more than 15,000 pounds of fentanyl in 2021. DEA also seized more than 20.4 million potentially deadly fake pills marketed by criminal drug networks, many of which contain lethal amounts of fentanyl.
- DEA sent a letter to law enforcement agencies across the country in April warning of an increase in mass overdose events and offering DEA resources and assistance to help trace mass-overdose events back to local drug trafficking organizations.
- Customs and Border Protection (CBP) significantly increased the amount of fentanyl seizures along the Southwest border, seizing an average of more than 800 pounds of fentanyl each month in fiscal year 2021, over twice as much as fiscal year 2020 and four times the amount seized in 2019.