Dr. Rahul Gupta’s Testimony Before the House Committee on Oversight and Accountability
“There is hope, there is progress, and there is an unwavering commitment from the Biden-Harris Administration to use this inflection point to further reduce drug overdose deaths and save more lives”
On July 27, 2023, White House Office of National Drug Control Policy (ONDCP) Director Dr. Rahul Gupta provided the following testimony to the U.S. House Committee on Oversight and Accountability for its hearing entitled “Oversight and Reauthorization of the Office of National Drug Control Policy.”
Chairman Comer, Ranking Member Raskin, and distinguished Members of the Committee, thank you for the opportunity to testify today regarding the Office of National Drug Control Policy’s (ONDCP) reauthorization, as well as our vital work to save American lives by strengthening public health and public safety, and preventing and reducing substance use and its harms, including drug overdose deaths.
Every five minutes, someone in America dies from a drug overdose or poisoning. Alongside those we have lost are those who have experienced a non-fatal overdose. Data show that, for every fatal overdose, there were nearly 14 non-fatal overdoses that presented to the emergency department.[1] We know that for the year ending July 2, 2023, there were nearly 213,000 non-fatal opioid-related overdoses that involved EMS professionals. Additionally, 46 million people in America, almost 17 percent of the population, are currently suffering from substance use disorder,[2] which takes a toll on them, their families, our communities, and our Nation as a whole. On top of the heartbreak, the overdose epidemic also has significant economic, public safety, and national security implications. Previous analyses have estimated that costs associated with the epidemic may be as high as $1.5 trillion for the year 2020.[3] As a practicing physician and former state and local health official in West Virginia, I have had a front row seat and seen the multi-faceted impacts of the opioid epidemic. And I – like President Biden – know we must do everything in our power to save as many lives as possible.
That is why ending the overdose epidemic is a key pillar of President Biden’s Unity Agenda for the Nation. The President has challenged his entire Administration to implement the National Drug Control Strategy (Strategy) in order to reduce the number of drug overdose deaths, put high-quality public health services within reach for people with substance use disorder, and strengthen public safety by disrupting the drug production and trafficking pipeline that profits by harming Americans.
Today, I want to emphatically state that the Biden-Harris Administration is delivering on unprecedented whole-of-government policy actions that are saving lives, and continue to take urgent and necessary action. In implementing the Strategy, the Biden-Harris Administration is going after two key drivers of this crisis: untreated addiction and the drug trafficking profits that fuel it. Through coordinated and bipartisan action, the government has taken significant public health and public safety actions—as well as directed historic resources to address overdoses.
Collectively, these remarkable efforts have led to the first glimmers of hope in years.
On July 12, 2023, the Centers for Disease Control and Prevention (CDC) released new provisional data showing that drug overdose deaths continued to flatten throughout 2022 and early 2023—a hopeful sign that the years-long period of rapid increases from 2019 to 2021 are coming to an end. This latest CDC report shows 109,940 predicted overdose deaths in the 12-month period ending in February 2023.[4] Most of these deaths are caused by illicit synthetic drugs, such as clandestinely manufactured fentanyl and methamphetamine, which are often used in combination with other drugs (e.g., cocaine, heroin, and the emerging threat illicit xylazine). Similar to the recent flattening observed in drug overdose deaths, nonfatal opioid overdoses declined five percent between 2021 and 2022.
The United States has reached an inflection point. While national overdose death numbers are flattening, a complex set of structural factors hampers our ability to make even more significant progress. Naloxone needs to be far more accessible, available, and affordable. Treatment needs to be available to everyone who is ready for it. Law enforcement needs the funding and support to target drug traffickers, disrupt their schemes, and the profits that fuel the illicit drug trade. The Biden-Harris Administration is tackling each of these challenges in turn.
Our choice is clear. We must double our efforts, both by surging our coordinated law enforcement efforts and ensuring wide access to public health services. These two key goals are the two sides of the same coin. In my 25 years as a practicing physician, I have witnessed addiction and suffering with my own eyes, and I have attended far too many funerals. I can share with you that individuals with substance use disorder are in a fight every single day. These Americans, their families, and our communities, expect this Administration to stay in their corner—and we will.
Securing the Border and Supporting Law Enforcement
Disrupting the flow of drugs into the United States is important not only to keep these substances from harming our citizens and denying drug traffickers illicit proceeds, but it is critical to allow our historic investments in public health to take hold. That is why this Administration has invested significant amounts of funding for law enforcement efforts to target and dismantle illicit fentanyl trafficking, deploy the latest drug detection technology, and enable historic seizures of illicit fentanyl along the southwest border.
Under President Biden’s leadership, there are now a record number of personnel working to secure the border. In just the last year, Customs and Border Protection (CBP) seized a historic 260,000 pounds of illicit drugs, including nearly 15,000 pounds of fentanyl, primarily at Ports of Entry on our border.[5] These numbers speak not only to the magnitude of the threat, but also to the corresponding strength of our strategic response and the incredible work of courageous and committed CBP officials who keep our borders secure and our communities safe.
Since I last testified before this Committee, we have also designated 15 new High Intensity Drug Trafficking Areas (HIDTA) counties across Kentucky, West Virginia, North Carolina, Pennsylvania, New York, New Jersey, Ohio, Florida, Oklahoma, California, and Indiana.[6] These areas have been hit hard by drug trafficking and overdoses, and we are working to get them the critical resources and support they need to enhance law enforcement collaboration.
The HIDTA program is one of our most impactful investments and in 2022, the HIDTAs seized an estimated $22 billion in illicit drugs and cash—a return on investment of $82.91 for every $1 budgeted for the program.[7] President Biden’s Fiscal Year (FY) 2024 budget calls for $290.2 million in funding for the HIDTA Program, which is managed by ONDCP.[8] Funding this program is a successful, time-tested, and evidence-based way for Congress to help us crack down on the illicit drug supply, prevent overdoses, save lives, and make our communities safer.
As part of President Biden’s Invest in America agenda, we are expanding the use of high-tech non-intrusive inspection (NII) systems to crack down on trafficking at the border. These systems, which can check vehicles faster and with greater precision than agents doing physical searches, are an integral part of a layered enforcement strategy to secure the border. The Biden-Harris Administration is working to deploy 123 new large-scale scanners along the southwest border by FY 2026. President Biden has called for $535 million in CBP funding for border technology in his FY 2024 budget, including $305 million for NII systems. These technology advancements will help CBP increase its inspection capacity from what has historically been around 1 percent of passenger vehicles and about 15-17 percent of cargo vehicles, to 40 percent of passenger vehicles and 70 percent of cargo vehicles.[9] But these investments are just the start; the goal is to ensure that every vehicle that needs it is inspected in a comprehensive manner.
In order to monitor the progress of this important work, I recently traveled to Arizona in June to witness firsthand the impact of the new fentanyl detection technology being implemented at the Area Port of Nogales and the work of U.S. Border Patrol to secure the Nogales-Sonora storm drainage system from exploitation by drug traffickers.
I also rode along with the ICE Shadow Wolves tactical patrol unit that works to disrupt all forms of transnational organized crime affecting the Tohono O’odham Tribal Nation, including trafficking and smuggling of methamphetamine, illicit fentanyl, humans, firearms, and cash. I visited the San Miguel border crossing to learn of the detail-oriented tracking work the Homeland Security Investigations Shadow Wolves Public Safety Group performs on their unique terrain in Sells, Arizona. I also met with the Arizona HIDTA’s Native American Targeted Investigation of Violent Enterprises task force and spent time with representatives from Tohono O’odham Healthcare to talk about substance use disorder in the community. These partnerships are critical to protecting public health and safety.
Beyond the Border: Commercial Disruption
While the Administration is aggressively pursuing and implementing investments in NII equipment, artificial intelligence, machine learning, and more to prevent and disrupt drug trafficking, it is of absolute importance to understand that this problem does not start at our border and it will not end at our border. It starts with the raw materials for illicit drug production, such as chemicals and pill presses, which are primarily sourced from the Peoples Republic of China (PRC). These materials are used to manufacture illicit fentanyl in Mexico as well as fake pills that harm and kill Americans. These products move across our borders and into our communities through a variety of means, and the story often ends in an emergency department or morgue somewhere in cities and towns across our Nation. At every step of the way, transnational criminal organizations use licit global supply chains to move their illicit goods and reap their illicit profits.
To address this evolving and dynamic environment, we have broadened our approach to focus on disrupting what is, in essence, a global illicit business enterprise that demonstrates access to huge capital resources, conducts routine collaboration among raw material suppliers across international borders, uses advanced technology to fund and conduct business, and possesses the capacity for product innovation and strategies to expand markets. Disrupting global illicit drug trafficking and cracking down on transnational organized crime is a key public health and public safety priority for this Administration.
Earlier this year, the Administration announced its Strengthened Approach to Crack Down on Illicit Fentanyl Supply Chains, a whole-of-government approach to save lives by disrupting the trafficking of illicit fentanyl and its precursors into American communities.[10] We term this approach Commercial Disruption, and it focuses and synchronizes our national security and public safety capabilities against criminal facilitators and enablers, and attacks key vulnerabilities in the illicit fentanyl supply chain.
Through commercial disruption, we are targeting not only the illicit finished drugs and those who sell them, but also raw materials like precursor chemicals and machinery used in production, the commercial shipping that moves these items around the world, and the flow of financial benefits and operating capital to individuals and groups directly and indirectly involved in the illicit drug industry.
Targeting these critical elements will allow us to remove the gaps illicit fentanyl producers and traffickers currently exploit, disrupt their production and supply chains, and reduce the availability of these dangerous substances in America’s communities.
As part of this approach, we are also working closely with our private-sector partners. The vast majority of the physical and virtual terrain on which drug traffickers operate, such as the dark web, e-commerce sites, mail and express consignment shippers and freight forwarders, banks, digital asset vendors, legitimate chemical suppliers, and pill press and die manufacturers, are private-sector entities. And some of them may have no idea they are a constituent and vital part of an illicit business enterprise.
We have also imposed sanctions on a range of targets across the diffuse and decentralized global illicit drug supply chain. The Administration released an Executive Order in December 2021 that broadened and modernized the Department of the Treasury’s sanctions authorities used to combat the illicit drug trade. Since this Executive Order was signed, Treasury’s Office of Foreign Assets Control has sanctioned 171 individuals and entities linked to the international proliferation of illicit drugs or their means of production, including in the illicit synthetic opioid trade.
We must raise a sophisticated awareness of this environment with the commercial sector around the world, and engage with them in a full partnership, so we can sift out the unwitting from the knowing and intentional actors in the United States and abroad, and then focus our efforts on the latter in a more precise way.
Commercial disruption embraces the fact that the production and trafficking of these drugs is a global problem, and global problems require global solutions. The United States has learned a great deal from its opioid and overdose crisis, and no other country has the depth of experience, expertise, or political wherewithal to lead on this issue. Our leadership serves as an example for how to navigate this complex problem with care for those suffering from the disease of addiction, while systematically dismantling the global infrastructure of those who continue to profit from the death of Americans.
As drug traffickers expand to other markets, the illicit synthetic drug problem is becoming an even larger global threat. The international community has successfully scheduled nearly a dozen precursor chemicals through the United Nations Commission on Narcotic Drugs, including five fentanyl precursors at the request of the United States. The United States has been a leader in raising global awareness of the illicit synthetic drug supply chain, and is working to take commonsense and responsible measures to disrupt the exploitation of legitimate commerce the international norm. We have doubled our efforts with the government of Mexico, to support their efforts to address illicit fentanyl production and trafficking. In early March, when I was part of the small delegation meeting with President Lopez Obrador, we stressed the importance that President Biden places on the issue, and today our two governments are working more closely than ever to establish tangible goals, assess progress, and follow through on mutual commitments to combat illicit fentanyl.
Given the combination of our shared border, our 200-year bilateral relationship, and the negative effects that drug producers and traffickers in Mexico have on both sides of the border, it is vital that our bilateral relationship is characterized by mutual respect, our shared responsibility, and coordinated efforts to tackle the threat of drug trafficking and its associated criminality. Further, we have strengthened the broader region in our work with Mexico and Canada through the trilateral North American Drug Dialogue.
Earlier in July, I joined Secretary of State Blinken for the first meeting of the Global Coalition to Address Synthetic Drug Threats.[11] This ministerial-level meeting, hosted by the United States, brought together nearly 100 countries and international organizations to accelerate efforts against synthetic drugs by preventing their illicit manufacture and trafficking; detecting emerging drug threats and drug use patterns; and promoting public health interventions and services to prevent and reduce drug use, overdose, and other related harms. This first-of-its-kind coalition will develop concrete solutions, drive actions, and leverage the collective effort of like-minded countries who recognize that countering illicit synthetic drugs must be a global priority.
Disappointingly, despite the fact that years of seizure and law enforcement data show that unscrupulous elements within the PRC have been a major source for precursor chemical shipments, pill presses, and die molds entering the Western Hemisphere, the PRC declined its invitation to participate in the launch of this coalition.
This is an issue in which the interests of the United States and the PRC align and our past coordination on the counternarcotics issue has brought some impressive results. For example, our coordination on the domestic scheduling of fentanyl as a class had an immediate impact on reducing the flow of fentanyl and its analogues directly from the PRC. However, years of seizure data show us that a large share of chemicals and pill presses used to create the drugs harming Americans originate from the PRC, and that criminal elements are exploiting legitimate businesses in China and elsewhere to sustain their illicit business. In spite of its outsized role in this global problem, the PRC has chosen to not take substantive steps to counter illicit synthetic drug production and trafficking for more than a year. With leadership comes accountability, and while the PRC plays a major role in this global problem, it has thus far refused to play a constructive role in helping to solve it.
As we lead the global effort to disrupt the production and trafficking of these drugs, we hope the PRC will join us in this work. However, no one should mistake our willingness to engage for acceptance of the status quo, especially on an issue felt so acutely in the United States and when so many lives and communities have been impacted.
The United States will work with the PRC whenever possible to fully address the grave and growing problem of illicit synthetic drug production and trafficking at the global level. We hope that the PRC can find the political will to address this problem commensurate with its capability to do so. Until then, we will continue to lead the international effort to address the global synthetic drug threat.
Our Strong Public Health Response
Because there is a complex interplay between the availability of illicit drugs in the United States and their use, our public safety efforts to reduce their presence in our communities must be closely linked with our equally strong public health efforts to reduce demand for and use of these substances. Untreated addiction, and the drug trafficking profits that fuel it, are two sides of the same coin. Traffickers are not going to import products no one wants, and individuals cannot overdose on drugs that are not available for them to purchase. The simple truth is that if it is easier to get drugs in America than it is to get treatment, we will never bend the curve on overdose deaths.
A year has passed since I testified before this Committee on the Strategy, and the Biden-Harris Administration has been hard at work tackling the structural factors that hamper our ability to decrease overdose deaths. We have committed billions of dollars, more than half our federal drug control budget, to public health measures to prevent our youth from falling into the cycle of drug use and addiction, reduce the harms caused by these drugs and save lives, extend treatment services to everyone who needs them, and make our communities and workplaces recovery-ready.
Much of this work is being done in partnership with Congress, and I want to thank the Members of this Committee and the Congress at large for your support of numerous pieces of legislation in helping improve the health of Americans.
These include the bipartisan Consolidated Appropriations Act of 2023, which included key provisions to help lower barriers to treatment and deliver necessary tools and resources to our communities to address the overdose crisis, such as the bipartisan Mainstreaming Addiction Treatment Act and the Medication Access and Training Expansion Act. Thanks to these provisions, prescribers across the country will be able to treat their patients who have opioid use disorder with buprenorphine, a medication proven to help people achieve recovery, without obtaining additional federal licensing. This drastically boosted the number of providers eligible to prescribe buprenorphine from roughly 130,000 to 1.9 million, making treatment far more accessible.
Currently, fewer than one in ten Americans with addiction can access the treatment they need,[12] but the Administration is continuing to bring down these barriers to care. The Department of Health and Human Services is working to finalize a rule to make permanent COVID-era policies that allow take home of methadone and the use of telehealth for buprenorphine treatment initiated by an opioid treatment program.
In April, the Centers for Medicare & Medicaid Services created a new opportunity for states to increase care for individuals in the period immediately prior to their release to help them succeed and thrive during reentry. The new Medicaid Reentry Section 1115 Demonstration Opportunity allows state Medicaid programs to cover services that address various health concerns, including substance use disorders and other chronic health conditions, for up to 90 days prior to the individual’s expected release date. Already, two states have had demonstration approved and another 13 are pending.[13] The new demonstration opportunity follows President Biden’s announcement in the State of the Union that all 122 federal Bureau of Prisons facilities will offer in-house medication-assisted treatment by this summer, as well as the release of a state model law to address substance use treatment in correctional settings to prevent overdoses. Nearly half (47%) of people who are incarcerated in U.S. prisons have a substance use disorder; these steps will help prevent overdose deaths, reduce crime, increase employment during reentry, and open doors to new beginnings, new opportunities, and fulfilling lives.[14]
We are also working to expand access to life-saving overdose reversal medications. In March, the Food and Drug Administration (FDA) approved the first naloxone nasal spray for over-the-counter, nonprescription use – a critical tool to save lives at a time when the majority of overdose deaths are driven by illicit opioids.[15] The Administration has taken historic action to increase access and President Biden has called for an additional $105 million for harm reduction services in his FY 2024 budget request, which will further the availability of this critical tool.
In June, I met with U.S. drug manufacturers who currently have FDA-approved overdose reversal medication products to discuss how we can increase access and affordability of these life-saving medications.[16] Expanding access to overdose reversal medications like naloxone is a key focus of the Strategy and supports President Biden’s Unity Agenda call to action to beat the overdose crisis. I asked these manufacturers to report on progress made over the next six months. ONDCP also works with the Legislative Analysis and Public Policy Association to develop model state drug laws on issues like expanding access to opioid overdose reversal medications.
We have also awarded nearly $100 million in grants over the past year as part of the Drug-Free Communities (DFC) Support Program, which provides funding to community coalitions across the country working to prevent youth substance use.[17] DFC coalitions constitute a critical part of the Nation’s drug prevention infrastructure – they are a catalyst for building capacity at the local level and engaging youth with messaging and resources tailored to their needs and the challenges they face. In fact, according to the latest DFC National Cross-Site Evaluation Report, 67 million Americans lived in a community with a DFC coalition and 35,000 people were successfully mobilized to engage in youth substance use prevention and reduction efforts.[18]
ONDCP has partnered with the Ad Council to educate young people across the country on the dangers of illicit fentanyl and the life-saving effects of naloxone.[19] The campaign meets young people where they are—including on social media platforms—and enlists the help of influencers such as college athletes and lifestyle content creators to talk about the pervasiveness of fentanyl in the Nation’s illicit drug supply and inform viewers about how they can keep themselves and their loved ones safe by carrying naloxone. As part of the campaign, information about naloxone will be featured on digital billboards in places that young people frequent, including college campuses, gas stations, bars, and restaurants. The new campaign builds on the Ad Council’s existing Real Deal on Fentanyl platform to highlight the importance of carrying naloxone and encourage young people to learn how to use and find naloxone in their communities. Based on this collaboration, DFC coalitions have access to additional messaging and resources that are reinforcing their efforts at the local level with approaches like fentanyl information campaigns, toolkits, webinars, and naloxone pop-up events.
ONDCP has also funded the development of a number of model state laws to help local jurisdictions improve substance use treatment in jails and prisons and deploy settlement funds from the various opioid lawsuits effectively, among others.
ONDCP is laser-focused on deploying every tool we have to address the opioid and overdose epidemic. However, in addition to longstanding structural factors, a changing and dynamic drug supply further complicates our work. Illicit xylazine—a veterinary tranquilizer also known as “tranq”—threatens the progress made to save lives and end the overdose epidemic. The presence of illicit xylazine has been detected in nearly every state. In CDC’s recent study of 21 U.S. jurisdictions, the monthly percentage of illicit fentanyl overdose deaths involving xylazine increased by 276 percent between January 2019 and June 2022.[20] In the same study, xylazine was detected in 10.9 percent of overdose deaths involving illicit fentanyl—roughly one out of every nine such deaths.
Earlier this year, under the authority granted by Congress, I designated fentanyl adulterated or associated with xylazine as an emerging drug threat facing the Nation, given its growing role in overdose deaths nationwide.[21] This marked the first time in our Nation’s history that a substance was being designated as an emerging threat by any Administration.
In line with statutory timelines, ONDCP released a National Response Plan on July 11, 2023, outlining action steps and key responsibilities for departments and agencies across the federal government to address fentanyl adulterated or associated with xylazine.[22] I have directed the National Drug Control Budget Agencies to update me on how they will implement concrete policy actions within the next two months. The National Response Plan contains both short- and longer-term actions that are already underway. So, to the parents, loved ones, community leaders, and those affected by xylazine use: I want you to know that help is on the way.
ONDCP’s Reauthorization
As you know, Congress established ONDCP under the Anti-Drug Abuse Act of 1988. A component of the Executive Office of the President, ONDCP oversees the implementation of the Nation’s drug control policy and leads the national drug control effort. ONDCP establishes policies, priorities, and objectives for the Nation’s drug programs and ensures that adequate resources are dedicated and coordinated to implement them. ONDCP was most recently reauthorized by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) in October 2018.
ONDCP’s upcoming reauthorization highlights opportunities to strengthen our ability to efficiently coordinate drug policy efforts across the Administration and with federal, state, local, Tribal, and territorial partners, and enhance our agility in responding to unexpected, emerging threats. There are a few areas where ONDCP could streamline processes or update requirements and still meet the intent of the 2018 reauthorization and we look forward to working with our interagency partners to submit reauthorization proposals to Congress.
I also want to take this opportunity to highlight significant progress we have made in implementing our recommendations from the Government Accountability Office (GAO). We take these recommendations seriously as they help us improve our efficiency and stewardship of taxpayer dollars. Over the course of this Administration, ONDCP has implemented more than half of our outstanding GAO recommendations, and we expect that several more recommendations will be implemented by the end of this calendar year. Many of these are related to improving the process and procedures for developing the National Drug Control Strategy, which we are aiming to release by the deadline. In addition, ONDCP created and leads an Interagency Drug Misuse High Risk List working group to coordinate across the interagency to make government-wide progress on the GAO Drug Misuse High Risk designation.
Conclusion
Every life saved means one less grieving family and community. There is hope, there is progress, and there is an unwavering commitment from the Biden-Harris Administration to use this inflection point to further reduce drug overdose deaths and save more lives. This crisis is not a red state or blue state issue; it’s America’s issue, and addressing it requires all of us to work together in a spirit of bipartisanship, which I am glad to say has been the case for many years. We have much work ahead of us, and your partnership will be as critical in the months ahead as it has been thus far.
On behalf of the hardworking people of the Office of National Drug Control Policy, I would like to thank the Committee and your Congressional colleagues for your foresight and leadership on this incredibly difficult issue. Ending the opioid and overdose crisis demands the best efforts of us all: the entirety of the federal government; states, Tribes, and local communities; private-sector partners and stakeholders; and the Congress, which has time and again demonstrated a strong spirit of bipartisanship on this issue.
The Office of National Drug Control Policy looks forward to continuing its work with this Committee, the Congress, and our other partners to disrupt the production and trafficking of these dangerous drugs, prevent and reduce drug overdoses and poisonings, save American lives, and protect our communities.
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[1] Vivolo-Kantor AM, Hoots BE, Scholl L, et al. Nonfatal Drug Overdoses Treated in Emergency Departments — United States, 2016–2017. MMWR Morb Mortal Wkly Rep 2020;69:371–376. DOI: http://dx.doi.org/10.15585/mmwr.mm6913a3
[2] Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report
[3] Florence C, Luo F, Rice K. The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017. Drug Alcohol Depend. 2021 January 01; 218: 108350. doi:10.1016/j.drugalcdep.2020.108350.
[4] Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. July 21, 2023. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
[5] White House Office of National Drug Control Policy. In Support of President Biden’s Plan to Address the Overdose Epidemic, White House Law Enforcement Awards for Outstanding Efforts to Stop Illicit Drug Trafficking. July 20, 2023. https://www.whitehouse.gov/ondcp/briefing-room/2023/07/20/in-support-of-president-bidens-plan-to-address-the-overdose-epidemic-white-house-announces-law-enforcement-awards-for-outstanding-efforts-to-stop-illicit-drug-trafficking/
[6] White House Office of National Drug Control Policy. The White House Announces Nine Newly Designated Counties Across America Are Joining the High Intensity Drug Trafficking Areas Program. July 6, 2023. https://www.whitehouse.gov/ondcp/briefing-room/2023/07/06/the-white-house-announces-nine-newly-designated-counties-across-america-are-joining-the-high-intensity-drug-trafficking-areas-program/
[7] White House Office of National Drug Control Policy. White House Announces Over $275 Million For Law Enforcement Officials Working to Disrupt Drug Trafficking and Dismantle Illicit Finance Operations. March 16, 2023. https://www.whitehouse.gov/ondcp/briefing-room/2023/03/16/white-house-announces-over-275-million-for-law-enforcement-officials-working-to-disrupt-drug-trafficking-and-dismantle-illicit-finance-operations/
[8] Executive Office of the President. Congressional Budget Submission: Office of National Drug Control Policy Fiscal Year 2024. https://www.whitehouse.gov/wp-content/uploads/2023/03/FY-2024-ONDCP-CONGRESSIONAL-BUDGET-SUBMISSION-FINAL.pdf
[9] White House Office of National Drug Control Policy. ONDCP Director Dr. Rahul Gupta Visits Arizona to Highlight Administration Efforts to Crack Down on Global Drug Trafficking, Including Implementation of New Technology at Border. July 3, 2023. https://www.whitehouse.gov/ondcp/briefing-room/2023/07/03/ondcp-director-dr-rahul-gupta-visits-arizona-to-highlight-administration-efforts-to-crack-down-on-global-drug-trafficking-including-implementation-of-new-technology-at-the-border/
[10] The White House. FACT SHEET: Biden-Harris Administration Announces Strengthened Approach to Crack Down on Illicit Fentanyl Supply Chains. April 11, 2023. https://www.whitehouse.gov/briefing-room/statements-releases/2023/04/11/fact-sheet-biden-harris-administration-announces-strengthened-approach-to-crack-down-on-illicit-fentanyl-supply-chains/
[11] White House Office of National Drug Control Policy. Dr. Rahul Gupta Releases Statement on the Launch of the Global Coalition to Address Synthetic Drug Threats. July 7, 2023. https://www.whitehouse.gov/ondcp/briefing-room/2023/07/07/dr-rahul-gupta-releases-statement-on-the-launch-of-the-global-coalition-to-address-synthetic-drug-threats/
[12] Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report
[13] Centers for Medicare and Medicaid Services. HHS Releases New Guidance to Encourage States to Apply for New Medicaid Reentry Section 1115 Demonstration Opportunity to Increase Health Care for People Leaving Carceral Facilities. https://www.cms.gov/newsroom/press-releases/hhs-releases-new-guidance-encourage-states-apply-new-medicaid-reentry-section-1115-demonstration
[14] Alcohol and Drug Use and Treatment Reported by Prisoners: Survey of Prison Inmates, 2016 | Bureau of Justice Statistics (ojp.gov)
[15] U.S. Food and Drug Administration. FDA Approves First Over-the-Counter Naloxone Nasal Spray. March 29, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray
[16] White House Office of National Drug Control Policy. Statement from ONDCP Director Dr. Rahul Gupta Regarding White House Meeting on Increasing Access and Affordability of FDA-Approved Overdose Reversal Medications. June 30, 2023. https://www.whitehouse.gov/ondcp/briefing-room/2023/06/20/statement-from-ondcp-director-dr-rahul-gupta-regarding-white-house-meeting-on-increasing-access-and-affordability-of-fda-approved-overdose-reversal-medications/
[17] Executive Office of the President. Congressional Budget Submission: Office of National Drug Control Policy Fiscal Year 2024. https://www.whitehouse.gov/wp-content/uploads/2023/03/FY-2024-ONDCP-CONGRESSIONAL-BUDGET-SUBMISSION-FINAL.pdf
[18] ICF (2022). Drug-Free Communities (DFC) Support Program National Cross-Site Evaluation: End-of-Year 2021 Report. Washington, DC: Office of National Drug Control Policy. https://www.whitehouse.gov/wp-content/uploads/2022/08/DCOS-EDITS-FINAL-FY-2021-DFC-National-Cross-Site-Evaluation-EOY-Report-Published-July-2022_dfc_template_2022_JUL13_Clean-DCOS.pdf
[19] White House Office of National Drug Control Policy. Biden-Harris Administration Launches Campaign to Raise Awareness About the Dangers of Fentanyl and the Life-Saving Effects of Naloxone in Partnership with the Ad Council. April 6, 2023. https://www.whitehouse.gov/ondcp/briefing-room/2023/04/06/biden-harris-administration-launches-campaign-to-raise-awareness-about-the-dangers-of-fentanyl-and-the-life-saving-effects-of-naloxone-in-partnership-with-the-ad-council/
[20] Kariisa M, O’Donnell J, Kumar S, Mattson CL, Goldberger BA. Illicitly Manufactured Fentanyl–Involved Overdose Deaths with Detected Xylazine — United States, January 2019–June 2022. MMWR Morb Mortal Wkly Rep 2023;72:721–727. DOI: http://dx.doi.org/10.15585/mmwr.mm7226a4
[21] White House Office of National Drug Control Policy. Biden-Harris Administration Designates Fentanyl Combined with Xylazine as an Emerging Threat to the United States. April 12, 2023. https://www.whitehouse.gov/ondcp/briefing-room/2023/04/12/biden-harris-administration-designates-fentanyl-combined-with-xylazine-as-an-emerging-threat-to-the-united-states/
[22] White House Office of National Drug Control Policy. Fentanyl Adulterated or Associated with Xylazine Response Plan. July 2023. https://www.whitehouse.gov/wp-content/uploads/2023/07/FENTANYL-ADULTERATED-OR-ASSOCIATED-WITH-XYLAZINE-EMERGING-THREAT-RESPONSE-PLAN-Report-July-2023.pdf
