Harm Reduction, Expanded Tx Access Included in White House Drug Policy Priorities

WASHINGTON — Reaction appears generally positive to the first-year policy priorities on illicit drug use issued last week by the Biden administration, although experts did say they would have added a few more things to the wish list.

Seven Major Priorities

The priorities were released last Thursday by the White House Office of National Drug Control Policy (ONDCP). They include:

• Expanding access to evidence-based treatment. “American researchers, health care systems, and payers need to develop, scale up, and support a broader array of evidence-based treatment and recovery supports, including services such as housing,” according to the document. The ONDCP promised to, among other actions, remove barriers to prescribing buprenorphine and establish policy to help pregnant women with substance use disorder obtain prenatal care and addiction treatment without fear of child removal.
• Advancing racial equity issues in our approach to drug policy. “For many people with substance use disorders, access to care in the United States is inadequate, but for Black, Indigenous, and People of Color (BIPOC), the situation is worse,” the report noted. The administration pledged to develop research priorities in this area and promote the use of stands for culturally and linguistically appropriate services.
• Enhancing evidence-based harm reduction efforts. “Harm-reduction organizations provide a key engagement opportunity between people who use drugs and healthcare systems, often employing peer support workers,” the report said. The administration said it would work with ONDCP and other federal agencies to “explore opportunities to lift barriers” for federal funding of syringe services programs and also look for ways to expand access to naloxone.
• Supporting evidence-based prevention efforts to reduce youth substance use. The authors noted that “Illicit drug use rises during adolescence and young adulthood (16.1% of those ages 16-17 years and 26.4% of young adults ages 21-25 years reported past month use); rates generally decline incrementally thereafter, indicating teens and young adults are key populations for prevention efforts.” The ONDCP intends to take inventory of federally developed and funded youth drug use prevention programs and “identify evaluations and assessments of their outcomes and effectiveness”; and look for grants or other ways to support substance use disorder screenings performed via school nurses, school health clinics, or back-to-school physicals.
• Reducing the supply of illicit substances. “The Biden-Harris administration believes that part of the solution to the opioid overdose epidemic involves preventing illicit drug trafficking into the United States,” said the report. “Many of the illicit substances harming Americans are produced outside the United States and brought through the nation’s ports of entry. These substances can be marketed and sold on the dark web using cryptocurrency, and they are delivered to the purchaser through the mail and commercial carriers or brought across the nation’s geographic borders by multiple conveyances.” The White House said it plans to work with Western Hemisphere partners such as Mexico and Colombia to “shape a collective and comprehensive response to illicit drug production and use by deepening bilateral collaboration on public health approaches, expanding effective state presence, and developing infrastructure.”
• Advancing recovery-ready workplaces and expanding the addiction workforce. “Employers are often reluctant to hire a person with a history of substance use disorder,” the report noted. “This reluctance is often based on misconceptions and fears, negative attitudes, and even beliefs that discrimination against people with substance use disorder is acceptable.” In addition, “the nation’s addiction workforce is experiencing staffing shortages, and we need to address future needs for various behavioral health occupations.” Proposed actions in these areas include offering grants to support recovery in the workplace and removing hiring and employment barriers, as well as “seek[ing] opportunities to expand the workforce of bilingual prevention professionals and peer specialists by offering incentives to train in the substance use disorder field.”
• Expanding access to recovery support services. “Recovery support services help people build recovery capital to manage and sustain long-term recovery,” the report noted. The administration said it would work with state and local governments as well as recovery housing stakeholders to “begin developing sustainability protocols for recovery housing, including certification, payment models, evidence-based practices, and technical assistance.”

“The COVID-19 pandemic has exacerbated the addiction and overdose epidemic, leaving many families and communities hurting,” ONDCP Acting Director Regina LaBelle said in a statement. “These priorities lay out the aggressive, evidence-based, whole-of-government response that we need to implement in the first year of this administration in order to bend the curve.”

Good But A Little “Tepid”

Joel Ario, managing director at Manatt Health, a New York City-based professional services firm, liked what he saw. “The Biden-Harris drug policy hits the right notes in highlighting the need to retain the broader access to evidence-based treatment which has proven effective during the pandemic, and expanding access to naloxone and other harm reduction programs at a time when overdose deaths are at record highs,” he said in an email. “Other areas of critical importance include addressing the most acute needs such as access to treatment for pregnant and post-partum mothers and justice-involved populations, and advancing equity in all policies for an epidemic that has tragically disparate impacts on diverse communities.”

Caleb Alexander, MD, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins University in Baltimore, generally agreed that the priorities were on target, “although to be clear, many of them are not new, and some of the goals, such as identifying barriers, developing research agendas, and examining best practices, felt fairly tepid,” he said in an email, adding that “We are fortunate to have a remarkable degree of bipartisan consensus on many evidence-based approaches to reducing drug-related morbidity and mortality, and these are reflected in the administration’s priorities focused on prevention, treatment and recovery.”

Alexander also liked the focus on harm reduction as well as “a welcome focus on racial, gender and economic inequities and how these may exacerbate barriers to prevention, treatment and recovery.” But he expressed concern that although the American Rescue Plan includes nearly $4 billion for the Health Resources and Services Administration and the Substance Abuse and Mental Health Services Administration — two agencies that play key roles in the federal government’s response to the drug problem — “this is an incredibly small amount of funding relative to the scope of the problem that we face.”

In addition, he said, “I was a little surprised not to see more coverage of criminal justice interventions that are important in promoting treatment and recovery, including Law Enforcement Assisted Diversion, ‘Quick Response Teams,’ drug courts and reentry programs.”

Role of Mental Health

Benjamin Miller, PsyD, chief strategy officer of the Well Being Trust, a foundation in Oakland, California, that aims to advance mental, social, and spiritual health, said in an email that the report shows that “it’s apparent that this administration is thinking critically about issues of addiction, and these priorities reflect a nuanced understanding of the issues our country is facing … It’s noteworthy how much an emphasis these priorities place on the evidence. Three of the seven have ‘evidenced based’ in the title, which is a huge breath of fresh air. Considering that the addiction space is often fraught with less than quality care, its important to build off the evidence as best we can.”

Two other points that Miller said he wants to see generally emphasized — although he added that they are not necessarily ONDCP’s focus, so it was not a criticism of the report — are the need to address mental health alongside addiction issues, and the need to better integrate care “into the places that people show up. A key element of any strategy for mental health and addiction should recognize that we must better bring care to people — make it easier for them to access it — and pay for it.”