In the wake of a March report from the Centers for Disease Control and Prevention (CDC) that drug overdose deaths climbed to a record 106,000 for the 12 months ending November 2021 (last November the agency reported 100,000 overdose deaths for the 12 months ending April 2021), the White House Office of National Drug Control Policy published a National Drug Control Strategy today.

On the positive side is ONDCP’s new appreciation for the benefits of harm reduction for reducing the risk of death and disease from using drugs obtained in the dangerous black market. The strategy includes a renewed emphasis on making the opioid overdose antidote naloxone more widely available. Unfortunately, the White House stops short of ordering the Food and Drug Administration to reclassify naloxone from prescription‐​only to over‐​the‐​counter, as I have written about here and here. As my colleague David Hyman and I spelled out in a Capitol Hill Briefing in October 2019, it is well within the power of either Congress or the Executive to make this happen.

The National Drug Control Strategy also calls for expanding evidence‐​based harm reduction strategies such as syringe services programs, and distributing drug testing devices such as fentanyl test strips.

Unfortunately, state‐​level drug paraphernalia laws are the big obstacle to the creation of syringe services programs and the distribution of testing devices. Many states still have laws that prohibit or severely curtail such programs despite the fact they are not federally illegal. Therefore, state lawmakers should repeal drug paraphernalia laws to clear the way for these proven harm reduction strategies.

The National Drug Control Strategy call for expanding Medication Assisted Treatment programs that use methadone or buprenorphine to treat addiction. But federal regulations stand in the way.

Congress can repeal the so‐​called “X‑waiver” that doctors must obtain in order to prescribe buprenorphine, and it can pass legislation permitting primary care providers to prescribe methadone on an ambulatory basis to treat addiction (as is done in the U.K., Canada, and Australia since the 1970s). I discussed these reforms in detail in a Statement for the Record I submitted to the Subcommittee on Health of the House Energy and Commerce Committee last April. Alas, the new drug control strategy makes no call for such reforms.

Another action that the federal government can take, but was not mentioned in the White House report, is for Congress to repeal the so‐​called “Crack House Statute,” so that local communities can establish Safe Consumption Sites—a time‐​tested means of reducing overdose deaths, in use throughout the developed world (there are 38 such sites in Canada alone), but federally prohibited in this country.

On a negative note, the remainder of the new report calls for doubling down on interdiction, border control, and other law enforcement measures aimed at curtailing the supply of illicit drugs—as if repeating the same failed strategies of the past half century, only with more gusto, will somehow work.

Oregon voters recently decided to try a new approach, and decriminalized all drugs within its borders while redirecting drug war resources to harm reduction strategies. Lawmakers in other states are watching Oregon closely and considering similar approaches.

While the new National Drug Control Strategy is an improvement over previous strategy, it would have been groundbreaking and visionary if the report had encouraged states to establish decriminalization pilot programs and allow the 50 “laboratories of democracy” to find ways toward a more realistic and humane drug policy.