President Biden presented his 2022 National Drug Control Strategy to Congress on April 21. Advocates applauded its unprecedented inclusion of harm reduction measures to prevent overdose and HIV and hepatitis C among people who use drugs, besides substance use disorder treatment. But Biden simulaneously remains heavily focused on “controlling” drugs by relying on law enforcement to prevent trafficking—a focus that undermines any federal harm reduction approach.
In the lengthy document, the Biden administration explains its plan to use agencies across the federal government—in partnership with state, local and tribal governments, together with international bodies like the United Nations—to address drug issues. “Saving lives is our North Star, and the 2022 National Drug Control Strategy calls for immediate actions that will save lives in the short term and outlines long-term solutions to reduce drug use and its associated harms, including overdose,” it states.
The Strategy includes eight broad categories: prevention and early intervention; harm reduction; substance use disorder treatment; building a recovery-ready nation; domestic and international supply reduction; criminal justice and public safety; and data and research.
“Despite over one million lives lost to drug overdose over the last 20-plus years, this is the first time an administration has included harm reduction in the National Drug Control Strategy.”
The harm reduction element is historic—no past president has ever even used the words “harm reduction” before, let alone advanced harm reduction policies. The administration’s plans to support a variety of harm reduction efforts throughout the country include shoring up state and local supplies of naloxone; increasing training and hiring of harm reduction workers; making it easier to prescribe buprenorphine for opioid use disorder; expanding syringe service programs (SSPs); and supporting drug-checking services.
To these ends, the Strategy encourages “the coordinated use of federal grant funds for harm reduction.” Last year, the administration launched an unprecedented but relatively small $30 million grant program to help fund harm reduction providers nationwide. The document also addresses barriers like federal or state laws that prevent distributing grant dollars to harm reduction organizations. So the signs are that federal funding for harm reduction will grow.
Advocates welcomed this departure.
“We applaud the Biden-Harris Administration for taking the historic step—to support access and funding for harm reduction services and reduce barriers to life-saving medications,” said Grant Smith, deputy director of the Office of National Affairs at the Drug Policy Alliance, in a press release. “Despite over one million lives lost to drug overdose over the last 20-plus years, this is the first time an administration has included harm reduction in the National Drug Control Strategy.”
The administration also lists specific nationwide objectives it hopes to achieve by 2025. These include a 13 percent reduction in overdose deaths; an 85 percent increase in the number of vulnerable counties with at least one SSP; and a 25 percent increase in the percentage of SSPs that offer drug-checking services.
While these harm reduction priorities are welcome, we should be skeptical. The document is dense with information and ideas, but relatively light on promises and specific actions. Few of these goals come with dollar amounts attached, or specific details on how the administration will implement them and how fast. Plenty of language promises to “identify obstacles,” “support research,” or “assess and provide recommendations”.
And the Biden administration has already proven that its pursuit of harm reduction is vulnerable to political pressures. Just a couple months ago, it caved to a social media backlash from Republican politicians and others over accusations it was giving out “free crack pipes.” The administration swiftly emphasized that none of its $30 million harm reduction grant program could be used to purchase sterile pipes and smoking kits—resources that are needed to protect people who use stimulants. Advocates have condemned this as an irrational distinction rooted in racism.
Unlike with its harm reduction goals, when it comes to enforcement the Biden administration is already putting its money where its mouth is.
Neither should we forget that an entire section of the Strategy is dedicated to an area where the federal government does have a long resume: drug interdiction and control. “Responding effectively to the illicit production, trafficking, and distribution methods of domestic criminal organizations and Transnational Criminal Organizations (TCOs) is a significant challenge and remains a Biden-Harris Administration priority,” the document reads.
Plans include improving intelligence-sharing among law enforcement agencies, using more federal, state and local “joint task forces,” and cracking down on drugs shipped in the mail. Beyond US borders, the administration promises to work more closely with Mexico, China, Colombia, Peru, Ecuador and India to crack down on drug production and transportation in those countries. It also promises to target trafficking organizations’ financial assets and money-laundering tools, and to work with private industries so they can police trafficking activity within their own supply chains.
In short, there’s a glaring disconnect between the Biden administration’s competing approaches.
And unlike with its harm reduction goals, when it comes to enforcement the Biden administration is already putting its money where its mouth is—with tens of billions of dollars allocated to drug-war agencies like the DEA, ICE and CBP. It recently proposed an additional $30 billion to support state and local police agencies over the next 10 years. The money spent on harm reduction thus far is mere pennies in comparison—the reallocation of even a fraction of the DEA budget could save far more lives.
In short, there’s a glaring disconnect between the Biden administration’s competing approaches. Supporting evidence-based harm reduction interventions nationwide, through funding and the removal of legal barriers, is essential. Yet continuing the drug war by targeting supply will cause more deaths and incarceration. Disrupting the drug supply in one community can cause chaos for people who depend on a reliable source. It can result in violence as new sellers compete for control. Prohibition incentivizes the marketing of more potent drugs. And the ongoing fear of arrest dissuades people from accessing the harm reduction resources that save lives.
“Prioritizing federal spending on public health rather than enforcement and interdiction is the best path forward,” said Smith. “But it must be done outside of the harmful apparatus of the drug war to be effective and provide the kind of racial equity this administration has long promised.”
Photograph of drugs seized by the US Coast Guard via the US Coast Guard
The Influence Foundation, which operates Filter, previously received a restricted grant from the Drug Policy Alliance to support a Drug War Journalism Diversity Fellowship.