New National Drug Control Strategy: Almost More Harm Reduction Access

    In 2022, the White House released a National Drug Control Strategy that it widely touted as the “first-ever to champion harm reduction.” Led by the Office of National Drug Control Policy (ONDCP), its harm reduction priorities were expanding access to naloxone, drug-checking and syringe service programs (SSP). In its first Strategy update since then, ONDCP reports that access was successfully expanded, except to places where it didn’t already exist.

    On May 29, ONDCP released its 2024 National Drug Control Assessment, the accompanying document for the 2024 National Drug Control Strategy released May 18. (Neither of these to be confused with the Drug Enforcement Administration’s 2024 National Drug Threat Assessment, also released in May.)

    The whole thing makes for a very abstinence-based approach to harm reduction, but no more than is expected. There’s nothing substantive about safe consumption sites, and no mention at all of access to safer smoking supplies or stimulant agonist medications. Nicotine vaping is addressed not as a harm reduction tool but as a “youth substance use” issue, alongside “prescription opioid misuse” and “binge drinking.” The closest reference to combustible cigarettes is that “youth who vape are more likely to engage in subsequent smoking.”

    For the most part, the ONDCP will do a decent job describing a given harm reduction goal as a broad concept, then choose a bizarre example to illustrate it and never mention the most obvious or impactful way to achieve it. 

    One of the ONDCP’s examples of harm reduction is Prescription Drug Take-Back Day. Elsewhere it suggests using harm reduction to update “policies like involuntary [methadone or buprenorphine] withdrawal for non-compliance,” rather suggesting those policies should end. 

    It explains that the “general public often views law enforcement as the only available public entity for responding to [overdose but] significant work is underway to shift this paradigm,” before describing overdose response efforts that only involve law enforcement.

    “Alongside all this progress, other overarching goals to prevent overdoses are being met,” the ONDCP states, “for example, trends related to prescription overdose deaths and deaths from heroin are decreasing.” This is a remarkable way to frame the decrease in heroin-involved deaths, but they might feel like “progress” if you don’t consider whether any other opioid deaths have increased instead.

    The people who have long struggled to access naloxone are not the people accessing it at pharmacies.

    The ONDCP discusses naloxone at length, but mostly to incorrectly attribute increased access to the fact that in 2023 the Food and Drug Administration authorized the first over-the-counter naloxone products, which are now for sale in pharmacies

    “The progress to date on naloxone has not just increased the available supply; it has created an entirely new system for accessing naloxone, particularly via retail stores,” the ONDCP states. These include “grocery stores and pharmacies, bringing naloxone to people who have long struggled to access it.”

    Harm reduction workers have created entirely new systems of naloxone access in recent years, but that’s not what ONDCP is talking about. Retails stores aren’t increasing naloxone access for people who who have long struggled for it. Generally speaking, the people buying naloxone for $44.99 at pharmacies are people whose relationship to naloxone is more recent and more casual.

    Though the ONDCP never really comes out and says that the barrier to naloxone saturation is cost, it indirectly references the problem by describing it in terms of grants and funding. But at no point does it ever mention that scores of public health distributors across the country could be purchasing several times more naloxone for a fraction of the cost by adding the generic intramuscular form, alongside the severely marked-up Narcan and other nasal sprays they’re ordering instead.

    In a few hundred pages of missed opportunities, what stands out is the repeated references to harm reduction access “where not prohibited by law.”

    For all the ONDCP’s emphasis on naloxone access in overlooked communities, there’s also no mention of naloxone access for anyone currently incarcerated. Which is part of a refrain that stands out amid several hundred pages of missed opportunities: the ONDCP repeatedly describing efforts to expand harm reduction services “where not prohibited by law.”

    These include access to naloxone; fentanyl and xylazine test strips; harm reduction supplies by mail; mobile van services; peer-led contingency management; and digital harm reduction services. But mostly it’s about access to SSP.

    All the ONDCP calls to action are for expanding SSP services wherever they’re already authorized. It addresses the entire issue of access where they are not authorized by referring back to a Legislative Analysis and Public Policy Association report from 2021. None of the ONDCP’s goals involve syringe access laws or drug “paraphernalia” statutes in states that ban SSP or de facto decriminalization. Just adding access wherever access of some sort already exists. 

     


     

    Photograph via City of Franklin, Tennessee

    • Kastalia is Filter‘s deputy editor. She previously worked at a number of other media outlets and wouldn’t recommend the drug coverage at any of them. When not at Filter, she works with drug users in NYC and drug checkers in North Carolina to track hyperlocal supply changes, and cohosts a national stimulant users call with Isaac Jackson.

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