In 2022 the White House Office of National Drug Control Strategy (ONDCP) published its first National Drug Control Strategy, which outlined seven goals to be achieved by 2025. On December 30, 2024, the ONDCP released the National Drug Control Strategy Performance Review System (PRS) Report—essentially a progress update on the Biden administration response to the overdose crisis between 2020 and 2022.
Though the ONDCP published an updated Strategy in May 2024, the new PRS report is intended to span data through 2022, corresponding to the original version. It has a tendency to veer into data from more recent years, however, which reflect a turnaround in overdose rates and as such look a lot better than the years the report is meant to cover.
The seven goals outlined in the original Strategy contain 25 objectives, most of which are assessed as on track. Five are already completed; five are behind schedule.
Viewed in the context of the recent drop in overdose mortality, the PRS updates would suggest that reducing drug-related deaths doesn’t actually require reducing access to drugs, but that’s probably beyond the scope of the ONDCP’s analysis.
Goal 1: Less drug use
The first objective for this goal was to reduce overdose deaths by 13 percent by 2025. The most recent Centers for Disease Control and Prevention data show a decrease of 16.9 percent, which according to the report is “[t]hanks in significant part to actions by the Administration.”
The second objective was to reduce prevalence of substance use disorders (SUD) specific to opioids, methamphetamine and cocaine by 25 percent.
The ONDCP attributed cocaine use disorder to 0.5 percent of the population in 2021, based on responses to the 2021 National Drug Use Survey. Which evolved between 2020 and 2021, and identifies different SUD by somewhat convoluted means, but the ONDCP doesn’t acknowledge non-problematic use of those substances and so approached use and SUD as the same thing. It attributed methamphetamine use disorder to 0.6 percent of the population, and opioid use disorder to 2 percent.
Per 2022 data, there’s been no change in baseline use of cocaine and meth. Opioid use increased to 2.2 percent, meaning “accelerated action” would be needed to finish on time.
Goal 2: More prevention
While the previous goal applied to ages 12 and up, this goal of ensuring that “Prevention efforts are increased in the the United States,” refers to youth drinking and vaping.
The first objective was to get youth alcohol consumption, measured by past 30-day use, under 6.5 percent by 2025. Data show that between 2021 and 2022 the rate decreased from 7.2 percent to 6.8 percent, which put it on track.
The second objective was to reduce youth use of nicotine vapes by 15 percent by 2025. Data show that in 2021, around 7.6 percent of middle- and high-school students reported having vaped within the past month. In 2022 this rose to 9.4, but the target for 2025 was anything under 11.1, so ONDCP considers this objective already met and the 2022 increase doesn’t change that.
Goal 3: More harm reduction
The first objective here was an 85-percent increase in the number of counties disproportionately affected by overdose that had at least one syringe service program (SSP). Data show that in 2020, 130 counties with high overdose death rates had at least one SSP; by 2022 this had increased to 180 counties, which was on track for the ONDCP goal of 241 counties by 2025.
The second objective was a 25-percent increase in SSP offering “some type of drug safety checking support service.” The 2025 target of 21.3 percent had already been met by 2021, but over the next year the number of SSP offering drug-checking services nearly doubled—2022 data show 46.7 percent of SSP met that criteria.
However, “some type” of drug-checking refers largely to fentanyl test strips, which are most useful to people who do not regularly use opioids. The more useful drug-checking service for people who do regularly use opioids—the population that SSP primarily serve—is on-site forensic analysis. This requires more expensive equipment, to which only a handful of SSP have access.
Goal 4: More treatment
The first objective was a 100-percent increase in admissions to treatment facilities among people considered at high risk for overdose involving opioids, methamphetamine or cocaine. This doesn’t include methadone maintenance or outpatient buprenorphine prescriptions. In 2021, treatment facilities reported 637,589 admissions among people using primarily opioids, methamphetamine, cocaine or other “synthetics,” which was already about one-third short of the target for that year. In 2022 admissions dropped to 604,096.
The second objective was to ease the shortage of behavioral health providers by 70 percent. The PRS report finds that this been pretty steadily on track and is projected to stay that way.
Goal 5: More recovery initiatives
The first objective here is to have at least 14 states operating a “recovery-ready workplace initiative” by 2025. The term refers to a Biden administration push for more equitable employment policies for workers with substance use disorder, which led to the creation of a national Recovery-Friendly Workplace Initiative in 2023. Data show this goal was met in 2022 with 16 states reporting a qualifying initiative, up from 13 in 2021.
The second objective was to increase the number peer-led recovery organizations to at least 194. This has been completed, as there were 232 as of 2022.
The third objective was to increase the number of recovery high schools to at least 47, which was on track with 45 operational as of 2022.
The fourth objective was to increase the number of collegiate recovery programs to at least 165, which was similarly on track with 149 as of 2022.
The fifth and final objective was to have at least 8,600 residential recovery programs operational by 2025. This too was on track as of 2022, with 7,957 programs.
Goal 6: “Criminal justice reform efforts include drug policy matters”
Despite the extremely broad title, this goal had pretty narrow objectives. The first was to have 80 percent of drug courts complete equity and inclusion trainings by 2025. As of 2022 we were at 19 percent, considerably behind schedule. The PRS report attributes this to a combination of COVID-19 pandemic restrictions and bureaucratic restrictions, which it expects to resolve.
The second objective was a 100-percent increase in access to medications for opioid use disorder (MOUD) in federal Bureau of Prisons facilities, and a 50-percent increase for in state prisons and local jails.
The PRS report does not differentiate between access to methadone and buprenorphine, which have been shown to decrease overdose risk, and naltrexone—which has been shown to increase overdose risk, and of the three Food and Drug Administration-approved MOUD is by far the favorite among corrections departments. With that in mind, the ONDCP goal is on track for federal and state prisons.
“Currently, there is no single data source that can be used to track progress in increasing the percent of local jails offering MOUD,” the report states. “For illustrative purposes, [the figure below] shows the estimated percent of local jails offering MOUD in the United States from 2019 to 2022.”
Goal 7: Less drugs
The first objective for this goal was a 365-percent increase in the “number of targets identified in counternarcotics Executive Orders and related asset freezes and seizures made by law enforcement.” This refers to people and entities associated with transnational drug-trafficking organizations. Per the report, 46 had been identified by 2022, and the administration was on track to identify 96 by 2025.
The second objective was a 14-percent increase in the number of people convicted of felonies as a result of Drug Enforcement Administration investigations using data from the Financial Crimes Enforcement Network (FinCEN). Per the DEA, as of 2022 it had used FinCEN data in investigations that led to the convictions of 6,529 people. This surpassed the goal of 5,775 people convicted by 2025.
The third objective was to have at least 70 percent of the DEA’s active priority investigations “linked to the Sinaloa or Jalisco New Generation cartels, or their enablers.” This was also on track, at 62 percent in 2022.
The fourth objective was to decrease “potential production” of cocaine by 10 percent, and that of heroin by 30 percent.
“The United States Government is internally realigning responsibility for conducting illicit crop estimates. As a result of the change in responsibility, there will be a temporary gap in data for 2022 and 2023,” the report states in reference to both cocaine and heroin. “This gap in data does not reflect a change in priorities.”
Potential cocaine production was decreased only slightly between 2020 and 2021, but was projected to be on track as of 2021.
“[I]t is important to note that provisional estimates of drug overdose deaths involving cocaine for the 12-month period ending in July 2024 were 14.1 percent lower compared to a year prior,” the ONDCP added. “The Administration will continue its efforts to reduce the supply of cocaine.”
Heroin interdiction was not on track, but the ONDCP made the same statement verbatim for heroin-involved deaths.
The fifth objective was to have a total of at least 14 incident reports—like seizures or stopped shipments—involving fentanyl precursors from China or India. From 2021 to 2022 the number dropped from 11 to two, but the ONDCP notes that this data is voluntarily reported by other entities and as such is unreliable. And also that preliminary estimates for 2023 look a lot higher.
Image via United States Drug Enforcement Administration
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