President Donald Trump’s administration introduced the first national plan on substance use disorder treatment as part of its annual drug strategy, a document often emphasizing abstinence and supply-side policing.
The Office of National Drug Control Policy (ONDCP) released its annual Strategy document on February 3, outlining the same usual three priorities: prevention, treatment, and policing of the drug trade.
“The 2020 National Drug Control Strategy maintains focus on President Trump’s overarching goal from day one – reducing the number of Americans dying from drug overdoses,” ONDCP Director Jim Carroll said. “While the Trump Administration has made significant progress in preventing substance misuse before it starts, getting more people into treatment and long-term recovery, and curbing the flow of deadly drugs into our communities, now is not the time to rest on this success.”
What’s different about this year’s is the addition of a supplementary National Treatment Plan for Substance Use Disorder “to address increasing access to treatment and closing the gap.”
A central priority for the Treatment Plan is the expansion of opioid substitution therapy to the nine out of 10 US-Americans who need it but are still not receiving it. The Strategy specifically aims to boost the “percentage of practitioners certified to administer, prescribe, and dispense buprenorphine for opioid use disorder” from four percent, as of December 2019, to 10 percent by 2022. It does not recommend eliminating the waiver administered by the Drug Enforcement Administration, which experts, lawmakers, and practicing physicians consider to be prohibitive.
Interventions for the growing number of people experiencing stimulant-related harms plays a role in the Plan. It suggests “Increas[ing] access to treatment programs” specific to stimulants and “explor[ing] allowing” the more-than 1,000 opioid treatment programs—which themselves are far too scarce—“to treat stimulant use disorder.”
Surprisingly, the strategy throws support behind services offered at syringe exchanges. The plan is likely not referring to those related to actual syringe distribution, given the ongoing ban on federal funding for such efforts. But the mention of syringe service programs at all is a departure from 2019’s strategy, where no mention was made of them.
This time around, Trump’s plan identifies peer workers as assets in increasing treatment accessibility because, in part, they “are effective in conducting naloxone distribution and training and in supporting syringe services programs.” It also even recognizes SSP’s efficacy: “Continued engagement with these [syringe] services may help people with [substance use disorder] feel comfortable enough to seek treatment and/or engage in less risky substance use.”
One advocate is skeptical of the new addition of elements supported by harm reductionists. “It’s a weird mix of “Just Say No” Drug Warrior rhetoric, with some evidence-based treatment thrown in. The only problem is, all of the treatment/recovery gains they want are contradicted by other Trump policies,” tweeted Drew Gibson, policy manager for HIV and drug user health at AIDS United and a Filter contributor. “I mean, I’m glad ONDCP acknowledges that we have a treatment gap in this country, but what are they gonna do about it when the guy they serve is trying to light the [Affordable Care Act] on fire & replace it with health care savings accounts?”
Screenshot of drug czar Jim Carrol and President Donald Trump in September 2019 by C-Span.