Relocations: Biden’s National Drug Control Strategy is a welcome breakthrough

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December 22, 2022

Drug abuse shouldn’t carry its own death sentence — This administration is the first to embrace harm reduction

By Herbert Rothschild

Last year the U.S. passed a grim milestone: 100,000 deaths by overdose. To be precise, according to the Centers for Disease Control (CDC), the reported number was 107,521. So far this year, people are ODing at about the same rate — 300 per day or 12 every hour.

Herbert Rothschild

In 2016, there were 65,000 deaths by overdose. On March 18, 2017, after the CDC released that figure, then-President Trump announced his remedy, which was to get tough with drug dealers, including using the death penalty. He did that — of the 16 people executed by the U.S. government since 1963, 13 were executed in the last year of Trump’s presidency (George W. Bush signed the other three death warrants). But because drug trafficking isn’t a federal capital crime, his bluster was simply that.

By contrast, on April 21, 2022, President Biden sent his National Drug Control Strategy to Congress. Biden’s statement on the occasion summed it up: “This strategy goes after two big drivers of the opioid epidemic: untreated addiction and drug trafficking. … It’s time we treat addiction like any other disease. And at the same time, we are disrupting drug traffickers’ financial networks, supply chains, and delivery routes, including on the internet.”

The SUPPORT Act of 2018 required that each administration produce a statement of drug policy priorities by April 1 of its first year and an inaugural National Drug Control Strategy in its second year. In the preface to the strategy paper, Dr. Rahul Gupta, Director of National Drug Control Policy, listed the priorities the administration had pursued in its first year.

  1. Expanding access to evidence-based treatment, particularly medication for opioid use disorder.
  2. Advancing racial equity in our approach to drug policy.
  3. Enhancing evidence-based harm reduction efforts.
  4. Supporting evidence-based prevention efforts to reduce youth substance use.
  5. Reducing the supply of illicit substances.
  6. Advancing recovery-ready workplaces and expanding the addiction workforce.
  7. Expanding access to recovery support services.

It was gratifying to see that law enforcement was assigned a low priority (No. 5), and that undoing the racism structured into the War on Drugs from its inception in 1971 was assigned a high one (No. 2).

SUPPORT is an acronym for Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities. What probably induced Congress finally to acknowledge that addiction is a disease and its spread a public health challenge was the opioid epidemic in white communities, including rural communities. In 2020, 62,317 whites died by OD, compared to 15, 256 blacks, and 10,606 Hispanics. By far the highest rate was in West Virginia (51.5 per 100,000 residents compared to a national average of 20.7 per 100,000). As long as drug abuse was perceived as an urban problem — especially a black problem — moral indignation and punishment seemed the appropriate public response.

Whatever the impetus for them, the recent changes in drug policy by some states and now at the federal level are welcome. Oregon has gone farthest in abandoning law enforcement as a useful strategy. No administration can afford politically to repudiate it outright, however, and we’ll continue to fund the Drug Enforcement Agency generously. Increasingly, though, the public’s bets will be placed on horses without so miserable a track record.

Which of these other horses will be winners? That depends on how one defines winning. The top priority should be the one listed above as No. 3 — harm reduction. Drug abuse shouldn’t carry its own death sentence. Biden’s administration is the first to embrace harm reduction, including needle exchanges, test strips to check drugs for the admixture of fentanyl, and wide distribution of naxalone kits, including to schools.

Development and distribution of medications to help addicts kick the habit are also promising. Some people got hooked from using prescription medicines to control physical pain, and they can be cured. Others abuse drugs for other reasons, and staying clean will require addressing them through rehab programs. But whatever problems lead to addiction, addiction itself becomes the problem that must be handled first.

Those other problems do demand attention. High as the number of OD deaths was before 2020, the trend line was almost flat for the previous three years. Then it jumped markedly, from somewhat over 70,000 to more than 100,000. Two causes have been singled out: a flood of fentanyl and the social isolation due to COVID-19. The latter simply exacerbated prevalent social conditions that lead to self-inflicted death.

Here’s what I wrote several years ago about opioid deaths and gun suicides (about 24,000 per year now, largely white men). The cause of most adult suicides, whether by firearms or opioids, is despair. And when suicides are rampant, the despair can’t simply be personal. These two epidemics are symptoms of a social order in decay.

Charles Hugh Smith, in “A Radically Beneficial World,” speaks of the “social defeat” that our socio-economic culture induces. He defines it as “the surrender of autonomy, fear of declining social status, and a permanent state of insecurity.” And the only remedy for widespread social defeat is to create a “social order that offers a variety of positive social roles and mechanisms for restoring autonomy to all its participants.”

To put forward that remedy requires more scope — and more boldness — than even a breakthrough national drug control strategy offers.

Herbert Rothschild is an unpaid board member. Opinions expressed in columns represent the author’s views and may or may not reflect those of Email Rothschild at

Dec. 23 update: Number of overdose deaths in 2016 corrected (65,000, not 42,000).

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Bert Etling

Bert Etling

Bert Etling is the executive editor of Email him at

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