EXECUTIVE OFFICE OF THE PRESIDENT OFFICE OF NATIONAL

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EXECUTIVE OFFICE OF THEPRESIDENTOFFICE OF NATIONALDRUG CONTROL POLICYWashington, DC 20503The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year OneThe overdose and addiction crisis has taken a heartbreaking toll on far too many Americans andtheir families. Since 2015, overdose death numbers have risen 35 percent, reaching a historichigh of 70,630 deaths in 2019. 1 This is a greater rate of increase than for any other type of injurydeath in the United States. 2 Though illicitly manufactured fentanyl and synthetic opioids otherthan methadone (SOOTM) have been the primary driver behind the increase, overdose deathsinvolving cocaine and other psychostimulants, like methamphetamine, 3 have also risen in recentyears, particularly in combination with SOOTM. New data suggest that COVID-19 hasexacerbated the epidemic, 4, 5 and increases in overdose mortality 6 have underscored systemicinequities in our nation’s approach to criminal justice and prevention, treatment, and recovery.President Biden has made clear that addressing the overdose and addiction epidemic is an urgentpriority for his administration. In March, the President signed into law the American RescuePlan, which appropriated nearly 4 billion to enable the Substance Abuse and Mental HealthServices Administration and the Health Resources and Services Administration to expand accessto vital behavioral health services. President Biden has also said that people should not beincarcerated for drug use but should be offered treatment instead. The President has alsoemphasized the need to eradicate racial, gender, and economic inequities that currently exist inthe criminal justice system.These drug policy priorities—statutorily due to Congress by April 1st of an inaugural year—takea bold approach to reducing overdoses and saving lives. 7 The priorities provide guideposts toensure that the federal government promotes evidence-based public health and public safetyinterventions. The priorities also emphasize several cross-cutting facets of the epidemic, namelyby focusing on ensuring racial equity in drug policy and promoting harm-reduction efforts. Thepriorities are: Expanding access to evidence-based treatment;Advancing racial equity issues in our approach to drug policy;Enhancing evidence-based harm reduction efforts;Supporting evidence-based prevention efforts to reduce youth substance use;Reducing the supply of illicit substances;Advancing recovery-ready workplaces and expanding the addiction workforce; andExpanding access to recovery support services.ONDCP will work closely with other White House components, agencies and Congress to meetthese priorities. 8 ONDCP will also work closely with State, local, and Tribal governments,1

ONDCP 2021The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year Oneespecially around efforts to ensure that opioid lawsuit settlement funds are used on programsthat strengthen the nation’s approach to addiction.Priority 1: Expanding access to evidence-based treatmentPresident Biden is committed to achieving universal coverage which will help provide morepeople with substance use disorders with the care they need. For far too long, people withsubstance use disorders have faced stigma and other barriers inside and outside of health careand addiction services. 9 Additionally, addiction treatment and mainstream health care haveexisted in two separate systems. As President Biden has emphasized, ensuring Americans haveaccess to affordable, high-quality health care and achieving universal health care are the mostcrucial steps toward addressing substance use disorders. Continued enforcement of the MentalHealth Parity and Addiction Equity Act (MHPAEA) 10 is essential to integrating treatment forsubstance use disorder into mainstream health care and improving the quality of care. Providershortages, 11,12 the cost of health care services, 13 reimbursement, 14,15 and other barriers totreatment 16 combine to make access to quality treatment out of reach for too many. 17American researchers, health care systems, and payers need to develop, scale up, and support abroader array of evidence-based treatment and recovery supports, including services such ashousing. A lack of adequate support from leadership and for reimbursement can dissuadeproviders from entering an area of practice. 18,19 Moreover, experts believe that even with greatersupport, regulatory oversight of providers and prescribers of medications for opioid use disorder(MOUD) 20,21,22 and attitudes toward individuals with substance use disorders 23 may cause healthcare providers to be reluctant to provide services to those in need. 24,25 The Biden-HarrisAdministration will carefully examine this complex legal and regulatory web, decide whichchanges are critical, and put in place or recommend the needed regulatory or legislative changes.In the first year, the Biden-Harris Administration will work through ONDCP to coordinate withother White House components and the interagency to: Evaluate progress made since the 2016 Mental Health and Substance Use Parity TaskForce issued its recommendations 26 and identify additional steps that need to be taken tocomplete these recommendations;Review policies relating to methadone treatment and develop recommendations tomodernize them;Remove unnecessary barriers to prescribing buprenorphine and identify opportunities toexpand low-barrier treatment services;Develop and establish a working group with health care insurers and employers topromote full implementation of the MHPAEA 27 to eliminate discriminatory barriers tomental health and substance use disorder services;Urge extension of the Opioid Public Health Emergency declaration and identify actionsthat can be taken under public health authorities to expand access to care;Evaluate and explore making permanent the emergency provisions implemented duringthe COVID-19 pandemic concerning MOUD authorizations, including allowingproviders to begin treating patients with MOUD by telehealth without first requiring an2

ONDCP 2021The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One in-person evaluation, as well as evaluating and ensuring the continuation of Medicaid andMedicare reimbursements for these telehealth services;Identify and address policy barriers related to contingency management interventions(motivational incentives) for stimulant use disorder;Explore reimbursement for motivational incentives and digital treatment for addiction,especially stimulant use disorder;Expand access to evidence-based treatment for incarcerated individuals by working withCongress and appropriate Departments and agencies;Publish final rules this year regarding telemedicine special registration and methadonetreatment vans; andExplore, identify barriers, and establish policy to help pregnant women with substanceuse disorder obtain prenatal care and addiction treatment without fear of child removal.Priority 2: Advancing racial equity in our approach to drug policyThere is a clear and discernable need to take steps to advance racial equity issues 28 resultingfrom current drug policy. President Biden has emphasized the need to eradicate racial inequitiesin the criminal justice system and has stated that people should not be incarcerated for drug usebut should be offered treatment instead. Executive Order 13985, Advancing Racial Equity andSupport for Underserved Communities Through the Federal Government, directs agencies topursue a comprehensive approach to advancing equity for all, including people of color andothers who have been historically underserved, marginalized, and adversely affected bypersistent poverty and inequality. 29 Such inequalities manifest in disparate access to care,differential treatment, and poorer health outcomes. For many people with substance usedisorders, access to care in the United States is inadequate, but for Black, Indigenous, and Peopleof Color (BIPOC), the situation is worse. A recent study showed that Black individualsgenerally entered addiction treatment 4-5 years later than White individuals and this effectremained when controlling for socio-economic status. 30 In Latino communities, those who needtreatment for substance use disorder were less likely to access care than non-Latino individuals. 31This discrepancy in treatment access is important to address at a time when rates of overdosesare increasing for some communities of color. 32In the first year, the Biden-Harris Administration will work through ONDCP to coordinate withother White House components and the interagency to: Identify data gaps related to drug policy to target unmet needs in diverse communities, incollaboration with the Equitable Data Working Group established by Executive Order13985;Establish a research agenda to meet the needs of historically underserved communities;Establish an interagency working group to agree on specific policy priorities forcriminal justice reform;Develop a drug budget that includes an accounting and analysis of how federal dollarsmeet the needs of diverse populations and shape drug budget recommendations to targetresources to address equity issues;3

ONDCP 2021The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One Direct agencies to begin collecting budget data that is thoroughly disaggregated bydemographic category where this information is not available;Identify culturally competent and evidence-based practices for BIPOC across thecontinuum of care that includes prevention, harm reduction, treatment, and recoveryservices; andPromote integration of the National Standards for Culturally and LinguisticallyAppropriate Services (CLAS) in Health and Health Care for providers of SUDprevention, treatment, and recovery support services, starting with a review of CLASstandards by executive departments and agencies with health care roles. 33Priority 3: Enhancing evidence-based harm reduction effortsAccess to quality health care, treatment, and recovery support services is essential for peoplewith substance use disorders. However, for some people with chronic conditions, formalsystems of care are often inaccessible. Their first point of contact may be through organizationsthat offer low-barrier services, including harm reduction. Such services meet people where theyare. These services include life-saving and evidence-based interventions such as providing theoverdose antidote naloxone, sterile syringes, fentanyl test strips (FTS), and testing for the humanimmunodeficiency virus (HIV) and Hepatitis C virus. Research has shown that syringe servicesprograms (SSPs) reduce HIV prevalence. 34,35,36 They also have the potential to connect at-riskpopulations to needed care. 37Harm-reduction organizations provide a key engagement opportunity between people who usedrugs (PWUD) and health care systems, often employing peer support workers. Regularengagement between harm reduction staff and PWUD builds trust, 38 allowing for an ongoingexchange of information, resources, and contact. This relationship can encourage individuals tofurther pursue a range of treatment options including MOUD induction, psychosocial treatment,and long-term recovery. Harm reduction staff can build trust over time with patients and are in aunique position to encourage PWUD to request treatment, recovery services, and health care.In the first year, the Biden-Harris Administration will work through ONDCP to coordinate withother White House components and the interagency to: Integrate and build linkages between funding streams to support SSPs;Explore opportunities to lift barriers to federal funding for SSPs;Identify state laws that limit access to SSPs, naloxone, and other services;Develop and evaluate the impact of educational materials featuring evidence-based harmreduction approaches that link PWUD with harm reduction, treatment, recovery support,health and social services through a diverse range of community members, including firstresponders, and train law enforcement officials in evidence-based approaches thataddress overdose and provide police-assisted recovery;Examine naloxone availability in counties with high rates of overdose and identifyopportunities to expand access in targeted areas among pharmacies, clinicians, peersupport workers, family and community members, and PWUD;Amplify best practices for FTS services, standards for FTS kits, and use of FTS as ameans of engagement in health care systems; and4

ONDCP 2021The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One Support research on the clinical effectiveness of emerging harm reduction practices inreal world settings and test strategies to best implement these evidence-based practices.Priority 4. Supporting evidence-based prevention efforts to reduce youth substance usePreventing youth substance use, including the use of alcohol, tobacco and illicit drugs, isessential to young people’s healthy growth and development. Delaying use until afteradolescence also decreases the likelihood of developing a substance use disorder. 39 Illicit druguse rises during adolescence and young adulthood (16.1 percent of those ages 16-17 years and26.4 percent of young adults ages 21-25 years reported past month use); rates generally declineincrementally thereafter, indicating teens and young adults are key populations for preventionefforts. 40 Interventions can be conducted with youth at higher risk as well as those who havealready initiated substance use. Research has shown that youth prescription opioid misuse is alsoassociated with other risky behaviors. 41 It is also important that we consider social determinantsof health such as poverty, homelessness, and other conditions as we build effective preventionstrategies.Scaling up science-based, community-level interventions to prevent and reduce youth and youngadult use as is evidenced by the Drug-Free Communit