“On the one hand, the administration is moving in the direction of liberalizing access to cannabis, but at the same time, in the strategy, it talks about the risks of doing so.”

By Aneri Pattani, KFF Health News

The White House’s newly released strategy to combat the nation’s drug and addiction crisis calls for some ambitious public health approaches that some experts say are laudable but will be hindered by the administration’s actions.

195 wide pages National Strategy for Drug Controlpublished on May 4, advocates making access to treatment easier than obtaining drugs, preventing young people from developing addictions in the first place, increasing support for people in recovery and reducing overdose deaths.

These broad goals are widely supported by public health researchers, addiction treatment clinicians, and recovery advocates.

But meeting such goals will be difficult for the administration mass layoffs of federal workers, cancel the investigation and community grants, attacks on institutions and practices which are useful for people who use drugs, and Medicaid cutsa state-federal health insurance program that is the nation’s largest payer of addiction and mental health care for low-income people.

Many of the components of the National Drug Control Strategy are “things that we would agree to and fully support”. Libby Joneswho leads overdose prevention efforts at the Global Health Advocacy Incubator, a public health advocacy group.

But “there are disconnects in terms of what’s important to the strategy and then what they’re actually going to fund,” he said of the Trump administration. “These inconsistencies are felt particularly loudly in this strategy.”

The White House’s National Drug Control Strategy has been released every two yearsit is a document that aims to define a coordinated approach to the federal government that has been one of the country’s defining issues in recent decades.

since 2000, More than 1.1 million people they have died of drug overdoses. Despite the deaths has decreased recentlythe number continues to rise compared to previous decades, and research suggests Overdose death rates for black Americans and Native Americans are disproportionately high.

The strategy document released this week is the first of President Donald Trump’s current term. In keeping with the administration’s approach to addiction issues, it places a strong emphasis on law enforcement efforts to reduce the supply of illegal drugs. The document repeatedly refers to a “war” against foreign “terrorist organizations” — the Trump administration’s term for drug cartels — and increased enforcement at US borders.

Also determines plans implementing artificial intelligence technologies to analyze illegal drugs brought into the country and wastewater testing to detect illegal drug use nationwide.

The second half of the strategy focuses on reducing the demand for drugs, supporting public health prevention efforts, addiction treatment, and helping people in recovery. Religion promotes the role of recovery and the widespread use of overdose reversal drugs such as naloxone.

In a news release, the White House Office of National Drug Control Policy called the document a “road map” that will “continue to dismantle our nation’s drug supply and defeat the scourge of illegal drugs.”

The Trump administration did not respond to requests for comment on how the strategy fits with its other actions.

In December, Trump signed one Reauthorization of the HELP Actcontinues with various treatment and recovery-related subsidies and the requirement that Medicaid cover all FDA-approved medications for opioid use disorders. He announced in January The Great American Recovery Initiativeincluding a 100 million dollar investment to combat homelessness, opioid addiction and public safety.

However, few details have been released about the initiative, and in January, about a month after the HELP Act was passed, billions of dollars in addiction-related grants suddenly became available. finish and reset In a frantic 24-hour period.

This “whirlwind” left a “sense of instability and uncertainty in the area”. Yngvild OlsenNational consultant for Manatt Health consulting. He led substance use treatment policy at the Substance Abuse and Mental Health Services Administration, or SAMHSA, under the Biden administration and left about six months into Trump’s second term.

Insecurity increased the president’s 2027 budget requestwhich proposes cutting various addiction and mental health programs and consolidating key federal agencies that work on these issues. Jones’ team and about 100 others in the field have done it he signed a letter Asking Congress to reject the proposals, as they did with similar requests last year.

The national drug strategy adds new and contradictory information to this confusing landscape.

Increasing access to treatment

One of the most significant public health goals in the strategy, mentioned at least half a dozen times, is to make treatment easier than buying illegal drugs.

National data underscores the need for: more than 80% of Americans those who need substance use treatment do not receive it.

The administration’s actions regarding health insurance may make it difficult to improve this statistic.

It’s Medicaid primary source of health coverage for adults with opioid use disorder. When implemented, the Medicaid work requirement in Trump’s One Big Beautiful Bill Act is expected to eliminate that coverage. About 1.6 million people with substance use disorders.

The last time the Medicaid rolls were purged was after that covid-era protections have expired – Many people who were receiving drugs for opioid addiction stopped and fewer people started treatment, according to one. research published last year.

Olsen, who is also an addiction medicine doctor, said she loves the strategy’s focus on making treatment readily available to anyone who wants it. But he said that’s “hard to really imagine when people might have to pay for it themselves because they might lose their Medicaid insurance coverage.”

Appreciate an analysis The upcoming Medicaid changes could cause 156,000 people to lose access to opioid use disorder medication and cause 1,000 more fatal overdoses a year.

People with private insurance may also be affected.

The Trump administration has he refused to enforce it Addressing the regulations of the Biden era strengthening mental health paritythe idea that insurance should cover mental illness and addiction treatment in comparison to physical treatments. And recently, the administration said that redo those regulations in total, raising fears that addiction treatment may become increasingly affordable.

The administration did not respond to specific questions about how it reconciles Medicaid and equity action with the goal of increasing treatment.

Prioritizing prevention

The strategy highlights that preventing addictions before they start is one of the keys to reducing drug demand. It calls for “promoting a drug-free America as the social norm” and implementing science-backed school and community-based programs.

“Investing in early prevention, before drug use starts, saves lives and resources,” he says, citing. several studies about cost effectiveness among such programs.

However, the president’s budget proposes cuts to these types of programs, and federal layoffs have decimated the agencies that would implement this work.

of the White House final quote request He proposes to cut approximately $220 million from SAMHSA Center for Substance Abuse Prevention and almost 40 million dollars Drug-free communities the program

Since the new administration began, SAMHSA has lost about half of the workforceand the Centers for Disease Control and Prevention about a quarter.

“It’s not clear to me that they’re going to have the funds or the people to make it happen,” Olsen said of the strategy’s prevention goals.

The strategy presents another wrinkle in the marijuana debate. The document points to marijuana use as one of the drivers of drug use disorders and “convergent evidence from multiple sources” suggests that cannabis use increases the risk of psychosis. It requires the development of new tools to treat marijuana withdrawal and addiction.

However, just two weeks ago, the White House led to reclassification medical marijuana is moving to and from a lower level of scheduled substances audition to do the same with marijuana.

“The administration, on the one hand, is moving in the direction of liberalizing access to cannabis,” Jones said, “but at the same time, strategically, it’s talking about the dangers of doing that.”

“There’s a disconnect there that begs the question: who do you think you are?” he added.

The administration did not respond to specific questions about its marijuana policies.

Stopping overdose deaths

One of the most surprising elements of the National Drug Control Strategy comes in the last paragraph of the last chapter. It focuses on public drug testing programs, which often use test strips to help people who use drugs determine whether their purchased lot contains more dangerous substances, such as fentanyl or xylazine. This helps them determine whether or not to use these drugs safely.

“Rapid test strips and similar technologies that detect fentanyl and other drugs are an important tool that should be legalized,” the strategy document says.

However, SAMHSA announced a last letter He said he would no longer pay for the test strips as part of the Trump administration’s “harm reduction and move away from practices that facilitate illegal drug use.”

The administration has also attacked harm reduction programs executive order and his the budget requests. He did not respond to specific questions about how that position affects the drug control strategy.

Regina LaBelleThe Georgetown University professor, who served as acting director of the Office of National Drug Control Policy in the Biden administration, wrote about the contradiction. a blog post: “It is the height of rhetoric over reality to defend an instrument while at the same time cutting off the funding used to acquire it.”

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