The Biden White House sent its first National Drug Control Strategy to Congress on April 21. It breaks positive new ground by explicitly acknowledging harm reduction measures to prevent overdose and blood-borne diseases among drug users. At at the same time, though, it also relies heavily on the destructive and counterproductive pursuit of failed prohibitionist drug policies -- and funds more law enforcement much more heavily than harm reduction.

The strategy comes out just weeks after the Centers for Disease Control and Prevention (CDC) reported that drug overdose deaths hit an all-time high of 106,000 in the year ending last November. The administration is responding with what it calls a "whole of government" approach to the crisis.

"The strategy focuses on two critical drivers of the epidemic: untreated addiction and drug trafficking," the White House said. "It instructs federal agencies to prioritize actions that will save lives, get people the care they need, go after drug traffickers' profits, and make better use of data to guide all these efforts. Saving lives is our North Star, and the 2022 National Drug Control Strategy calls for immediate actions that will save lives in the short term and outlines long-term solutions to reduce drug use and its associated harms, including overdose."

While the strategy includes long-familiar categories such as drug treatment, prevention, supply reduction, and criminal justice and public safety, it also emphasizes an evidence-based approach, "building a recovery-ready nation," and for the first time, harm reduction.

"The Biden-Harris Administration's efforts focus on meeting people where they are and building trust and engagement with them to provide care and services," the White House said. "Specifically, the strategy calls for greater access to harm reduction interventions including naloxone, drug test strips, and syringe services programs. It directs federal agencies to integrate harm reduction into the US system of care to save lives and increase access to treatment. It also calls for collaboration on harm reduction between public health and public safety officials, and changes in state laws and policies to support the expansion of harm reduction efforts across the country."

The strategy calls for "the coordinated use of federal grant funds for harm reduction," and the administration last year broke new ground with a $30 million grant program for harm reduction providers. But in a sign of continued reliance on traditional law enforcement priorities, the strategy also envisions a $300 million increase for Customs and Border Patrol and another $300 million increase for the DEA. Those figures were released as part of the White House's FY 2023 budget released last month.

"Responding effectively to the illicit production, trafficking, and distribution methods of domestic criminal organizations and Transnational Criminal Organizations (TCOs) is a significant challenge and remains a Biden-Harris Administration priority," the White House said.

That kind of talk suited mainstream Democrats just fine.

"Illicit drugs cause immeasurable pain and loss in our communities. As the Chairman of the Senate Caucus on International Narcotics Control, I've pressed for an updated federal plan to tackle them," said Sen. Sheldon Whitehouse (D-RI). I've been clear that the plan must include a more coordinated approach to cracking down on drug trafficking and transnational criminal organizations, especially the ways in which they launder and protect their ill-gotten gains using US rule of law and financial networks; and more and better cooperation with our international partners to reduce the supply of precursor chemicals used to manufacture illicit drugs and to levy tougher sanctions against transnational drug syndicates. I'm pleased to see my priorities reflected in this new strategy, and I look forward to working with the Biden administration to deliver on those priorities."

Whitehouse also lauded the strategy's "tearing down barriers to treatment, including expanding access to life-saving naloxone and medication-assisted treatment; improving our data collection systems to better understand the effects of our intervention efforts."

Reform advocates offered praise -- sometimes lukewarm -- for the administration's tentative embrace of harm reduction, but blasted its reliance on tired, failed drug war paradigms.

In its analysis of the strategy, the Washington Office on Latin America (WOLA) called it "a major step forward" and lauded the administration for "focusing on ensuring access to treatment for substance use disorders and highlighting the crucial role of harm reduction services." But WOLA also noted that, "when measured against the scale of the nation's overdose problems and the urgency of the needs, Biden's new plan appears quite timid."

WOLA also warned that the strategy's "positive innovations regarding investment in treatment and harm reduction strategies risk being undermined by a continued commitment to the kinds of policies that have exacerbated the present crisis and that continue to absorb the lion's share of resources, namely, drug criminalization at home and wildly exaggerated expectations for what can be achieved through supply control efforts abroad."

Similarly, the libertarian-leaning Cato Institute called the attention to harm reduction a "positive," but noted steps that it did not take, such as making the opioid overdose reversal drug naloxone available over-the-counter and repealing the so-called Crack House Statute that stands in the way of federal approval of safe injection sites.

"On a negative note," Cato observed, "the remainder of the new report calls for doubling down on interdiction, border control, and other law enforcement measures aimed at curtailing the supply of illicit drugs -- as if repeating the same failed strategies of the past half century, only with more gusto, will somehow work."

So there it is: The Biden administration's first crack at a national drug strategy deserves kudos for its embrace of harm reduction and evidence-based approaches, but beyond that, it is pretty much more of the same old same old.

An Oklahoma psychedelic research bill advances minus a decriminalization provision, Mississippi regulators roll out initial guidelines for the state's medical marijuana programs, and more.

Marijuana Policy

New Jersey Regulators Okay First Recreational Marijuana Sales. The state's Cannabis Regulatory Commission on Monday opened the way to recreational marijuana sales by approving seven medical marijuana dispensaries to sell to anyone 21 or over. The commission's executive director, Jeff Brown, said retail licenses could be issued within a month, once dispensaries pay fees and undergo compliance checks. The move comes more than a month after the state blew through a February 22 deadline for dispensaries to begin selling to adults. The commission had been concerned about maintaining adequate supplies for patients, but those concerns seem to have been assuaged. "All of the (dispensaries) here, we believe have proven and have shown that they have adequate supply for their medical patients, that they are willing to put in place the necessary mechanisms to protect that supply, and ensure that medical patients are not impacted,” Brown said.

Medical Marijuana

Mississippi Medical Marijuana Program Rules and Regulations Released. The state Health Department on Monday released preliminary rules and regulations for the state's nascent medical marijuana program. These beginning measures address qualifying conditions, obtaining registry and identification cards, and how to certify as a practitioner, among other things. The list of qualifying conditions includes cancer, Parkinson’s, Huntington’s, muscular dystrophy, glaucoma, spastic quadriplegia, HIV, AIDS, hepatitis, amyotrophic lateral sclerosis (ALS), Crohn’s, ulcerative colitis, sickle cell anemia, Alzheimer’s, agitation of dementia, PTSD, autism, pain refractory to opioid management, diabetic/peripheral neuropathy, spinal cord disease, or severe injury; chronic medical treatment that causes cachexia or wasting, severe nausea, seizures, severe and persistent muscle spasms, or chronic pain. Patients may only get recommendations from doctors with whom they have an existing relationship and will pay $25 for a 1-year ID card. Those applications will be available on or before June 2.

Psychedelics

Oklahoma Senators Approve Psilocybin Research Bill but Remove Decriminalization Language Approved by House. The Senate Health and Human Services Committee voted unanimously Monday to approve a bill passed by the House that would allow eligible research and medical institutions to cultivate and administer psilocybin for research purposes, but only after amending it to remove a provision that decriminalized the possession of the drug. House Bill 3414 "came over [from] the House—it had some decriminalization elements in there," Sen. Lonnie Paxton (R) said on Monday, adding that lawmakers had "worked a lot with it, trying to make sure that we clean it up." They did that by erasing the decriminalization provision. “That no longer exists," he said. "This is just for a university study."

Drug Treatment

US Department of Justice Issues Guidance Concerning Legal Protections for Individuals Recovering from Opioid Use Disorder. The Justice Department published guidance last week explaining how the Americans with Disabilities Act (ADA) protects people who are in treatment or recovery for opioid use disorder (OUD), including those who take prescription medications as part of that treatment. The guidance says those people are considered disabled under the ADA, that they may be prescribed medications such as methadone, buprenorphine, and naltrexone, among others; and that employers may not discriminate against them if they are in treatment and using those drugs. The guidance also notes that while employers may conduct drug testing, they may not fire or refuse to hire people legally using those medications—unless the use renders the person unable to safely or effectively perform the job. DOJ said the guidance "is part of the department’s comprehensive response to the opioid crisis, which promotes prevention, enforcement and treatment" and lists several civil rights lawsuits it is pursuing over such discrimination.

Medical marijuana bills advance in Georgia and Kentucky, Honduras' former "narcopresidente" is a step closer to being extradited to the United States on drug charges, and more. 

Marijuana Policy

Rhode Island Governor Has "Concerns" About Marijuana Legalization Bill's Cannabis Control Commission. Gov. Dan McKee (D) has "significant constitutional concerns" with Senate Bill 2430, the marijuana legalization bill backed by House and Senate leadership. The concerns are around the proposed three-member cannabis control commission's members are to be appointed—and removed if necessary. The governor's office argues that the bill would give the Senate "unfettered discretion" on whether to remove a commissioner, which is says is a violation of the separation of powers. But one of the key sponsors of the bill, which was crafted after long deliberation, Sen. Joshua Miller (D-Cranston), said the governor's objection is not an insurmountable obstacle. "It’s not a big impediment," said Miller. "It’s solvable." 

Medical Marijuana

Georgia House, Senate Pass Separate Medical Marijuana Bills. The House approved a bill to revamp the state's dysfunctional medical marijuana system, House Bill 1425 on Tuesday. The bill would allow the provision of low-THC cannabis oil "from any available legal source" by August 1 and begin providing it to patients now on the state registry by August 15. The state had passed a low-THC cannabis oil law in 2015, but legal challenges have left Georgians without any legal supply. The Senate, meanwhile, approved its own medical marijuana bill, Senate Bill 609, which would require the medical cannabis commission to issue its initial licenses by May 31. Tuesday was the last day for bills to pass their original chamber, so both bills remain alive.

Kentucky House Approves Medical Marijuana Bill. The House on Thursday approved House Bill 136, which would legalize medical marijuana in the state. The legislation now heads to the Senate. This is the third try for bill sponsor Rep. Jason Nemes (R), who got a similar bill through the House in 2020 only to see in die in the Senate and whose 2021 effort got nowhere in the midst of the pandemic. The bill now heads to the Senate, where Senate Judiciary Chairman Whitney Westerfield (R) says he will back it despite personal reservations.

Psychedelics

California Psilocybin Legalization Initiative Falls Short on Signatures. Decriminalize California, the group behind a psilocybin legalization initiative campaign, announced Wednesday that it had failed to gather enough valid voter signatures to qualify for the November ballot. The all-volunteer effort faltered during the winter outbreak of the omicron variant of the coronavirus. "We were doing great there collecting and then in mid-December just about everyone of our core volunteers got COVID and most of the events we were scheduled at either closed, postponed or had an extremely weak turnout," campaign manager Ryan Munevar said in an email to supporters. The group will now do fundraising in coming months to determine whether it is feasible to start a second effort in either June or October of next year for 2024.

International

At Urging of US, CND Acts Against Precursor Chemical Used to Produce Illicit Fentanyl. The UN Commission on Narcotic Drugs (CND) voted Friday to control three chemicals used by drug traffickers to produce illicit fentanyl, a powerful synthetic opioid that is driving overdose deaths in the United States. At the request of the United States, and with the recommendation of the International Narcotics Control Board, the Commission’s Member States voted unanimously to take international action and control the acquisition, production, and export of three precursors used to manufacture illicit fentanyl and its analogues. "President Biden has made clear that ending the overdose epidemic is a top priority. As part of the Administration’s efforts to reduce the supply of illicit fentanyl driving overdose deaths, the United States called on the global community to regulate three chemicals commonly used to produce it, and today that call was answered," said Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy (ONDCP). "This new action makes it more difficult for drug traffickers to obtain and use these chemicals for illicit purposes. It will also help disrupt synthetic drug trafficking that not only leads to deaths caused by overdose, but also corruption, drug-related violence, and insecurity. The collective work of the international community to address global drug-related challenges has never been more important. The Biden-Harris Administration is committed to building on today’s progress."

Honduran Judge Okays Extradition of Former President to Face US Drug Charges. A judge in Honduras has ruled the former President Juan Orlando Hernandez can be extradited to the United States to face drug charges. Hernandez was president from 2014 until last month, after he lost an election, and was considered a US ally even though federal prosecutors alleged he was involved in drug trafficking throughout his presidency. He was detained last month by the new government at the request of the US. The "narcopresidente" has until Saturday to appeal the Wednesday ruling, after which he could be extradited. Meanwhile, he remains in prison in Honduras.

War Deepens Suffering for Ukraine's Drug Users. Drug users in the country are facing shortages of methadone and street drugs as the Russian military campaign in the country disrupts daily life. "Today, I went around five pharmacies where I used to get methadone on prescription. None were open. Another place was open today, but there was a queue of at least 200 people and I didn’t want to go into withdrawal right there, and so I went home," one drug user said. In the city of Kyiv, there were 45 fee-based centers serving opioid-dependent patients each; now they are all closed after the doctors evacuated. Similar clinics in the Crimean Peninsula were shut down when Russian forces took over in 2014; since then, of approximately 800 Crimean methadone patients, at least 80 have killed themselves, died of fatal overdoes, or died of other narcotic causes. 

Arkansas could soon see two seperate marijuana legalization initiative campaigns, a new poll shows DC voters are ready for drug decriminalization, and more.

Marijuana Policy

Arkansas Sees Second Marijuana Legalization Initiative Campaign Launched. And then there were two. Activists with Arkansas True Grass already have a marijuana legalization initiative in the signature gathering phase, and now, a former state House minority leader has announced the formation of a new advocacy group, Responsible Growth Arkansas, to push a second legalization effort. That former lawmaker, Democrat Eddie Armstrong, says his proposed initiative would "allow the regulated sale of adult-use cannabis in the state." Armstrong has yet to file an initiative text with state officials but promised more information in coming weeks. Statutory initiatives require 71,321 valid voter signatures. If Armstrong's initiative takes the form of a constitutional amendment, it would need 89,151 valid voter signatures. In either case, signature gathering must be complete by next July.

Medical Marijuana

Michigan Bills to Restrict Cultivation by Caregivers Advance. A package of bills that would limit the amount of medical marijuana that caregivers can grow is headed for the House floor. Under the package, caregivers would have to obtain a new specialty medical marijuana grower license and comply with a variety of new regulations. Under current rules, caregivers can grow up to 72 plants and must register with the state, but do not need a license. Under the bill package, caregivers could grow only 24 plants without a license. Because the package of bills alters the voter-approved 2008 medical marijuana initiative, it must garner 75 percent of the vote in both houses to pass.

Drug Policy

DC Voters Support Drug Decriminalization, Poll Finds. Just a week after activists announced a push for drug decriminalization in the nation's capital, a new poll finds very strong support for the notion. The poll had 83 percent saying the DC Council should pass an ordinance to "remove criminal penalties for possession of small amounts of commonly-used controlled substances consistent with personal use." That includes 65 percent who strongly support the far-reaching reform. The reform is being pushed by a coalition called DecrimPovertyDC, which includes groups such as the Drug Policy Alliance and Students for Sensible Drug Policy.

Harm Reduction

HHS Secretary Vows More Federal Support for Harm Reduction Measures. Health and Human Services (HHS) Secretary Xavier Becerra on Wednesday outline the Biden administration's approach to reducing drug overdoses and committed to more federal support for measures such as needle exchanges, increased access to naloxone, and test strips to check drugs for the presence of fentanyl. The strategy also includes expanding medication-based treatment, reducing "inappropriate" opioid prescribing (which could drive users into the more dangerous black market), and more support for drug treatment. Becerra even expressed some openness to safe injection sites: "When it comes to harm reduction, we are looking for every way to do that. … We probably will support the efforts of states that are using evidence-based practices and therapies." According to an HHS report released Wednesday, 840,000 people died of drug overdoses from 1999 to 2019. Becerra's comments reflect a statement of priorities for the administration’s first year released in March by the White House Office of National Drug Control Policy.