On April 21, 2023, the Biden Administration unveiled a landmark plan to transform the federal government’s approach to substance use disorder (SUD). The National Drug Control Strategy is a sweeping framework that addresses addiction, overdose prevention, and the illicit drug trade both inside the U.S. and internationally. At its core, the strategy focuses on helping individuals struggling with substance use disorders survive their challenges and transition toward recovery.
This National Drug Control Strategy is notable because it marks the first time harm reduction is positioned as a primary federal response to SUD. Historically, drug policies often emphasized criminalization and supply reduction. Now, the administration emphasizes a science-driven, compassionate approach that centers people and communities.
The National Drug Control Strategy outlines six key focus areas:
- Prevention and early intervention
- Harm reduction
- Substance use disorder treatment
- Enabling recovery
- Reducing illicit drug supply, nationally and internationally
- Reforming justice and public safety systems
President Joe Biden highlighted the plan’s foundation on “the best science, evidence, and data available,” underscoring the goal of ushering in a new era of drug policy focused on dignity, health, and equity.
Why This Plan Is Transformative: The Rise of Harm Reduction
One of the most significant shifts in this National Drug Control Strategy is the elevation of harm reduction. Instead of focusing solely on abstinence or incarceration, harm reduction recognizes that people use drugs and that saving lives and reducing negative health impacts must come first.
The report defines harm reduction as helping people who use drugs access services they need to stay alive, build trust, and find pathways to care when ready. This philosophy runs through nearly every element of the plan.
Key harm reduction initiatives include:
- Expanding access to naloxone, the opioid overdose reversal medication proven to save lives.
- Distributing drug test strips so users can detect potentially lethal substances hidden in drugs, such as fentanyl.
- Supporting syringe services programs, which prevent the spread of communicable diseases like HIV and hepatitis C by providing sterile needles and safe disposal.
By adopting harm reduction as a federal priority, the Biden Administration acknowledges the realities of drug use and embraces pragmatic solutions that can save thousands of lives each year.
Improving Treatment Engagement: Meeting People Where They Are
Despite the widespread prevalence of substance use disorders, treatment remains vastly underutilized. Federal survey data shows that only about 6.5% of people aged 12 and older with an identifiable SUD received any treatment. This gap reflects many barriers, including stigma, limited availability of services, and inadequate screening.
The new National Drug Control Strategy calls for a nationwide screening initiative to be integrated across all health care settings, especially those connected to public health. This means primary care providers and other health professionals would screen for SUD much like they do for diabetes or hypertension. Early identification is critical to linking people with the care they need before crises occur.
Moreover, the plan emphasizes low-threshold programs—services designed with minimal barriers to entry. This might mean offering immediate access to treatment options on-site or virtually, with referrals to specialized care as needed. The goal is to reduce delays and drop-offs in treatment engagement.
These efforts are crucial to addressing SUD as a chronic disease requiring ongoing support, not as a moral failing.
Reforming Treatment Quality and Payment Systems to Expand Access
One of the biggest challenges to expanding addiction treatment is the fragmented and often inadequate reimbursement system. Many SUD treatment providers either do not accept insurance or restrict services because payment rates do not cover costs or allow sustainable operations.
The Biden Administration’s National Drug Control Strategy calls for payment reform to remove these financial barriers. This includes educating Congress and providing technical assistance to revise laws and regulations that restrict access to care, especially medication-assisted treatment (MAT), which is proven effective for opioid use disorder.
Specifically, the strategy advocates:
- Removing laws limiting buprenorphine prescribing and enabling methadone to be prescribed in more federal healthcare settings.
- Encouraging health plans to better monitor and coordinate SUD care.
- Exploring reimbursement for care coordination as a strategy to improve treatment outcomes.
- Urging state Medicaid programs to innovate through demonstration projects approved by the Centers for Medicare & Medicaid Services (CMS).
- Evaluating Medicare reimbursement rates for SUD services, which often lag behind those for other medical conditions.
- Achieving full parity between SUD services and other health services under insurance reimbursement rules.
Improved reimbursement models will make it more financially viable for providers to accept insurance and expand treatment capacity, especially for marginalized populations.
Supporting At-Risk and Underserved Populations
Certain groups face disproportionately high risks from substance use disorders, including those involved with the criminal justice system. Overdose risk spikes dramatically after incarceration, and access to treatment in jails and prisons is often limited or nonexistent.
The National Drug Control Strategy prioritizes expanding evidence-based treatment options such as MAT and telehealth in correctional settings. It also calls for improved care coordination between justice and health systems to support individuals post-release.
The report acknowledges that treatment cannot happen in isolation from social needs. Many people struggle with housing, childcare, and other health issues that must be addressed for treatment to be effective. Privacy protections are also emphasized to ensure people can seek care without fear of stigma, discrimination, or legal consequences.
Building the Behavioral Health Workforce and Infrastructure
A crucial barrier to addressing the nation’s SUD epidemic is the shortage of qualified behavioral health professionals. Federal estimates project a need for tens of thousands more psychiatrists, addiction counselors, and other specialists by 2030 to meet rising demand.
To build this workforce, the National Drug Control Strategy proposes:
- Financing education and training through loan forgiveness or repayment programs tied to service in underserved areas, especially rural communities.
- Expanding addiction treatment education in medical schools, nursing programs, and schools of public health to broaden provider knowledge.
- Offering additional SUD training to psychologists, pharmacists, social workers, and others already in practice.
On the infrastructure side, the plan urges all states to adopt Certified Community Behavioral Health Clinics (CCBHCs), which combine comprehensive mental health and substance use services with innovative, value-based payment models.
The strategy also calls on federally qualified health centers—safety net providers for underserved populations—to expand SUD services. It encourages expanding telehealth for behavioral health across state lines and enhancing incentives for office-based buprenorphine treatment.
Conclusion
The Biden Administration’s National Drug Control Strategy represents a significant shift in federal drug policy. By centering harm reduction, expanding low-barrier treatment, reforming payment systems, supporting at-risk groups, and building the workforce, the plan aims to meet substance use disorder with a comprehensive, evidence-based response.
The true test will be implementation. Success requires coordination across federal agencies, state governments, healthcare systems, and communities. But this National Drug Control Strategy signals a hopeful new chapter—one focused on saving lives, reducing stigma, and supporting people with substance use disorders toward lasting recovery.