White House Issues Its First National Drug Control Strategy

Soon after James W. Carroll was sworn in as the Trump administration’s new “drug czar” on Thursday, the White House issued its first national drug control strategy.

And already the heat is on.

The leader of the House Committee on Oversight and Reform is criticizing the Office of National Drug Control Policy’s (ONDCP’s) National Drug Control Strategy report, saying it does not appropriately address the ongoing opioid crisis.

Rep. Elijah Cummings (D-MD) said he would hold a hearing on February 12 to examine the strategy — the first-ever issued during President Donald J. Trump’s presidency.

“Although I am encouraged that the White House has finally put out its long overdue plan, I am very concerned that this strategy fails to identify additional resources to make treatment available for many who desperately need it, fails to identify quantifiable and measurable objectives and goals, and — in my opinion — fails to address the gravity of the generational crisis our nation now faces,” said Cummings, in a statement.

The 23-page National Drug Control Strategy‘s introduction states that the opioid overdoses have “resulted in more American deaths in just two years than in the course of the entire Vietnam War,” with 47,500 overdose deaths in 2017 attributable to an opioid. Half of those opioid deaths involved synthetic opioids such as fentanyl and its analogues.

The report also notes that overdose deaths involving heroin, cocaine, methamphetamine, and prescribed opioids have all increased since 2014.

The report describes the ease of synthetic opioid production and discusses strategies to block the entry of fentanyl and other illegal drugs into the United States as a means of reducing the number of new users.

Initiation can also be prevented with public awareness and education campaigns. “Studies show that addiction is a disease that can be prevented and treated through sound public health interventions,” the report states.

Multiple Goals

The strategy also calls for increased use of Prescription Drug Monitoring Programs, better guidelines for clinicians on the use of opioids for acute and postsurgical pain, and an exploration of alternatives to opioids to treat pain.

The report basically follows the recommendations of The President’s Commission on Combating Drug Addiction and the Opioid Crisis, issued in November 2017. It includes urging greater awareness and use of naloxone, wider use of evidence-based treatments such as medication-assisted treatment, and removing barriers to treatment for substance use disorders.

The report did set some goals in terms of gauging the strategy’s effectiveness:

• A significant reduction in the number of Americans dying from a drug overdose within 5 years
• A one-third reduction in nationwide opioid prescriptions within 3 years, and that all healthcare providers have adopted best practices for opioid prescribing within 5 years
• To make evidence-based addiction treatment, particularly medication-assisted treatment for opioid addiction, more accessible nationwide
• A significant reduction in the production of plant-based and synthetic drugs outside the United States
• To make illicit drugs less available, reflected in increased price and decreased purity
• To realize an increase each year in drug seizures at all US ports of entry

The drug control strategy was long-time in coming. Typically, the ONDCP releases a strategy each year, but the Trump administration had not previously issued one. That may be in part because the ONDCP has suffered from a lack of confidence from the president and no permanent leadership of the drug office during his presidency.

The White House has periodically threatened to strip all funding from the ONDCP.

Carroll, who had been leading the ONDCP on an interim basis, was eventually nominated as the permanent drug czar — after the previous nominee, former Rep. Tom Marino (R-PA), had to withdraw in the wake of reports that he’d spearheaded an effort to essentially stop policing opioid manufacturers.

Carroll, an attorney, was confirmed by the Senate on January 2.

He was enthusiastic about the new drug control strategy. “This comprehensive plan reaffirms President Trump’s commitment to addressing the opioid crisis aggressively and in partnership with our partners across the nation,” he said, in a statement.

“The Strategy builds upon our current whole-of-government approach that educates Americans about the dangers of drug abuse, ensures those struggling with addiction get the help they need, and stops the flow of illegal drugs across our borders,” Carroll said.

https://www.medscape.com/viewarticle/908599