What’s the Biden Administration Doing about Opioids?

Drug overdose deaths in the US reached a record high of 93,331 in 2020, according to data from the Centers for Disease Control and Prevention (CDC).  Synthetic opioids including fentanyl played a major role, contributing to 60% of all overdose deaths.  While the opioid epidemic isn’t exactly new, the pandemic has certainly exacerbated the epidemic, causing an uptick in illicit drug use and driving many to use in isolation.  With the Biden administration currently focused on the COVID-19 pandemic, what’s being done to address the other public health crisis facing the nation?

New Drug Czar, New Focus on Opioids?

On October 28, the Senate confirmed Dr. Rahul Gupta as Director of the White House Office of National Drug Control Policy (ONDCP).  The first medical doctor to serve as “drug czar,” Gupta is no stranger to the opioid epidemic.  As West Virginia’s health commissioner, Gupta gained national recognition for his data-driven drug treatment work in a state that has been devastated by the epidemic.  By appointing Gupta, the administration could be signaling a new focus on addressing the opioid crisis.

First-Time Support for Harm Reduction Policies

Since his confirmation, ONDCP Director Gupta and other top public health officials including Health and Human Services (HHS) Secretary Xavier Becerra have put forth a strategy known as “harm reduction” that provides care and support to people actively using illicit drugs.  While some state and local government already employ harm reduction strategies, they’re still considered controversial and have never previously been utilized by the federal government. 

One harm reduction policy the administration has specifically endorsed is a needle exchange program that involves giving sterile syringes to people who inject drugs.  While the administration believes this strategy will help reduce transmission of infectious diseases associated with illegal drug use, some lawmakers and law enforcement officials are expected to oppose the new policy. 

Higher Prison Sentences for Fentanyl?

Many opioids sold on the street are laced with fentanyl, contributing to the rise in overdose deaths.  To combat the growing prevalence of fentanyl, the Biden administration recently recommended that all fentanyl related substances be permanently placed into Schedule I of the Controlled Substances Act as currently fentanyl is a Schedule II drugAccording to the administration, this will provide law enforcement with the tools they need to respond to the trafficking and manufacture of fentanyl in an effort to reduce the overall supply of fentanyl. 

However, criminal justice and civil rights advocates say the move would lead to harsher prison sentences, and in return, exacerbate racial disparities already prevalent in the criminal justice system.  Doing so, they argue, would make for a repeat of the nation’s experience with higher penalties for cocaine possession in the 1980s and 1990s, where criminal defendants had little recourse due to a lack of legal resources. 

Other plans put forward by the Biden administration include:

  • Reducing stigma for people suffering from addiction.
  • Greater access to drug treatment.
  • A program to address racial and regional inequities in how people are treated for substance use disorder.

Will It Make a Difference?

Most of the administration’s proposals require congressional approval, and so far, a key proposal on harm reduction has gotten traction in Congress.  The Fiscal Year (FY) 2022 Labor-HHS-Education funding bill that was approved by the House in July 2021 removes a longstanding general provision that prohibits federal funds from being used to purchase syringes, thus clearing the way for needle exchange programs.  But as Congress grapples with high-priority items like the Build Back Better Act, FY 2022 spending, and the debt ceiling – all with aspirations to finish them by the end of the year – it remains to be seen how much Congress will do in the near-term to enable the administration to take new steps to reign in the opioid epidemic.  With perhaps a waning pandemic in 2022, lawmakers may be better positioned to work with the administration on addressing the opioid crisis in the second session of the 117th Congress.

Who Will Be the Next Drug Czar?

“We need a drug czar, Mr. President,” a young Senator repeatedly uttered in the early 1980s as illicit drug use surged in the nation’s cities.  There were several agencies fighting the war on drugs, and the Senator thought it would be best to have one person coordinating the federal response.  Then, in November 1988, President Ronald Reagan signed into law legislation to create an Office of National Drug Control Policy (ONDCP) to be headed by an official known colloquially as the “drug czar.”   

The young Senator who pushed for this position is none other than Joe Biden of Delaware.  Now as the 45th President, Biden is confronting another drug crisis, and to turn the tide, he needs a permanent drug czar.  Who will that be?

A New Drug War

Just as in the 1980s, a surge in drug use has ushered in a public health crisis that makes it more important than ever for the US to have a permanent drug czar.  This time around, the nation’s drug epidemic is being driven by a surge in opioid use that has only been made worse by the COVID-19 pandemic.  According to the Centers for Disease Control and Prevention (CDC), there were 88,295 predicted overdose deaths September 2019 through August 2020, a record high that is almost 19,000 more deaths, or 27% higher than the total for the previous 12-month period.  Experts say job losses, social isolation, anxiety, financial problems, and other pandemic-induced issues have made it difficult for people with substance use disorders to manage their addiction, leading to a sharp uptake in drug use. 

What Does the Drug Czar Do?

As part of the Executive Office of the President, ONDCP is tasked with coordinating the nation’s drug control policy through development and oversight of the National Drug Control Strategy and Budget, an annual report that is required by law.  In addition to running ONDCP, the Director evaluates, coordinates, and oversees both the international and domestic anti-drug efforts of executive branch agencies.  The Director also advises the President on anti-drug efforts.

The Director of National Drug Control Policy was notably a cabinet-level position from 1993 until 2009, when then-President Obama downgraded the position to a presidential appointment in the Executive Office with seemingly no explanation.  While advocates against substance use disorders have been pushing Biden to restore the position to its former level, the new Administration  has yet to make a decision on changing the drug czar’s status.  Interestingly enough, Biden criticized then-President George H. W. Bush in 1989 for declining to make ONDCP Director a cabinet-level position.

Who’s in the Mix to Lead ONDCP?

A top contender to lead ONDCP is Rahul Gupta, an internal medicine physician who currently serves as Chief Medical & Health Officer at the March of Dimes.  Gupta is no stranger to addiction issues, having previously served as Commissioner for the West Virginia Department of Health and Human Resources, where he was lauded for his efforts to slow overdose deaths in the state.  Gupta also has ties to the current Administration through his leadership of Biden’s transition efforts for ONDCP.  One factor that gives Gupta an edge is his strong relationship with Sen. Joe Manchin (D-WV), who has become a key swing vote in a divided Senate and could likely be counted on to vote to confirm Gupta.  However, Gupta has attracted some criticism for his perceived failure to address a 2017 HIV outbreak in West Virginia that resulted from a safe needle-exchange program.

Another notable contender is Regina LaBelle, who is currently serving as ONDCP’s Acting Director.  LaBelle formerly served as Chief of Staff of ONDCP during the Obama Administration, where she oversaw the Agency’s efforts to address the opioid epidemic and implement the National Drug Control Strategy.  Between serving in the Obama and Biden administrations, LaBelle led the Addiction and Public Policy Initiative at Georgetown University. 

Other contenders for the top job at ONDCP include former Rep. Patrick Kennedy (D-RI), a mental health advocate who has struggled with substance abuse in the past, and H. Westley Clark, a professor at Santa Clara University with extensive experience in addiction psychiatry. 

Slow Progress on Confirmations

The drug czar isn’t the only Administration post to go unfilled for some time.  While the Biden Administration has been nominating appointees at a faster pace than recent administrations, the Senate has been slow to confirm the Administration’s picks.  As of June 10, 2021, the Senate has only confirmed 42 of the current Administration’s nominees.  In contrast, by the end of May of their first year in office, Barack Obama had 145 confirmations, while George W. Bush logged 126 and Bill Clinton secured 151.

A major reason for the slow progress on nominations is a divided Senate.  Control in the upper chamber is currently split 50-50, and with Vice President Kamala Harris tilting the majority in Democrat’s favor with her tie-breaking vote, the Biden Administration needs unanimous support from the Democratic caucus to advance a nominee.  While President George W. Bush also began his first term with a 50-50 Senate, the current Senate is much more polarized, meaning Biden’s chances of attracting votes from Republicans on controversial nominees are slim to none.  The new Administration experienced this polarization firsthand when Neera Tanden, its nominee for Director of Office of Management and Budget, withdrew her name after Sens. Manchin and Susan Collins (R-ME) announced they would oppose her nomination.  Given the 50-50 split and highly polarized environment, it’s no surprise why the current Administration is facing a longer timeline to fill key positions.