WASHINGTON — The new strategic plan from the Office of National Drug Control Policy (ONDCP) is fine as an outline but too short on detail, independent experts told MedPage Today — especially since the Trump administration took 2 years to finally pull one together.
“There’s nothing wrong with what they put out, it’s just not … very specific. It doesn’t set goals, it doesn’t include directives to certain agencies, and I’m not sure what that says about the role of the office,” said Regina LaBelle, JD, principal for LaBelle Strategies and a former ONDCP official in the Obama administration.
Caleb Alexander, MD, of the Johns Hopkins Bloomberg School of Public Health, said much the same when asked to comment on the plan: “Ideally the ONDCP would be quarterbacking the whole federal response or at least be clearly in the huddle, and I’m not sure that that’s the case.”
And Mike Riggs, an associate editor at Reason magazine — a libertarian publication that is generally critical of government anti-drug efforts — blasted the plan as “like a book report from a student who may or may not have read the book, and who may or may not have written his report on the bus ride to school.”
He noted that, at just 20 pages, it’s far less detailed than the last such document issued under President Obama, which was 87 pages long.
Congress mandated that ONDCP issue strategy reports each year, but this one was the first since President Trump took office in January 2017. Media reports last year suggested the agency was in disarray, without a permanent head until just a few weeks ago.
In the new report, ONDCP said it plans to focus on three core areas: preventing new “initiates to drug use,” increasing access to treatment and long-term recovery services, and curbing the availability of illicit drugs.
Its prevention agenda highlights a nationwide media campaign, the importance of prescription drug monitoring programs and community supports, as well as the office’s Drug Free Communities (DFC) program, which was created in 1997 to curb youth substance use at the community level.
The plan also mentions two media campaigns: “RxAwareness” and “The Truth About Opioids.” The latter aims to educate the public about “the speed at which chronic substance use can develop, the drastic measures those suffering from substance use disorder will take to feed their addiction and the need to reduce the stigma associated with addiction and treatment for substance abuse.”
The office continues much of the prevention work that began under the previous administration, LaBelle said.
Fred Wells Brason II, head of a community-based overdose prevention called Project Lazarus based in North Carolina, told MedPage Today he was pleased that prevention was an ONDCP focus.
“But education alone, we’ve been doing that for, what, 60 years?”
Brason said prevention should be defined better and the agency should put more emphasis on social determinants such as poverty, trauma, generational substance abuse, and “adverse childhood experiences.”
“All of those have to be addressed on a much higher level, otherwise we just spin the cycle again,” he added.
LaBelle was unhappy that the plan didn’t specify numeric goals for preventing drug abuse but used terms such as “significantly reduce” instead.
“We certainly want [overdose deaths] reduced,” commented Brason, “but that isn’t the single data point that proves success, because you can look at the mortality from overdose, but what about the data of non-fatal overdose. … The data point should be reduced mortality, emergency department visits, and increases in addiction treatment … all of those factors.”
“What gets measured matters, and I think it’s critically important that we have measurable goals and benchmarks along the way to meet those goals,” LaBelle said.
As for treatment and recovery, the report underscores the need to expand the number of physicians providing medication-assisted treatment to increase access to naloxone and to grow the addiction workforce, which includes drug counselors, physician assistants, community health workers, and others.
The focus on workforce expansion struck Yngvild Olsen, MD, MPH, public policy chair for the American Society of Addiction Medicine, as a positive aspect of ONDCP’s strategy.
“This is critical not only for the current opioid crisis but for the future health of our country. A robust, competent workforce able to provide the broad range of effective prevention, harm reduction, treatment and recovery services is worth the investment this will require,” Olsen told MedPage Today.
Sally Satel, MD, a resident scholar at the American Enterprise Institute and staff psychiatrist at a methadone clinic here found “no surprises” in the report and saw it as “a reasonable effort to hit on all the obvious angles” of prevention, interdiction, and treatment.
On the role of expanding access to treatment, Satel was “especially heartened” to see drug courts included in the report.
“Because as methamphetamine ramps up, that will probably be one of the best interventions there is,” Satel wrote in an email.
She cited the Project HOPE program in Hawaii as demonstrating “how well people addicted to methamphetamine respond to sanctions and incentives.”
LaBelle, however, found it troubling that ONDCP omitted any mention of needle exchange programs. These are “critically important” in stemming HIV and hepatitis C transmission, especially in rural areas and in the South, and the administration’s support “could carry some weight,” she said.