Citing a leaked document, news reports recently revealed a proposal by the Office of Management and Budget to drastically cut the budget of the Office of National Drug Control Policy.
The proposal calls for eliminating two grant programs, one focused on community-based drug prevention and the other a law enforcement grant program. Accompanying elimination of these grants is steep reductions to ONDCP staffing levels. Democrats and Republicans alike have decried this proposal, calling it short-sighted considering today’s opioid epidemic.
ONDCP is a small agency — with less than 100 people — yet its influence and policy direction can help steer and coordinate drug policy across the Federal government, as well as with state and local governments.
President Obama referred to the work of government as steering a ship.
{mosads}As he said in 2015, “Sometimes the task of the government is to make incremental improvements or try to steer the Ocean liner two degrees North or South so that 10 years from now, we’re in a very different place than we were.”
At ONDCP, we sought to steer the ship, incrementally. We went too fast for some, not fast enough for others. But we were making changes. The degree of change helped to set a course in drug policy that will continue for years to come.
President Obama appointed Michael Botticelli as his second ONDCP director. His appointment and unanimous Senate confirmation marked an important turning point because it was the first time an ONDCP director came from a public health background.
He was also the first director openly in recovery from a substance use disorder. His tenure was significant because it steered the Agency in the direction of a public health approach to drug policy.
As ONDCP Director, Botticelli ordered that grant language be revised so drug courts receiving federal grant funds could no longer disqualify drug court participants for receiving medication-assisted treatment.
Again, a seemingly insignificant change but one with broader repercussions. Michael Botticelli also stressed that medication, combined with behavioral therapies, is the “gold standard” for treating opioid use disorders, dispelling the notion that it is just “replacing one drug with another.”
The Obama era also marked the first time a drug budget proposal allocated the same amount to prevent and treat substance use disorders, as was allocated to reduce the supply of drugs.
Over the course of the opioid epidemic, distributing naloxone to reverse overdose deaths took on added importance as overdose rates climbed.
However, mass naloxone distribution was difficult because naloxone is only available via prescription and overdoses were occurring in remote areas, making access to naloxone challenging. Then-Director of National Drug Control Policy Kerlikowske sought law enforcement support to outfit law enforcement agencies with naloxone.
We began small and built support nationwide. Quincy, Mass., was first and more and more police departments followed. Law enforcement and local communities embraced this effort, an effort that might previously have been dismissed as enabling drug use.
Opposition to syringe services programs has existed since they were introduced in the US in the 1980s. Except for a few years, a longstanding ban on spending federal funds for syringe services programs has existed.
However, working in a bipartisan manner, ONDCP led efforts to overturn the federal ban and today, federal funding is available to cover much of the costs associated with syringe services programs. Another degree in the ocean liner’s trajectory.
We did not accomplish all we set out to do. But we began to change the trajectory, to set a course that will be difficult to redirect.
ONDCP has both a public health and public safety mission, therefore, it can speak to both aspects of the drug policy issue with authority.
On many occasions, we helped to coordinate discussions between law enforcement and public health officials, people who had seldom spoken before. That is the unique nature of the office and why its continued work matters.
ONDCP’s influence is not because of its size, or even its statutory authority. The agency is important because it operates between the notes — it seeks to harmonize and find common ground between disparate agencies with different agendas.
Degree by degree, we were making a difference in the lives of people with substance use disorders, their families and their communities.
Money spent on ONDCP and its grant programs is an investment in the future health and well-being of all of us.
Regina LaBelle is the former Chief of Staff and senior policy advisor at ONDCP, serving in the Obama Administration as a political appointee from 2009 to 2017.
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