Citation

Incze MA, Kelley AT, Singer PM. J. Am. Med. Assoc. JAMA 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, American Medical Association)

DOI

10.1001/jama.2023.1041

PMID

36745436

Abstract

The inaugural National Drug Control Strategy (NDCS) released by the Biden administration in 2022 signals a new direction for opioid use disorder (OUD) care in the US. In response to escalating overdose deaths, the strategy--titled "Saving Lives is Our North Star"--newly emphasizes harm reduction practices, medications for treating OUD, and criminal justice reform in addition to more familiar objectives, such as supporting long-term recovery and interrupting illicit drug trafficking.1 This ambitious agenda, if fully realized, could transform the OUD treatment landscape and dramatically reduce opioid overdose deaths. Its success, however, will depend not only on a commitment of federal resources, but also on a concerted effort across multiple spheres of action--including state, community, and individual actors--working in harmony with NDCS objectives.

While federal legislation has expanded access to OUD treatment over the past decade, at times policy changes have fallen short at state and community levels. These events illustrate how legislation must be accompanied by an implementation strategy that includes state, community, and individual levels of action to effectively actualize NDCS objectives. For example, federal repeal of the X-waiver training requirement for buprenorphine prescribing has had limited impact in part because it was often not paired with sufficient training or institutional resources to support clinicians in adopting OUD treatment into practice.2 Identifying ways to amplify federal policy across spheres of action is necessary to ensure that the NDCS will lead to effective, long-term change. Targeted policy changes--especially relating to harm reduction, access to medications for OUD, and criminal justice reform--may catalyze a multitiered response necessary to end the opioid crisis and improve the health of people with OUD...

Language: en