Government Spending on Drug Control: Are the Priorities Right?
The U.S. is plagued with an ongoing drug epidemic, with the current abuse and overuse of prescription opiates grabbing the headlines. Throughout different iterations of its ‘War on Drugs’, the federal government has played an active role in addressing the drug crisis. Previously, its policies and spending focused on addressing drug problems primarily as a law-enforcement issue, with treatment and prevention lagging far behind. However, as the various epidemics continued, drug control policies changed, particularly during the Obama administration. This leads to the natural question, what are these newly implemented policies and will they bring about more effective change?
The budget for the National Drug Control Strategy identifies resources that address three broad goals that will presumably diminish drug use including: (1) Stopping the Use Before it starts; (2) Intervening and Healing America’s Drug Users; and (3) Disrupting the Market. Eleven drug control agencies are part of the budget, which can be categorized into two large divisions: demand reduction and supply reduction.
The following chart shows the breakdown of U.S. drug control spending within the Bush Administration, during the fiscal years 2001 to 2008. Supply reduction, which includes law enforcement and punitive measures, received the bulk of funding. By 2008, emphasis was heavily placed on programs centered on domestic enforcement, extensive border security, and international initiatives by targeting notorious “drug source” countries. Demand reduction focuses on strategies to reduce the public’s interest in illicit drugs, through educational awareness, treatment, and prevention. As shown below, just 36% of all funding was devoted to demand reduction strategies.
HISTORICAL DRUG CONTROL FUNDING BY FUNCTION, FY 2001-FY 2008
(Budget Authority in Millions)
In contrast, the Obama administration has prioritized treatment, with demand reduction strategies now accounting for 44.8% of annual Drug Control Spending, as shown in the chart below, extracted from a White House report. Despite its shift in focus, its leading priority, domestic law enforcement, remains firm, and accounts for 35% of spending.
FEDERAL DRUG CONTROL SPENDING BY FUNCTION, FY 2014-FY 2016
(Budget Authority in Millions)
1. Expanding Medication-Assisted Treatment (MAT)
Research has shown that the use of buprenorphine/naloxone(Suboxone)has long-term positive health outcomes. There is a profound need for more access to this treatment. Traditionally, access has been limited due to inadequate insurance coverage, paucity of trained prescribers, and bias within the health care and criminal justice systems. MATs suppress cravings and have the ability to stop or reverse overdoses. In testimony to the Senate Caucus on International Narcotics Control, Nora D. Volkow, MD of the National Institute on Drug Abuse stated, “Medications have also become an essential component of an ongoing treatment plan, enabling opioid-addicted persons to regain control of their health and their lives.”
2. Prescription Drug Monitoring Programs (PDMPs)
PDMPs provide health care providers with information about drug abuse disorders and general warning signs. This educational reinforcement allows providers the opportunity to intervene before the problem becomes chronic. Most PDMPs are state-based, working to prevent prescription drug abuse and misuse within each state like SAMHSA’s Strategic Prevention Framework Program.
3. Prescription Drug Overdose Prevention for States Programs
The CDC is now providing 29 state health departments with resources and support for preventing prescription drug overdoses, including maximizing PDMPs and improving the protocol for collecting heroin-related overdose data. SAMHSA is also helping states purchase naloxone, another form of medication-assisted treatment that has been proven effective in reversing overdoes. Research has shown that the use of buprenorphine/naloxone (Suboxone) in monthly office-based treatments has long-term positive health outcomes.
Addiction to prescription opiates is deeply rooted and a comprehensive approach to treatment is essential. Identifying the root of any issue is pivotal to change. The federal government needs to keep applying the knowledge of what works, and what doesn’t, to address the epidemic, while directing its resources in the most cost-effective way within its budget. Increased funds for demand reduction should remain consistent. It would be a mistake to focus too much on law enforcement (supply reduction) as change will not come from a punitive approach, but more of a restorative one.