The Biden Administration hopes to remake the federal response to substance use disorder (SUD) with its new drug control plan.

The White House released the “National Drug Control Strategy” on April 21, a document encapsulating the federal government’s proposed approach to addressing addiction, overdose and the domestic and international illicit drug trades in the U.S.

It places major emphasis on helping people grappling with substance use disorders live through their ordeal and move toward recovery.

The White House touts this plan as transformative because it’s the first of its kind to include harm reduction as a primary response to SUD.

The strategy report lists several guiding principles and dozens of proposed action items in six focus areas — prevention and early intervention, harm reduction, SUD treatment, enabling recovery, reducing the supply of illicit substances nationally and internationally and the justice and public safety systems.

“These actions are based on the best science, evidence and data available,” President Joe Biden said in a preface to the report. “Through them, we strive to usher in a new era of drug policy centered on individuals and communities.”

The new drug control plan is part of Biden’s “Unity Agenda,” which he revealed during his State of the Union address.

Biden also called for addiction to be treated “like any other disease” and for the nation to better address unidentified and untreated cases of SUD.

We’re going to focus on the principles and action items for harm reduction and SUD treatment. You can read the 152-page report here.

Harm reduction

Preventing people from overdosing and helping them avoid other bad health outcomes while they use drugs runs through nearly all elements of the strategy report.

“[Harm reduction] means helping people who use drugs access services they need to stay alive,” the report states. “It means building trust with them so that when they wish to seek help, they know where to turn.”

Specific harm reduction efforts include expanding access to the opioid overdose reversal drug naloxone, providing drug test strips to detect concealed substances in drugs and syringe services programs that help prevent the spread of communicable diseases.

Improve treatment engagement by meeting people where they are

Only 6.5% of people aged 12 and older who could be identified as having a SUD received treatment previously, according to federal survey data.

The drug control plan calls for federal agencies to develop a screening initiative that will be rolled out in all health care settings — especially those that tie directly to public health services. Specifically, it calls for primary care providers to screen for SUD in a similar way that they would for diabetes and other chronic diseases.

If identified by a provider or if a patient seeks care, a provider should be able to provide “low-threshold” programs that have a “low barrier to entry” immediately, and a connection to specialty care later.

Improving treatment quality including payment reform

Health plan reimbursement is a major obstacle to wide and ready access to addiction treatment. Many SUD treatment providers don’t accept insurance or limit services based on what they can make.

“Reform is needed so that those treating groups most at risk receive funding, and so providers can make a business case for treating more of these patients and for accepting insurance,” the plan states.

Several action items in the report call for legislative action. A specific action item for payment reform is educating Congress and providing technical assistance to address outdated or unhelpful laws and regulations.

The report highlights removing laws that may limit access to medication-assisted therapy (MAT), specifically the use of buprenorphine to treat opioid use disorder (OUD). Similarly, regulatory agencies will look for ways to safely remove barriers to MAT, including allowing methadone to be prescribed in more federal health care settings.

The report puts an emphasis on using health plans themselves and their benefits as a tool to improve engagement with care. While not making a policy prescription, the report calls on health plans to better monitor and coordinate care. It states that reimbursement for care coordination should be researched.

At the state level, the plan encourages Medicaid departments to present innovative reimbursement models through the Centers for Medicare & Medicaid Services (CMS) for Medicaid section 1115 demonstration programs.

Medicare, the federal health plan for seniors, should evaluate reimbursement rates for SUD and related services, the report states.

It also calls for full parity between SUD and other health plan reimbursements.

Supporting at-risk populations

People who are incarcerated or have recently been incarcerated and struggled with SUD are among those most at risk of death via drug overdose. This section of the report focuses on bringing additional treatment — MAT, telehealth and other evidence-based therapies — and establishing care coordination with prisons and jails.

“Certain populations could benefit from treatment, but it may be close to impossible for them to participate without first having met their needs for shelter, childcare or other health issues resulting from drug use like overdose or infections,” the report states. “We also must continue to maintain strong privacy protections for people with SUD as we reform treatment so people who need care will attend without fear of shame, nor social or legal repercussions”

Build the treatment workforce and infrastructure

One federal estimate shows that the U.S. would need to add tens of thousands of more behavioral health professionals, especially psychiatrists and addiction counselors, to meet demand projections in 2030.

The workforce initiatives focus on financing prospective providers’ education — through loans or loan repayment — in exchange for work in designated areas. The report specifically highlights rural areas.

It also seeks to widen the pipeline of behavioral health professionals and deepen the understanding of other provider types by pushing for more addiction treatment education and training for medical schools, schools of nurses and public health professionals.

Psychologists, pharmacists and social workers already in the field could contribute to the workforce through additional training in SUD treatment as well.

On the infrastructure front, it calls for all states to adopt Certified Community Behavioral Health Clinics (CCBHCs), a federal program that pairs an all-encompassing mental health and substance use model with a payment model. It also calls for federally qualified health centers — safety net health care providers backed by the federal government — to add SUD services.

Additionally, telehealth services for behavioral health should be provided across state lines and the federal government should better incentivize office-based buprenorphine models, the report states.