NATIONAL DRUG
CONTROL STRATEGY
THE WHITE HOUSE
EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF NATIONAL DRUG CONTROL POLICY
MAY 2024
, Table of Contents
Preface from Dr. Gupta, Director ..............................................................................1
Introduction and Executive Summary .......................................................................2
Chapter 1: Strengthening Prevention and Early Intervention .................................10
Chapter 2: Expanding Access to Evidence-Based Harm Reduction Strategies .....19
Chapter 3: Expanding Access to Evidence-Based Treatment ................................29
Chapter 4: Building a Recovery-Ready Nation ......................................................37
Chapter 5: Reducing the Supply of Illicit Substances in the Homeland ................44
Chapter 6: Cracking Down on the Global Suppliers of Illicit Drugs and Related
Criminal Networks ...................................................................................................50
Chapter 7: Improving the Criminal Justice System’s Response to Substance Use
Disorder ....................................................................................................................56
Chapter 8: Building Better Data Systems and Research ........................................63
Appendix A: National Treatment Plan ...................................................................71
Appendix B: Drug Data Plan .................................................................................82
Appendix C: Northern, Southwest, and Caribbean Border Counternarcotics
Strategies .................................................................................................................96
Glossary....................................................................................................................98
References/Notes ...................................................................................................102
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Preface from Dr. Gupta, Director
I recently called a mother to express my condolences. She had just lost her daughter, Michelle,
to drug overdose. Three years prior, her other daughter, Maya, had passed away after developing
substance use disorder (SUD) related to prescribed pain medications, and the mother had been
the one to find Maya unresponsive at home – every parent’s worst nightmare. In the last few
years, I’ve met too many Americans like Michelle, Maya, and their mother who have been
impacted by this Nation’s overdose crisis. Addressing this crisis is a top priority across the
Nation. The experiences of all those impacted by this crisis—parents, grandparents, children,
siblings, friends, neighbors, community members, caregivers, siblings, teachers, police officers,
correctional officers, doctors, nurses, peers, harm reductionists, and people in recovery—are the
building blocks behind the 2024 National Drug Control Strategy (Strategy).
This Strategy doubles down on the ongoing efforts to address two key drivers of the overdose
crisis: untreated addiction and the manufacturers and drug trafficking networks that profit from its
distribution and sale. Here’s the bottom line: SUD is a disease that must be treated, and the supply
chain for illicit drugs must be disrupted. It is now critical to accelerate our endeavors to prevent
young people from initiating drug use; expanding access to life-saving interventions like naloxone;
acting on emerging drug threats like xylazine; removing barriers to, and stigma of, treatment; and
supporting people in recovery and welcoming others to pursue it. We also need to tackle the
supply of these deadly drugs using every tool in our toolbox to go after the producers, distributors
and sellers or these drugs, as well as the illicit financial networks that support this deadly activity.
We have taken important steps, including by increasing global counternarcotics cooperation,
increasing prosecutions of drug traffickers, strengthening drug detection technologies on the border,
stepping up sanctions on drug trafficking organizations (DTOs) and individuals who threaten and
harm Americans, and making life-saving treatments more readily available. Because of this work,
El Chapo’s son is behind bars; naloxone is available over the counter; and the X-waiver, which was
a barrier to both prescribing and accessing buprenorphine for treating opioid use disorder, is no
more. And every day, there are more people in recovery because of our work 1—people like Freddie.
I first met Freddie at a jail in New Jersey where he shared his long history of struggling with
opioid use disorder, and how that led to his involvement with the criminal justice system. While
in jail, he received the treatment he needed, and now he talks of hope, family, and a future.
Because evidence-based public health and public safety measures were implemented with
fidelity, Freddie received the support and resources he needed to support his recovery journey.
But we still have work to do. All too many Americans like Michelle and Maya are still dying every
year of an overdose, 2 and many people are using more than one substance. 3 This is a crisis, and we
will not stop until we have squeezed every choke point in the global supply chain of illicit drugs,
fully denied producers and traffickers operating capital and profits by disrupting the commerce of
illicit drugs, and advanced technology to detect and stop the import of all deadly drugs. Let’s give
every impacted person and family a reason to hope by tackling this crisis together.
Rahul Gupta, MD, MPH, MBA
Director of National Drug Control Policy
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Introduction and Executive Summary
America is facing the deadliest drug threat in our history. Over the last 25 years, drug overdose
deaths in the United States from synthetic opioids, including fentanyl, have risen to more than
100 times their 1999 levels. The rate of fatal overdoses from other drugs, including cocaine and
methamphetamine, has also surged. 4 The overdose crisis calls for bold action.
The Office of National Drug Control Policy (ONDCP) has outlined vital steps for attacking two
drivers of this crisis. First, we need to protect against overdoses and reduce demand for drugs,
including by preventing drug use before it starts, saving lives, and supporting people in recovery.
Second, we need to dismantle the supply chains of illicit drugs, including cracking down on the
global criminal networks fueling American deaths. These lines of effort are two sides of the
same coin. Both must be pursued aggressively for meaningful and lasting change.
We have made progress. State Opioid Response (SOR) grant programs have prevented over
600,000 overdose deaths. 5 Historic federal investments have scaled up treatment efforts, with
SOR programs delivering nearly 10 million naloxone kits since 2020 6. Pharmacy prescriptions
for life-saving naloxone, an opioid overdose reversal medication (OORM), have surged 37
percent in the last two years, 7 while naloxone has started being sold over-the-counter for the first
time ever, thanks to actions by the Food and Drug Administration (FDA). The share of eligible
veterans in the Department of Veterans Affairs (VA) system receiving medication for opioid use
disorder (MOUD) has climbed steadily since 2020, 8 as has the percentage of people involved in
the criminal justice system with opioid use disorder (OUD) receiving treatment in federal
prisons, from 3 percent in 2020 to 60 percent today. 9 Meanwhile, our workforce of addiction
professionals continues to grow and the FDA’s approval last year of two naloxone products for
over-the-counter sales has expanded accessibility further. A bipartisan law, the Mainstreaming
Addiction Treatment (MAT) Act, increased the number of providers who may initiate
buprenorphine treatment from 129,000 to more than 2 million, bringing the medication to many
rural and underserved communities for the first time. 10 The Department of Health and Human
Services (HHS) has also expanded flexibility to prescribe MOUD in telehealth appointments,
facilitated the operation of mobile vans providing MOUD services, and increased opportunities
for states to apply for Medicaid funding to treat OUD in prisons and jails.
The American Rescue Plan (ARP) of 2021, which delivered direct relief to Americans in
response the COVID-19 pandemic, sharply scaled up efforts, including through expending more
than a billion dollars boosting mobile crisis intervention units, and another billion to expand the
community health workforce, including mental health care workers. Finally, the ARP ushered in
unprecedented measures to prevent homelessness, both a symptom of overdose crisis and a major
barrier to recovery. Most significantly, it ushered in a national eviction ban that helped bring
down eviction filings to 20 percent below their pre-2021 average. 11
Other efforts are helping prevent drug use before it begins and support people in recovery, saving
lives, all while improving equity. Partnering with the Ad Council, ONDCP launched the Real
Deal on Fentanyl campaign. Through the campaign, targeted messages on social media and
digital billboards have reached millions of young people nationwide, educating them on the
dangers of fentanyl and how to save lives by administering naloxone. Additionally, historic
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numbers of people with federal criminal offenses for simple possession and use of marijuana
have received federal pardons. Bipartisan legislation that invests in creating jobs has also
contributed to efforts against the overdose crisis. For example, the Bipartisan Infrastructure Law
is investing $546 billion to create good-paying jobs, 12 which have downstream effects that help
stop drug use and support people seeking recovery.
On the supply side, officials stopped more fentanyl at ports of entry (POE) over the last two
years than in the previous five years combined, 13 helping keep tens of millions of fentanyl-laced
pills and thousands of pounds of fentanyl powder away from our communities. New drug
detection machines and enforcement surges at the border have interdicted historic amounts of
illicit drugs, and the number of drug traffickers and their affiliates facing sanctions has more than
doubled since 2020. 14 The United States has criminally charged leaders of the world’s largest
and most powerful drug cartel – including Ovidio Guzman Lopez, the son of “El Chapo” – and
thousands of drug traffickers distributing fentanyl on our streets and on social media. The
Department of the Treasury has leveraged new authorities to sanction more than 290 people and
organizations involved in the global illicit drug trade. The United States has also built a global
coalition to accelerate the fight against illicit drugs, engaged key partners, such as Mexico,
Canada, and others to work collaboratively to detect emerging drug threats and disrupt
trafficking. After a period of suspended cooperation, the People’s Republic of China (PRC)
agreed to resume bilateral cooperation on counternarcotics, and we launched the United States-
PRC Counternarcotics Working Group (CNWG) in January 2023, with the goal of reducing the
flow of precursor chemicals and deadly drugs into the United States and around the world.
Yet, there is much more work to do be done. With fatal overdoses and poisonings still claiming
the lives of many tens of thousands of Americans every year, ONDCP and its federal partners
will continue to do all it can to meet the crisis.
ONDCP’s 2024 Strategy looks to the future this Nation needs. That future is one with greater
access to prevention, treatment, harm reduction and recovery support services; with a focus on
equity and equal justice; with support for incarcerated individuals, as well as post-incarceration
reentry assistance; with a SUD and health care workforce that meets our Nation’s needs; with a
payment system that sufficiently funds care; and with a concerted transnational effort to hold
drug traffickers, their enablers, and facilitators accountable.
The 2024 National Drug Control Strategy
The 2024 Strategy is aimed at addressing the overdose crisis from multiple angles. This includes
preventing youth substance use, expanding access to life-saving medications like naloxone,
expanding access to evidence-based treatment, building a recovery-ready Nation, and ramping
up efforts to disrupt and dismantle drug trafficking.
Chapter 1: Strengthening Prevention and Early Intervention
National survey data highlight the progress made in decreasing substance use from 2020 to 2021
among 8th, 10th, and 12th graders across many substances, including alcohol, marijuana, and
vaped nicotine. 15 Other data demonstrates that current use of alcohol, marijuana, and binge
drinking among high school students decreased from 2019 to 2021. 16 Agencies such as HHS
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have supported school-based programs that have referred over 200,000 students for behavioral
health or related services in recent years. But despite this progress, important challenges remain.
For example, almost one-third of high school students report substance use, and among those,
more than one-third report they are using more than one substance. 17
Achieving further success in preventing substance use before it begins will require focusing on
root causes, as well as key risk and protective factors at the individual, family, and community
levels, and promoting mental health and wellness, particularly among youth and adolescents.
With continued challenges with suicidal behaviors and deaths by suicide among adolescents, 18
some of which involve opioids or other substances, 19 attention and investment towards
prevention and early intervention among youth populations are necessary.
This chapter of the Strategy outlines areas where further prevention efforts can make a
measurable difference, including by raising awareness of substance use harms in the collegiate
community and the workplace, establishing a community of practice for evidence-based
prevention of youth substance use and adverse childhood experiences (ACEs), expanding
screening for substance use for school-aged children in health care settings, translating research
findings into clinically and culturally appropriate tools, and more. It also includes continued
support for community institutions, like Drug-Free Communities (DFC) coalitions, with a
documented track record of reducing youth substance use.
Chapter 2: Expanding Access to Evidence-Based Harm Reduction Strategies
Prior Administrations have not incorporated harm reduction into its activities as an evidence-
based strategy for reducing adverse outcomes resulting from substance use, especially in the
cases of people who do not receive services through traditional health care systems. These
programs involve an array of essential health and social services, including OORM (such as
naloxone), sterile supplies like syringes, access to MOUD, and test strips for drug checking,
among other services. In many cases, the strong relationships that develop between harm
reduction program clients and staff lead to clients expressing interest in entering formal SUD
treatment on their own terms, with the confidence of choice and control.
Access to harm reduction services remains vital, particularly as illicitly manufactured fentanyl
continues to be increasingly present in the drug supply. Illicit fentanyl, a highly potent synthetic
opioid, is involved in the vast majority of drug overdose deaths in the United States. 20 Bringing
awareness to and widely distributing OORM is an important step toward slowing the rise in
overdose deaths. Recent efforts with naloxone present one example. Historic federal investments
in the SOR grant program, which helps deliver life-saving naloxone to people who need it, have
prevented over 600,000 overdose deaths in the last three years. 21
Since the publication of the 2022 Strategy, progress has been made to broaden access to harm
reduction services in jurisdictions that permit these activities, and advocate for change in
jurisdictions that do not yet allow them. This chapter of the Strategy focuses on ways to do this,
including through model state laws, training and education for the treatment workforce, engaging
states to ensure the experiences and perspectives of people actually performing lifesaving harm
reduction work are considered in decisions around funding, and more.
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Chapter 3: Expanding Access to Evidence-Based Treatment
In order to save as many lives as possible and bring down the rate of overdose fatalities, it is
imperative that people living with SUD have access to health care that identifies and treats their
condition while supporting them with needed additional services to ensure they can enter
recovery and thrive during and after the recovery process.
Since the publication of the 2022 Strategy, progress has been made in expanding access to
substance use treatment. This includes taking the step to expand access to treatment for OUD for
millions of Americans. Under the Consolidated Appropriations Act of 2023, prescribers of
controlled substances no longer must secure a waiver from the federal government to register as
an opioid treatment program (OTP) to initiate buprenorphine treatment for OUD, meaning
people can access treatment from their primary care provider. 22 This policy change significantly
increased the number of providers who can offer this treatment. Other progress includes
certification of many new mobile units that provide MOUD, as well as federal investments that
have steadily expanded the number of eligible veterans receiving MOUD within the VA system.
Landmark legislation like the ARP, in particular, has dramatically scaled up health workforce
training and mobile unit deployment in recent years, with the ARP investing billions of federal
dollars in these areas.
This chapter examines ways to further expand access to treatment for SUD so every American
who needs it can access it by 2025. Additionally, the ONDCP Treatment Plan (Appendix A),
required by the 2018 Substance Use-Disorder Prevention that Promotes Opioid Recovery and
Treatment for Patients and Communities Act (SUPPORT Act), elaborates further on screening,
connections to care, workforce, and other elements necessary to continue reducing overdose and
fatalities.
Chapter 4: Building a Recovery-Ready Nation
In 2022, an estimated 48.7 million Americans aged 12 or older had SUD. 23 Notably, among
people aged 18 and older with SUD, more than 60 percent, or nearly 27 million Americans, were
employed, and more than 3 out of 4 worked full-time. 24 SUD is widespread, including in the
workplace 25,26,27 and in secondary and higher education settings. 28,29,30,31 Fortunately, recovery
is prevalent as well. That same year, among the estimated 30 million Americans aged 18 or
older who recognized that they experienced a lifetime alcohol or other drug issue, 21.3 million
(71 percent) identified as “in recovery” or “recovered” from a substance use issue. 32 Stigma,
discrimination, and misunderstanding are among the most pervasive barriers to treatment and a
life in recovery. 33
Since the publication of the 2022 Strategy, progress has been made in advancing efforts to build
a recovery-ready Nation. For instance, the federal government has worked to promote the
adoption of recovery-ready workplace (RRW) policies across the public and private sectors,
including within the federal government. More states today operate RRW initiatives than ever
before, and since 2020, peer-led recovery community organizations nationwide have surged by
nearly 50 percent. 34
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This chapter focuses on continuing to build a recovery-ready Nation, one community at a time.
Federal agencies will continue to partner with states, local governments, employers in the for-
profit and not-for-profit sectors, and communities to address the social determinants of health
and the laws, regulations, and practices that can serve as barriers to treatment and recovery
support. Concurrently, work must be done to build recovery capital at the individual, family,
caregiver, community, and societal levels.
Chapter 5: Reducing the Supply of Illicit Substances in the Homeland
Since the publication of the 2022 Strategy, the federal government has made progress on taking
important steps to tackle the supply of deadly drugs, in accordance with the Strategy objectives.
This includes collaboration across state, local, Tribal, territorial, and federal law enforcement
agencies to keep drugs off our streets.
In Fiscal Year (FY) 2023, for example, the federal High Intensity Drug Trafficking Areas
(HIDTA) program, which funds grants across all 50 states to improve law enforcement
intelligence sharing and operational coordination among federal, state, Tribal, territorial, and
local law enforcement agencies, supported the seizure of more than 29,000 pounds of illicit
fentanyl, more than 248,000 pounds of methamphetamine, nearly 365,000 pounds of cocaine,
over 4,300 pounds of heroin, and denied DTOs $20 billion in illicit profits. 35 U.S. Customs and
Border Protection (CBP) seized almost 240,000 pounds of illicit drugs, primarily at southwest
border POE, which includes nearly 27,000 pounds of fentanyl. 36 And the United States Postal
Inspection Service (USPIS) seized over 4,200 pounds of fentanyl from the domestic mail
system. 37 In the last two years, officials have halted more fentanyl at POEs than over the
previous five years combined. 38 These actions took deadly drugs off the streets and prevented
overdose deaths.
This chapter focuses on the ongoing efforts to identify and seize deadly drugs before they hit our
streets, and otherwise disrupt the supply chain for illicit drugs.
Chapter 6: Cracking Down on the Global Suppliers of Illicit Drugs and
Related Criminal Networks
Though the impact of the overdose epidemic is felt acutely in local community emergency
rooms, the problem is global, and the solution is global as a result. For this reason, the United
States’ collaboration with partner countries to reduce the supply and flow of fentanyl and
precursor chemicals into the United States is a key component of reducing the number of
fentanyl-related deaths in the country.
In the past few years, the United States has prioritized disrupting the global supply chain and
global networks that manufacture and ultimately distribute deadly drugs into the United States.
The United States has stepped up counternarcotics cooperation with key governments –
including Mexico, Canada, India, and the PRC– and launched the Global Coalition to Address
Synthetic Drug Threats, which unites more than 150 countries in the fight against drug
trafficking cartels and illicit finance. The Trilateral Working Group with Mexico and Canada
has worked collectively to identify key enforcement gaps, collaborate on particular enforcement
efforts, and address related concerns associated resulting from arms trafficking. After years of
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suspended cooperation, the United States and the PRC launched a CNWG in January 2024,
aimed at increasing joint enforcement efforts, a direct outcome of President Biden’s and
President Xi Jinping’s Leaders’ Summit in Woodside, California, in November 2023.
The United States also has taken law enforcement action against drug traffickers and their key
enablers that operate around the globe. The Department of Justice (DOJ) has prosecuted leaders
of some the world’s largest and most powerful drug cartels. And since 2021, the Department of
the Treasury also has sanctioned more than 290 people and organizations involved in the global
illicit drug trade.
Chapter 7: Improving the Criminal Justice System’s Response to Substance
Use Disorder
People with SUD who have contact with the criminal justice system should have access to
quality, evidence-based treatment to support sustained recovery and reduce the risk of
recidivism. Throughout the last two years, strides have been made to make this goal a reality.
These steps include investments in evidence-based diversion and deflection programs led by
prosecutors, courts, and law enforcement officers, which safely reduce unnecessary criminal
justice system involvement as appropriate and consistent with public safety. They also include
expanding access to FDA-approved MOUD to people in jails and prisons, to facilitating
successful reentry outcomes, investing in evidence-based approaches improve individual and
collective public health and public safety outcomes. Today, a majority of people who need
MOUD in federal prisons now receive it, and 43 percent of state and local jails are providing
MOUD in correctional settings, up from barely any just a few years ago. 39
These evidence-based approaches, based upon successful and proven federal, state, and local
strategies, improve individual and collective public health and public safety outcomes and also
advance equal justice under the law. As an illustrative example, while white, Black, and Brown
people use marijuana at similar rates, Black and Brown people have been arrested, prosecuted,
and convicted at disproportionate rates. Addressing disparities in arrest, prosecutions,
convictions, and sentences is essential. Equally important is taking action to relieve the
collateral consequences of convictions, which needlessly raise barriers to successful reentry and
in fact undermine public safety. Recent years have brough progress on these issues, including
with the full, unconditional pardon of many Americans with prior federal or District of Columbia
convictions for use or simple possession of marijuana. These pardons have lifted barriers to
employment, housing, education, and other opportunities. ONDCP is committed to working to
end the sentencing disparity between crack and powder cocaine, which has led to
disproportionate sentences for Black and Brown Americans.
This chapter includes a discussion of the progress that has been made, areas for additional focus,
and a story that brings this work to life.
Chapter 8: Building Better Data Systems and Research
Effective drug prevention and treatment policies will improve the health and safety of our
communities, increase life expectancy, reduce the economic burden associated with drug use,
and most importantly, prevent overdose and overdose deaths. Development of such policies
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requires timely, comprehensive, and geographically precise data to inform local communities
about the dangers of the illicit drug supply and to provide data-driven insights that inform the
distribution of lifesaving overdose reversal drugs, harm reduction programs, and treatment
services and supports.
Since the publication of the 2022 Strategy, progress has been made in advancing data systems
and research. One example is the development of the nonfatal opioid overdose tracker, led by
ONDCP and the Department of Transportation’s (DOT) National Highway Traffic Safety
Administration (NHTSA), which uses national Emergency Medical Services (EMS) data to
determine where nonfatal overdoses are occurring so jurisdictions can direct resources to these
areas. This dashboard is updated regularly and has only a two-week lag, which is a significant
improvement over past efforts to track overdoses, and provides key information for local and
national policymakers.
This chapter looks at some of the remaining shortcomings in existing data systems, how to
develop methods for identifying emerging drug use trends in real-time or near real-time, how to
prioritize data and analytical efforts to support advancing equity for underserved populations,
and more. Additionally, the ONDCP Drug Data Plan (Appendix B), required by the 2018
SUPPORT Act, presents a plan to collect, analyze, and use data to inform implementation and
assessment of the Strategy.
Specific Goals and Measuring Federal Performance
The 2022 Strategy established goals and objectives with measures and targets that were detailed
in the 2022 Performance Review System report (PRS), and are incorporated herein by reference.
In the midst of a dynamic illicit drug environment where progress has been made but additional
work is needed to strengthen public health and public safety outcomes, the 2024 PRS details a
discussion of evolving goals, objectives, and targets.
Consultation for the 2024 National Drug Control Strategy
ONDCP is statutorily required to consult with and solicit input for the Strategy from a variety of
parties affected by federal drug policy, including federal agencies and departments charged with
carrying out these policies; members of Congress and congressional committees; states, local,
Tribal, and territorial governments; nongovernmental organizations and community activists; and
foreign governments, among others.
The consultation process for the 2024 Strategy began in February 2023, and ONDCP received
significant input from a wide range of interested parties. ONDCP convened the National Drug
Control Program Agencies (NDCPA) for in-person consultation, and received written input from
these agencies as well, and held virtual meetings and received written input from dozens of
leaders while developing this Strategy. Input was received from drug policy experts, advocates,
and stakeholders from across the Nation, including federal, state, Tribal, territorial, and local
leaders; law enforcement; public health; academia; and more. Following publication, ONDCP
will coordinate with the interagency to implement this Strategy. ONDCP thanks all partners who
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