The story of the emergence of the opioid epidemic through the corruption of big pharma has been told, the heartbreaking consequences to American families and communities have been explored, but never has someone working inside the agency leading national efforts against drugs revealed why government has failed to produce better results and what to do about it. As a career civil servant who has served through five administrations at the White House Office of National Drug Control Policy (ONDCP), and earlier as a Congressional staff member and writer/researcher on drug policy, the author has had a perch inside the war on drugs like no other. From the start of his career working on the crack cocaine epidemic on Capitol Hill, to a year-long stint as Acting Drug Czar during the Trump Administration, he has worked on every aspect of the drug issue.
Why, one might ask, when there is so much consensus among democrats and republicans, both in Washington and in state capitols, on the need to address the devastating opioid epidemic, are the results so poor? Part of the answer is the sheer lethality and ubiquity of fentanyl and the isolating covid-19 epidemic, but there is much more to the story. There are critical gaps, the author explains, in both how we understand the drug problem and how government organizes and funds the national response. The rise in fatal overdoses to over a 100,000 a year is telling us that we cannot keep operating the same way. The devastating four waves of the opioid epidemic has revealed serious weaknesses in America’s drug strategy. These weaknesses are not the fault of one administration or one political leader. Rather they are baked in deeply to how government grapples with the massive epidemic of addiction and overdose throughout the nation. These weaknesses can only be addressed if we directly confront the hard lessons from inside the war on drugs.
Every component of the drug fight needs to change. The health system must do so much more than just increase the number of quality and affordable treatment slots they provide. Instead, treatment professionals must get out of their brick-and-mortar offices and start bringing mobile health services directly to people who need help. The justice system needs to accept that their job is not just to disrupt retail drug markets but also to minimize wasteful and unfair arrests while steering many more people into treatment. Homeland Security officials must tightly focus on disrupting fentanyl trafficking organizations wherever they operate and resist the political pressure to fixate over border infrastructure. Congress must increase federal spending but stop relying so heavily on large block grants that fail to produce the highest return on investments. Bureaucratic rivalries must be overcome in Washington, especially regarding the Office of Management and Budget’s damaging 30-year ’drug war-civil war’ with the Drug Czar’s office.
There is a lot of blame to go around for the opioid crisis. It is time for Washington to own up to its own errors and change how it takes on the drug problem. Major reforms are urgently needed, both to address the opioid crisis and to be prepared for whatever comes next. Past mistakes ignored for too long must be forthrightly confronted so they are not repeated. This book will reveal the hard lessons and lay out a better, sounder path forward.
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