Remarks by ONDCP Director Dr. Rahul Gupta at the National Conference of State Legislatures 2023 Summit
Dr. Gupta brings President Biden’s Unity Agenda message and urgent call to action to nation’s largest gathering of legislators and legislative staff
Indianapolis, IN – Today, White House Office of National Drug Control Policy (ONDCP) Director Dr. Rahul Gupta delivered remarks at the National Conference of State Legislatures (NCSL) Annual Legislative Summit in Indianapolis, Indiana.
At the conference, Dr. Gupta underscored the critical need for partnership across state and federal government to address the overdose epidemic, highlighted state policy options for high-impact action, and reinforced the Biden-Harris Administration’s unwavering commitment to supporting a whole-of-society response to this crisis.
During his first State of the Union address, President Biden announced beating the overdose epidemic as one of the four pillars of his Unity Agenda, focused on issues where members of both parties can come together and make progress for Americans. The Biden-Harris Administration has made this issue a top priority, and taken historic actions over the past two years to address substance use, protect public health and public safety, go after drug traffickers’ profits, and save lives.
Read Dr. Gupta’s remarks as prepared from the summit below:
Hello. I bring you greetings from President Biden and Vice President Harris.
It’s great to be here with you to talk about the opioid crisis, what the Biden-Harris Administration is doing to address it, and the impact it has in your states and on your work.
First, I would like to express my condolences to the families and communities of lost ones for the ongoing calamity in Maui. Every preventable life lost, no matter the cause, is a tragedy.
Now take a look at this map and see if you can find your county.
In the last year, there were more than 110,000 overdose and poisoning deaths in America.
Substance use cuts across every geographic, demographic, and economic boundary.
As a physician and state and local health officer, I’ve had a front row seat to this epidemic.
We’re in this situation because we’re in the most dynamic drug supply environment in our nation’s history.
Synthetic drugs are a growing problem across the country.
While methamphetamine has been around for a while, illicit fentanyl is everywhere.
And now, fentanyl mixed with xylazine—a veterinary sedative—is increasingly finding its way into our drug supply.
This combination called tranq dope is complicating the efforts of first responders to reverse opioid overdoses and save lives.
Tranq dope is making fentanyl look like a walk in the park.
And it’s not only the drugs that have changed but also the way they are sold, bought, and consumed.
Somewhere in America today—including right here in Indianapolis—a teenager will log onto social media and find these drugs.
The DEA reports that 6 out of 10 pills bought online—which may look like the real thing—actually contain a potentially lethal dose of fentanyl.
6 out of 10.
These odds are worse than playing Russian Roulette with your life.
And this crisis is having an enormous impact on our nation – from health care costs, to criminal justice costs, and so much more. And as states, you are paying most of these costs.
This is a new era of drug threats that requires a new era of drug policy and actions.
And that’s exactly what we’re doing.
Before I get to that, let’s see a show of hands: Who here is already familiar with ONDCP?
For those of you who don’t know us yet, ONDCP is the White House agency that develops and coordinates all federal drug control policy.
We oversee the drug-related programs and more than $42 billion budget of the 19 federal agencies that work in this space at the intersection of public health and public safety – from HHS to the Department of Justice to the State Department and more.
We work closely with states, tribes, and local officials to make sure you have the tools and resources you need to address drug threats.
And we have grant programs you may have heard of:
There are two programs, funding for which goes directly to local communities. We provide funding to almost 750 Drug-Free Community coalitions working to prevent youth substance use across all 50 states, and the High Intensity Drug Trafficking Areas Program, or HIDTA, brings together federal, state, local, and Tribal law enforcement to coordinate on anti-trafficking efforts.
A few weeks ago, I testified before the House Oversight Committee, and members from both sides of the aisle wanted to talk about how effective the HIDTA program is.
And when Congressman Jake LaTurner, a Republican from Kansas, asked for details, here’s what I told him:
Last year, our HIDTA program seized 26,000 pounds of fentanyl before it could harm Americans. And for every dollar our nation invested in the HIDTA program, we saw nearly $83 in return.
$83.
And just two days ago, I had the honor of presenting an award to the Indiana HIDTA for their work to take down an outlaw motorcycle gang that was trafficking drugs throughout the nation, and committing many other crimes along the way, including murder, racketeering, and more.
Working with the ATF and the FBI, and state and local officers, this task force resulted in 31 indictments and the seizure of drugs, guns, cash, motorcycles and other assets, including as many as 25,000 potentially lethal doses of fentanyl, taken off the street before they could hurt Americans.
Honestly, the details of this case sound like an episode of that TV show, Sons of Anarchy.
But make no mistake, these are deadly, dangerous people who have no business walking—or riding—free.
And today, they’re not.
And that’s just one aspect of our work.
I’m a practicing physician. I’ve practiced in towns where patients paid me with fresh apple pie and homegrown tomatoes.
I want to tell you about a patient I had.
When I met Billy, I had just begun my primary care practice in Florala, Alabama, a picturesque rural town of 1,800…just above the Florida panhandle.
He was one of my first patients there.
I discovered he’d been receiving pain medications from different physicians for years, and I diagnosed him with opioid use disorder.
I knew he needed help, and that if he didn’t get it, he could die.
But here was the problem: I couldn’t help him—at least not directly.
Federal regulations at the time allowed me to prescribe an addictive category of opioids for pain to my patients… but they prevented me from treating Billy for his opioid addiction without getting another federal approval. And I was busy running a private practice.
So, the solution at the time was to refer Billy to a specialist nearly 100 miles away.
Billy provided for his family of four working at a small business in town on minimum wage, but my referral meant he would need to take time off work and spend money on gas to get there.
And guess what?
Billy never made it to the specialist.
Instead, he started buying drugs on the street.
And one day, while I was working in the ER, Billy came in experiencing an overdose.
But it was too late. Billy died in my hands that day.
This story has played out all across America, time and time again.
But now, stories like Billy’s will be history.
In December, President Biden signed a bill to eliminate that extra requirement, meaning that every prescriber of controlled substances can now begin treating patients with buprenorphine for opioid use disorder.
With the stroke of his pen, our nation went from 129,000 providers with this capability to nearly 2 million.
This is a game changer.
The bottom line is that when it comes to the opioid crisis, we can’t focus just on supply or just on demand. We gotta do both. Because we can’t treat dead people.
It’s common sense, and that’s why the President’s National Drug Control Strategy is going after two key drivers of the opioid crisis: untreated addiction, and the drug trafficking profits that fuel it.
They really are two sides of the same coin.
And we’re getting results. Let me sum it up:
El Chapo’s son is behind bars and naloxone or Narcan is over the counter.
Treatment for addiction is more accessible than it’s ever been.
And overdoses flattened in 2022 after sharp increases from 2019 to 2021—and this shows our efforts are working.
Still, we cannot stop. We must keep pushing forward.
As you may have seen, we’ve taken numerous actions against traffickers.
We’re shutting down dark web fentanyl supply chains.
We’re seizing record amounts of fentanyl at the border and in communities nationwide. I saw our CBP agents in action myself just last month when I was down in Nogales, AZ, and I saw the new high-tech scanners they’re using to catch fentanyl before it kills people.
And we’re working with Mexico to arrest several cartel leaders.
And while bringing these criminals to justice is important, we also have to attack the root causes of trafficking – the profits.
So, we’re going after the financial mechanisms that enable drug trafficking… and we call it commercial disruption.
We’re imposing sanctions against individuals and entities—not just cartels, but their enablers like brokers, accountants, and real estate agents.
And we’re making it costlier for them to do business.
So, prioritizing commercial disruption is a key part of making our country safer.
And just last week, President Biden called on Congress to direct another $800 million toward reducing the supply of illicit drugs and expand access to addiction care.
This funding will help us install our advanced scanners at the border more quickly. And once they’re in place, we’ll be able to scan every vehicle crossing our border that needs to be scanned.
Every single one.
So, we’ll catch more drugs before they reach communities.
On the public health side, we’ve partnered with the Department of Transportation to launch a non-fatal overdose tracker using EMS data so states and communities can direct resources to hotspots.
We’ve launched a national social media campaign to reach youth where there are – online – and warn them about the dangers of fentanyl and the importance of carrying naloxone.
This has helped generate 1.8 billion impressions about fentanyl awareness.
And we’re working to further expand treatment, including through telehealth… and during incarceration.
As many as 65 percent of people who are incarcerated have substance use disorder.
These are people who need treatment, but usually aren’t getting it.
One study found that people reentering society are more than 120 times more likely to die from an overdose in the first few weeks following release.
And we estimate there are thousands of people dying from drug overdose every year right after they are released from jail or a prison.
And to help address this, HHS recently informed states they can apply to use Medicaid funds to treat people with substance use disorder before reentry.
So far, 13 states have applied for this 1115 waiver, California and Washington have been approved… and more will follow.
And if your state hasn’t applied, you should.
Because this is federal money you can use to save lives.
And this speaks to the fact that working together is how we accomplish big things.
For instance: One month ago, I released our national response plan to the emerging threat of xylazine combined with fentanyl, which will help states and communities address this threat locally. This plan will help develop treatment protocols and reduce the supply of illicit xylazine, and more.
And it’s based in part on what some states have already done.
The laboratories of democracy are helping guide federal actions, just like the founders intended.
We’re doing all of these things because of people like Billy, and his kids who grew up without a dad, and the fact that every overdose death represents an empty seat at the dinner table each night. Our families, our communities, and our nation deserve better.
And here’s the truth: the opioid crisis isn’t a red state or blue state issue—it’s America’s issue.
That’s why, in his State of the Union earlier this year, President Biden made ending the opioid crisis one of the four parts of his Unity Agenda.
Addressing addiction and mental health, and saving American lives… this is something we can all come together to fix.
I’ve spoken with Republicans and Democrats about this from all across the country…from those in Congress like Mitch McConnell and Marjorie Taylor Greene and Chuck Schumer… to governors from many of your states.
And I’ve told them the same thing I’m telling you: We must double down on what works and address the challenges that remain to save American lives.
Now, federal actions are only part of the equation.
Each of you, as a state legislator, has a critical role to play in addressing this crisis.
And we’ve created tools to help you do this.
For example:
We’ve partnered with the Legislative Analysis and Public Policy Association, or LAPPA, to develop model state acts to help you pass effective substance use disorder policies.
These are fully baked, and you can introduce these acts today to improve your state’s response to this crisis.
I wish I had access to when I was the state health officer in West Virginia…instead of having to reinvent the wheel every time.
Here are some highlights… first, deflection.
In a growing number of states, public safety and public health partnerships “deflect” people with substance use disorders away from traditional criminal justice programs and connect them to evidence-based treatment, harm reduction, and recovery services.
These approaches save lives, and they reduce the burden on first responders and law enforcement. So, it’s a win-win, and our model act will help you establish these programs.
This is the first Administration to embrace evidence-based harm reduction as a key tool for saving lives, and three of the model laws focus on harm reduction, including expanding access to naloxone, syringe services programs, and fentanyl test strips.
Last month, I joined Vice President Harris for a meeting with 8 state attorneys general about actions to address illicit fentanyl, and harm reduction was a topic of our discussion.
And that shows just how far we’ve come.
Just a few years ago, naloxone was controversial in some circles.
But now we have Florida and Tennessee passing laws legalizing the use of fentanyl test strips, joining Ohio, Pennsylvania, South Dakota, Kentucky, and Mississippi, who already have.
With how prevalent fentanyl has become, people need to know if they have counterfeit pills or if fentanyl was added to another substance they have.
Because if they don’t know it’s there, there’s a good chance it will kill them.
Our next act is designed to make it easier for hospital emergency departments to initiate substance use treatment and connect patients to care following discharge.
Too often – and I’ve seen this myself – emergency departments “treat and street” overdose victims.
So, this act breaks barriers in order to help people who are most at risk for dying after being discharged.
Next, pregnant women with substance use disorder often do not seek care for fear that they will be arrested or that their child will be taken from them.
Yet medications for opioid use disorder can be used safely during pregnancy. So, our model act provides certain protections to pregnant or postpartum individuals with a substance use disorder.
Because keeping families together is critical for achieving good health outcomes, as long as children are not in danger.
The last one I’ll mention is the Model Opioid Litigation Proceeds Act, which helps states establish a dedicated fund to address substance use disorder.
It will ensure all proceeds received by the state from the opioids lawsuits actually go toward helping people affected by this crisis.
I used to sit for depositions for these cases and I can’t emphasize enough how important this is.
We all know how tight state budgets are these days and how many competing priorities there are.
The temptation to use these funds to shore up budget shortfalls will be strong.
But we want to avoid repeating the mistakes that were made with how Tobacco Litigation settlement funds were used.
Altogether, these model laws have the ability to make a real difference for communities, and I encourage you to introduce and pass them.
And to find them, just go to White House Dot Gov and search “state model laws.”
And there are many other resources for you and your states, as you can see here.
Now, here’s a question for you: Why did you run for office?
Maybe you saw a problem in your community and state and wanted to fix it.
Maybe you were tired of politicians doing the same thing over and over again and expecting different results.
Maybe you wanted to give back to your state.
Whatever your reason, people who enter public service have a special quality to them. A sense of purpose, a belief they can accomplish really big things and make a positive difference for their community, for their state, and for their country.
So, I want you to think about what you can do to end this crisis. What steps you can take to ensure people can access the care they need, and help your community heal.
From my point of view, you have a lot of power to help save lives and get the job done.
You can pass the model laws I spoke about.
You can encourage your state to apply for the 1115 waiver to treat people behind the walls.
And you can make sure that, as the federal government reduces barriers to lifesaving treatment, harm reduction, prevention, and recovery services, your state doesn’t erect new ones… and instead keeps making progress, because thousands and thousands of lives are on the line.
And I want you to know that my door is always open.
Please reach out if you want guidance on our model laws or anything I discussed today.
Because it’s clear that working together, we can beat this epidemic.
As President Biden says, “we are the United States of America and there is nothing, nothing beyond our capacity if we do it together.”
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