ONDCP Blog

Commission on Narcotic Drugs Endorses Alternatives to Incarceration for Substance Use Disorders

Earlier this month, the United Nations Commission on Narcotics Drugs (CND) approved a resolution that called for justice and health agencies to work together to provide a range of alternatives to incarceration for those affected by a substance use disorder. The CND, held in Vienna, Austria, is the largest annual governmental meeting on drug issues with 53 member states. The White House Office of National Drug Control Policy initially proposed the resolution.

“A global consensus is emerging that no nation can solve its drug problem by simply arresting and incarcerating those affected by a substance use disorder,” said Director of National Drug Control Policy Michael Botticelli, who represented the United States at the CND. “The United States is strongly committed to advancing strategies that bring justice and health agencies together on innovative solutions for drug-involved individuals wherever they are in the world.”

The United States introduced the resolution, which emphasizes that too many individuals with substance use disorders around the world are serving extended prison sentences, but not receiving evidence-based treatment or other needed health services. Increasing the use of alternatives to incarceration and the provision of treatment for these individuals, whether in the community or in prison, supports sustained recovery from substance use disorders, promotes fairness, and reduces prison overcrowding.

The resolution encourages all countries to utilize a range of alternatives to incarceration and other criminal justice reforms that also promote treatment for substance use disorders.  The health-related interventions referenced in the resolution include screening for substance use disorders, access to treatment, including medication-assisted treatment, counselling services and other behavioral health services, overdose prevention and treatment, recovery support services, treatment for HIV, hepatitis, and other infectious diseases and mental health disorders. The alternatives to incarceration and other reforms listed include reduced or suspended sentences, diversion programs before or during trial, home detention, community service, fines, victim restitution, random drug testing, and GPS tracking.

Effective combinations of supervision and drug treatment, which are a subject of ongoing research in the United States, can result in more effective crime reduction, better health outcomes and lower prison costs. These alternatives can also allow incarcerated individuals with substance use disorders to return to their families and communities, while concurrently receiving treatment and helping to break the cycle of drug use, arrest, incarceration, relapse and re-arrest.

The resolution, specifically called for the following:

• Greater collaboration between health and justice agencies on alternatives to incarceration;
• Establishment of mechanisms to “break down the silos” between health and justice agencies so they can work together better to provide health services for those under criminal justice supervision;
• Training for justice officials on the effectiveness and importance of evidence-based treatment for substance use disorders;
• Recommendation that governments review their drug sentencing practices to ensure that they allow for alternatives to incarceration for those affected by a substance use disorder; 
• Collection and sharing of best practices and research on collaborations between justice and health agencies on alternatives to incarceration for those with a substance use disorder;

The full title of the resolution is: Supporting the Collaboration of Public Health and Justice Authorities in Providing Alternatives to Conviction or Punishment for Drug-Related Offenses of a Minor Nature. The following countries co-sponsored the resolution: Australia, Ecuador, El Salvador,  European Union, Germany, Greece, Guatemala,  Israel, Lithuania, Mexico, Namibia, and Uruguay.

The Work Before Us: A Message from Michael Botticelli

Many great movements to change public perception and policy around a public health issue have been fueled by people with a disease speaking out publicly.  What is seen as someone else's problem—someone else’s disease – takes on a new dimension when people speak up about it.  

Such was the case when Betty Ford revealed her breast cancer diagnosis and her substance use disorder. Such was the case when Magic Johnson revealed that he was HIV positive, spurring action to stem the AIDS epidemic.

Yet, despite the fact that nearly every family and community in America is affected by a substance use disorder, those fighting to overcome this disease are too often hidden in the shadows of shame and denial.  It is whispered about. It is met with derision and scorn. 

According to the National Survey on Drug Use and Health, only 1 in 9 people with a diagnosable substance use disorder gets treatment.  Compare this to the treatment rate for diabetes, for which 72% of people with the disease receive care.

When treatment is provided for substance use disorders, it too often comes at the most acute stages of the disease when effective treatment is far more challenging and costly than in the early stages. Because substance use disorders have historically gone unidentified for far too long, and timely access to treatment has been far too difficult to come by, a person is expected to hit “rock bottom” before seeking help for a substance use disorder.

Standard medical care does not allow a diabetic to enter kidney failure before offering insulin.  Yet untreated substance use disorders routinely proceed unchecked until they have reached such levels of emergency.  In addition to the unnecessary suffering for patients and their families, our current approach costs the United States hundreds of billions a year in increased health care costs, crime and lost productivity-- over $223 billion related to alcohol and $193 billion related to illicit drugs.

Decades of scientific research have proven that substance use disorders are a health issue:  chronic medical conditions with genetic, biological and environmental risk factors.  Effective substance use disorders requires a comprehensive, public health approach involving evidence-based prevention, early intervention, treatment and recovery support services.  The National Drug Control Strategy, the Obama Administration’s template for drug policy, outlines more than 100 action items across federal government to prevent drug use and its consequences.

Earlier this month, President Obama in his 2016 Budget requested historic levels of funding --including $133 million in new funds-- to address the opioid misuse epidemic in the U.S. Using a public health framework as its foundation, our strategy also acknowledges the vital role that federal state and local law enforcement play in reducing the availability of drugs—another risk factor for drug use.  It underscores the vital importance of primary prevention in stopping drug use before it ever begins by funding prevention efforts across the country. It sets forth an agenda aimed at stripping away the systemic challenges that have accumulated like plaque over the decades: over-criminalization, lack of integration with mainstream medical care, insurance coverage and the legal barriers that make it difficult for people once involved with the criminal justice system to rebuild their lives.

The implementation of the Affordable Care Act will dramatically increase coverage for treatment and ensures that services are comparable to other chronic conditions for more than 60 million Americans. This is the biggest expansion of substance use disorder treatment in a generation, and it will transform millions of lives.

All of these advancements, however, are not enough unless we fundamentally change the way we think about people with addiction.  There are millions of people in recovery in the United States leading meaningful, productive lives full of joy and love and laughter – and I am one of them.

Tonight, the United States Senate voted to confirm my nomination as Director of National Drug Control Policy. This is an honor I never dreamed of 26 years ago, when my substance use disorder had become so acute that I was handcuffed to a hospital bed. I accept this challenge with the humility and tenacity of someone in long term recovery.

I am open about my recovery not to be self-congratulatory, I am open about my recovery to change public policy. I have dedicated my life to treating drug use as a public health issue, and that’s how I approach this new role, as well.  I hope that many more of the millions of Americans in recovery like me will also choose to “come out” and to fight to be treated like anyone else with a chronic disease. By putting faces and voices to the disease of addiction and the promise of recovery, we can lift the curtain of conventional wisdom that continues to keep too many of us hidden and without access to lifesaving treatment.

It is time to make a simple, yet courageous decision to be counted, to be seen and to be heard.

Share your story with us today. 

Michael Botticelli serves as Acting Director of National Drug Control Policy. Today, the U.S. Senate voted to confirm him as Director of National Drug Control Policy. 

Learn How to Transform Your Community and Change Lives

In my home state of New Mexico, substance abuse and addiction present serious challenges to our families and way of life.

The destructive influence of drugs and crime that threaten our communities require a holistic approach and dedication – and this means coming together to help those in need who suffer from addiction, to help prevent youth from ever using, and to stand opposed to those who traffic these dangerous substances. This is not a unique challenge to New Mexico, but one that cities and towns across America confront. In my district, one of the organizations that has been successful in getting results has been the Taos Alive Coalition, and one of the things that has aided them in their missions has been the grant they received from the Drug-Free Communities (DFC) Support Program.

The Taos Alive Coalition came together when a collaboration of the Taos and regional programs applied for funding through the Drug-Free Communities Support Program in 2010. In the past five years Taos Alive has worked on numerous fronts, including prescription drugs, alcohol, and synthetic drugs. Its prescription drug initiative has been one of the most successful initiatives to date – establishing the permanent drop boxes in our community and successfully assisting with bi-annual Prescription Drug Take Back events. Before the Taos Alive Coalition formed with DFC funding, Take Back Taos County collected less than 3 pounds of drugs. With the involvement of Taos Alive, they estimate that more than 65 pounds was collected. Further, Taos Alive—whose members include medical professionals from government and private practice--created opioid prescribing guidelines in the local emergency room and is working on community opioid prescribing guidelines. Youth media prescription drug training is given to all Taos High School youth & school staff in Taos County; and they have helped several schools to create prescription drug policy & procedures.

Through these community efforts, Taos Alive is improving its community and making it a safer place to live. And it is able to do this so effectively, in part, because of the Drug-Free Communities Grant from the Office of National Drug Control Policy. Since the passage of the DFC Act in 1997, the DFC Program has funded more than 2,000 coalitions and currently mobilizes nearly 9,000 community volunteers across the country. Grantees establish and strengthen collaboration among communities – public and private non-profit agencies – as well as Federal, state, local, and tribal governments to support the efforts of community coalitions working to prevent and reduce substance use among youth and, over time, reduce substance abuse among adults by addressing the factors in a community that increase the risk of substance abuse and promoting the factors that minimize the risk of substance abuse.

The FY 2015 DFC Request for Applications (RFA) has been released and is available online. In recognition of how transformative these grants are, and to assist community groups with the application process, ONDCP is hosting workshops on the technical aspects of filling out grant applications. While these workshops are not mandatory, they will offer guidance on the process that many groups that are less experienced filling out grant applications may find useful. Workshops will be held on:

A videotaped version of this workshop is also available on the ONDCP website. Register for the workshops and find information about the Drug Free Communities Program.

I’m proud of the work I have seen from the DFC grantees in my district, and know that they are succeeding around the country. A DFC grant is one way for communities to come together to fight back against the influence of substance abuse and addiction. Commitment and collaboration are essential tools for change, and working together we can help our family, friends, and towns heal and thrive.

Congressman Ben Ray Luján represents New Mexico's Third Congressional District. 

Securing our Nation’s Caribbean Border

In 2009, President Obama signed an Executive Order that expanded the purview of the President’s Task Force on Puerto Rico to seek advice and develop recommendations on policies for the island that promote job creation, education, health care, clean energy, economic development, and public safety.  Addressing these issues has been an on-going effort for the Task force and the Administration. Today, the President announced the release of the 2015 Caribbean Border Counternarcotics Strategy, a major step forward on matters of utmost importance to the people of Puerto Rico –  public health and public safety.

By delivering on this important recommendation, the Obama Administration, in an effort spearheaded by the Office of National Drug Control Policy, seeks to substantially reduce the threat posed by drug trafficking, transnational organized crime, and associated violence to Puerto Rico and the U.S. Virgin Islands.

In its 2011 report to the President, the Task Force concluded that both the capacity of local law enforcement and the efforts of the Federal agencies charged with public safety in Puerto Rico require a significant amount of attention from Federal and local stakeholders.

Strengthening Public Safety

Public safety is a major challenge in Puerto Rico.  During the Task Force’s public hearings, residents of Puerto Rico raised concerns about crime and the law enforcement response. The homicide rate in Puerto Rico is alarmingly high. Puerto Rico’s geographic location, with approximately 300 miles of unprotected shoreline, makes it especially vulnerable to transnational crime. Located along the Mona Passage, a heavily used shipping lane between the Dominican Republic and Puerto Rico, the region has become an increasingly important point for drug trafficking between South America and the continental United States and Europe.

Drug traffickers have long used this region as a transshipment point.  Recently however, the nature of the trafficking has changed.  Due to stepped-up law enforcement efforts, drug traffickers have decreased air activity and increased maritime shipping.  There has also been an increase in detected maritime transport of cocaine loads to the Puerto Rico area.  According to the Puerto Rico Police Department, high homicide rates can be attributed to power struggles and turf wars among violent gangs and drug trafficking organizations whose members compete to supply the demand for both illegal and diverted legal drugs.  These groups frequently use intimidation, violence, and murder to gain and retain control of retail drug markets.

Cocaine is the principal drug threat and a source of associated violence throughout the Caribbean. The trafficking threat and violence is also associated with marijuana, heroin, and prescription drugs.  Illicit trafficking is a highly fluid enterprise.  The documented cocaine flow from the source zone to the United States via the Caribbean—including Puerto Rico, the Dominican Republic, and Eastern Caribbean countries—has more than doubled in the past three years, from 38 metric tons (MT) in 2011, to 59 MT in 2012 and 91 MT in 2013, according to the interagency Consolidated Counterdrug Database. This marks the highest documented cocaine flow since 2003.

Unlawful firearms trafficking also poses a threat to public safety and contributes to the high homicide rate and drug-related violence.   The danger posed to children by the drug trade and gang violence continues to increase.  Criminal incidents that frequently occur in the school system include violence, vandalism, and property theft.  As drug trafficking activities increase in the region, so do related financial crimes.  Trafficking organizations have displayed limited sophistication in money laundering.   Rudimentary schemes to use the drug proceeds, either laundered through the financial system or transported to foreign locations, have been used in bulk-cash smuggling operations.  These conditions create an environment conducive to a broad range of corruption activities.  

In light of these challenges, the Task Force recommended that the various Federal agencies with security and law enforcement responsibilities convene a formal, interagency process of coordination and collaboration regarding Puerto Rico’s security and safety.  Improvements in public safety would benefit the people of Puerto Rico and help in the broader effort to combat drug trafficking throughout the region.

Federal Response to Date

Cooperative partnerships, expanded bilateral agreements, and training programs are essential force-multipliers that help counter the transnational drug threat.  Federal agencies must continue to leverage established partnerships among themselves and with local law enforcement agencies to capitalize on the unique authorities and capabilities of each organization.  Building and improving bilateral and multilateral partnerships through law enforcement agreements, professional exchanges, training, and joint operations is essential to reducing illicit drug flow through the region.

In response to increases in drug trafficking and related crime, Federal law enforcement agencies have expanded their efforts in the region.  The Departments of Justice and Homeland Security have devoted resources to address drug-related violent crime on the islands and have coordinated with Federal and local partners to confront this ongoing threat to public safety. 

2015 Caribbean Border Counternarcotics Strategy

Today’s announcement demonstrates the Obama Administration’s commitment to strengthen Puerto Rico’s public safety.  The 2015 Caribbean Border Counternarcotics Strategy (Caribbean Strategy) articulates the U.S. framework for reducing the threats associated with drugs at the border and is guided by the following strategic objectives:

Strategic Objectives

1. Enhance intelligence and information-sharing capabilities and processes associated with the Caribbean border.
2. Interdict illicit drugs and drug proceeds at and between U.S. ports of entry in the Caribbean.
3. Interdict illicit drugs and illicit drug proceeds in the air and maritime domains in and around the Caribbean border; maximize evidence and intelligence collection to support criminal investigations leading to associated and higher echelon networks.
4. Disrupt and dismantle transnational criminal organizations operating in and around the Caribbean border.
5. Substantially reduce the level of drug related violent crime in Puerto Rico and the U.S. Virgin Islands.
6. Strengthen communities and reduce the demand for drugs.

The Caribbean Strategy outlines supporting actions and identifies the Federal agencies responsible for coordinating and executing these actions.  To ensure effective implementation, the Caribbean Strategy provides indicators to develop baselines and enable status tracking.

This Caribbean Strategy is aligned with the Task Force recommendation, and it complies with the report language accompanying the Consolidated Appropriations Act, 2014 (P.L. 113-76) (Appropriations Act), initiated by Puerto Rico’s congressional representative, Congressman Pedro Pierluisi, which requires that the Office of National Drug Control Policy submit to Congress a biennial Caribbean Border Counternarcotics Strategy.