I served on an ONDCP-supported White House Commission in the Bush administration and worked inside the agency as senior policy adviser for the first year of the Obama administration. Candidly, my colleagues and I succeeded in some things and failed in others, but I consistently came away impressed with how ONDCP has the power to improve U.S. drug policy in at least three important ways.
First, ONDCP is the White House’s only repository of detailed knowledge on the country’s drug problems. When President Barack Obama’s health care policy team was designing the Affordable Care Act, ONDCP provided the essential details for how and why addiction treatment should be covered under the law, including exactly how many people needed treatment and for what, the types of programs that would help them, their costs and their benefits.
Without a drug policy office, the needed facts for designing intelligent policies regarding the opioid epidemic would no longer be readily available to the White House. Yes, the facts required to create good policy could theoretically be reassembled by trawling all government agencies and the scientific literature over months or years, but the odds of anyone taking the trouble to do that are low. Deprived of facts, drug policymakers tend to “go with their gut,” an apt metaphor given what our guts are designed to produce.
Second, ONDCP can accelerate the speed at which effective programs are taken to national scale. Equipping police with the overdose rescue drug naloxone and using 24/7 Sobriety management strategies for alcohol-involved criminal offenders were local innovations (in Massachusetts and South Dakota, respectively) with little national profile when I wrote about them in President Barack Obama’s first national drug control strategy. The White House endorsement and promotion helped these life-saving programs rapidly become nationally available, federally supported programs.
Third, ONDCP coordinates drug policy across our massive government. When, for example two different agencies create overlapping programs that will conflict with each other, ONDCP can evaluate them both in the budget development process, endorsing the one with more likelihood of success and eliminating the other, which is a good in itself and also reduces burden on the taxpayer. ONDCP’s policy coordination also involves a fair amount of nudging (bordering when needed on nagging) to speed up federal agencies in adopting effective policies. Recent examples include encouraging the Veterans Health Administration to report its opioid prescribing to state prescription drug monitoring programs so as to reduce overdoses among veterans and engaging with the Defense Department’s health care system to have it cover methadone maintenance treatment for addicted military personnel and their families.
Policy coordination also means helping Congress fulfill its constitutional duty of holding the president accountable. If drug policy responsibility is scattered across a dozen departments, Congress loses the ability to monitor progress or lack thereof. Indeed, a relevant Washington joke is that Congress likes White House policy offices because it gives members a single person to yell at.
Particularly in light of the Trump administration’s support of repealing the Affordable Care Act, which would deny treatment access to almost 3 million addicted Americans, Congress is going to want someone to yell at about opioid overdose deaths in the coming years. More importantly, families facing addiction deserve informed and coordinated drug policy, which the White House cannot provide if it kicks its most knowledgeable staff out the door.
Keith Humphreys is a professor of psychiatry at Stanford University