The Office of National Drug Control Policy (ONDCP) released the 2026 National Drug Control Strategy.

The main point: The Strategy has a major focus on supply-side efforts, but it also includes several laudable public health goals and strategies, including expanding access to treatment, preventing substance use and addiction among youth, and supporting recovery. But these messages are at odds with some of the administration’s actions.

The details:

Supply-side efforts: The Strategy places heavy emphasis on law enforcement efforts to reduce the supply of illicit drugs, including by expanding detection capacity using AI and other technology, enhancing border security, and continuing efforts to dismantle cartels (“foreign terrorist organizations”).
Surveillance: The Strategy proposes enhancing data to stay ahead of emerging drug threats, including integrating public safety and public health data and using wastewater testing, AI, and other technology to analyze the drug supply.
Prevention: The Strategy aims to create “a drug-free America as a social norm.” It advocates for effective primary prevention programs, including the Drug-Free Communities program, as well as partnerships with organizations that support healthy youth, a national media campaign, and support for federal drug-free workplace efforts. The Strategy notes the early underlying risk factors that contribute to addiction and suggests expanding access to primary prevention programs that “build resilience, teach coping and decision-making skills, and strengthen protective factors such as family engagement, community connections, and academic success.”
Harm Reduction: The Strategy does not use the term “harm reduction,” but it does include strategies for “rescue and overdose response” as “the beginning of recovery.” That includes naloxone distribution and training, responding to mass overdose events, and improving drug testing in clinical settings. It also notes that drug test strips are an “important tool and should be legal and not considered drug paraphernalia.”
Treatment: The Strategy states a goal of making treatment easier to access than drugs. It emphasizes the role of faith-based treatment. It also calls for screening/early intervention and integrating addiction care with other medical care. It notes that medications are “an important tool,” calls for research for medication treatments for other substances beyond alcohol and opioids, and expresses support for contingency management. The Strategy doubles down on the “Treatment First” over the Housing First model favored by experts, requiring participation in treatment/recovery services as a condition for federal housing support.
Recovery: The Strategy includes a focus on faith-based recovery programs. Other recovery strategies include expanding peer support services and recovery-ready workplace programs.

BUT: The rhetoric in the Strategy contradicts other administration actions, which will make implementing many of these strategies challenging.

Overall: The Strategy comes as the Substance Abuse and Mental Health Services Administration (SAMHSA), the agency responsible for substance use programs, experiences major changes under the administration, including repeated layoffs, funding cuts, and lack of director. The administration’s 2027 budget request proposes cuts to several mental health and substance use disorder programs and the consolidation of key federal agencies working on the issues. Implementing any of the efforts the Strategy suggests will be challenging with limited funding and curtailed agency capacity.
Prevention: While the Strategy proposes expanding primary prevention programs, the administration’s budget proposes cutting roughly $220 million from SAMHSA’s Center for Substance Abuse Prevention and nearly $40 million from the Drug-Free Communities program. The strategy calls for addressing the risks associated with marijuana use, but the administration just rescheduled medical marijuana and is moving to consider the same for all marijuana.
Harm Reduction: The Strategy touts the importance of drug test strips, contradicting the administration’s recent decision to bar federal funding for them. The administration has similarly aimed to move away from harm reduction programs through an executive order and its budget requests.
Treatment: While one of the goals in the Strategy is to make it easier to get treatment, that will be undermined by the changes to Medicaid enacted last summer. Medicaid is the largest payer of mental health and addiction services, so the coverage losses expected from these changes will lead to fewer people being able to access addiction treatment. The administration has also not enforced and may redo the 2024 regulations aimed at bolstering parity, which could also make treatment increasingly unaffordable. The Strategy importantly supports medications for addiction treatment, but the administration also recently issued new guidance warning against its use unless accompanied by other services.