To Whom It May Concern,
On behalf of the National Conference of State Legislatures (NCSL), the bipartisan organization representing the legislatures of our nation’s states, territories and the District of Columbia, I write to provide your team with input from the states as ONDCP develops its 2026 National Drug Control Strategy. NCSL appreciates the opportunity to contribute to the administration’s efforts to reduce the devastating impact of illegal drugs on our citizens. We hope that state initiatives will help inform the national drug framework and will address state actions on each proposed objective stated in your letter of May 20.
Reduce the Number of Overdose Fatalities, with a Focus on Fentanyl
- Naloxone access: Support state strategies that increase naloxone access. All 50 states have naloxone access laws and most states have enacted "Good Samaritan laws”, granting immunity to those who administer naloxone in an emergency. States continue to evaluate naloxone access, including spending opioid settlement dollars on the drug and identifying vulnerable populations.
- Syringe service programs: Federal support for access to syringe service programs plays a role in preventing overdoses by increasing access to naloxone and substance use disorder treatment. Over 500 SSPs are operating across the United States and its territories and provide treatment, test for bloodborne infections and provide access to naloxone.
- Fentanyl test strips/drug checking equipment: The use of fentanyl test strips or other drug checking equipment is a vital component to overdose reduction. This remains a key strategy for states, but less so now that fentanyl is the drug people are seeking and not so much a contaminant. NCSL has seen a big push by legislatures to require high schools and colleges to carry naloxone/drug checking equipment as that population is less likely to be seeking fentanyl and more likely that it’s a contaminant to an illicitly purchased stimulant or an ADHD medication.
- Polysubstance Compounds: Xylazine is an increasingly frequent factor in overdose deaths. Continued surveillance and reporting of xylazine-involved overdoses through the CDC SUDORS is critical.
Prevent Drug Use Before It Starts
- Non-Opioid pain treatment options: Providing access to non-opioid alternatives for pain management can help reduce the risk of opioid misuse and overdose. At least eight states have enacted legislation promoting alternative pain management strategies since 2010. Mandating health insurance coverage for non-opioid alternatives is one such strategy.
- Drug awareness campaigns and education: Support state efforts to raise awareness about drug misuse, provide education and reduce stigma. Several states have launched campaigns focused on fentanyl awareness and some states have enacted legislation to provide age-appropriate drug education and positive youth development programs in grades K-12. These efforts aim to equip communities with knowledge and resources needed to prevent overdoses and address impacts of substance use, as well as serve as a primary prevention tool for youth.
- Adverse Childhood Experiences: Research indicates that people with any history of adverse childhood experiences are at higher risk of developing a substance use disorder. Support state efforts to develop statewide, cross agency frameworks that incorporate trauma informed practices to prevent and mitigate ACEs including training in ACEs, screening and referral protocols and improved data collection.
- Diversion and Deflection: NCSL released a report looking at diversion and deflection efforts for individuals with behavioral health needs. Pretrial diversion programs and treatment courts are not a new or emerging trend. Diversion programs expanded across the country in the 1960s and problem-solving courts, specifically drug courts, have been operating since the 1970s. What has changed over time is the creation of state legislative frameworks for these programs, expansion of eligibility and shifting focus to interventions earlier in the legal process so participants can access treatment sooner and potentially avoid deeper involvement with the criminal justice system. The increased use of pre-arrest deflection programs demonstrates this shift over time, with most of these programs emerging in the last 10 years.
Stop the Flow of Drugs Across our Borders and into Our Communities
- Penalties for Fentanyl: States have taken the initiative to propose and enact legislation addressing the possession, manufacture or trafficking of fentanyl which can help stem the flow of this drug into our communities. The Legislative Analysis and Public Policy Association (LAPPA) compiled this 50-state resource on fentanyl-specific criminal provisions in June 2023. This resource, also from LAPPA, compiled information on drug-induced homicide laws as of August 2023. To date, over 115 bills related to fentanyl have been enacted. Most bills intersect with the criminal justice and public health systems. States introduced bills to change the classification of fentanyl as a controlled substance, and they considered increasing penalties for possession and distribution, drug-induced homicide and drug delivery resulting in death. States also focused on increasing awareness about the risk associated with illicitly manufactured fentanyl and funded training programs for first responders. NCSL has a searchable Sentencing and Corrections Significant Enactment Database where the text of these enactments can be found.
Provide Treatment That Leads to Long-Term Recovery
Examples of strategies states are using to address medication-assisted treatment:
- Expanding the scope of practice for providers to prescribe buprenorphine or methadone
- Removing prior authorization for buprenorphine
- Permitting the use of buprenorphine in EMS and emergency department settings after an overdose
- Permitting telehealth prescribing of MAT drugs and expanding behavioral treatment capacity (including by expanding Certified Community Behavioral Health Clinics).
- Permitting and supporting treatment in carceral facilities (several states have applied for1115 reentry waivers and other legislative initiatives to fund or require MAT in jails.)
NCSL has a brief which further describes these strategies.
Innovate in Research and Data to Support Drug Control Strategies
- Reliable data is an important factor in state efforts to create effective drug control strategies. Support federal and state efforts to create and maintain timely, comprehensive and complete data sets and facilitate sharing of these data sets across federal and state agencies without preempting state privacy, transparency and data collection laws.
NCSL welcomes the opportunity to work with ONDCP as you develop the 2026 National Drug Control Strategy. We have a wealth of research and analysis that we would be happy to share. Please don’t hesitate to reach out to NCSL staff Lauren Kallins and Susan Frederick for more information and discussion.
Sincerely,
Tim Storey
Chief Executive Officer
National Conference of State Legislatures