32 Recommendations for Modernizing America’s Response to the Opioid and Synthetic Drug Crisis

These 32 recommendations translate the 12 Hard Lessons from Inside America’s Opioid Crisis into a practical national reform agenda for policymakers, journalists, advocates, families, public health leaders, treatment providers, law enforcement, and community organizations.

The recommendations are organized into five pillars:

I.     Governance, Oversight, and Industry Accountability

II.    Treatment, Recovery, and Community Support

III.   Justice, Sentencing, and Public Safety

IV.   Enforcement and International Strategy

V.    Data, Prevention, and Future Readiness

I. GOVERNANCE, OVERSIGHT, AND INDUSTRY ACCOUNTABILITY

1. Establish an Opioid Crisis Memorial Museum and Education Center in Washington, D.C.

The opioid crisis has taken hundreds of thousands of American lives and reshaped families and communities across the country. A national memorial and education center would honor those lost, preserve the stories of families and people in recovery, educate future generations, and document the policy, medical, commercial, and criminal justice failures that allowed the crisis to grow. It should also serve as a center for public learning about addiction, overdose prevention, treatment, recovery, and the continuing threat posed by synthetic drugs. Funding: $100 million.

2. Create a Congressional Committee to Modernize Drug Laws and Funding Streams

America’s drug laws were built in a different era and too often reflect old assumptions about drugs, addiction, enforcement, sentencing, and treatment. Congress should create a bipartisan committee to review outdated drug statutes and recommend reforms that better reflect today’s opioid, fentanyl, methamphetamine, and polysubstance crisis. The committee should examine federal drug scheduling, sentencing, treatment access, recovery support, enforcement authorities, international supply control, and data systems. Funding: None.

3. Strengthen FDA Accountability for Drug Approval Officials

Top FDA drug approval officials should face strong conflict-of-interest restrictions after government service, including a lifetime ban on employment by pharmaceutical companies whose products they helped approve or regulate. The opioid crisis demonstrated the devastating consequences of weak oversight, commercial influence, and regulatory failure. This reform would help restore trust and reduce the risk that public officials make decisions with future private-sector employment in mind. Funding: $5 million.

4. Impose an Opioid Crisis Fee on the Pharmaceutical Industry to Fund Implementation of these Recommendations

The pharmaceutical industry played a central role in creating the opioid crisis and should help finance the long-term national response. A targeted opioid crisis fee should generate sustained funding for treatment, recovery support, prevention, data modernization, and enforcement efforts. The goal is to build the capacity required to repair damage, prevent future loss of life, and reduce the enormous social and economic costs of the opioid crisis. Revenue: +$10 billion annually.

5. Modernize and Rename Prescription Drug Monitoring Programs

Prescription Drug Monitoring Programs should be modernized and reframed as clinical and public health tools, not simply enforcement databases. They should provide better real-time information to prescribers and pharmacists, improve interstate data sharing, support patient safety, and help identify risky prescribing patterns without causing inappropriate abandonment of patients with pain or addiction. Renaming and modernizing PDMPs would help shift their purpose from surveillance alone to responsible clinical decision support. Funding: $100 million.

6. Require Drug Policy Risk Assessments for Major Initiatives

Major drug policy initiatives should be accompanied by formal but rapid, risk assessments. Before changing prescribing guidance, launching major enforcement initiatives, approving new controlled substances, or expanding sweeping state-level reforms nationally, policymakers should assess likely unintended consequences, including overdose risk, treatment displacement, racial impact, illicit market shifts, and effects on pain patients. Drug policy has repeatedly suffered from poorly anticipated consequences. Risk assessment should become a standard part of responsible policymaking. Funding: None.

7. Rigorously Study State-Level Drug Policy Changes Before National Expansion

States are often described as laboratories for policy innovation, but major drug policy reforms should not be treated as national models until they are carefully studied. Federal funding should support rigorous evaluations of state-level experiments involving cannabis legalization, sentencing for drug offenses, decriminalization, treatment access, medications for addiction treatment, psychedelics reform, and recovery support. The goal is to learn from innovation while avoiding ideology, anecdotes, or selective use of data. Funding: $100 million.

II. TREATMENT, RECOVERY, AND COMMUNITY SUPPORT

8. Fund 1,000 Engagement and Support Centers for People with Addiction

The country needs easily accessible community-based places where people with substance use disorders can receive immediate walk-in help without preconditions. Engagement and Support Centers would provide basic services, overdose prevention, peer support, treatment navigation, connection to medications for addiction treatment, housing referrals, and recovery support. These centers would help people earlier — before repeated overdoses, arrests, emergency room visits, homelessness, or deeper justice-system involvement. Funding: $1.8 billion.

9. Hire 100,000 Recovery Coaches and Peer Counselors

The rapid rapport that can be established between those struggling with a substance use disorder and those in recovery is an invaluable asset to reduce overdoses and increase treatment entry. Those first few steps towards recovery can best be supported by those with their own lived experience. Even after initial treatment entry, many people need practical, persistent, trusted support to stay connected to care, housing, employment, family, and community. A national recovery workforce of 100,000 additional recovery coaches and peer counselors would help people after overdose, during treatment, after relapse, after jail or prison release, and during the long process of rebuilding a stable life and building new relationships, stability, and purpose. Funding: $1 billion.

10. Survey Drug Users and First Responders to Identify Better Paths to Treatment Entry

The country needs better information from the people closest to the crisis: people who use drugs, people in recovery, first responders, outreach workers, and families. Structured surveys and interviews should identify what helps people initiate and sustain treatment, what barriers keep them away, what kinds of outreach are most effective, and what happens after overdose, arrest, hospitalization, or treatment discharge. A more honest understanding of lived experience should guide policy design. Funding: $50 million.

11. Expand Access to Medical Innovation for Addiction Treatment

The addiction treatment system must make better use of medical innovation and high-quality health services over a longer duration. This includes expanding access to medications for opioid use disorder, including long-acting injectable medications, improving treatment for stimulant use disorders, supporting development of new medications, studying the possible therapeutic role of psychedelics under appropriate medical oversight, and exploring how artificial intelligence and digital tools can improve treatment entry, retention, and support, while advancing medical research. Funding: $100 million.

12. Build a Recovery-Friendly Culture in Colleges, Workplaces, and Communities

Recovery should be supported not only in treatment programs, but also in colleges, workplaces, faith communities, recreation programs, housing systems, and civic life. The country should invest in recovery high schools, collegiate recovery programs, recovery-friendly workplaces, recovery community organizations, family support, and community education. People in recovery need places where sobriety, purpose, employment, education, and belonging are actively supported. Funding: $500 million.

13. Expand Recovery Housing and Recovery-Oriented Supportive Housing

Housing instability is one of the greatest barriers to recovery, but housing programs must also be safe, well-managed, and connected to a clear pathway toward stabilization and recovery. The country needs far more recovery housing, transitional housing, and recovery-oriented supportive housing for people leaving treatment, jail, prison, homelessness, or unstable living situations. These programs should meet people where they are while operating under clear standards, supervision, and expectations for progress over time. Housing should be paired with recovery support, employment services, medication access, health care, and help reconnecting to family and community. No one should be expected to maintain recovery while returning immediately to the same unsafe or unstable environment — but public funding should support housing models that promote safety, dignity, recovery, and measurable improvement.Funding: $2 billion.

III. JUSTICE, SENTENCING, AND PUBLIC SAFETY

14. Target the Most Dangerous Drug Dealers and Violent Trafficking Networks

Drug enforcement should focus on the most dangerous people and networks: those driving violence, supplying fentanyl and other lethal drugs, exploiting vulnerable users, selling counterfeit pills, or operating sophisticated trafficking organizations. Enforcement should not return to broad, mass arrest strategies. A targeted approach and use of innovative, research-based policing strategies in partnership with communities can protect public safety, disrupt drug markets, and strengthen community trust. Funding: $500 million.

15. Establish a DEA Digital Drug Markets Division to Disrupt Illicit Internet and Social Media Drug Sales

Drug trafficking has moved aggressively online, including through social media platforms, encrypted communications, and internet-based sales of counterfeit pills and synthetic drugs. DEA should have a dedicated covert division focused on identifying, infiltrating, and disrupting online drug markets, especially those reaching young people. This capability must evolve as quickly as traffickers adapt. Funding: $200 million.

16. Reform Sentencing So Punishment Reflects a Person’s Role, Not Just Drug Weight

Federal and state sentencing should better distinguish between cartel leaders, violent traffickers, high-level distributors, low-level couriers, people supporting their own addiction, and people with minor involvement in drug offenses. Drug weight alone is often a poor measure of culpability. Sentencing reform should preserve accountability for serious trafficking while reducing excessive punishment for lower-level, nonviolent offenders. Funding: None.

17. Authorize Limited Expungement of Felony Drug Convictions

Many people with old felony drug convictions face long-term barriers to employment, housing, education, and reintegration. Limited expungement should be available for appropriate nonviolent drug convictions, especially when individuals have completed their sentences and demonstrated rehabilitation. This reform would help people rebuild their lives while maintaining public safety safeguards. Funding: $10 million.

18. Reform Marijuana Policy with a Focus on Public Health

Cannabis policy should move beyond simplistic arguments over legalization or prohibition. States and the federal government should focus on public health, youth prevention, impaired driving, high-potency THC products, pregnancy risks, psychosis concerns, product labeling, marketing restrictions, and better data. Cannabis reform should not repeat the mistakes of alcohol, tobacco, or opioids by allowing commercial interests to overwhelm public health. Funding: $100 million.

19. Make Police Deflection and Treatment Linkage a Standard Alternative to Arrest

Police-facilitated deflection programs can help move people with substance use disorders toward treatment and services instead of jail. These programs should become a standard option across the country, especially for nonviolent individuals whose criminal behavior is closely tied to addiction. Effective deflection requires strong partnerships among law enforcement, treatment providers, recovery coaches, peers, public health agencies, and community organizations. Funding: $1 billion.

20. Create 500 “Treatment First” Drug Courts to Speed Access to Care and Reduce Drug Overdoses

Drug courts should be strengthened and expanded with a clearer “treatment first” orientation to reduce overdoses during the gap between arrest and treatment initiation. Courts should provide rapid access to evidence-based treatment, medications for opioid use disorder, recovery support, housing assistance, and meaningful supervision. The goal should be sustained recovery and reduced criminal behavior, not punishment for relapse. Funding should support 500 drug courts that meet high standards for treatment access, fairness, data collection, and outcomes. Funding: $250 million.

IV. ENFORCEMENT AND INTERNATIONAL STRATEGY

21. Establish 50 ONDCP Treatment Coordination Task Forces in High-Need Areas

ONDCP should lead 50 Treatment Coordination Task Forces in communities with the greatest need. These task forces would bring together federal, state, local, tribal, and community partners to expand treatment access, improve deflection, strengthen reentry support, coordinate recovery services, and reduce overdose deaths. The model, build on ONDCP’s High Intensity Drug Trafficking Areas program, should combine federal leadership with local problem-solving and accountability. Funding: $250 million.

22. Reinforce DHS Capacity to Turn Drug Seizures into Drug Cartel Investigations

The Department of Homeland Security plays a critical role in investigating transnational criminal organizations, smuggling networks, money laundering, and cross-border trafficking. DHS investigative capacity should be reinforced so DHS and Customs and Border Protection have the resources to follow up on drug seizures, in partnership with federal and state agencies, to further enhance complex cartel investigations through controlled deliveries and development of confidential sources. This should include support for long-term investigations targeting the networks, brokers, logistics systems, and financial infrastructure that make drug trafficking possible. Funding: $200 million.

23. Use International Financial Sanctions Against Trafficker Vulnerabilities

Drug trafficking organizations depend on money movement, chemical suppliers, brokers, front companies, logistics networks, corrupt facilitators, and professional money launderers. The United States should use financial sanctions more aggressively and strategically against these vulnerabilities. Sanctions should be paired with law enforcement, intelligence, diplomatic, and private-sector cooperation to disrupt the financial architecture of synthetic drug trafficking. Funding: $50 million.

24. Fund a Ten-Year Bilateral Anti-Drug Partnership with Mexico

The United States and Mexico need a sustained, well-funded, ten-year partnership focused on fentanyl, methamphetamine, precursor chemicals, cartel laboratories, ports, border security, corruption, violence, and shared public health goals. Short-term pressure is not enough. A durable partnership should include enforcement cooperation, chemical control, intelligence sharing, public health collaboration, institution-building, and accountability. Funding: $500 million.

25. Negotiate a New Global Treaty on Synthetic Drugs and Precursor Chemicals

The international drug-control system was built for an earlier era. Today’s synthetic drugs and precursor chemicals can emerge and spread faster than governments can respond. The United States should lead negotiations toward a new global agreement focused on synthetic drugs, rapid scheduling, mandatory controls on dual-use chemicals required for methamphetamine and cocaine production, increased pre-export notification of precursors, supply-chain integrity, and stronger international cooperation. Funding: None.

‍ ‍

V. DATA, PREVENTION, AND FUTURE READINESS

26. Establish Drug Policy “Return on Investment” Teams at ONDCP and in Each State

Drug policy funding should be judged by results. ONDCP and every state should have teams responsible for assessing return on investment across prevention, treatment, recovery, outreach to drug users/harm reduction, enforcement, reentry, and data programs. These teams would help identify what works, what does not, what should be expanded, and what should be redesigned or ended. The goal is to spend smarter to save more lives more quickly. Funding: $100 million.

27. Build a Real-Time National Drug Data System Led by ONDCP

The country still lacks a truly real-time drug data system. ONDCP should lead development of a national system that integrates overdose data, toxicology, emergency medical services, law enforcement seizures, wastewater testing, treatment data, drug checking, and emerging-threat information. Policymakers and responders need timely information to detect new substances, identify regional trends, and adapt quickly. Funding: $100 million.

28. Establish a National Center on Implementation Science at ONDCP

Many promising drug policy initiatives fail because they are poorly implemented, not because the ideas themselves are wrong. A National Center on Implementation Science at ONDCP would help federal, state, and local partners scale proven and promising models with fidelity, training, technical assistance, coaching, evaluation, and continuous improvement. This would help move the field from isolated innovation to broad national impact. Funding: $25 million.

29. Fund an Intensive Drug Policy Boot Camp for New Government Appointees

New political appointees and senior officials often arrive with limited experience in drug policy, addiction, overdose, enforcement, treatment, recovery, or international supply control. An intensive drug policy boot camp would provide rapid education on the history of the crisis, current threats, evidence-based interventions, federal programs, data systems, legal authorities, and implementation challenges. Better-prepared leaders make better decisions. Funding: $10 million.

30. Ensure Every Student Participates in Evidence-Based Prevention Programs

Every student should receive evidence-based, age-appropriate prevention education in every grade. Many policymakers may not realize that this does not occur today. Prevention programs need to be evidence based and tailored to address drug use trends in each state. Generally, they should address fentanyl, counterfeit pills, high-potency cannabis, vaping, alcohol, polysubstance use, mental health, peer pressure, social media, and how to seek help. The elimination of major national school-based prevention infrastructure early in the opioid crisis was a serious mistake. Youth prevention must be rebuilt for the fentanyl era. Funding: $400 million.

31. Expand Recreational and Developmental Opportunities in High-Addiction Counties

Young people in high-addiction counties need more than warnings about the risks posed by drugs. They need opportunity, structure, connection, mentoring, recreation, education, employment pathways, arts, sports, and safe places to belong. A national youth opportunity initiative should invest in communities where addiction, overdose, poverty, isolation, and limited access to positive recreational and social activities reinforce one another. Prevention must include giving young people more low-cost, accessible, and appealing opportunities to find a sport, team, club, creative outlet, skill, or activity that is fun, meaningful, and connected to positive peers and adults. Funding: $350 million.

32. Launch a National Youth Anti-Drug Media Campaign Using Private-Sector Tactics

The country needs a modern youth anti-drug media campaign designed for how young people actually receive information today. The campaign should address fentanyl, counterfeit pills, high-potency THC, polysubstance use, overdose risk, and the rapidly changing drug supply. It should use social media, streaming platforms, gaming, influencers, music, sports, and private-sector marketing strategies — and it should be tested, adapted, and evaluated continuously using private-sector tools to measure reach, engagement, message retention, and behavior change. Funding: $200 million.

‍ ‍Conclusion: A Larger, Focused Response for a More Dangerous Era

The fentanyl crisis has revealed deep weaknesses in America’s approach to addiction, overdose, drug markets, treatment, recovery, prevention, and international supply control. Families have carried the pain of this crisis, but they should not have to carry the burden of driving overdue policy and funding changes alone.

The country has the knowledge, resources, and institutional capacity to do better. What has been missing is scale, coordination, urgency, and sustained investment equal to today’s dangerous and continually evolving drug crisis.

We should welcome the recent decline in overdose deaths, but we should not mistake progress for victory. Today’s drug supply — marked by fentanyl, polysubstance use involving stimulants, sedatives, counterfeit pills, and rapidly changing synthetic substances — will remain a high-risk environment for the foreseeable future.

Taken together, these 32 recommendations represent a national strategy equal to the severe threat. We should honor the lives lost not only with remembrance, but with action.