Federal, State, Local, and Tribal Governments

Provide leadership, guidance, and vision in supporting a science-based approach to addressing substance use-related health issues.

Coordinated federal, state, local, and tribal efforts are needed to promote a public health approach to addressing substance use, misuse, and related disorders. As discussed throughout this Report, widespread cultural and systemic issues need to be addressed to reduce the prevalence of substance misuse and related public health consequences. Government agencies have a major role to play in:

  • Improving public education and awareness
  • Conducting research and evaluations
  • Monitoring public health trends
  • Providing incentives, funding, and assistance to promote implementation of effective prevention, treatment, and recovery practices, policies, and programs
  • Addressing legislative and regulatory barriers
  • Improving coordination between health care, criminal justice, and social service organizations
  • Fostering collaborative initiatives with the private sector

For example, federal and state agencies can implement policies to integrate current best practices—such as the Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain29 or mandatory use of PDMPs—among federal and state supported service providers.

Improve coordination between social service systems and the health care system to address the social and environmental factors that contribute to the risk for substance use disorders.

Social service systems serve individuals, families, and communities in a variety of capacities, often in tandem with the health care system. Social workers can play a significant role in helping patients with substance use disorders with the wrap-around services that are vital for successful treatment, including finding stable housing, obtaining job training or employment opportunities, and accessing recovery supports and other resources available in the community. In addition, they can coordinate care across providers, offer support for families, and help implement prevention programs. Child and family welfare systems also should implement trauma-informed, recovery-oriented, and public health approaches for parents who are misusing substances, while maintaining a strong focus on the safety and welfare of children.

Implement criminal justice reforms to transition to a less punitive and more health-focused approach.

The criminal justice and juvenile justice systems can play pivotal roles in addressing substance-related health issues across the community. These systems are engaged with a population at high risk for substance use disorders and often at a teachable moment—when individuals are more open to prevention messaging or to accepting the need for treatment. Less punitive, health-focused initiatives can have a critical impact on long-term outcomes. Sheriff’s offices, police departments, and county jails should work closely with citizens’ groups, prevention initiatives, treatment agencies, and recovery community organizations to create alternatives to arrest and lockup for nonviolent and substance use-related offenses. For example, drug courts have been a very successful model for diverting people with substance use disorders away from incarceration and into treatment.30 It is essential that these programs promote the delivery of evidence-based treatment services, including MAT.

Many prisoners have access to regular health care services only when they are incarcerated. Significant research supports the value of integrating prevention and treatment into criminal justice settings.31,32 In addition, community re-entry is a particularly high-risk time for relapse and overdose. Criminal justice systems can reduce these risks and reduce recidivism by coordinating with community health settings to ensure that patients with substance use disorders have continuing access to care upon release.

Facilitate research on Schedule I substances.

Some researchers indicate that the process for conducting studies on Schedule I substances, such as marijuana, can be burdensome and act as disincentives. It is clear that more research is needed to understand how use of these substances affect the brain and body in order to help inform effective treatments for overdose, withdrawal management, and addiction, as well as explore potential therapeutic uses. To help ease administrative burdens, federal agencies should continue to enhance efforts and partnerships to facilitate research. Some of these efforts have already borne positive outcomes. For example, a recent policy change will foster research by expanding the number of U.S. Drug Enforcement Administration (DEA)-registered marijuana growers. Making marijuana available from new sources could both speed the pace of research and afford medication developers and researchers more options for formulating marijuana-derived investigational products.


29. Substance Abuse and Mental Health Services Administration. (2015). Federal guidelines for opioid treatment programs. (HHS Publication No. (SMA) PEP15-FEDGUIDEOTP). Rockville, MD: Substance Abuse and Mental Health Services Administration.

30. Wilson, D. B., Mitchell, O., & MacKenzie, D. L. (2006). A systematic review of drug court effects on recidivism. Journal of Experimental Criminology, 2(4), 459-487.

31. Belenko, S., Hiller, M., & Hamilton, L. (2013). Treating substance use disorders in the criminal justice system. Current Psychiatry Reports, 15(11), 1-11.

32. Fletcher, B. W., & Wexler, H. K. (2005). National Criminal Justice Drug Abuse Treatment Studies (CJ-DATS): Update and progress: Justice Research and Statistics Association Forum.