Public policy debates on drug policy are highly polarized. The discussions often revolve around prohibition versus decriminalization. Advocates on both sides make valid points but often ignore a crucial element: a system that meets the growing need for addiction treatment and recovery services.
Prohibition’s Concerns
Prohibition advocates emphasize the severe dangers of current drugs, which are frequently more lethal and addictive than before. Synthetic opioids like fentanyl, more than 50 times as potent as heroin, contributed to over 55,000 overdose deaths in the past year, according to provisional data from the Centers for Disease Control and Prevention. These drugs require strict regulation for public health and safety.
Reform Advocates’ Critique
Drug reformers argue the “war on drugs” has failed to reduce trafficking, use, and overdose fatalities. They propose a new approach based on evidence, health, equity, and human rights. Despite over five decades of prohibition, drugs have become cheaper, stronger, and more accessible. Reformers argue for treating illicit drugs as a public health issue.
The Role of Treatment and Recovery Services
Both prohibition and reform depend on effective treatment and recovery services. History shows that increased regulation can have unintended consequences. For example, in 2005, the U.S. government imposed stringent controls on ephedrine and pseudoephedrine to curb methamphetamine production. While the crackdown succeeded, production shifted to Mexico and empowered drug trafficking organizations. Similarly, reducing prescriptions of opioid painkillers led many to turn to heroin and fentanyl.
Decriminalization also faces challenges, as shown by Oregon’s Measure 110. The measure removed criminal penalties for small possessions but failed due to a lack of treatment options. With more than 95 percent of people ignoring tickets and less than 1 percent completing health assessments, Oregon wasn’t ready to support treatment demand.
Building a Robust Treatment Infrastructure
The fundamental obstacle for both approaches is inadequate treatment infrastructure. Establishing a new Department of Treatment and Recovery may be ambitious; however, immediate actions can strengthen the system. The focus should be on people and places.
There is a shortage of professionals in addiction treatment and recovery fields, such as counselors, social workers, and healthcare providers. As of 2025, more than 40 percent of the U.S. population lived in areas where demand far exceeds available mental health professionals. The shortage is even more severe in rural and carceral settings, where substance use and overdose rates are higher.
Investing in the behavioral health workforce is crucial. This includes promoting careers in treatment and recovery, offering competitive salaries, streamlining education and licensing, ensuring stable funding, and supporting peer systems to reduce burnout.
The U.S. also faces a scarcity of treatment facilities like inpatient detox beds and residential centers. Almost 80 percent of U.S. counties lack an opioid treatment program. Wyoming, for example, has none. To improve care, the U.S. must expand treatment capacity, extend services to underserved areas, and create accessible care settings.
An Essential Path Forward
These investments form the foundation for transforming the U.S. drug treatment system. For too long, essential care components have been neglected, leaving many Americans without help. Expanding these services is vital to advancing drug policy and saving lives. Building this system is essential for effective drug policy.
Jim Crotty is the former deputy chief of staff for the U.S. Drug Enforcement Administration, an adjunct professor at American University’s School of Public Affairs, and a member of the Advisory Board for United Against Fentanyl and End Overdose.