The federal government has long sought to prevent the horrors of drug addiction by interdicting the supply of dangerous psychoactive drugs—and reducing demand for them.

One step was the Anti-Drug Abuse Act of 1988. It established the Office of National Drug Control Policy (ONDCP) within the Executive Office of the President. Headed by a director colloquially known as “drug czar,” ONDCP had the task of developing a national drug-control strategy to reduce drug use. Its creation symbolized a strong bipartisan effort to prevent illicit drugs from destroying lives and weakening the nation.

Sadly, we have lost that shared mission. No president since George W. Bush has publicly demonstrated a deep and firm support for ONDCP and its mission.

The agency does not reside in the White House office building, let alone the West Wing. The federal government has largely been a bystander despite the unraveling of restrictive opioid prescribing, state implementation of medical/recreational marijuana programs in violation of federal laws, and the incipient movement by states to legalize psychedelics. Most presidents have largely ignored these trends.

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The first Trump administration assembled a commission to combat drug addiction and the opioid crisis. The current one should support a comprehensive effort led by ONDCP to overhaul drug policies and strengthen America’s commitment to reducing and delegitimizing drug use. We need a revitalized ONDCP equipped with innovative goals and measurable outcomes to disrupt the pipeline to addiction and to cease preventable, premature deaths and mental health decline. A single centralized agency ensures coordination across federal agencies, state, and local levels to maximize efficiency and accountability.

Today, some members of America’s political class are desensitized to the drug crisis. They tolerate normalizing psychoactive substance use and the addiction, health crises, deaths, and collateral damage to families that follow.

Reformers advocate destigmatizing regular use of hazardous psychoactive drugs. “Harm reduction” practices, initially framed as temporary measures, now are uncritically promoted in some quarters without clear boundaries or outcome goals.

This “Meet drug users where they are” approach has regressed to a “Leave them where they are” one. The grim realities of “tranq”-induced catatonia on the streets of Philadelphia’s Kensington neighborhood, San Francisco’s Tenderloin district, Boston’s Mass and Cass intersection, and other drug-ridden homeless encampments lay bare the stark failure of America’s waning resolve to minimize drug use.

Among other nations, we are an outlier. America’s drug crisis has escalated dramatically since ONDCP was born. Overdose deaths surged from 3,907 (1.6 per 100,000) in 1987 to a record 107,543 (32.2 per 100,000) in 2023, with teen rates doubling recently. Among twelfth-graders, 13 percent use marijuana daily, despite heightened risks for addiction and psychosis. In 2023, daily use of marijuana and regular use of hallucinogens among 19- to 30-year-olds reached record levels, fueled by pervasive myths about “safety” or “medical” efficacy

Whether used for medical or recreational purposes, or both, 25 percent of cannabis users have a cannabis-use disorder; among twelve- to 24-year-olds, such a disorder is more prevalent than alcohol-use disorder. Over 90 percent of individuals with substance-use disorders (48.7 million people) neither recognize their need for help nor seek treatment.

Topping it off, seizures of fentanyl-laced pills exploded from 49,000 in 2017 to a staggering 115 million in 2023. Reversing this runaway train demands a transformative political and cultural shift led by the president, ONDCP, and Congress.

How?

Start by learning from past mistakes. The relentless movement to legalize drug use has succeeded, largely by appealing to the goodwill and sympathies of the American public. In 1996, activists persuaded California’s voters to adopt marijuana as a medicine by labelling it as “compassionate use” for end-stage cancer and HIV-AIDS wasting.

That success gave legalizers a foothold. Slowly, the movement persuaded other states to adopt medical-use marijuana for myriad purposes without a shred of evidence; this later morphed into recreational-use programs. Dual-purpose “dispensaries” now sell marijuana for any reason. Activists persuaded the medical profession that pain was the “fifth vital sign” and pressured caregivers to prescribe highly addictive opioids liberally for any type of pain. We know where that went.

Finally, recent campaigns to use political means to normalize hallucinogens for medical use bear a striking resemblance to the two campaigns noted above, including media hype and their tendency to lampoon cautious Cassandras. Compassion is a virtue, except when it leads to long-term harm.

Those who are driving the normalization of substance use as a chemical shortcut for pleasure or relief are willing to sacrifice long-term well-being for short-term escapism. Without prevention strategies to disrupt this pathway of use, addiction, and death, no amount of treatment or law enforcement will resolve the crisis.

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We should oppose efforts to destigmatize drug use but support destigmatization of individuals with substance-use disorders to ease their entry into treatment and recovery. To end the frequently heard lament of parents—“If only I knew”—we need a national educational campaign that counters the myths promulgated by proponents.

We need more research to understand why substance-use disorders are resistant to treatment- and recovery. Harm-reduction strategies that don’t show objective reductions in disordered use should be challenged. And we must recognize that minorities are hurt, not helped, by liberalizing drug use because it can worsen the conditions in already suffering neighborhoods.

Finally, we should strengthen ONDCP by returning it to cabinet-level status and empowering it to adopt a results-driven business model. Steps would include, on the demand side, ensuring that federal funding is allocated to prevention and treatment programs that prioritize objective, evidence-based positive outcomes.

For supply reduction, the U.S. must send a clear message to the world that we are not an open market for drugs. This will involve stopping the smuggling of fentanyl, dismantling illegal markets, and seizing traffickers’ ill-gotten gains. Incentives and penalties can persuade nations that produce drugs and their precursor chemicals to curb their export of substances poisoning Americans.

President Trump has a unique opportunity to pivot and reform America’s recurring drug crises. A bold approach will signal America’s commitment to reversing our damaging trajectory.