States Forge Ahead in the Fight Against Drug Overdoses as Federal Action Stalls

Overdose rates are surging, fueling a crisis in American communities. As federal action stalls, the drug crisis has now become a top legislative priority in states across the country, including Arkansas, California, Hawaii, and New York.

In 2020, overdose rates rose from 65,000 to over 110,000 a year and reached a record 112,000 deaths in 2023, with the dangerous synthetic opioid fentanyl accounting for 70% of deaths. Drug overdoses are a leading cause of death for Americans aged 18-45.

While overdose deaths continue to climb, experts agree that federal policies that reform our nation’s health and criminal justice systems and expand access to addiction and mental health programs should all be considered as part of the solution. But in an increasingly divided Congress, finding bipartisan solutions to these issues has become a challenge, and comprehensive policy solutions to combat the drug crisis have remained stalled on the federal level, which has left states taking more direct measures to help address the overdose crisis.

A key measure in fighting addiction on the federal level, the bipartisan SUPPORT Act signed into law in 2018, expired on September 30, 2023, after Congress missed the reauthorization deadline. The SUPPORT Act invested $20 billion into treatment, prevention, and recovery, including at the community level. This landmark legislation was built on previous law, including the bipartisan Comprehensive Addiction and Recovery Act, which was the first major federal addiction law enacted in 40 years and the most comprehensive legislative effort taken to address the opioid epidemic that focused on a coordinated federal response with six key pillars: prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. The SUPPORT Act also built upon the 21st Century Cures Act, another bipartisan bill that passed in 2016, which helped to reform federal policy on mental healthcare and address substance abuse disorders.

Following the expiration of the SUPPORT Act last September, legislation to reauthorize it passed in the U.S. House in December 2023. While the U.S. Senate Health, Education, Labor, and Pensions Committee marked up and advanced its own SUPPORT Act in December 2023, it is still awaiting consideration by the Senate today.

In the absence of comprehensive federal legislation, policies to address the overdose crisis have become a priority for state lawmakers from both sides of the aisle. According to the National Conference of State Legislatures, over three dozen states and the District of Columbia have enacted legislation in recent years. In 2023 alone, there were over 600 bills introduced in the states related to fentanyl, and at least 103 of these bills were enacted into law. Many of these bills intersect between public health and criminal justice system reform, as well as investing in overall education and prevention efforts.

Legislative efforts in the states continue this year. In Washington, Democratic Governor Jay Inslee proposed a $50 million plan to increase education and awareness of drug addiction. The plan also increases the supply and distribution of naloxone, an overdose reversal medication. Similarly, in Iowa, Republican Governor Kim Reynolds proposed a $13 million plan to invest in youth treatment and recovery programs.

In addition to investing in necessary mental and behavioral care and community programs, various legislation has advanced in state legislatures, including proposals to decriminalize fentanyl test strips, which have already been implemented in at least 15 states over the past several years, including Arkansas, Hawaii, Kansas and Mississippi. In Illinois, a new law took effect in January that would allow pharmacists and retailers to sell fentanyl strips over the counter to test for the substance. The law also allows trained overdose responders to use fentanyl strips. Similarly, the Pennsylvania state legislature passed a bill this year requiring hospitals to test for fentanyl and xylazine when administering emergency room drug screenings.

Increasing access to the lifesaving overdose reversal drug naloxone is another way that states are addressing the crisis. Legislation that is moving forward in Georgia would allow vending machines to dispense overdose drugs, such as Narcan or naloxone, making it easier for people to access the lifesaving overdose reversal medication. If passed, Georgia would join with at least 33 states and the District of Colombia, including California, Michigan, New York and Oklahoma, which have already implemented naloxone vending machines.

Tackling the drug crisis has become a top policy issue in the states in recent years, and calls for support and coordination from the federal government continue to grow. As pressure mounts, advocates continue to push for advancing federal policies that help support state efforts to address this worsening crisis.