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care not just for SUD treatment both for any identified health issue. Further, HHS and DOJ should review existing technical assistance and training programs to ensure that they have the expertise and capacity to serve those interested in expanding comprehensive harm reduction services, including both non-profit groups and state and local agencies. HHS should also assess how to better understand the share of federal grant funds that are dedicated to harm reduction. D. Consult with international partners on harm reduction programs. (Agencies Involved: DOS; ONDCP; USAID) In addition to the important work and research conducted inside the United States, the international community has learned much about harm reduction initiatives over the past two decades or more. It is important to highlight that just as within the United States “Abstinence isn’t wrong, and it is a deeply desired goal for many drug users, but there are changes a person can accomplish whether they stop using or not. The hallmark of harm reduction models is a combination of respect for the customer, non-judgmental stances, compassion, empathy and practicality.” —Edith Springer1 Springer E. No. 15 - Winter 2003, Harm Reduction Communication. Issuu. https://issuu.com/harmreduction/docs/hrc_2003_wint er_editedtoc. Published January 1, 2003. Accessed September 2, 2021. « « « « « « 44 NATIONAL DRUG CONTROL STRATEGY there is a wide range of variation in defining what is described as harm reduction, this is also true internationally. Some countries have a strong public posture against harm reduction, yet may widely distribute naloxone. Although U.S. laws and traditions may differ from those of international partners, consultations with those partners and a review of the research literature associated with their efforts can inform the development of U.S. programs, including by identifying barriers to program expansion and fair and equitable access to services. The United States should learn what we can from the successes and challenges associated with developing and sustaining international harm reduction initiatives. The Department of State, ONDCP and HHS should collaborate on a consultation process to hear the views of international partners and share existing international resources as appropriate. « « « « « « NATIONAL DRUG CONTROL STRATEGY 45 Substance Use Disorder Treatment According to the 2020 National Survey on Drug Use and Health (the National Survey),2 40.3 million people aged 12 or older had a past-year substance use disorder (SUD).160 Among these, 70.3-percent (or 28.3 million people) had a past year alcohol use disorder, 45.7-percent (or 18.4 million people) had a past year illicit drug use disorder, and 16-percent (or 6.5 million people) had both an alcohol use disorder and an illicit drug use disorder.161 This survey also shows that, in 2020, among the 41.1 million people who needed treatment only 2.7 million (6.5-percent) of received treatment received treatment at a specialty treatment facility in the past year. 162 This disparity in unmet needs of SUD is known as the “treatment gap.” Substantial federal funding in recent years has expanded and improved treatment services; however, access to diagnostic and treatment opportunities do not exist in the same manner that they do for other chronic illnesses (e.g., the rate of undiagnosed diabetes is about 39-percent).163 Research shows that more than 95-percent of people identified in the 2020 National Survey as meeting criteria for SUD who did not seek treatment felt they did not need treatment.164 Another 3-percent of those individuals thought they should get treatment but did not try to get it.165 SUDs including alcohol, prescription and illicit drug use disorders are medical conditions166 that respond to evidence-based treatments (EBTs).167,168,169 EBTs have scientific evidence supporting the effectiveness of the treatments, and may be pharmacotherapies, such as methadone (for opioid use disorder, or OUD) or naltrexone (used for both OUD and alcohol use disorder), or evidence-based therapies, such as contingency management. It is clear that if we were to appropriately screen, diagnose, and treat individuals with SUD similarly to chronic conditions we would be able to significantly reduce mortality and several aspects of morbidity associated with substance use. As such, the more people who are treated, the fewer lives will be lost. Treating more people who have SUD is one of the highest drug policy priorities. Certain factors are associated with an elevated risk of overdose for people with cocaine, methamphetamine, other stimulant, or OUD (or a combination of these) such as experiencing homelessness,170 injecting drugs,171 having a prior history of non-fatal overdose,172 using nonprescribed benzodiazepines,173 and detoxification without follow-up medication treatment (in people who use opioids ).174 Additionally, overdose is the highest risk factor for death among people leaving incarceration.175,176 Geographic and other barriers to accessing services can confer vulnerability and even differ based on race.177 Studies have shown racial disparity in naloxone prescribing and delivery is a health inequity that must be addressed.178 Treatment for high-risk populations is especially important. Evidence-based 

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