US drug policy is the federal framework — anchored in the Controlled Substances Act of 1970 — that decides which substances are legal, which are criminal, how offenses are punished, and how the government responds to addiction and overdose. In 2025 and 2026 that framework is moving in several directions at once: overdose deaths are falling for a third straight year, marijuana is being partially rescheduled, psychedelic therapies are getting expedited federal review, sentencing reform is chipping away at old disparities, and harm reduction has moved close to the mainstream. Fentanyl is still the largest single driver of drug deaths, and the racial disparities built into decades of enforcement have not gone away.
The Federal Legal Framework
Every regulated substance in the United States is placed into one of five schedules under Title 21 of the U.S. Code. Placement depends on abuse potential, whether the drug has an accepted medical use, and the risk of dependence.1DEA. Drug Scheduling
Schedule I is the strictest tier and is reserved for substances the federal government treats as having a high potential for abuse and no accepted medical use. Heroin, LSD, and psilocybin sit here, and so does marijuana, though its status is actively under review. Schedule II covers drugs with high abuse potential that do have medical uses, including fentanyl, oxycodone, methamphetamine, and Adderall. Schedules III through V cover progressively lower abuse potential: Schedule III includes ketamine, testosterone, and certain codeine products; Schedule IV includes benzodiazepines like Xanax and Valium; Schedule V covers preparations with small quantities of narcotics.2DEA. Drug Scheduling3Office of the Law Revision Counsel. 21 USC 812 – Schedules of Controlled Substances
Scheduling decisions can be initiated by the DEA, by the Department of Health and Human Services, or by outside petitions. Federal law lays out eight factors that weigh into the decision, including scientific evidence, history of abuse, and public health risk.4DEA. Controlled Substances Act The CSA also lets prosecutors treat unscheduled substances as Schedule I when they are structurally or pharmacologically similar to a listed drug and intended for human consumption.2DEA. Drug Scheduling
Fentanyl and the State of the Overdose Crisis
The opioid crisis has shaped federal drug policy for more than a decade. What began with pharmaceutical overprescription in the late 1990s became a heroin epidemic and then, by the mid-2010s, a fentanyl crisis. Fentanyl is roughly 50 times more potent than heroin and 100 times more potent than morphine, and a single kilogram can yield more than a million pill-sized doses.5ICE. Opioid Crisis
Overdose deaths peaked near 110,000 in 2022 and 2023 and have declined for three consecutive years since. Provisional CDC data released in May 2026 estimated roughly 70,000 overdose deaths in 2025, a nearly 14 percent drop from about 81,300 in 2024. Opioid-specific deaths fell to an estimated 44,564 in 2025 from 55,296 the prior year.6Reuters. US Drug Overdose Deaths Dropped Third Straight Year The CDC attributes much of the decline to the wider availability of naloxone. Fentanyl still causes the largest share of overdose deaths, and New Mexico, Arizona, and Colorado saw increases of 10 percent or more against the national trend.7U.S. News & World Report. Decline in US Drug Overdose Deaths Driven by Big Drop in Fentanyl-Related Fatalities
On the enforcement side, the federal government runs the High Intensity Drug Trafficking Area program, Border Enforcement Security Task Forces, and the Organized Crime Drug Enforcement Task Force. On the public health side, the CDC funds the Overdose Data to Action program across 47 states and the Overdose Response Strategy links public health and law enforcement data across all 50.8CDC. Congressional Testimony on Overdose Prevention
The HALT Fentanyl Act, signed on July 16, 2025, permanently placed fentanyl-related substances on Schedule I. It also streamlined research on Schedule I substances by letting researchers with active FDA applications use an expedited notice process rather than full DEA registration.9U.S. Congress. Evidence-Based Drug Policy Act of 2025 In April 2026 the U.S. Sentencing Commission adopted amendments to the federal sentencing guidelines that implement the HALT Fentanyl Act, scheduled to take effect November 1, 2026, pending congressional review.10U.S. Sentencing Commission. Commission Adopts 2026 Amendments
Marijuana Rescheduling
Marijuana has sat on Schedule I alongside heroin and LSD for the entire life of the CSA. That is changing. President Trump signed Executive Order 14370 on December 18, 2025, directing the Attorney General to complete the process of moving marijuana to Schedule III on an expedited basis. The order also tells HHS to develop research into the long-term health effects of marijuana and CBD in vulnerable populations, and directs the White House to work with Congress on a regulatory framework for hemp-derived cannabinoid products, including THC and CBD dosage limits.11Federal Register. Increasing Medical Marijuana and Cannabidiol Research12The White House. Fact Sheet – Increasing Medical Marijuana and Cannabidiol Research
On April 23, 2026, Acting Attorney General Todd Blanche issued an order placing FDA-approved marijuana products and marijuana products subject to qualifying state-issued medical licenses onto Schedule III, effective immediately.13Department of Justice. Justice Department Places FDA-Approved Marijuana Products Into Schedule III The broader question of whether to reschedule marijuana in general is still working through a formal rulemaking. The DEA withdrew a prior hearing process and scheduled a new evidentiary hearing to begin June 29, 2026, at its Arlington, Virginia facility, with proceedings set to conclude no later than July 15, 2026.14Federal Register. Rescheduling of Marijuana – Notice of Hearing
Rescheduling to Schedule III is not legalization and it is not descheduling. The Drug Policy Alliance and others have argued marijuana should be removed from the CSA entirely. The MORE Act, which would do that and address harms from past criminalization, was reintroduced in the House in August 2025 with 40 cosponsors led by Representatives Jerrold Nadler, Dina Titus, Ilhan Omar, and Nydia Velázquez. It passed the House in 2020 and 2022 but has not moved in the Senate.15Office of Representative Jerrold Nadler. MORE Act Reintroduction
Psychedelics at the Federal Level
Psychedelics have long been classified as Schedule I, and most, including LSD, MDMA, and psilocybin, remain federally banned outside approved research. That backdrop is now shifting quickly. On April 18, 2026, President Trump signed an executive order directing the FDA to give expedited consideration to qualifying psychedelics, aiming to compress the typical review timeline from six to twelve months down to one to two. The order also directs $50 million in ARPA-H funding to match state investments in psychedelic research for serious mental illness.16Time. Trump Psychedelics Executive Order – What to Know
The FDA responded within days. On April 24, 2026, it issued national priority vouchers to three companies studying psilocybin for treatment-resistant depression, psilocybin for major depressive disorder, and methylone for PTSD. The agency also authorized the first U.S. clinical study of noribogaine hydrochloride, an ibogaine derivative, for alcohol use disorder.17FDA. FDA Accelerates Action on Treatments for Serious Mental Illness The executive order further directs the FDA and DEA to build a pathway for patient access to investigational psychedelic drugs under the Right to Try Act, which allows terminally ill patients who have exhausted approved options to reach unapproved treatments that have completed at least Phase 1 trials.18The White House. Accelerating Medical Treatments for Serious Mental Illness
The push comes after setbacks in the standard approval process. The FDA rejected an application to approve MDMA for PTSD in August 2024, citing a need for further study, and in early 2026 the agency denied a request for accelerated consideration of Compass Pathways’ synthetic psilocybin treatment for severe depression.16Time. Trump Psychedelics Executive Order – What to Know
Sentencing Reform and the War on Drugs
Modern American drug policy took much of its current shape from the “War on Drugs” launched by President Richard Nixon in 1971. Former White House domestic policy advisor John Ehrlichman later said the strategy was designed in part to target Black communities and the anti-war left by associating them with heroin and marijuana, in order to justify heavy policing and disrupt political organizing.19Leonard Davis Institute, University of Pennsylvania. The War on Drugs as Structural Racism
The framework expanded sharply in the 1980s and 1990s. The Anti-Drug Abuse Act of 1986 created mandatory minimum sentences and set a 100-to-1 sentencing disparity between crack and powder cocaine: five grams of crack triggered the same mandatory sentence as 500 grams of powder. The 1994 Violent Crime Control Act expanded the federal death penalty, funded 100,000 new police officers, introduced federal “three strikes” rules, and stripped Pell Grant eligibility from prisoners.20Brennan Center for Justice. Race, Mass Incarceration, and the Disastrous War on Drugs The federal prison population grew nearly 800 percent after 1980, with close to half of federal prisoners serving time for nonviolent drug offenses.21American Bar Association. Federal Sentencing Reform
The racial consequences have been documented at every stage. ACLU data from 2010 to 2018 shows Black people are 3.6 times more likely than white people to be arrested for marijuana possession despite similar use rates, and the gap widened in 31 states over that period. In 2016, Black people were arrested for cocaine offenses at more than double the rate of white people, and Black defendants convicted of crack offenses historically received sentences roughly twice as long as those given to white defendants for the same conduct.22NACDL. Race and the War on Drugs Disparities extend to treatment: white patients with opioid use disorder are three to four times more likely to receive buprenorphine than Black patients, and Black Americans currently have the fastest-rising overdose rate in the country.19Leonard Davis Institute, University of Pennsylvania. The War on Drugs as Structural Racism
Reform has come in two major pieces so far. The Fair Sentencing Act of 2010 reduced the crack-to-powder ratio from 100-to-1 to 18-to-1. The First Step Act of 2018 made that change retroactive, expanded the “safety valve” that lets judges depart from mandatory minimums for certain nonviolent drug offenses, and created earned-time credits for prisoners who complete rehabilitation programs. Through early 2024, more than 4,000 people received sentence reductions under the retroactive Fair Sentencing Act provision, the safety valve expansion affected about 1,400 people in its first year, and more than 129,000 adults were transferred to reentry centers or home confinement through earned credits between 2019 and 2023. Recidivism for people released under the First Step Act was 9.7 percent, compared with 46.2 percent for the general federal release population in 2018.23Brennan Center for Justice. Analyzing the First Step Acts Impact on Criminal Justice
An 18-to-1 ratio still means crack carries substantially harsher penalties than powder despite no significant chemical or pharmacological difference. The EQUAL Act would eliminate the remaining disparity and apply the change retroactively. The bill passed the House in the previous Congress 361 to 66 and was reintroduced in February 2023 by Senators Cory Booker and Dick Durbin with Representatives Kelly Armstrong and Hakeem Jeffries.24Office of Senator Cory Booker. Bipartisan Legislation to Eliminate Federal Crack and Powder Cocaine Sentencing Disparity The U.S. Sentencing Commission has estimated passage would cut the average sentence of about 7,800 eligible individuals by more than six years.25Princeton School of Public and International Affairs. Analysis of Federal Crack-Powder Cocaine Sentencing Disparity
Harm Reduction Goes Mainstream
Harm reduction — reducing the negative consequences of drug use without requiring abstinence — has moved from the margins toward the center of federal policy. The largest single shift was the FDA’s March 2023 approval of Narcan (4 mg naloxone nasal spray) for over-the-counter sale, making it the first naloxone product available without a prescription.26FDA. FDA Approves First Over-the-Counter Naloxone Nasal Spray Manufacturer Emergent BioSolutions priced a two-pack under $50, and a modeling study predicted the switch to OTC would increase naloxone sales by 15 to 179 percent.27The Lancet Regional Health – Americas. Naloxone Reclassification Analysis
Other changes have followed. The federal government removed the waiver requirement for prescribing buprenorphine, loosened restrictions on methadone take-home doses and mobile distribution, and allowed federal funds to be spent on fentanyl test strips.28Agency for Healthcare Research and Quality. Harm Reduction Strategies to Improve Safety for People Who Use Substances Syringe service programs operate in most states, though some still classify syringes as drug paraphernalia and effectively block sanctioned programs.
Overdose Prevention Centers, also called supervised consumption sites, remain rare. New York City opened two sites in 2021, and Rhode Island became the first state to formally authorize supervised consumption in July 2021, with its center opening in December 2024.29National Harm Reduction Coalition. Overdose Prevention Centers
Drug Courts and Diversion
The most established alternative to incarceration for drug offenses is the drug court. The first opened in Miami-Dade County, Florida, in 1989, and more than 2,600 now operate across all 50 states. Participants generally complete addiction treatment, submit to regular drug testing, and appear before a judge to track progress, with the possibility of expungement for those who complete the program.30Stanford Network on Addiction Policy. Drug Courts as Alternative to Incarceration
A review of 154 evaluations found drug court participation reduces recidivism by 38 to 50 percent on average. Participants were more than four times as likely to receive addiction treatment and two-thirds less likely to be rearrested than those under standard supervision.30Stanford Network on Addiction Policy. Drug Courts as Alternative to Incarceration The National Institute of Justice found drug courts lower processing costs by about $1,400 per person and produce average public savings of $6,744 per participant, rising above $12,000 when reduced victimization costs are included.31National Institute of Justice. Do Drug Courts Work A comprehensive drug court runs roughly $2,500 to $4,000 per offender per year, against $20,000 to $50,000 for incarceration.
Broader prosecutorial diversion, which routes people into treatment or community service instead of prosecution, is still limited. The national average is about 9 percent of eligible cases. A 2010 study estimated that diverting just 10 percent of eligible people into community-based substance abuse treatment instead of prison would save $4.8 billion.32ACLU. Diversion Programs Are Cheaper and More Effective Than Incarceration
What Oregon Showed About Decriminalization
Oregon’s Ballot Measure 110, passed with 58 percent of the vote in November 2020, was the most ambitious drug decriminalization effort in American history. It replaced criminal penalties for possession of small amounts of hard drugs with a $100 fine and directed cannabis tax revenue to addiction services. It did not last four years.
Unintentional opioid overdose deaths in the state rose from 280 in 2019 to 956 in 2022. A state-funded treatment hotline averaged about 10 calls a month at roughly $7,000 per call, and only a few hundred people entered treatment through that system.33Politico. Oregon Drug Criminalization and Portugal34NPR. Oregon Pioneered a Radical Drug Policy, Now Its Reconsidering State auditors found funding was slow to reach services, and the rollout overlapped with a fentanyl-driven overdose spike and the fallout from COVID-19.
In March 2024 the Democratic-controlled legislature voted to recriminalize possession, making it a misdemeanor punishable by up to six months in jail, effective September 1, 2024. The new law lets people avoid jail by opting for treatment and encourages counties to create deflection programs, though it does not require them. Twenty-eight of Oregon’s 36 counties applied for state grants to fund such programs. Oregon has invested more than $1.5 billion in treatment capacity over four years, funding over 350 new beds expected to become operational in 2025, though the Oregon Health Authority estimated the state still needs up to 3,700 additional beds to meet demand.35PBS NewsHour. Oregon Law Rolling Back Drug Decriminalization Takes Effect
Supporters of decriminalization said the measure failed because treatment infrastructure was not in place before criminal penalties came off, not because the underlying approach was wrong. They pointed to Portugal, which decriminalized all drug possession in 2001 and saw improvements in overdose deaths and HIV infections over the following decade. Portugal’s own system has since come under strain: funding for drug programs there dropped from $82.7 million in 2012 to $17.4 million, the number of users in treatment fell from 1,150 in 2015 to 352 in 2021, and overdose rates hit a 12-year high. João Goulão, the architect of the Portuguese model, said, “What we have today no longer serves as an example to anyone.”36Wharton School, University of Pennsylvania. Is Portugals Drug Decriminalization a Failure or Success
What’s Pending
Several bills reflect where the reform debate sits now. The Evidence-Based Drug Policy Act of 2025, introduced by Representatives Dina Titus and Ilhan Omar, would remove statutory restrictions that prevent the Office of National Drug Control Policy from funding research on medical or recreational use of Schedule I substances or supporting rescheduling efforts for drugs without FDA approval.37Office of Representative Dina Titus. Evidence-Based Drug Policy Act of 2025 The broader Drug Policy Reform Act, first introduced in 2021 by Representative Watson Coleman, proposed decriminalizing personal use of all drugs, moving federal oversight from the Department of Justice to HHS, and giving people affected by drug war policies a path to seal records and regain access to federal benefits.38Congressional Progressive Caucus. The Drug Policy Reform Act of 2021
The Office of National Drug Control Policy released the 2026 National Drug Control Strategy on May 4, 2026, a biennial roadmap coordinating 19 federal agencies with a combined drug control budget of $44 billion. The strategy focuses on dismantling drug supply chains and addressing the overdose epidemic, and follows the Trump administration’s April 2025 statement of drug policy priorities and a September 2025 designation of two new High Intensity Drug Trafficking Areas.39The White House. 2026 National Drug Control Strategy Released
Federal policy is in an unusual moment. Overdose deaths are falling after years of relentless increase, marijuana is being rescheduled at the federal level for the first time, psychedelic therapies are getting real government backing, and the sentencing legacy of the war on drugs is under active revision. Oregon’s reversal has cooled interest in the most sweeping reform proposals, fentanyl remains a mass killer, and enforcement disparities have not closed. The RAND Drug Policy Research Center noted in a December 2024 commentary that the future of drug policy remains unclear on how federal priorities will interact with state efforts to liberalize cannabis and psychedelic laws or to maintain substance use disorder treatment access.40RAND Corporation. Drug Policy Research Center