To date, the National Drug Control Policy has failed to address the coupling of the epidemics of HIV and substance use. Indeed, thus far, the Office of National Drug Control Policy (ONDCP) and other federal agencies have barely recognized the linkages. In the 1991 report from ONDCP, (a 161 page report), there are only three paragraphs of text addressing this issue. The failure to acknowledge this – the obvious – is bewildering and tragic. The first step is for the ONDCP, and other federal drug agencies to fully recognize the problem. In order to do this, the federal government must recognize that HIV and substance use is one of the issues of paramount concern within the "war on drugs." Any program which does not deal with the duality of the HIV/drug epidemic is destined to fail.

The current national approach to the problems of substance use is to deal with those who are addicted primarily by means of the criminal justice system. Clearly, this approach is not working and a public health approach is desperately needed. Despite the fact that "we [a]re incarcerating people at a greater rate than any nation in the world, and incarcerate blacks at a higher rate than South Africa," substance use continues, and transmission of HIV related to injection drug use has increased rapidly over the past decade. The criminal justice system is the least viable setting for providing treatment and addressing issues of HIV and substance use. Yet this has become the primary strategy in our "war on drugs." Those forums which should have a proactive role in dealing with substance use, namely the medical and public health communities, have been seriously neglected. We must develop a system which coordinates public health and health care with treatment and outreach, both of which have shown positive results.