40 years after the Anti-Drug Abuse Act, punishment is law and treatment is lacking

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40 years after the Anti-Drug Abuse Act, punishment is law and treatment is lacking
When the Boston Celtics drafted Len Bias second overall on June 17, 1986, he told reporters, “My dream has come true.” Two days later, he died after his cocaine use triggered a fatal cardiac event. He was 22.
In response to the national alarm following Bias’s death, on Oct. 27, 1986, President Ronald Reagan signed the Anti-Drug Abuse Act and promised it was “not intended as a means of filling our jails with drug users.” The country’s job, he said, was to reach people who use drugs and help them quit.
In that instance, Congress acted with a purpose Americans across the political spectrum shared: reduce drug use and save lives. Despite that good intention, the reality 40 years later is that Congress made the drug penalties permanent law, while drug treatment was left to be determined during annual budget fights. That imbalance is the law’s most lasting legacy.
In 1986, Congress wrote the penalties quickly. Eric Sterling, the House Judiciary Committee counsel who worked on the bill, later recalled that the mandatory minimums were added in the final days before the August recess, as members headed home to campaign. The drug quantities that triggered them received no hearings.
Five grams of crack cocaine, about the weight of a nickel, drew the same five-year minimum as 500 grams of powder, which weighs more than a pound. Crack cocaine produces a faster, more intense high when smoked than powder does when snorted, but it is not 100 times more powerful. The U.S. Sentencing Commission later found nothing in the legislative record explaining that 100 to 1 ratio. More than two decades after his death, a House committee acknowledged that Bias died from powder cocaine, not crack.
The costs fell unevenly and lasted for decades. In 1993, 88 percent of people convicted of federal crack trafficking offenses were Black. By 2011, the federal prison population had tripled in 20 years, and the Sentencing Commission named mandatory minimums as one cause. Congress has spent decades narrowing the crack-powder gap, and an 18 to 1 ratio is still federal law.
The law’s title also promised to “expand Federal support for drug abuse treatment and rehabilitation efforts,” but that promise needed money every year. In January 1987, 10 weeks after the signing, the administration’s budget requested no new money for drug treatment services, according to members of the House narcotics committee. Rep. Benjamin Gilman (R-N.Y.), the committee’s senior Republican, called the cuts “appalling.”
Treatment has been the weaker half ever since. Much of the federal money behind treatment and overdose response is still renewed one year at a time. In 2025, 84 percent of the 47.2 million people who needed substance use treatment did not receive it, according to the federal government’s own survey.
The distance between permanent punishment and temporary care is widest and most deadly following incarceration. A study of people released from North Carolina prisons found that in their first two weeks home, they died of opioid overdoses at 40 times the rate of the state’s general population.
Congress knows how to make treatment permanent. In 2024, it made permanent Medicaid’s coverage of medications for opioid use disorder. Federal law still generally bars Medicaid from paying for care during incarceration, so states have relied on waivers to start treatment before release. In September, however, federal officials cut the maximum pre-release window for future adult waivers from 90 days to 60. No vote was required.
The bipartisan Reentry Act would address this by letting every state cover the last 30 days before release without a waiver; a floor no agency could shrink. Congress should address the deadliest gap in treatment by including the Reentry Act in the year-end spending package before current funding expires Dec. 11. Congress should also keep the federal grants that pay for addiction treatment intact rather than fold them into a single block grant, as the president’s budget proposes.
In 1986, Congress acted on a young man’s untimely death with a speed it could not match when the consequences of its choices became clear. Forty years later, the penalties remain certain, while access to treatment remains questionable. It’s time for lawmakers to change that.
Libby Jones is associate vice president of the Overdose Prevention Initiative at the Global Health Advocacy Incubator. Regina LaBelle is a professor and director of Georgetown University’s Master of Addiction Policy and Practice program. She served in the White House Office of National Drug Control Policy in both the Biden and Obama administrations.
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