to support their habit. united states in the united states, drug policy is primarily controlled by the federal government. the department of justice's drug enforcement administration (dea) enforces controlled substances laws and regulations. the department of health and human services' food and drug administration (fda) serve to protect and promote public health by controlling the manufacturing, marketing, and distribution of products, like medications. the united states' approach to substance abuse has shifted over the last decade, and is continuing to change. the federal government was minimally involved in the 19th century. the federal government transitioned from using taxation of drugs in the early 20th century to criminalizing drug abuse with legislations and agencies like the federal bureau of narcotics (fbn) mid-20th century in response to the nation's growing substance abuse issue. these strict punishments for drug offenses shined light on the fact that drug abuse was a multi-faceted problem. the president's advisory commission on narcotics and drug abuse of 1963 addressed the need for a medical solution to drug abuse. however, drug abuse continued to be enforced by the federal government through agencies such as the dea and further legislations such as the controlled substances act (csa), the comprehensive crime control act of 1984, and anti-drug abuse acts. in the past decade, there have been growing efforts through state and local legislations to shift from criminalizing drug abuse to treating it as a health condition requiring medical intervention. 28 states currently allow for the establishment of needle exchanges. florida, iowa, missouri and arizona all introduced bills to allow for the establishment of needle exchanges in 2019. these bills have grown in popularity across party lines since needle exchanges were first introduced in amsterdam in 1983. in addition, ab-186 controlled substances: overdose prevention program was introduced to operate safe injection sites in the city and county of san francisco. the bill was vetoed on september 30, 2018, by california governor jerry brown. the legality of these sites are still in discussion, so there are no such sites in the united states yet. however, there is growing international evidence for successful safe injection facilities.