March 13, 2018; WFYI Indianapolis
For nearly six months since declaring the opioid crisis a public health emergency, President Trump and his administration have done little but fan the flames of public outrage over the ever mounting death toll. Notably, after declaring a public health emergency, Trump did not even request any federal funding to address the issue. Making matters worse, an Obama-era law that designated a billion dollars in state opioid crisis assistance runs out this year, and there has been no sign that Trump will ask Congress to renew this funding. As time goes on and more Americans fall victim to the opioid epidemic, advocates are left wondering what the Trump administration is doing to address this health crisis.
While pouring resources into solving the crisis would make sense, the president’s 2018 budget proposed to cut funding from key agencies, such as the Substance Abuse and Mental Health Services Administration (SAMHSA), which works to address opioid addiction, specifically in programs related to substance abuse prevention and mental health treatment. Keith Humphreys, a Stanford University professor of psychiatry and Obama-era policy advisor to the Office of National Drug Control Policy (ONDCP), says, “The administration’s impulse seems to be not to spend more—in fact, to spend less.”
Humphreys goes on to say, “It’s very hard to make sense of. I mean, it’s like closing a fire station in the middle of a wildfire.”
The Trump administration has made some tiny attempts to salvage the situation. The Centers for Medicare and Medicaid Services (CMS) announced a policy change shortly after the emergency was declared to broaden Medicaid eligibility for coverage of residential drug treatment through a state Medicaid waiver. With this waiver, states can request CMS to pay for residential drug treatment at facilities with over 16 beds. In states without a waiver, residential treatment is only Medicaid-eligible at facilities with less than 16 beds. As Medicaid waivers must be budget-neutral, this is a way to increase the number of beds available to low-income residents in need of substance abuse treatment without increasing expenditure on the part of the federal government. President Trump also signed the Interdict Act, which gave border agents more tools for detecting synthetic opioids like fentanyl, which make up a growing proportion of opioid use.
While treatment for those addicted to opioids is sorely needed, President Trump seems more focused on penalties for who he calls the “pushers and drug dealers,” even suggesting the death penalty for drug dealers during the recently held White House Opioid Summit. The Trump administration is pushing a public awareness and education campaign to prevent people from using opioids in the first place. Some sources say this campaign will not be led by the experts at the ONDCP, but rather Trump’s advisor, Kellyanne Conway.
President Trump also suggested an interest in the federal government pursuing lawsuits against pharmaceutical companies that manufacture opioids, saying, “A lot of states are doing it, but I keep saying, if the states are doing it, why isn’t the federal government doing it? So that will happen.” As NPQ has covered, states, localities, and American Indian nations have already filed over 200 lawsuits against pharmaceutical companies for damages caused by the opioid epidemic. Causes of action include creating a public nuisance, deceptive marketing, lax monitoring of highly suspicious opioid orders by pharmacies, and unjust enrichment through unfair business practices. Federal participation in these efforts would likely be welcomed by participating plaintiffs.
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Other steps by the Trump administration, though, are headed in the wrong direction, particularly those that focus on criminalization and fear. Years of data show that tougher penalties for drug dealers and “Just Say No” campaigns do not work. In fact, the D.A.R.E. campaign famously resulted in an increase of drug use. NPQ has covered the downfall of this program as well as Attorney General Jeff Sessions’ attempts to resurrect this failed program.
Mark Kleiman, professor of public policy at NYU Marron Institute of Urban Management, argues a penalty-based system is not the solution.
We have done the experiment with extreme mass incarceration to shrink the drug market and it failed. Between 1980 and today, the number of drug dealers behind bars has gone up by a factor of 30 and the prices of heroin and cocaine have fallen more than 90 percent. So, the problem with putting drug dealers in prison is there is another drug dealer in there to take his place.
The only penalty that might work is litigation against manufacturers of opioids. NPQ has covered in detail the growing number of lawsuits against Purdue Pharma—and potentially the Sackler family itself—among other opioid manufacturers. While civil suits absolutely paved the way for litigation, they were ultimately not very successful. However, as NPQ’s Steve Dubb indicated, if a “class” can be defined to bring a class action lawsuit against opioid manufacturers, like the litigation against tobacco companies in the 1990s, then government suits have a good chance of enforcing penalties and gaining funds that could be used to pay for treatment.
Although President Trump’s statements appear to miss the mark when it comes to solving the crisis, the plans laid out by HHS Secretary Alex Azar and HUD Secretary Ben Carson at the White House Opioid Summit focused heavily on increasing access to treatment and providing community support, as well as research into non-addictive painkillers. This seems to be supported by funding, which is great news for advocates and those working on the frontlines of opioid treatment. As NPQ has previously reported, resources are critically needed not only for treatment but also for exhausted frontline staff and volunteers to continue their important work with opioid victims.
In an NPR interview, Surgeon General Jerome Adams gives communities a glimmer of hope, indicating that funding will not only be restored but increased to federal agencies such as SAMHSA in fiscal year 2019: “The Trump administration is supporting increasing funding for drug courts. The Trump administration has also tripled the amount of funding going to SAMHSA for treatment from just under $500 million to $1.5 billion. The president has requested and Congress is moving through the largest allocation for opioid treatment and response in the history of the United States—$6 billion.”
Surgeon General Adams goes on to say, “Communities need to be talking about how best to spend that money and making sure on a state and local level they are asking for and getting that money from SAMHSA and through Medicaid waivers and through all the different mechanisms that we have to funnel that money down to communities.”—Sheela Nimishakavi