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America is in the middle of its deadliest drug crisis. Trump wants to gut the agency that can help.

Trump’s proposal would cut funding to the Office of National Drug Control Policy by about 95 percent.

On the campaign trail, President Donald Trump made all sorts of lavish promises about what he would do to combat the opioid epidemic: He would build a wall to stop heroin from coming into the US, crack down on drug dealers, and increase spending on drug treatment.

So far, Trump has not taken action on any of these promises. But his administration has proposed at least one major policy change related to the opioid epidemic: He wants to gut the office in charge of handling the federal response to big drug crises.

On Friday, Jacqueline Alemany reported the proposal. Based on the memo obtained by CBS News, Trump’s Office of Management and Budget will soon propose slashing nearly 95 percent of funding — from $380 million in 2017 to $24 million in 2018 — for the Office of National Drug Control Policy (ONDCP), which is colloquially known as the drug czar’s office. The proposal needs Congress’s approval to become law.

The drug czar’s office, which has been around in some form since the days of President Richard Nixon, has long been known for pushing the country’s war on drugs. But in the past few years, under President Barack Obama, it became a big advocate of treating drug crises as issues of public health, not solely criminal justice — with former drug czar Michael Botticelli repeatedly arguing that “we can’t arrest and incarcerate addiction out of people.”

More broadly, the office has played a big role in guiding US drug policy. As the coordinator for national drug policy, it helps bring together a sprawling network of federal agencies that may not coordinate otherwise to ensure that they’re all working toward a coherent, focused goal.

When you take all this together, it sure looks like Trump is attempting to significantly weaken the one office that could coordinate a serious federal response to opioids. At the same time, this continues what’s become a pattern with Trump: Despite his talk about the opioid epidemic on the campaign trail, the concrete proposals he has put forward while in office would in fact make the nation’s deadliest drug overdose crisis ever even worse.

What the ONDCP cuts would do

The Trump administration’s memo argues that its cuts will merely streamline ONDCP so it can focus on coordinating federal agencies.

The cuts, however, would eliminate a lot of staffing at ONDCP, cutting the equivalent of about 33 full-time employees, Dan Diamond reported for Politico. With around 70 employees today, this would cut nearly half of staff.

The cuts would also eliminate some federal anti-drug grants, including the High Intensity Drug Trafficking Areas (HIDTA) program. Trump’s budget office argues that the grants are “duplicative of other efforts across the Federal government and supplant State and local responsibilities.” But law enforcement officials argue that these types of programs are needed to coordinate different local, state, and federal efforts in the fight against drugs.

But the cuts would also eliminate efforts like the Drug-Free Communities Support Program. Despite bipartisan support, this has funded education programs, such as DARE, that have a bad record of preventing drug use — with various studies showing that DARE in particular failed to significantly reduce drug use among participants.

That’s to say that there probably is some room to trim or refocus ONDCP’s budget. But overall, the cuts would devastate the office’s efforts to coordinate anti-drug policies.

“These drastic proposed cuts are frankly heartbreaking, and if carried out, would cause us to lose many good people who contribute greatly to ONDCP's mission and core activities,” Richard Baum, ONDCP acting director, told staff in an email.

The White House didn’t immediately respond to requests for comment about the cuts.

Where the cuts will take overall US drug policy remains unclear. One possibility, however, is that as ONDCP dwindles down, anti-drug efforts under Trump will be more likely to go through the US Department of Justice, which is led by anti-drug hardliner Jeff Sessions, and the Drug Enforcement Administration, which historically takes a “tough on crime” approach to drugs. If so, we could expect a more criminal justice–focused drug policy — more traditional war on drugs, less public health focus — than we saw under Obama.

But it could also mean that without a significant ONDCP presence, it will be much harder to coordinate efforts to double down on a criminal justice–oriented war on drugs, as Trump and Sessions have suggested they want to do. That’s one reason why the reform-focused Drug Policy Alliance mostly praised the cuts, while calling HIDTA and the Drug-Free Communities Support Program “a phenomenal waste of money that contribute to the incarceration and stigmatization of drug users.” But, as the Drug Policy Alliance suggested, the problems with the office could be fixed through reform — without elimination.

The drug czar’s office plays a big role in national policy

The idea of the drug czar’s office is simple: There are all sorts of federal agencies that deal with drugs, from the Department of Justice and DEA to the Department of Health and Human Services and Substance Abuse and Mental Health Services Administration. The drug czar’s office coordinates all of these different anti-drug efforts so that they don’t overlap and follow a coherent strategy instead of going down multiple directions at once.

The existence of a drug czar’s office goes back to President Richard Nixon, who established the position through the Special Action Office for Drug Abuse Prevention. But with the Anti-Drug Abuse Act of 1988, the office was elevated and rebranded by Congress as ONDCP.

While the drug czar’s office under Nixon actually took a surprisingly progressive public health approach to drugs, it moved toward focusing more on drugs as a criminal justice issue over the years and especially with the establishment of ONDCP. In the middle of the crack cocaine epidemic of the 1980s and ’90s, President George H.W. Bush named anti-drug hardliner Bill Bennett to head the agency.

In ONDCP’s first national drug control strategy, Bush and Bennett set a clear tone: In the table of contents, the first item for “National Priorities” is “The Criminal Justice System,” not treatment or prevention.

“It was a culture war document,” David Courtwright, a drug policy historian at the University of North Florida, told me. “It’s very much a statement about personal responsibility, zero tolerance, directed law enforcement to crack. It was very much a drug war document.” He added, “In terms of actual impact on policy [and] media coverage, it’s a very big deal in the late ’80s.”

The document exemplifies what the drug czar typically does: He sets the tone for the national conversation on drugs. Whether that leads to actual policy changes depends on whether the president and Congress actually accept the drug czar’s advice — since the office itself does not have much direct power in terms of changing policy.

ONDCP “is in an advisory capacity,” Courtwright said. “If you go back and look at the national drug control strategy documents, they make suggestions. They prioritize programs. … But do they actually set policy? I guess they do if the president and Congress say it’s a good plan and do it.”

Still, the history suggests that Congress and the president do tend to follow what the drug czar says on drug policy issues.

In this way, the office has recently guided the nation toward a more public health–oriented approach to drugs. Under Botticelli, Obama’s drug czar, the office proposed the first drug control budget in decades that would have spent more on treatment and prevention programs than law enforcement and interdiction.

The Obama administration and Congress took Botticelli seriously, passing in 2016 the Cures Act, which, among other measures, allocated $1 billion for drug treatment over two years to confront the opioid epidemic. And although Congress didn’t approve the last budget proposal put forward by ONDCP, under Obama federal anti-drug spending did generally shift toward more treatment and prevention instead of largely focusing on interdiction and law enforcement.

This was all very deliberate, done under the recommendations of ONDCP.

With a severely weakened office, though, it’s going to be much harder to coordinate all of the different federal agencies dealing with drugs to move toward any direction in a coherent manner.

It also might make it harder to ensure that agencies are seeking out the best, most evidence-based programs and aren’t duplicating different efforts. In doing this, ONDCP can actually save money, Stanford University drug policy expert Keith Humphreys told me, by ensuring that different agencies don’t overlap in what they’re doing.

So while the cuts seem to be geared toward saving money by supposedly streamlining the office, they could lead to more wasteful spending overall. That’s on top of the risk that the federal response to the opioid epidemic may end up less coherent overall.

Trump’s only concrete proposals for the opioid epidemic range from ineffective to bad

It’s hard to overstate the depth of tragedy of the opioid epidemic. In 2015, it led to more than 52,000 drug overdose deaths — more than deaths from guns, car crashes, or even HIV/AIDS during that epidemic's peak in 1995. This death toll has pushed lawmakers on all sides of the aisle to work to fight the crisis. Trump dedicated a whole speech to combating the epidemic in October, weeks before he was elected.

But now that we are several months into the Trump administration, it’s easier to get a better grasp of what he’ll actually do. And so far, everything he has done, according to experts, will either have little effect or may actually make the crisis worse.

Here’s a quick rundown:

  • Trump wants to build a wall at the US-Mexico border, in part to stop the flow of heroin into America. There’s wide consensus among border security experts, however, that a wall and even tougher border security would have little to no effect on drug trafficking. The simple reason: Most drugs come through the legal ports of entry, meaning a wall and similar efforts will do nothing to hinder drugs where they’re actually coming through.
  • Trump supports the American Health Care Act, which would cost millions of people their health insurance and severely weaken protections for drug treatment coverage. According to a previous analysis, this could leave as many as 2.8 million Americans with drug use disorders — including 222,000 with opioid use disorders — without adequate access to care.
  • Trump will propose slashing ONDCP, which could hurt efforts to coordinate a federal response to the opioid epidemic.
  • Trump has proposed other cuts to the budget that will hurt access to drug treatment: He called for $100 million in cuts to the Substance Abuse and Mental Health Services Administration’s mental health block grants, which could ultimately impact some addiction services.
  • Trump set up a commission to study the opioid crisis and recommend a coordinated response. The commission, however, will take months to produce its recommendations, and the administration isn’t required to follow through on any of them.

In short, Trump’s big ideas for the opioid crisis are either all talk (the commission) or ineffective (the wall). Meanwhile, his other policy ideas would gut major protections for patients with drug use disorders, possibly cut funding for addiction services, and seriously hinder the one office that coordinates anti-drug efforts across the nation.

Keeping in mind that some of the key counties that swung from Obama to Trump were some of those hit hardest by the opioid epidemic, the lack of action is not just a blow to public health advocates but will likely come as a major disappointment to some of Trump’s most important voters. It’s yet another example of a president who’s failed to deliver on his promises.

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