The opioid epidemic is supposed to be an issue that President Donald Trump cares about, New York Times reporter Maggie Haberman said, “on an emotional, just-get-it-done level.” And Trump talked a big game about confronting the crisis on the campaign trail, promising more money for addiction treatment and prevention efforts.
But as the end of Trump’s first year in office nears, and despite a lot of supposed talking, planning, and coordination, the White House has done nothing of actual substance on the opioid crisis.
The latest news is that White House counselor Kellyanne Conway seems to be doubling down on the role she assumed in February or March by coordinating different federal agencies through, Lev Facher at STAT reported, a new “opioid cabinet.”
This follows yet another coordination effort in which a commission set up by the White House and led by outgoing New Jersey Gov. Chris Christie looked at the opioid epidemic. That group in November released its final recommendations, detailing several ways to, in particular, expand access to addiction treatment.
The opioid cabinet’s job, apparently, is to coordinate federal agencies to start getting some of these recommendations done.
Despite all of this talking and planning in the past few months, the only thing close to a significant action so far is Trump declaring the opioid crisis a public health emergency in October. While the move will streamline some processes to hopefully get treatment to more people, the declaration got a lukewarm reaction from opioid policy experts. For one, it’s at best only a start, since it unlocks no new significant funding for the opioid epidemic.
“I’m disappointed,” Andrew Kolodny, an opioid policy expert at Brandeis University, told me at the time of Trump’s declaration and speech. “Mentioning a few helpful items … is not a plan for tackling a public health emergency. We need a plan with details, and we need an appropriation request in the billions to build a treatment system. Until effective outpatient treatment is easier to access than pain pills, heroin, and fentanyl, overdose deaths will remain at record-high levels.”
This is really the heart of the issue: Advocates are wondering where the money is. Talk is nice. But at the end of the day, the fundamental problem with the opioid epidemic is more resources are needed to address the crisis — as much as tens of billions of dollars each year, according to experts.
Time is ticking. In 2016, more than 64,000 people died of drug overdoses — more than 170 people a day, and the highest single-year overdose death toll in US history. Since 1999, more than 630,000 have died to overdoses in the US — more people than live in Baltimore. As time goes on, the death toll will keep growing — making it all the more important that the White House finally does something about it.
Show us the money
The opioid epidemic goes back to the 1990s, with the release of OxyContin and mass marketing of prescription painkillers, as well as campaigns like “Pain as the Fifth Vital Sign” that pushed doctors to treat pain as a serious medical problem. This contributed to the spread of opioid painkiller misuse and addiction, which over time also led to greater use of illicitly produced opioids like heroin and fentanyl. Drug overdose deaths have climbed every year since the late ’90s as a result.
The issue has really turned into two simultaneous crises — which Keith Humphreys, a Stanford University drug policy expert, has described as the dual problems of “stock” and “flow.” On one hand, you have the current stock of opioid users who are addicted; the people in this population need treatment or they will simply find other, potentially deadlier opioids to use if they lose access to prescribed painkillers. On the other hand, you have to stop new generations of potential drug users from accessing and misusing opioids.
Addressing these crises will, experts say, require tens of billions of federal dollars. As I previously explained, we have a pretty good idea of what those resources should go to: They could be used to boost access to treatment (particularly the highly effective medication-assisted treatment), pull back lax access to opioid painkillers while keeping them accessible to patients who truly need them, and adopt harm reduction policies that mitigate the damage caused by opioids and other drugs.
Some states are attempting to seriously confront this crisis. Vermont, for example, has built a “hub and spoke” system that treats addiction as a public health issue and integrates treatment into the rest of health care. Potentially as a result, the state was the only one in New England to have a drug overdose death rate below the national average in 2015. (For more, check out my in-depth breakdown of Vermont’s system.)
But Vermont managed to build this new system in large part with federal dollars, particularly through Obamacare’s insurance expansion and a special Medicaid waiver that states can obtain through the health care law. It’s that kind of federal support that budget-strained states will need to deal with the opioid crisis.
Democrats have introduced a bill that would push in this direction, allocating $45 billion over the next 10 years. The extra money would go to funding prescription drug monitoring, improving doctors’ prescribing practices, expanding access to addiction treatment, and supporting other public health initiatives related to drug misuse and addiction, among other moves.
But the Trump administration has done nothing to support this bill or any other like it. In fact, the White House’s legislative priorities — including its budget proposal and its plan to repeal Obamacare — would actually reduce funding to the opioid crisis. And the White House has yet to fill major administration vacancies that could help address the crisis, including the permanent lead roles at the Office of National Drug Control Policy and the Drug Enforcement Administration.
The only good news is Conway is currently in discussions, according to STAT, with Office of Management and Budget Director Mick Mulvaney about finding extra funds.
So more talking for now. At what point do we see the actual money?