In President Donald Trump’s first budget blueprint, the administration promises “a $500 million increase above 2016 enacted levels to expand opioid misuse prevention efforts and to increase access to treatment and recovery services to help Americans who are misusing opioids get the help they need.” Finally, it seems Trump is living up to his promise to “expand treatment for those who have become so badly addicted.”
Except … maybe not.
The $500 million referred to might not be funding that Trump initiated at all. Instead, it very well could be an allocation of spending that Congress and President Barack Obama already approved in the past year as part of the 21st Century Cures Act. That law put forward $1 billion for drug treatment over two years — $500 million in the current fiscal year (2017) and $500 million in the next fiscal year (2018).
Trump’s budget covers 2018. Yet it oddly uses fiscal year 2016 as a benchmark when it comes to opioid and drug treatment spending, while more logically using 2017 as the benchmark for other programs in the budget blueprint.
Well, one reason why that may be the case is that the Cures Act was in effect in fiscal year 2017, so the Trump administration couldn’t trumpet a $500 million increase over 2017. So it has to wind the clock a bit further back — to 2016 — to get a time when this is an actual increase.
The reality, though, is that if this is money taken from the Cures Act, it was not initiated by Trump. It’s instead something that Obama signed into law — and that Trump is now trying to take credit for by looking like he’s the one increasing opioid and drug treatment spending.
I reached out to multiple Trump administration officials about this today. I got bounced around between communication offices at the White House, the Office of Management and Budget, the US Department of Health and Human Services, and the Substance Abuse and Mental Health Services Administration. But I could never get a clear answer to my simple question: Is this $500 million really new spending, or is it simply an allocation of the Cures Act?
There is definitely a case to be made for more spending. According to 2014 federal data, at least 89 percent of people who met the definition for a drug abuse disorder didn’t get treatment. Patients with drug use disorders also often complain of weeks- or months-long waiting periods for care. (Even Prince, a rich superstar musician, couldn’t access care quickly enough — and died as a result.) More spending could help alleviate these gaps.
But if Trump’s budget doesn’t actually add new spending, it suggests the White House isn’t really willing to allocate more funding for treatment to deal with the worst drug crisis in US history. Instead, he’s just trying to take credit for what his predecessor did to falsely appear like he’s living up to his promises.
The opioid painkiller and heroin epidemic, explained in fewer than 600 words
In 2015, more Americans died of drug overdoses than any other year on record — more than 52,000 deaths in just one year. That's higher than the more than 36,000 who died in car crashes, the more than 36,000 who died from gun violence, and the more than 43,000 who died due to HIV/AIDS during that epidemic's peak in 1995.
This latest drug epidemic, however, is not solely about illegal drugs. It began, in fact, with a legal drug.
Back in the 1990s, doctors were persuaded to treat pain as a serious medical issue. There's a good reason for that: About one in three Americans suffer from chronic pain, according to a 2011 report from the Institute of Medicine.
Pharmaceutical companies took advantage of this concern. Through a big marketing campaign, they got doctors to prescribe products like OxyContin and Percocet in droves — even though the evidence for opioids treating long-term, chronic pain is fairly weak, despite their effectiveness for acute, short-term pain. Painkillers proliferated, landing in the hands of not just patients but also teens rummaging through their parents’ medicine cabinets, other family members and friends of patients, and the black market.
So opioid overdose deaths trended up — sometimes involving opioids alone, other times involving drugs like alcohol and benzodiazepines (typically prescribed to relieve anxiety). By 2015, they totaled more than 33,000 — close to two-thirds of all drug overdose deaths.
Seeing the rise in opioid abuse and deaths, officials have cracked down on prescriptions painkillers. Law enforcement, for instance, threatened doctors with incarceration and the loss of their medical licenses if they prescribed the drugs unscrupulously.
Ideally, doctors should still be able to get painkillers to patients who truly need them — after, for example, evaluating whether the patient has a history of drug abuse. But doctors who weren’t conducting even such basic checks are now being told to give more thought to their prescriptions.
Yet many people who lost access to painkillers were still addicted. So some who could no longer access prescribed painkillers — or perhaps could no longer afford them — turned to cheaper, more potent opioids: heroin and fentanyl, a synthetic opioid that's often manufactured illegally for non-medical uses.
Not all painkiller users went this way, and not all opioid users started with painkillers. But statistics suggest many did: A 2014 study in JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 analysis by the Centers for Disease Control and Prevention found that people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.
So other types of deadly opioid overdoses, excluding painkillers, also rose.
That doesn't mean cracking down on painkillers was a mistake. It appeared to slow the rising number of painkiller deaths, and it may have prevented doctors from prescribing the drugs to new generations of potential addicts.
But the likely solution is to get opioid users into treatment. So federal and state officials have pushed for more treatment funding, including medication-assisted treatment like methadone and Suboxone.
Some states, like Louisiana and Indiana, have taken a “tough on crime” approach that focuses on incarcerating drug traffickers. But the incarceration approach has been around for decades — and it hasn’t stopped massive drug epidemics like the current opioid crisis.