After Months of Inaction on the Opioid Crisis, Trump Sets the Stage for a Harmful Response

On October 28, 2017, President Trump declared the opioid crisis a national health emergency. But the declaration, on its own, did nothing. Many health care workers, policy experts and advocates were hoping the announcement would be paired with various requests for funding and a detailed plan of attack — but that was not the case.

Now, however, Trump’s newly released budget proposal for fiscal year 2019 promises aggressive action toward the crisis. But the measures include funding cuts that will damage public health services, while potentially bolstering criminalization. The $237 billion cut to Medicare, and the $300+ billion cut to Medicaid, for example, will weaken two programs that have proved vital to expanding access to treatment.

Previously, the Trump administration had provided a way around what is known as the “IMD exclusion,” which limited states to only paying for care at mental health facilities with fewer than 16 beds. This rather archaic rule desperately needed to be updated, as it restricted people in need of long-term mental health and substance abuse treatment from receiving it. In November, Trump donated his $100,000 quarterly salary to the Department of Health and Human Services, which again, was almost entirely a ceremonial gesture. The president also named Kellyanne Conway — a former pollster with no experience in health care or drug policy, and a penchant for “alternative facts” — as a key figure in the administration’s opioid crisis efforts.

Additionally, Senate Minority Leader Chuck Schumer and Senate Majority Leader Mitch McConnell announced last week that the congressional budget deal includes $3 billion a year in additional mental health and opioid addiction funding for 2018 and 2019. McConnell said the additional funds will “fund new grants, prevention programs and law enforcement efforts in vulnerable communities all across our country.”

This is not reassuring, particularly given that “law enforcement efforts” are the last thing needed to address the opioid crisis. It is a health care crisis, and to combat it, we need billions more than what is being proposed here, and we need the vast majority of the funding to go to dramatically increase access to treatment — not to policing and so-called prevention programs. (Consider the colossal failure of the country’s most famous “prevention” program, the abstinence-based Drug Abuse Resistance Education, or DARE.) Research shows that medication-assisted treatment — that is, therapeutic treatment done in conjunction with medications methadone, buprenorphine and naltrexone — is the most effective, and yet, a significant portion of clinics still do not offer it.

The “war on drugs” and drug use prevention programs have both been wildly unsuccessful at addressing drug misuse, but the Trump administration seems primed to continue along the “law-and-order,” “Just-Say-No” path.

Of course, it’s hard when it comes to the illicit drug trade. It’s nearly impossible to separate the perpetrators from the victims, when it comes to drug issues. Many drug dealers are also living with drug addiction; selling is a way to support their habit. Statements like these further demonize drug users and push them to the fringes of society, making them less likely to seek help when they need it.

It became clear over the course of the 2016 presidential campaign, and in the time he has spent as president, that “law and order” is Trump’s default setting. When something isn’t going well, Trump’s solution is to get tough and mean and punitive. And when one compounds a statement like this with the regressive actions of Attorney General Jeff Sessions’s Department of Justice, which seems primed to amp up the drug war, the vision of the future grows all the more grim.

The only thing worse than inaction is action in the wrong direction.

The war on drugs has been successful in the following ways: It has filled prisons to the brim, lined the pockets of for-profit prison magnates, disproportionately locked up people of color, and helped usher in a wave of mass incarceration that led the US to secure the title of “country with the highest rate of incarceration on the planet.” However, it has not been successful in stopping drug misuse, despite costing over a trillion dollars.

During the national health emergency declaration, Trump said,

Nobody has seen anything like what is going on now. As Americans, we cannot allow this to continue. It is time to liberate our communities from the scourge of drug addiction.

As data from the Centers for Disease Control and Prevention show, the overdose rate continues to climb, and it seems all Trump has in terms of solutions is to “get really, really tough.”

Getting tough will not solve the opioid crisis; it will exacerbate it. It’s high time that those in power began to treat drug users with compassion and empathy rather than scorn. We need far more needle exchanges, and we need to follow San Francisco’s lead and work to implement supervised injection sites. We need to ensure the overdose reversal drug naloxone is available everywhere.

Finally, we need to greatly expand medication-assisted treatment (MAT) — something Medicaid has been very successful at achieving. According to a report from the Kaiser Family Foundation, four in 10 non-elderly adults receiving treatment for addiction are covered by Medicaid. And every Medicaid plan covers at least one MAT medication, with most covering all three.

While Trump has promised this week to take concrete action to respond to the opioid crisis, he seems hell-bent on cutting funding to programs that have proven effective in the past. Those who praise his new opioid policies should not overlook the fact that his budget proposal comes at the expense of those who are already marginalized.