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For Trump, Opioids Are Still Not a Crisis

Ideas
Lu served as the Deputy Secretary of Labor and White House Cabinet Secretary during the Obama Administration and is a Senior Fellow at the University of Virginia Miller Center; Hunn, who worked in the White House Office of Cabinet Affairs, is a law student at U.C. Berkeley.

During his recent “working vacation,” amidst a whirlwind of controversial and divisive statements, President Donald Trump made one statement that should have been a unifying one. Speaking at his New Jersey golf course on August 10, he said: “The opioid crisis is an emergency. And I'm saying officially right now it is an emergency. It's a national emergency.”

Unfortunately, the President has failed to act with the speed and force required by a national emergency that claims 142 lives each day. The chaotic start to the Trump Administration has left unfulfilled many of his campaign promises, including his pledge that the government will “not only stop the drugs from pouring in, but we will help all of those people so seriously addicted get the assistance they need to unchain themselves.” Also left unused for now are the broad powers of the federal government to address this epidemic.

It’s not as if the President is lacking for solutions to this problem. In July, Trump received the interim findings of a presidential commission he created to examine federal resources to fight opioids and the availability of treatment services. Yet, so far, the Administration has failed to prepare the proper paperwork for a formal emergency declaration, nor has it explained what resources or authority would come with a declaration.

In the meantime, Trump has resorted to offering naive advice to kids about drug addiction: “No good, really bad for you in every way. But if they don’t start, it will never be a problem.” This embarrassing statement flies in the face of medical research about how addiction begins (most opioids are initially prescribed) — and the painful reality in areas facing widespread drug abuse.

The Trump Administration also has pushed policies that would exacerbate the opioid problem.

The President has contradicted the recommendations of his own opioid commission by supporting proposals that would make it more difficult to obtain drug treatment. The Trump-backed bill to repeal Obamacare would have slashed almost $800 billion from Medicaid, which Ohio Senator Sherrod Brown called “the number one tool we have in the fight against opioids.” Last year, Ohio spent $939 million to fight substance abuse addiction, of which 70% was covered by Medicaid. In Pennsylvania, Medicaid helped provide drug or alcohol addiction services to 124,000 people.

To make matters worse, the Trump Administration initially considered eliminating the Office of National Drug Control Policy, which coordinates federal drug activities, including Trump’s own opioid commission. Following a bipartisan outcry from Congress, the Administration backed off this idea, proposing instead to slash $374 million from the Substance Abuse and Mental Health Services Administration, which funds critical prevention and treatment programs.

Beyond seeking to gut funding for critical programs, the Department of Justice released sentencing guidelines in May that encourage federal prosecutors to “charge and pursue the most serious, readily provable offense.” This will put low-level drug offenders at the mercy of the criminal justice system, instead of the health care system.

Altogether, the Trump opioid solution favors punishment over prevention and treatment.

If Donald Trump is serious about addressing this issue, he needs to marshal the full array of federal resources for the fight. This requires not only the dedication of sufficient funding, but also a comprehensive approach that uses all tools at the government’s disposal.

One of the challenges in fighting the opioid epidemic is its far-flung nature. While the crisis has most affected a dozen Midwestern and Southern states, no region in the U.S. has been spared. Clusters of high prescription counties stretch from California to Maine, and half of all states are dealing with annual increases in opioid deaths that exceed 10%. Nationwide, there are enough opioid prescriptions written to provide each adult American with a bottle of the drugs.

To deliver cost-effective assistance and reach all Americans struggling with addiction, the federal government must adopt a whole-of-government approach, leveraging its broad network of field offices and personnel across the country, and including agencies not typically involved in fighting drug addiction.

For instance, the Department of Labor has nearly 2,500 jobs centers around the country that provide employment assistance. The Department of Agriculture has more than 2,100 local service centers that connect rural communities to government resources like housing and business loans. These federal centers are located in many of the small towns hardest hit by the opioid crisis and can serve as important points of entry for government assistance. For instance, there are 114 jobs centers in Kentucky, 93 jobs centers in Michigan and 33 agricultural service centers in West Virginia.

A cross-agency, silo-busting approach to fighting opioids could use these local offices for a range of services, such as distributing information about treatment options, collecting data about the severity of the epidemic, coordinating private donations and even providing space for counselors or community health workers to meet with patients. For federal agencies opening their offices to these drug-related services, a healthier population also complements their core mission, whether it’s equipping people for employment or developing rural economies — missions that can't be accomplished in the face of widespread drug addiction.

Blue-ribbon commissions, like Trump’s opioid commission, can galvanize action. But recommendations alone won’t improve the lives of those grappling with addiction without adequate funding and a mechanism to deliver services to those in dire need.


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