President Donald Trump will soon sign an executive order to tackle what he’s called the “total epidemic” of opioid abuse and addiction. The main objective of the order is to create a commission that’s tasked with publishing a report on what to do about America’s deadliest drug crisis ever.
Donald Trump believes the solution to the opioid crisis is talk
A top drug policy expert fears his plan is “an empty gesture.”
The administration’s decision to prioritize this urgent public health issue is promising. But drug policy experts are already calling the commission a meaningless step in the battle against the opioid problem, particularly since Trump wants to cut funding for opioid treatment. And the desperate need for better treatment is just one of the things we already have a lot of expert advice and scientific evidence on — more than enough to take concrete action right now.
The commission will be led by Chris Christie, and include Attorney General Jeff Sessions, Secretary of Health and Human Services Tom Price, Secretary of Veterans Affairs David Shulkin, and Secretary of Defense James Mattis, yet many of the key anti-drug positions in government — the “drug czar,” the head of the Centers for Disease Control and Prevention — haven’t even been filled, and are absent from this panel.
“It’s bizarre to create a new entity outside of government to dig into things that have already been dug into, to not use the expertise you have, and not have the commission report to the president,” said Keith Humphreys, a drug policy expert at Stanford. At best, this is a redundant exercise that may bring some political attention to opioids. At worst, Humphreys said, it’s an “empty gesture.”
The opioid problem is not “untalked about”
We know the epidemic of opioid abuse is one of the most pressing public health challenges in the United States today. In 2015, there were 52,000 overdose deaths — more than 30,000 linked to opioids, which is the most of any other year on record. As Vox’s German Lopez has explained, drug overdoses now kill more people than car crashes, gun violence, and HIV/AIDS.
“Opioid abuse has become a crippling problem throughout the United States,” Trump said today. “And I think it’s almost untalked [sic] about compared to the severity that we’re witnessing.”
But it’s actually not “untalked about.” There have been many, many reports about how to address the opioid problem. Most recently, the nonpartisan office of the Surgeon General came out with a report that included clear, evidence-based suggestions about what steps need to be taken.
The long and short of it is that America must double down on treatment options for addicts, and make sure insurers cover those benefits. As the Surgeon General’s report stated, “Substance use disorder treatment in the United States remains largely segregated from the rest of health care and serves only a fraction of those in need of treatment.” Only 10 percent of people with an addiction of any kind get treatment, and more than 40 percent also have a mental health condition, yet fewer than half get treatment.
Others, including the American Medical Association Task Force to Reduce Opioid Abuse, have called for the urgent need to address this “treatment gap.”
So we already have reports. We already have opioid task forces. We already have reams of expert advice.
We also have at least three government agencies that deal with drug problems — the White House Office for National Drug Control Policy (colloquially referred to as the nation’s “drug czar”), which coordinates America’s anti-drug spending; the Centers for Disease Control and Prevention; and Substance Abuse and Mental Health Services Administration, which administers the block grant for addiction treatment in the US.
Trump hasn’t filled the key appointments in these agencies, which are all crucial to combatting the addiction problem. That’s not to mention the fact that the Surgeon General is not a political appointee; he’s still in his office and could be tapped for advice. Instead, Trump is coming out with this commission … to create another report.
The only thing about the commission that makes sense to Humphreys is the appointment of Chris Christie, who will lead the effort. With his progressive policies around opioids in New Jersey, and his personal stake in the epidemic after watching a close friend battle addiction, Christie is probably the single best person in the GOP to tackle drug policy.
Still, though, the commission seemed almost designed to not have much of an impact, Humphreys said. In addition to the dearth of experts from government in the mix, there have been reports that the group will report to Trump’s son-in-law and adviser Jared Kushner instead of the president himself. (The commission is part of the White House Office of American Innovation, chaired by Kushner.)
“In Washington, that’s death,” said Humphreys. “When you put somebody down in the bureaucracy in charge, that signals [people] don’t need to put much effort in.”
The Trump administration has meanwhile been subtly sabotaging the fight against opioids with funding cuts
The Trump administration has actually been moving in the opposite direction of what experts say is needed to curb the epidemic of opioid abuse. As Vox’s Lopez wrote, “[Trump’s] recent budget plan wouldn’t increase funding for drug treatment above what Congress already approved. In fact, Trump has proposed $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.”
Painkiller addiction disproportionately affects low-income Americans, many of whom rely on Medicaid to get their health care.
The Obama administration made treatment for mental health and addiction an essential health benefit through the Affordable Care Act. One of the most useful things Trump could do is expand Medicaid in every state and continue to ensure coverage of opioid treatment.
Yet, the Obamacare replacement plan the GOP was trying to push through Congress last week would have cut funding Medicaid expansion, pushing people off their health care — and their addiction treatment. The GOP was also talking about getting rid of the essential health benefit requirement, which would drop addiction treatment from the health services insurers must cover.
If this administration wants to have an impact on the epidemic, it would expand Medicaid in every state, it would increase funding for drug treatment, and it would spend the billion dollars allocated to the opioid problem through the 21st Century Cures Act. How to solve the opioid crisis isn’t a mystery. We know what to do. We don’t need more expert opinion. We need action.
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