President Donald Trump announced an aggressive new initiative Monday to reverse the tide in America’s cascading opioid crisis, focusing on cutting demand and supply, as well as increasing support for Americans suffering from opioid addiction.
Trump appeared before an audience in Manchester, N.H. The state is home to the second-highest overdose death rate in the United States, a fact Trump put front and center in his remarks.
"This scourge of drug addiction in America will stop. It will stop. Every day 116 Americans die from an opioid-related overdose. In New Hampshire the overdose death rate … is double the national average," Trump said. "It's got difficulties like people wouldn't believe. Defeating this epidemic will require the commitment of every state, local, and federal agency. Failure is not an option."
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More than 42,000 Americans died from opioid overdose in 2016, prompting the Trump administration to designate the epidemic a public health crisis. Now, the White House is rolling out a three-pronged plan to help cut the demand for and supply of opioids, while also assisting addicted Americans.
The administration aims to cut down on demand for opioids, in large part by targeting levels of prescription. There were some 66.5 opioid prescriptions per 100 Americans as of 2016, itself a notable decline from the peak of 81.2 prescriptions per 100 Americans in 2010. The administration's stated goal as of Monday is to reduce that number further, cutting nationwide opioid prescription fills by one-third within three years.
It is not obviously the case that prescription opioids are a major contributor to the opioid epidemic. Studies show that those who are prescribed opioid painkillers do not in general become addicted to them, according to Dr. Sally Satel, a practicing psychiatrist and resident scholar at the American Enterprise Institute. Reductions in the ease with which patients can obtain licitly prescribed opioids may lead to severe resurgence of chronic pain, with one doctor documenting at least two dozen individuals who have killed themselves rather than cope with untreated chronic pain.
While those who are directly prescribed opioids may not be at risk for addiction or overdose, diversion of those prescribed drugs for illicit use remains a pressing policy concern. A federal survey on drug use and mental health found that among those self-reporting abusing prescription pain relievers, a majority obtained their drugs from a friend or relative. Around 14,000 people died in 2016 from overdose on natural and semisynthetic opioids, a CDC category that includes prescription opioids like morphine, oxycodone, and hydrocodone.
Additionally, while there may be some extreme cases to the contrary, it is unclear how efficacious opioids are for the population as a whole. A recent study comparing immediate-release opioids to generic Tylenol found that there was no statistically significant reduction in chronic pain.
In addition to reducing the number of prescriptions, the administration intends to fund research into alternative painkillers and an opioid-addiction vaccine. It will also introduce a nationwide, evidence-based campaign to discourage opioid abuse. Such public health campaigns have had mixed success in past. For example, a mid-2000s campaign to reduce youth use of marijuana had no short-run effect and may have encouraged marijuana use in the long run. However, analyses have suggested that the "Truth" anti-cigarette media campaign has been successful at reducing teen smoking.
The Trump administration's plan is not constrained to demand reduction, but is also focused on aggressive cuts to the supply of illicit drugs. That includes support for the Department of Justice's newly formed Prescription Interdiction and Litigation task force, focusing specifically on opioid manufacturers, including pharmaceutical companies. It also includes more proactive screening of international mail shipments, which a recent Senate report highlighted as a major source of illicit Chinese fentanyl entering the United States.
"Whether you are a dealer, or doctor, or trafficker, or a manufacturer, if you break the law and illegally peddle these deadly poisons, we will find you, we will arrest you, and we will hold you accountable," Trump said.
President Trump had previously discussed seeking a new federal death penalty statute for major drug dealers, in the mold of nations like Singapore. Despite deceptively phrased headlines to the contrary, Monday's plan does not seek a new federal statute, instead calling on the Justice Department to simply pursue the death penalty for major drug traffickers under preexisting federal law.
"The Department of Justice will seek the death penalty against drug traffickers when it’s appropriate under current law," a White House domestic policy advisor told the Wall Street Journal Sunday night.
Lastly, the opioid initiative will focus on treating Americans presently struggling with opioid addiction. By expanding federal funding and working to cut red tape that limits Medicaid reimbursement, the plan will expand on the initial moves made by the White House in October, when it first designated the opioid epidemic as a public health crisis.
The White House's addiction assistance plan includes especially support for individuals in the criminal justice system suffering from opioid addiction. As part of the administration's broader focus on prison reform, federal inmates will be screened for opioid addiction intake and provided access to treatment for addiction. Additionally, the administration will increase its support for State, Tribal, and local drug courts, which divert users out of the criminal justice system and into treatment.
Carrie Wade, harm reduction policy director at the R Street Institute, told the Free Beacon that while she was disappointed by Trump's focus on the death penalty, she thought many of the interventions to help addicts were a step in the right direction.
"[Trump] mentioning job security and job training for people coming out prison, I think that's really important. And having a more open attitude towards naloxone distribution in high schools, I think is really important, and kind of sets a tone for how public health and public schools can address this problem," Wade said.
The approach that Trump articulated Monday was, according to Hudson Institute Senior Fellow David Murray, a welcome return to form for federal drug policy after what Murray saw as the less-balanced approach of the Obama administration.
"In many respects, the plan is not novel. It's a restoration. This used to be the boundaries and pillars of standard American drug policy, what they’ve brought back together in this statement and plan," Murray said.
"It was a balanced strategy, that wove together the strengths of prevention, treatment, supply reduction, organizational attacks with the criminal justice system, and international partnerships," Murray added, describing both the pre-Obama approach and the Trump administration's strategy.