In the US, people consume more opioids than anywhere else in the world. Opioid overdoses—largely due to abuse of prescription pain pills like OxyContin and Percocet—kill 142 people nationally every day, according to the latest data from the Centers for Disease Control and Prevention.
This pain-pill epidemic has reached such epic proportions in the US that opioid addiction is about to be declared a national emergency by the president. Later today (Oct. 26) Donald Trump is expected to make the unusual declaration official, White House sources report. The president will speak about his plan to tackle the crisis and provide recommendations to agencies, based on a report issued by a task force he convened for this reason with an executive action in March.
An unnamed “top administration official” told Axios that the president’s plan “will include Melania Trump,” who last month held a White House roundtable on opioid abuse. The president is also expected to propose health care policy changes, and a massive advertising and public relations campaign.
The opioid commission’s first interim report, published in July, noted that in 2015, the amount of opioids prescribed in the US was enough for every American to be medicated around the clock for three weeks. According to the report:
The average American would likely be shocked to know that drug overdoses now kill more people than gun homicides and car crashes combined. In fact, between 1999 and 2015, more than 560,000 people in this country died due to drug overdoses—this is a death toll larger than the entire population of Atlanta.
The report recommended declaring a national emergency and engaging in widespread efforts to change health policy and raise national consciousness.
Trump’s move to classify opioid addiction a national emergency is unusual; it’s a first for a drug crisis. That dubious distinction is usually reserved for natural disasters, like hurricanes, say, or terrorist attacks, and it’s not yet clear how exactly it will work. Theoretically, it would allow the administration to take funds earmarked for emergencies and use them to address the opioid epidemic.
But Trump’s rhetoric thus far suggests he is either confused about the drug crisis or insincere. For one, the president fails to distinguish between harsh, addictive drugs, like heroin and prescription pain killers, and milder substances, like marijuana, which research suggests could help curb opioid abuse. And he’s intent on repealing national healthcare in the midst of a national health crisis, which seriously undermines claims that he cares about all the addicted Americans who desperately need drug treatment. Today’s grand gesture doesn’t square with his other actions.
Trump hasn’t supported marijuana, which could be a powerful opioid alternative
Trump kept mum on state marijuana laws until May, when he indicated somewhat obliquely through a rider in an omnibus spending bill that the federal government would not go after states legalizing pot. In a statement on the bill, he noted, “Division B, section 537 provides that the Department of Justice may not use any funds to prevent implementation of medical marijuana laws by various States and territories. I will treat this provision consistently with my constitutional responsibility to take care that the laws be faithfully executed.”
That falls far short of the resounding cry for federal research into medical marijuana’s efficacy as an opioid alternative, issued by other politicians, including conservatives at the state and federal levels. Medical marijuana may be an effective non-narcotic alternative to prescription painkillers, but there’s been limited reliable research in the US because of federal prohibitions on the drug. Conservative US senator Orrin Hatch in September introduced a bill to expedite weed research for this reason. But there’s no indication that Trump intends to take that same tack.
Attorney general Jeff Sessions could get in the way
Trump’s choice of US attorney general doesn’t inspire confidence in the president’s ability to make research-supported policy decisions around drug use and abuse.
For one thing, Sessions opposes marijuana legalization vehemently. In June, the Washington Post reported on a letter Sessions wrote to Congress opposing the aforementioned restrictions on federal funding for Department of Justice actions to prevent states from implementing marijuana laws “particularly in the midst of a historic drug epidemic.” In other words, Sessions cited the opioid crisis as a good reason to prevent states from legalizing medical marijuana, even as his conservative colleagues were sponsoring legislation calling for more medical marijuana research in order to curb that same crisis.
The National Institute on Drug Abuse cites preliminary research showing opioid prescriptions, addiction, abuse, and overdoses are lower in states where medical marijuana is legal; Sessions’ statements seem to deliberately obfuscate and conflate issues which, as a top national lawyer, he must surely be able to distinguish.
Trump is tight with Big Pharma
In September, Trump nominated Republican representative Tom Marino from Pennsylvania to lead the charge on the opioid epidemic. In October, Marino withdrew from consideration for the “drug czar” role after reports that he was instrumental in limiting the Drug Enforcement Administration’s ability to crack down on pharmaceutical companies fueling that same epidemic. On Oct. 16, after Marino withdrew, Trump said about drug companies in a press conference, “They contribute massive amounts of money to political people.”
The president failed to note that he, too, took funds from Big Pharma, leading Stat+ News (paywall) to remark about the occasion, “When it comes to pharma donations, Trump was with the elephant in the room.” While Trump only took about $6,500 from Pfizer in 2016 for his presidential run, his inaugural committee accepted $1 million from the pharmaceutical company (which makes the extended-release opioid Embeda) in 2017 for the presidential inauguration.
Pharma money aside, on a philosophical level, the fact of having initially chosen Marino, who has suggested that drug addicts be treated in “prison-slash-hospitals” indicates Trump either doesn’t understand the national drug problem or doesn’t plan to solve it. Imprisoning addicts isn’t an option when they are everywhere in society; hospitalizing them all is also not possible, especially since Trump is intent on repealing the Affordable Care Act (ACA), a move which would leave many Americans without any health insurance whatsoever and others without the level of coverage they’d need to treat opioid addiction.
Trump wants to limit Americans’ ability to pay for addiction treatment
Trump’s distaste for national health care and his support for the Republican mission to revoke “Obamacare” will almost certainly stand in the way of solving a crisis based in addiction. His efforts to repeal the ACA could, in fact, leave addicts without options and could exacerbate the national problem.
The Substance Abuse and Mental Health Services Administration in 2015 reported (pdf) that only one in 10 Americans with substance disorders receives treatment, and nearly a third of all those who needed treatment but did not seek it out cited the high cost or lack of insurance coverage as a reason. Based on these data, it seems likely that making insurance less accessible will further discourage addicts from seeking treatment and exacerbate the crisis rather than solve it.
In an August Plos Medicine editorial, Leana Wen, a physician and health commissioner of Baltimore, Maryland, argues that the Republican plans to repeal and replace the ACA would “weaken or even eliminate the requirement that marketplace plans cover ‘essential health benefits,’” including treatment for opioid use disorders. That would leave even those who are insured without treatment options. “The plans would also allow states to waive the requirement to cover pre-existing conditions, immediately pricing people with [opioid use disorders] out of the individual market,” she writes.
In 2012, the National Institutes of Health reported that every $1 invested in addiction treatment saves society $12 in costs later. Wen predicts that Trump’s proposed health policies, like reversing recent expansions on Medicaid and minimizing insurance options, will prove expensive, concluding:
No matter what, the American people will bear the cost of this epidemic—either by paying for treatment now or by paying for the medical, economic, and social consequences of denying it later. The choice should be clear.
What should actually be done about the crisis?
Declaring a national emergency is relatively easy. But solving opioid addiction is not. The problem is profound, widespread, and has been in the making for decades. To resolve it will require new regulation and oversight of the pharmaceutical companies who pushed the pills, and doctors who prescribe them; more access to treatment for more people, which means more insurance, not less; a compassionate approach toward the nation’s many addicts; and patience, persistence, and cooperation across many domains. Plus lots of money.
Some argue that the funds should not come from coffers reserved for national emergencies. Rafael Lemaitre, at the White House Drug Policy Office and the Federal Emergency Management Agency during the Obama administration—so someone with a professional interest in drugs and disaster—recently tweeted his suggested response to the crisis, writing, “Answer to opioids is dedicated, long term funding from Congress it deserves—not raiding the rainy day fund for disasters.“