Words but Little Action on Opioids

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President Donald Trump's brother died an alcoholic, so it's hard to dispute that Trump understands the horrors of addiction.



But in what was billed as a major speech on Thursday, Trump demonstrated that he has not grasped what's needed to combat the opioid problem and, more important, the ways in which his own policies impede recovery for millions of Americans.



He declared the opioid epidemic a national public health emergency, which sounds urgent but doesn't free any significant new money to fight it. In doing so, he ignored the plea of his own opioids commission to declare a full-on national emergency, which would immediately free billions of dollars for emergency response, addiction treatment and efforts to stop the flow of illegal opioids into the country — a comprehensive approach that is so far missing.



Combine this with his repeated attempts to gut health care for poor and middle-class Americans, and the president has offered few tangible solutions for a scourge that now kills about 50,000 Americans a year.



Trump said he would address the flow of deadly, illegal synthetic opioids into this country during his coming trip to China, and repeated old promises to stop drug trafficking from Mexico by building the wall. He announced tough-sounding but vague plans to ban one prescription opioid he did not name but called "evil," to train federally employed prescribers in safe prescribing practices and to develop nonaddictive painkillers.



He said the administration would produce "really big, really great advertising" aimed at young people because, "If we can teach young people not to take drugs, it's really, really easy not to take them." This is sloganeering reminiscent of the ineffective, Reagan-era "Just Say No" programs, when the ravages of drug abuse in black and Hispanic communities were treated with harsh punishment, rather than the empathy and care that is being called for today.



Deaths from opioid overdoses have more than tripled since 2002. As of 2015, an estimated 2 million Americans were addicted to prescription opioids, and nearly 600,000 to heroin. Opioid addiction rose most swiftly among white, middle-class Americans, though it now spares no state, race or income group. Efforts to treat the disease have nearly bankrupted people whose insurance falls short. Financial constraints often prevent uninsured people from seeking treatment at all. The Affordable Care Act improved access to addiction treatment by expanding Medicaid, which covers 3 in 10 non-elderly adults with an opioid addiction. Yet the Trump administration and Republicans in Congress have repeatedly tried to repeal the law or slash its benefits.



At least Trump said on Thursday that the administration planned to roll back a rule preventing Medicaid funding from being used for treatment in large inpatient addiction facilities, a recommendation made by the opioids commission in late July.



But it is still not clear who will lead the response to the epidemic, since Trump has yet to appoint a number of officials who could do so. He was forced to withdraw his nominee to head the Office of National Drug Control Policy, Rep. Tom Marino, R-Penn., after news emerged that Marino had helped drug wholesalers make it harder for the Drug Enforcement Administration to crack down on black-market opioid distribution. Tom Price, Trump's former health and human services secretary, lost his job because of his use of private jets.



The opioids commission's final recommendations are scheduled to be released Wednesday, but the administration has yet to act on most of the commission's interim recommendations. "I still have not seen the passion for this epidemic that I saw in the AIDS epidemic," Gov. Chris Christie, the commission's chairman, said recently.



There are some in the administration who do seem to get it: In a hearing this week, Scott Gottlieb, commissioner of the Food and Drug Administration, advocated expanding the use of medication-assisted treatments, such as methadone, buprenorphine and naltrexone, citing evidence that they are effective in reducing overdose deaths.



One would have hoped that Trump would be eager to deliver real relief for an epidemic that affects millions of American families. As deaths from addiction escalate, he's still just in the talking stages.



~ The New York Times


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