Trump Has Been All Talk, No Action On The Opioid Crisis

Tom Petty was an old friend. The first time we met in person, it involved me watching with amusement while he Dwight Twilley and a journalist friend chasing each other around a hotel room for the last bit on coke in an envelope. I think that was right before or right after the release of American Girl. More recently, many decades later, Tom became the latest of several superstars-- Prince, Heath Ledger, Philip Seymour Hoffman-- to die from opioid use. Most people caught up in the epidemic aren't superstars and aren't multimillionaires and will only be mourned by their families and close friends. Chronic pain hits all strata of society-- and is making pharmaceutical companies profitable beyond reason. According to the CDC, the highest death rates from opioid overdoses are in Trump country-- West Virginia, Ohio, Pennsylvania and Kentucky-- but there are no states that are immune from the scourge.

Trump's rhetoric about fighting a war against the opioid epidemic went over well in West Virginia counties like McDowell and Kanawha-- which had the highest overdose mortality rate in the U.S. Kanawha gave Trump 58% of its vote and McDowell gave him a startling 74.7%. In October Trump declared the opioid epidemic a national public health emergency. That looked like a big deal... but it wasn't, since there was no funding behind it, just more empty rhetoric, what former congressman Patrick Kennedy (D-RI), a member of Trump's commission called "a charade" and "a sham... tantamount to reshuffling chairs on the Titanic...You can't expect to stem the tide of a public health crisis that is claiming over 64,000 lives per year without putting your money where your mouth is." Trump, he said is "playing politics instead of pursuing solutions for issues that impact the lives of Americans. For people and families struggling with addiction in this epidemic, it's essentially been a government shutdown from the start."

Yesterday, German Lopez, writing for Vox, reported that the consensus from experts and advocates agree: "a lot of talk, little action." It's basically been a year of empty p.r. Trump promised everything-- and delivered nothing.

There has been no move by Trump’s administration to actually spend more money on the opioid crisis. Key positions in the administration remain unfilled, even without nominees in the case of the White House’s drug czar office and the Drug Enforcement Administration (DEA). And although Trump’s emergency declaration was renewed last week, it has led to essentially no action since it was first signed-- no significant new resources, no major new initiatives.

Chuck Ingoglia, a senior vice president at the National Council for Behavioral Health, which advocates on addiction issues, summarized the general takeaway of experts and advocates: “A lot of talk, little action. It’s great that the president says this is a priority. It’s great that he convened a task force so we have another paper that says the opioid crisis in America needs attention. But too little has happened to actually do anything about it.”

For experts and advocates, this is hard to understand. Taking action on the opioid epidemic could have been an easy win. It’s an issue that crosses partisan lines, with both Democrats and Republicans angling to do something about it. There’s evidence it’s very relevant to Trump’s own base. While experts talk about needing as much as tens of billions of dollars for the crisis over the next few years, that’s actually not much in federal budget terms-- a fraction of a percent for a government that spends trillions a year.

And yet the Trump administration has barely budged. Beyond declaring a public health emergency, the administration has done little to nothing to combat the crisis.

That’s not because the crisis is getting better. In 2016, the latest year with a full official count, there were nearly 64,000 drug overdose deaths in the US-- an all-time high. The rise in drug overdose deaths was a big reason that life expectancy fell for the second year in a row in the US, which had not happened since the early 1960s. And the early data suggests that 2017 was worse: According to preliminary figures from the Centers for Disease Control and Prevention, there were nearly 67,000 drug overdose deaths in the 12-month period through June 2017, up from more than 57,000 in the 12-month period through June 2016.

If the worst trends continue, Stat forecast that as many as 650,000 people will die within the next decade-- the equivalent of the entire population of Baltimore.

This is the reality facing Trump, the reality in which his administration has responded with next to nothing.

...The most notable actual policy change is the INTERDICT Act. This law’s effect, however, will likely be greatly limited. The federal government has for decades tried to intercept illicit drugs before they come into the US, but drugs have consistently gotten through in huge numbers anyway. Along these lines, experts are deeply skeptical that any effort to beef up border security, including Trump’s wall, would do much, if anything, to stop the flow of drugs into the US.

Meanwhile, Trump hasn’t appointed anyone to lead the Office of National Drug Control Policy, and the office is mired by staffing problems-- including the hiring of a deputy chief of staff who apparently lied in parts of his résumé. The drug czar’s office, as it’s known colloquially, is crucial to coordinating federal efforts on drugs, according to experts.

Trump also has not nominated anyone to head the DEA, which is tasked with enforcing the nation’s drug laws.

In his proposals, Trump has also tried to cut the budget for the Office of National Drug Control Policy by 95 percent-- a move that his team initially walked back after facing bipartisan opposition during last year’s budget talks but reportedly may try again this year.

His budget plan also proposed keeping spending for addiction treatment relatively flat, while cutting prevention funding. The administration has also been silent on proposals in Congress to increase funding to the opioid epidemic, including Democratic plans to add tens of billions of dollars in spending to deal with the crisis.

...[E]xperts generally agree on what more federal resources should go to: They could be used to boost access to treatment (particularly highly effective medications for opioid addiction), pull back lax access to opioid painkillers while keeping them accessible to patients who truly need them, and adopt harm reduction policies that mitigate the damage caused by opioids and other drugs.

Advocates and experts argue about whether the extra resources should come through Medicaid, block grants for mental health and addiction care, or some other source. The consensus, though, is that much more federal support is needed-- in the tens of billions of dollars over the next few years.

“I was just in West Virginia this week. These counties are really devastated,” LaBelle said. “I know that’s been covered a lot. But it’s really something when you talk to a county official and you see how little money they have to put toward the epidemic.”

Some states are attempting to seriously confront this crisis. Vermont, for example, has built a “hub and spoke” system that treats addiction as a public health issue and integrates treatment into the rest of health care. The state was the only one in New England to have an overdose death rate that wasn’t significantly above the national average in 2016. (For more, check out my in-depth breakdown of Vermont’s system.)

But Vermont managed to build this new system in large part with federal dollars, particularly through Obamacare’s insurance expansion and a special Medicaid waiver that states can obtain through the health care law. It’s that kind of federal support that budget-strained states will need to deal with the opioid crisis.

These are the kinds of considerations and ideas that experts say can help the country move toward ending the opioid epidemic.

But in its first year, the Trump administration did nothing to make sure states can set up more programs like Vermont’s. So the opioid epidemic continues, killing tens of thousands of Americans every year.

Trump's job approval rating in West Virginia-- his strongest state in 2016-- has finally started to slip. 51% approve and 48% disapprove. His approval in states with the biggest opioid problems are down significantly since they voted for him:

• West Virginia- minus 20 points from +42
• Ohio- minus 13 points from +8
• Pennsylvania- minus 11 points from +1%
• Kentucky- minus 22 points from +30