WASHINGTON ― At a roundtable discussion on the opioid epidemic Wednesday, President Donald Trump lamented that a crisis which has claimed tens of thousands of lives in recent years has not gotten enough attention. And in an effort to turn the tide, he announced he was forming a commission led by New Jersey Gov. Chris Christie.
“It’s really one of our biggest problems our country has, and nobody really wants to talk about it,” Trump said, flanked by top administration officials and individuals with firsthand experience battling addiction to opioids. “More importantly, we have to solve the problem.”
Trump has pledged to play an active role in combating opioid abuse, and his appointment of Christie, who elevated the issue as a candidate in the 2016 Republican presidential primaries, shows he still is paying attention to the topic.
But for those on the front lines of the epidemic, much of what the president has done so far has been, at least, a disappointment and, at worst, likely to do more harm than good.
Trump, for starters, seems willing to unwind approaches that were working to alleviate the crisis in favor of going back to the combative “drug war” policies of the 1980s, which have long since been discredited. Attorney General Jeff Sessions reflected this antiquated mindset when he recently called for a return to former first lady Nancy Reagan’s “Just Say No” strategy to address drug use.
“There’s a lot of frustration from the advocacy community,” said Daniel Raymond, the deputy director of planning and policy at Harm Reduction Coalition, which seeks to end the stigma of addiction and champions public health reforms. “Are we really going to spend six months reinventing the wheel here at a time when overdose deaths have never been higher? Nobody feels like we can take a wait-and-see approach.”
But it’s not just the framework that has advocates worried. It’s the financial commitments, too. The administration’s proposed budget calls for steep cuts to the Department of Health and Human Services and the National Institutes of Health as well as a reorganization of the Centers for Disease Control and Prevention ― agencies vital to funding treatment initiatives and research to improve treatment for future generations.
Last week, in an embarrassing defeat, Trump tried to help pass a bill to repeal and replace Obamacare, an effort that would have stalled the Medicaid expansion in multiple states. It also would have had severe consequences for those in recovery, advocates warned. But the harm wouldn’t stop there. The GOP replacement bill would have allowed insurance companies to stop offering mental health coverage or drug addiction treatment. If it had passed, 24 million Americans would have lost their health insurance, according to Congressional Budget Office projections.
Are we really going to spend six months reinventing the wheel here at a time when overdose deaths have never been higher? Daniel Raymond, Harm Reduction Coalition
Setting up a symbolic commission while working to defund actual initiatives, therapies and research has reinforced public health officials’ fears that Trump hasn’t studied up on the epidemic enough and might stall the progress the Obama administration made in addressing the issue.
“This is a national crisis that demands a sustained strategy and funding and a real commitment,” said Joshua Sharfstein, an associate dean at the Johns Hopkins Bloomberg School of Public Health. “That has not been evident to date.”
The opioid epidemic was fairly central to Trump’s political appeal during the campaign. In the early days of the presidential race, he brought up the issue on the stump as a way to justify his promise to build a wall along the U.S.-Mexico border. And he had an audience for his message. The crisis has devastated states across the country, most notably in Rust Belt communities in West Virginia and Ohio and in early primary states, including New Hampshire.
With the spread of deadly synthetic opioids such as fentanyl, communities have struggled to maintain the spread of overdose deaths. A recent CDC study showed that opioids killed more than 33,000 people in 2015, a record. Drug overdoses now kill more than the HIV/AIDS epidemic did at its height in the U.S.
The Obama administration gradually ― some argue too gradually ― coalesced around a policy that shunned the drug warrior tactics for a public health approach that helped to mainstream programs such as needle exchanges. The then head of the White House Office of National Drug Control Policy, Michael Botticelli, derided the war on drugs as a failure.
Botticelli and others in the administration, most notably officials in the Department of Health and Human Services, reduced barriers to medication-assisted treatment, which the medical establishment views as the best chance for someone with an opioid addiction to make a lasting recovery. The treatment combines medications such as Suboxone or methadone with counseling. It has been shown to dramatically lower the rate of overdose deaths.
By the end of his term, President Barack Obama, along with bipartisan allies in Congress, successfully included $1 billion in funding in the 21st Century Cures Act to enhance evidence-based treatment. The surgeon general also published a definitive report on the epidemic and how to address it.
But since taking office, Trump has rebelled against Obama’s policies. “I think there is a tremendous amount of fear that we are going to retreat from all of the science and evidence that we know to be true about addiction,” Botticelli told The Huffington Post in late January, before the end of his tenure as the nation’s drug czar.
In the runup to their budget unveiling, Trump and his team have floated the idea of dismantling the drug czar’s office. And advocates are worried that the commission headed by Christie ― which includes the heads of HHS and Veterans Affairs, along with Sessions ― would replace it.
“Commissions are nice to have and they are great for generating news, but at the end of the day we have to remember the federal government already has tools in place to address this issue in a smart way,” says Rafael Lemaitre, who worked in the drug czar’s office for more than a decade. “It just needs to use them. There are literally dozens of nonpartisan experts working in the White House today that should be leaned on and supported. There’s already a commission to address the opioid crisis. It’s called the ONDCP.”
To Lemaitre’s point, there were relatively few actual experts at Trump’s event on Wednesday. Along with Cabinet secretaries, there was Pam Bondi, the attorney general of Florida, and retired New York Yankees reliever Mariano Rivera. One of, if not the only, treatment specialists who appeared was AJ Solomon, a 26-year-old who used to work for Christie’s advance team. He is in recovery and started his own treatment facility in New Jersey, which offers intensive therapeutic services. He was just happy to be able to meet the president.
“It was just awesome ― beyond my wildest dreams ― as someone in recovery meeting the president,” he told HuffPost.