As a candidate, President Trump vowed to “take care” of the opioid epidemic. But some addiction experts say his action so far, a commission, is a waste of time.
WASHINGTON — Weeks before the presidential election, at a packed rally in New Hampshire, Donald J. Trump recounted the story of a young woman and her boyfriend who had fatally overdosed within a year of each other. He promised not just a border wall to keep drugs out, but also more access to treatment.
“We’re going to take care of it,” he said of the opioid addiction epidemic, which has disproportionately hit states that were crucial to his election victory. “What’s taking so long?”
Five months into his term, though, President Trump has enthusiastically supported a health care bill that would deeply cut the Medicaid program that has provided treatment to thousands of addicted Americans. He has yet to fill the nation’s top public health and drug policy jobs. And while he has appointed a bipartisan commission on the opioid crisis, which will hold its first official meeting on Friday, it remains to be seen how much attention the panel can command from Mr. Trump’s turbulent administration.
Some addiction specialists say that waiting for a commission’s recommendations when hundreds of people are dying each week — and when countless groups around the country have studied the issue already — is wasting time. What is really needed, the specialists say, is the type of concerted, emergency action that public health officials have used to fight outbreaks of infectious diseases.
“There really isn’t anything this commission is going to figure out that we don’t know already,” said Dr. Andrew Kolodny, who directs opioid policy research at Brandeis University’s Heller School for Social Policy and Management. “What we need is an enormous federal investment in expanding access to addiction treatment, and for the different federal agencies that have a piece of this problem to be working in a coordinated fashion.”
Many experts, including Dr. Kolodny, say they believe that former President Barack Obama was also slow and, until the end of his tenure, ineffective at addressing the opioid problem. Some think his administration was so focused on rolling out the Affordable Care Act that it overlooked the public health crisis that was unfolding in the meantime.
“It would not be hard for Trump to do better than Obama on the opioid crisis,” Dr. Kolodny said.
Yet even some Republicans have voiced concern about aspects of the president’s approach. Senator Rob Portman of Ohio was alarmed when Mr. Trump’s budget office floated the idea of gutting the White House Office of National Drug Control Policy, which is led by a drug czar appointed by the president (Mr. Trump has yet to name someone for the role) and gives out grants to reduce drug use and trafficking.
The cuts were far less severe in the official budget proposal that Mr. Trump submitted last month — about 3 percent instead of 95 percent — but Mr. Trump has proposed other cuts, including to the Community Development Block Grant Program, that could put certain drug treatment and mental and public health programs at risk.
John P. Walters, who led the Office of National Drug Control Policy under President George W. Bush, said he hoped the Trump administration would approach the opioid problem with “a much more extensive surveillance effort,” saying a federal lag in reporting overdose data was “shameful.”
“I think we need a revolution here, and at its essence has to be to truly understand this as an epidemic and begin to map it, follow up, find individuals who are at risk and more aggressively encourage them to get treatment,” he said.
On the interdiction side, Mr. Walters added: “You need to treat this like a live shooter incident. If somebody is distributing something that you now know is causing people to collapse and be at the risk of death, you need to try to find them and stop them, not just have extra bandages to treat the wounded. We’re not there yet.”
Mr. Trump’s budget proposal calls for an additional $103 million for the Department of Justice to fight the flow of heroin and other illicit drugs into the country.
In April, the Trump administration sent nearly $500 million to the states for addiction treatment through a new law, the 21st Century Cures Act, which was enacted with bipartisan support last year and signed by Mr. Obama. It will provide an additional $500 million next year. Another law passed last year, the Comprehensive Addiction Recovery Act, is also helping expand treatment and prevention through grants.
While these new funds are important, some state and local officials and advocates insist it is more critical to preserve expanded Medicaid and the “essential benefits” that the Affordable Care Act requires insurers to cover, including addiction and mental health treatment.
“We laid it on the line for Secretary Price,” said Representative Ann McLane Kuster, Democrat of New Hampshire. She was describing a recent meeting with Tom Price, Mr. Trump’s health secretary, who has declared the opioid crisis one of his top priorities. “Virtually every single person at that meeting, as we went around the table, said we cannot lose Medicaid expansion or people will die.”
The bill that the House passed in March to repeal and replace the Affordable Care Act would phase out Medicaid expansion by 2020 by eliminating the extra federal funding that covered most of the cost. With the Senate now finishing its own bill, a group of moderate Republicans is pushing for a phaseout over seven years, not three. One of the senators, Mr. Portman, said that instead of limiting 21st Century Cures money for treatment to $1 billion over two years, another option would be to continue that funding stream indefinitely to provide addiction treatment to those who would lose Medicaid.
“I’d like to see everyone move faster,” Mr. Portman said. “But I feel like we’re beginning to put in place a comprehensive approach that will help us turn a corner.”
Mr. Trump’s executive order creating the opioid commission said the panel was supposed to produce an interim report by the end of this month and a final report by Oct. 1. The commission is then supposed to “terminate,” unless Mr. Trump decides on an extension.
Gov. Chris Christie of New Jersey, a Republican whom Mr. Trump appointed to lead the commission, did not respond to a request for an interview. But another member, Dr. Bertha K. Madras, a Harvard Medical School professor who specializes in addiction biology, said she had been exhaustively studying data in preparation for Friday’s meeting, which will be open to the public through live streaming. The commission has already been busy at work, she added; Mr. Christie has met with Mr. Trump on the issue.
“I’m trying to memorize everything so I can be equipped,” Dr. Madras said. “The fact that the commission is small is very positive. If you pick five ferociously committed, dedicated people — zealots — you can get a lot done.”
The other members are Gov. Charlie Baker of Massachusetts, a Republican; Gov. Roy Cooper of North Carolina, a Democrat; and Patrick Kennedy, the former Democratic congressman from Rhode Island, who has had highly publicized struggles with addiction.
Mr. Kennedy said he saw the commission’s role not as figuring out new steps to take, but rather as pushing for what experts already know is needed.
“It’s a matter of applying political will,” he said, “and we can do that if Christie has got the president’s ear on this and makes it a ‘Here’s what I want,’ the way Christie can.”
Kriss Blevens, a makeup artist and advocate for addiction issues in Manchester, N.H., whose stepdaughter died of a heroin overdose in 2014, is not so sure that any of this amounts to meaningful progress. Ms. Blevens joined Mr. Trump at a round-table discussion about the opioid crisis in Manchester last fall and conveyed to him “my passion for what needed to be done,” she said.
“I feel like I’m in the dark,” she said, adding that she is still waiting for evidence that Mr. Trump is taking on the crisis.
”In his defense, though, he’s also the candidate who until right to the very last debate kept the conversation about this alive,” she continued. “So I am being patient and waiting for some kind of unified response.”