Nestled amid health department cuts in President Donald Trump's budget proposal released Thursday is a supposed $500 million commitment to curbing the opioid epidemic. But many addiction experts say the budget falls short, and will actually worsen the epidemic.
"I'm not optimistic," said Dr. Andrew Kolodny, the co-director of opioid policy research at Brandeis University in Boston.
The opioid epidemic—which kills 91 Americans every day, according to the Centers of Disease Control—was a major theme throughout Trump's campaign. The candidate pledging to stop the import of illegal drugs and improve care to prevent overdose deaths. His base includes populations most impacted by this scourge, as evidenced in the election, when Trump performed best in the counties hardest hit by the opioid epidemic.
In the budget blueprint, Trump highlighted investments in opioid addiction and substance abuse treatment. In particular, the president noted this budget includes "a $500 million increase above 2016 enacted levels to expand opioid misuse prevention efforts and to increase access to treatment and recovery services."
However, as Kolodny pointed out, it's not clear whether this is a new, additional investment, or if this is the $500 million already devoted to opioid addiction treatment programs under the 21st Century Cures Act, which President Barack Obama signed at the end of last year, and guaranteed $1 billion for these programs over the next two years. I emailed a White House press contact for clarification, but had not heard back at the time of publication.
"You're spending money on eliminating supply, and that doesn't do much about the demand."
The budget also highlighted an increased spending of $175 million in the Department of Justice's budget to target drug traffickers, and specifically noted this was to help tackle the opioid epidemic from a law enforcement angle. But cracking down on drug dealers alone won't solve the problem, according to Katharine Neill, a drug policy postdoctoral fellow at Rice University in Houston.
"That's an old 'War on Drugs' tactic that we've seen in the past and it doesn't tend to work," Neill told me. "You're spending money on eliminating supply, and that doesn't do much about the demand."
Both Neill and Kolodny told me they're even more concerned by overall changes and cuts to healthcare. The Republican proposal to replace the Affordable Care Act will result in 24 million American losing health insurance coverage, according to the Congressional Budget Office. It would also rein in expansions for Medicaid coverage, leaving the most vulnerable Americans—many of whom are struggling with addiction—without care.
To tackle this deadly epidemic, the Trump administration needs to do more than set aside some law enforcement dollars to fighting drug dealers, the experts told me. The health care plan would need to be changed to ensure people can afford and keep insurance, the Food and Drug Administration would need to enact stricter regulations on drug marketing, and the federal government would need to expand funding for programs that include medication-assisted treatment (such as methadone), not just abstinence-based care.
But so far, the Trump administration hasn't addressed any of these other facets to slowly the toll of America's opioid crisis, and that's leaving experts troubled.
"We weren't in a great place before Trump came in and the things Trump is talking about doing, I do believe, will make the epidemic worse," said Kolodny.