President Donald Trump is expected to sign a thick bundle of bipartisan opioid bills Wednesday that he falsely claimed had “very little Democrat support.” The legislation easily passed the Senate 98-1 earlier this month.
Trump made those remarks during a recent rally in Ohio, one of the hardest-hit states, where he was attempting to drum up support from his base. It was among the president’s latest attempts to portray his administration’s response to the opioid epidemic as effective, and came shortly before a midterm election cycle in which Republicans are fighting to maintain control of Congress.
But almost a year after Trump declared the opioid epidemic a national public health emergency, and more than six months after he detailed what he’d like to do to address it, drug policy experts and critics still say the president hasn’t done enough to address a tide of drug addiction that killed more than 72,000 people in 2017, according the Centers for Disease Control and Prevention.
Even the legislative package, which is among the more significant moves on opioids made under Trump, “will not turn the epidemic around,” said Keith Humphreys, former drug policy advisor in both the Bush and Obama White Houses and professor at Stanford University.
“There’s smart stuff in there, and it will save some lives, but that’s pretty minimal ambition,” he said.
The stack of nearly 70 proposals will remove some regulatory hurdles that complicate Medicaid and Medicare paying for addiction treatment, expand law enforcement efforts to better detect packages coming into the U.S. that contain deadly, synthetic opioid drugs like fentanyl, and direct funding to the National Institutes of Health for research into a new, non-addictive painkiller, among other initiatives.
Wednesday’s signing event will represent Trump’s latest effort to address some of the campaign promises he made regarding the opioid crisis: more arrests of drug dealers and traffickers, better access to treatment, and more money toward solutions. Still, Republicans are simultaneously threatening health care programs like Medicaid expansion access under the Affordable Care Act, which ultimately helped drug users get access to treatment.
And overdose deaths continue to tick up in parts of the Midwest, Appalachia and Southeast — regions where Trump won by a landslide in 2016 — and in states where midterm races are tight, such as Tennessee and West Virginia.
While overdose fatality rates appear to be leveling off nationally — and may have actually dropped off by 2.8 percent in the 12-month period ending March 2018, according to preliminary CDC data — tens of thousands of people are still dying each year. The director of the CDC, Robert Redfield, cautioned at a conference Tuesday that while that data is promising, it’s still preliminary, according to Politico. It’s also unclear what is driving the decrease in overdose deaths.
What’s been done — and what hasn’t
So far, advocates say, Trump’s statements on the opioid epidemic have been far-reaching with a lot of bluster, and often aren’t followed by direct action. In May, Trump said of the epidemic that “the numbers are way down” and that his administration was “doing a good job with it.” Democrats have derided similarly nonspecific comments.
“What we still don’t have from the Trump administration is a plan of action, and it was over a year ago that he referred to the opioid crisis as a public health emergency,” said Andrew Kolodny, co-director of opioid policy research at Brandeis University. He noted that while addressing the opioid epidemic is mostly a bipartisan issue, “we need a sustainable funding stream, and it is only from Dems that we’ve had proposals to create a new funding stream, or to get sustained funding.”
Trump, for his part, has charged that Democrats haven’t helped by rallying against his proposed southern border wall and other criminal justice–based initiatives he says will stem drug trafficking, including imposing harsher sentences on low-level drug offenders and zero tolerance policies on undocumented immigrants crossing the border.
The efforts to bring charges against anyone who enters the United States illegally may have actually diverted resources from some drug-smuggling cases, according to internal emails between Justice Department and Homeland Security staff obtained by USA Today.
Trump declared the opioid epidemic a national public health emergency in October 2017. The emergency declaration did little but draw attention to the crisis, making it a public priority of the administration and placing added pressure on Congress to get something done.
A new Government Accountability Office audit obtained by Vox on Tuesday showed that the declaration succeeded in clearing some paperwork requirements for surveying health providers about addiction treatment, allowed two states to move along their programs to address the crisis a bit faster, and expedited research into treatment. It didn’t do much else, according to Democratic Sens. Patty Murray and Elizabeth Warren.
“To me, it looks like empty words and broken promises. Hand-waving about faster paperwork and speeding up a few grants is not enough — the Trump administration needs to do far more to stop the opioid epidemic,” Warren said in a statement to Vox.
The Massachusetts senator introduced a bill in April with Democratic Rep. Elijah Cummings that called for $100 billion toward the epidemic over a decade, which didn’t get buy-in from Republicans. (The emergency declaration, meanwhile, opened up access to the Public Health Emergency Fund, which had a balance of $57,000.)
And a few months before the emergency declaration, Trump attempted to almost entirely gut the budget of the Office of National Drug Control Policy. That led to blowback, with Richard Baum, the acting director for the office, calling it “frankly heartbreaking” in an internal email published by The Washington Post in May. Sen. Rob Portman, a Republican from Ohio, called the agency “critical to our efforts to combat drug abuse in general, and this opioid epidemic in particular.”
“If the president was really going to lead on this, I don’t think it would be hard to get Republicans on board,” Kolodny said. “If there was just a little bit of leadership.”
When the emergency declaration was signed last October, the Office of National Drug Control Policy lacked a permanent director. Pennsylvania Rep. Tom Marino had just withdrawn his nomination to head the office after reports revealed he had helped cripple the Drug Enforcement Agency’s efforts to enforce drug policy.
That left the job to Kellyanne Conway, White House counselor and former pollster, who coordinated much of the administration’s efforts to stem the epidemic, at times taking on responsibilities typically held by the drug czar.
After October, the administration mostly went silent on opioids. Then, in February of this year, Trump tapped Jim Carroll, a White House deputy chief of staff with no drug policy experience, to hold the position. A month later, in March, the president unveiled a much-awaited three-pronged plan to address the epidemic.
The plan included education and awareness to prevent drug addiction and overprescribing, stopping the flow of illicit drugs through border control and criminal justice policies, and expanding opportunities for addiction treatment. The White House also rolled out its public awareness campaign on the “Crisis Next Door.” Meanwhile, some of the criminal justice policies he proposed were widely unpopular among advocates, such as instituting the death penalty for drug traffickers.
And it wasn’t clear how the administration would pay for its plan, while Conway noted that fighting the opioid epidemic would require “a lot more money,” according to the Washington Post.
However, a Republican-controlled Congress passed a budget deal in February that directed $6 billion to the epidemic over two years. And another bill to fund the Department of Health and Human Services added $3.7 billion to address the epidemic passed the Senate in August. That pales in comparison to what might be the actual cost of the epidemic, though. Trump’s White House Counsel of Economic Advisers said the opioid overdoses and abuse cost the U.S. economy $504 billion in 2015 alone.
Humphreys said that if Republicans maintain control of Congress after the midterm elections next month and are able to see the GOP’s legislative priorities through, “I think what you’ll see is potentially rolling back of other policies that could make the epidemic worse.”
Senate Majority Leader Mitch McConnell, in recently deeming the ballooning federal budget deficit “disappointing,” also suggested both parties would have to tackle entitlement reform to reduce spending. He also said in an interview with Reuters that he’d like to try to repeal and replace the Affordable Care Act after the midterms.
Democrats have seized upon those threats as a key part of their platform heading into the midterms, with health care showing up as a top issue for voters in poll after poll.
"While the White House has largely ignored the opioid crisis, Congress did take bipartisan action to prevent opioid trafficking and expand access to treatment,” Daniel Wessel, a spokesman for the Democratic National Committee, said in an emailed statement. “However, we need to do far more to invest in addiction treatment, and Republicans must end their health care sabotage."
Cover: President Donald Trump speaks about his plan to combat opioid drug addiction at Manchester Community College, Monday, March 19, 2018, in Manchester, N.H. (AP Photo/Elise Amendola)