President Donald Trump had the opportunity this week to be the strong leader that is needed to change policies and attitudes about addiction to better address the country’s opioid crisis.
Instead, Trump, who met with administration officials about the crisis on Tuesday, said the best way to avoid the problem would be for people to never abuse drugs. He also called for more law enforcement and prosecution of drug offenders. Prevention and law enforcement are important, of course, but when 142 Americans are dying every day from drug overdoses, a lot more than prevention is needed.
A commission on opioid addiction, appointed by Trump, offered concrete steps that should be taken now, such as the universal distribution of the anti-overdose drug Narcan to all police officers and expanded access to medication-assisted treatment, which has been found to be the most effective therapy.
The biggest impediment to many of these recommendations is that they run counter to the Trump administration’s rhetoric about substance abuse and medical care. The commission, headed by New Jersey Gov. Chris Christie, did not call for the hiring of more police officers or the construction of a border wall to reduce the flow of illegal drugs through Mexico. Instead, it rightly focused on proven steps that should be taken to reduce the death toll from what is a medical and health crisis, in terms of treatment for those who already are addicted to opioids and preventing new addictions by tightening the supply of these drugs, most of which are obtained with prescriptions.
The group’s interim report has a necessary tone of urgency, calling on the president to designate a national emergency to focus federal agency attention and funding, which must be approved by Congress, on the issue.
On Thursday, Trump designated a national emergency but he didn’t elaborate on what other action he supported. Health and Human Services Secretary Tom Price told reporters Tuesday that an emergency declaration wasn’t necessary.
Sen. Angus King praised the commission report for “saying all the right things.” A national emergency declaration could make a psychological, as well as practical, difference, he told the BDN, if it is followed with the coherent policies in the commission report.
Therein lies the problem: We don’t need another commission to know what to do to ease the opioid crisis. What we do need is a leader who makes stopping the opioid crisis a priority with a commitment to federal support of what works: Medication-assisted treatment, federal and state reimbursement rates that aren’t so low that they dissuade medical providers from offering this treatment, the elimination of time limits that often cut short needed treatment and an expansion, not contraction, of Medicaid to enable more Americans to access treatment.
Commissions, in Maine and other states, cities like Bangor and nationally have come up with “wonderful ideas,” Dr. Mark Publicker, an addiction specialist in Portland, told the BDN. But, without leadership these ideas don’t get implemented, he recalls of his decades of advocating for more addiction treatment and funding.
Rapidly increasing access to medication-assisted treatment, as the commission calls for, is the best place to start.
“Medications for the treatment of opioid use disorder have proven to be both clinically and cost-effective, but are seriously underutilized despite epidemic growth in the number and severity of opioid-related deaths,” the American Society of Addiction Medicine concluded in a 2014 review of opioid treatment studies. “Better physician training and more facilitative policies for medication for the treatment of opioid use disorder could reduce mortality with substantial cost savings.”
Yet, too few medical practitioners offer this treatment, in part, because of low reimbursement rates and rules restricting treatment options, including time limits on treatment. Trump can’t just wipe these problems away, but he can direct his agencies to remove the barriers under their control and work with other federal agencies and state governments to eliminate other counterproductive hurdles.
The White House commission has set out a reasonable and helpful path. Trump should take it.