March 31, 2017

Even as Trump gathers opioid epidemic roundtable, some experts skeptical of opioid policies

Daily Briefing

    President Trump on Wednesday held a roundtable discussion on efforts to address the United States' opioid misuse epidemic—but some public health experts say the move is undermined by Trump's proposals to cut funding on medical research and treatment.

    The discussion included White House and other Trump administration staff, as well as law enforcement officials and individuals who have dealt with substance use disorders.

    According to the Washington Times, the meeting was intended to kick-off the administration's new commission on opioid-related substance use disorders, which will be led by New Jersey Gov. Chris Christie (R). Trump on Wednesday signed an executive order creating the commission, which will study the opioid-misuse epidemic, under the White House's new Office of American Innovation.

    In addition, Trump during the meeting said he would bolster efforts to stop drugs from illegally entering the United States. "Drug cartels have spread their deadly industry across our nation, and the availability of cheap narcotics, some of it comes in cheaper than candy, has devastated our communities," he said, adding, "It's really one of our biggest problems, our country has, and nobody really wants to talk about it. More importantly, we have to solve the problem."

    According to Politico, Trump has indicated that his proposed border wall between the United States and Mexico could help prevent illicit drugs from entering the United States.

    Trump also called for greater law enforcement efforts to help address the epidemic. "We must ... focus on prevention and law enforcement," he said Wednesday. "That is why I have issued previous executive actions to strengthen law enforcement and dismantle criminal cartels."

    Advocates, lawmakers say Trump's policies could fall short

    Public health advocates say Trump's newly announced plans to address the opioid misuse epidemic are somewhat duplicative to efforts implemented under former President Barack Obama. For example, public health experts noted that the U.S. Surgeon General last year issued a report that included recommendations on how to combat the crisis.

    Keith Humphreys, a drug policy expert at Stanford University, said, "It's bizarre to create a new entity outside of government to dig into things that have already been dug into, to not use the expertise you have." He said the initiative was at best, redundant and, at worst, an "empty gesture."

    Further, advocates have said some of the Trump administration's policies—such as efforts to scale back the Affordable Care Act and proposals that would reduce public health funding—actually could hinder efforts to curb substance misuse.

    Sen. Patty Murray (D-Wash.) said she would take Trump's "proposed efforts on opioids more seriously if he hadn't spent the last two months trying to derail the historic steps forward on substance abuse treatment through the [ACA]—and if his budget didn't also include a 20 percent cut to mental health services, which are so important in the fight against this epidemic."

    Trump taps 'SWAT team' of business execs to tackle opioid crisis

    Leo Beletsky, a law professor at Northeastern University who specializes in health and drug policy, also said the Trump administration's proposals so far do not "bode well for the public health approach." For instance, Beletsky said Republican calls to increase legal penalties for drug users would "certainly make the situation much worse."

    Other advocates said focusing on the supply-side of the epidemic might not result in much success, and that drug cartels could find ways to get drugs into the United States even if a wall is built between the United States' border with Mexico.

    Laura Hanen, chief of government affairs at the National Association of County and City Health Officials, explained that efforts to reduce over-prescribing of prescription opioids have been coupled with a corresponding uptick in fentanyl and heroin use. "You squeeze one end of the balloon and the air goes to the other end," she said, adding, "Our hope is [the Trump administration] would take a public health approach to addressing this epidemic" (Boyer, Washington Times, 3/29; Diamond/Karlin-Smith, Politico, 3/29; Belluz, Vox, 3/29; Colvin, AP/Sacramento Bee, 3/29).

    How to integrate pharmacists into primary care

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    Drug-related morbidity and mortality cost nearly $200 billion annually in the U.S.

    See how five organizations have integrated pharmacists into their primary care teams to improve patient outcomes and reduce avoidable spending—and explore six critical components of an integrated pharmacy program.

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