President Trump on Monday unveiled a plan to combat the U.S. opioid epidemic, including an advertising campaign to discourage drug use, increasing access to addiction treatment for those in need, and a proposal for certain drug dealers to face the death penalty.
Trump's speech in New Hampshire comes five months after he declared opioid misuse a public health emergency. The latest CDC data show more than 64,000 people died of drug-related overdoses in 2016, with many of those deaths linked to opioids, such as illicit fentanyl, heroin, and prescription drugs.
White House's opioid misuse plan
The White House's plan features three main parts:
- Prevention through provider and consumer education, as well as new research into technologies and therapies to prevent addiction, including a possible vaccine to prevent opioid use disorder;
- Policies to increase access to evidenced-based treatment for those struggling with addiction; and
- Law enforcement policies to combat international and domestic illicit drug supply chains.
1. Trump's plan to prevent opioid misuse, curb overprescribing
A key facet of the White House's plan to prevent individuals from misusing opioids is to fund a nationwide advertising campaign. Trump said, "The best way to beat the drug crisis is to keep people from getting hooked in the first place," adding, "This has been something I have been strongly in favor of—spending a lot of money on great commercials showing how bad it is."
The White House's plan also sets several goals to reduce opioid-related overprescribing, though it provides few details on how it will achieve those goals. For instance, the White House said within three years it would cut opioid prescriptions by a third and ensure 75% of opioid prescriptions covered by federal health care programs, including Medicare and Medicaid, are prescribed using "best practices."
2. Trump's plan to increase access to treatment
To increase access to treatment, Trump proposed expanding Medicaid coverage for inpatient substance misuse treatment, leveraging overdose tracking systems to direct resources to areas with high overdose rates, and supplying first responders with naloxone—a drug that can reverse the effects of an opioid overdose.
Trump's proposal also outlines policies intended to provide care to inmates with substance use disorders. For instance, the plan proposes screening all federal inmates for opioid misuse when they enter the system and coordinating care for those who screen positive, and when appropriate encouraging drug courts to steer drug offenders to evidence-based treatment as an alternative to incarceration.
3. Trump's plan to bolster law enforcement efforts
Trump's plan also includes a controversial proposal to bolster criminal penalties for opioid drug dealers. For instance, Trump's plan calls on Congress to reduce the threshold needed to impose mandatory minimum sentences for trafficking fentanyl and other opioids "that are lethal in trace amounts" and calls on the Department of Justice (DOJ) to seek the death penalty for drug traffickers "where appropriate under current law." The White House's plan does not offer examples of when it would be appropriate for DOJ to invoke the death penalty, but Trump in his speech suggested DOJ would seek the death penalty for "big pushers, the ones who are really killing people."
He said, "If we don't get tough on the drug dealers, we are wasting our time. ... And that toughness includes the death penalty." He added, "This is about winning a very, very tough problem and if we don't get very tough on these dealers, it is not going to happen, folks."
Attorney General Jeff Sessions in a statement following Trump's speech said, "We will continue to aggressively prosecute drug traffickers and we will use federal law to seek the death penalty wherever appropriate."
The White House's plan also calls for new policies to keep illicit drugs out of the country. For instance, the plan proposes requiring electronic data for 90% of international mail shipments with goods within three years and working with China and Mexico "to reduce supplies of heroin, other illicit opioids, and precursor chemicals."
Trump in his speech also reiterated his proposal to build a border along the United States and Mexico border as a way to stem the opioid misuse epidemic.
Trump's proposal to combat the opioid misuse epidemic drew mixed response from legal and public health experts, with some raising concerns about Trump's focus on law enforcement efforts. And according to Vox, it remains unclear whether Congress would provide the necessary funding to implement Trump's proposals.
Former Rep. Patrick Kennedy (D-R.I.), who was a member of White House's opioid commission last year, said the Trump administration is "treating this like a criminal epidemic as opposed to a public health epidemic."
Jesselyn McCurdy, deputy director of the American Civil Liberties Union's Washington office, called Trump's proposal to invoke the death penalty for drug dealers "absurd." McCurdy said, "Drug trafficking is not an offense for which someone can receive the death penalty," citing a Supreme Court precedent that places limits on using the death penalty in cases where the person convicted did not commit murder.
Further, some experts said past experience shows tougher criminal penalties does not stem drug trafficking. Harold Pollack, an urban public health professor at the University of Chicago, said, "I don't think the death penalty for drug dealers will accomplish very much." Pollack was co-author of a 2014 research review that found no good evidence that increasing criminal penalties stem the flow of drugs.
In addition, the Los Angeles Times reports that physician groups, public health advocates, and state officials say the White House's previous Medicaid reform proposals, which would reduce federal Medicaid funding relative to current law by hundreds of billions of dollars, would negatively affect efforts to combat the opioid epidemic. According to the Times, Medicaid is the main source of reimbursement for drug addiction treatment.
However, David Safavian, deputy director for the American Conservative Union Foundation's Center for Criminal Justice Reform, said Trump's plan offers some positive policies, such as "identifying those reporting to prison with addiction issues" and ensuring the Bureau of Prisons has sufficient resources to treat inmates with substance use disorders (Diamond/Ehley, Politico, 3/19; Merica, CNN, 3/19; Rampton, Reuters, 3/19; Lopez, Vox, 3/19; Horsley, NPR, 3/19; White House briefing, 3/19; Bierman/Levey, Los Angeles Times, 5/19).
Learn more: How to combat the opioid epidemic
Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties.
This report outlines three imperatives to guide hospitals and health systems in their efforts to reduce the impact of inappropriate opioid prescribing and misuse.