Why Trump’s opioid plan falls short

President Trump’s long-delayed plan to combat the nation’s opioid epidemic, announced in a Monday speech in New Hampshire, led with a headline-grabbing call: impose the death penalty on drug dealers.

This emphasis on capital punishment only underscores the president’s over-reliance on supply reduction and law enforcement efforts, two strategies that have failed to produce meaningful change in a public health crisis that claimed more than 63,000 lives in the U.S. in 2016.

While law enforcement does have an important role to play, we’ve learned that an emphasis on arrest and incarceration doesn’t work. Many law enforcement officials at the national, state, and local levels have come to understand the futility of this approach. During my time at the Office of National Drug Control Policy under President Obama, the most frequent request from law enforcement officials was to increase access to treatment.

Over time, clinicians and researchers have identified the steps that must be taken to support recovery: notably, expanding health care capacity and access to treatment for those with a substance use disorder. The Obama administration and Congress charted this course in a bipartisan way, and Trump’s own commission recommended many of the same approaches — yet the president has seemingly been reluctant to act.

Trump’s plan does advance a number of evidence-based ideas around treatment and prevention that had already been adopted by Obama and Congress, including wider availability of the overdose-reversal drug naloxone, reducing opioid prescribing, and providing better access to medications for addiction treatment.

So, some 14 months later, this is all we have — a promise only now to act on solutions that have been available since day one of his administration.

It’s a bit ironic that one of the things that he announced was to ask Congress to remove a decades-old Medicaid rule in an effort to expand treatment. While this proposal has problems in its own right, it does correctly acknowledge the huge role Medicaid plays providing treatment for millions of Americans. Given that fact, will Trump stop calling for efforts to dismantle the Affordable Care Act and instead encourage every state to expand Medicaid?

Other aspects from Trump’s Monday announcement were short on specifics and far from comprehensive:

• The initiative speaks of “leveraging” federal resources, but apparently offers no new funding beyond that already approved by Congress during the Obama administration. At the very least, I’m heartened that the president is finally indicating public support of the $6 billion proposed by Congress.
• Expanding naloxone distribution by first responders is certainly a noble goal, but his announcement lacked any specific mention of how the administration plans to pay for the ever-increasing cost of this lifesaving medication.
• While screening federal inmates and placing them in treatment is a good start, the vast majority of prisoners with substance use disorder are in state and local jails, and the plan does not speak to that population. The federal plan also calls for the use of only one medication, naltrexone, rather than allowing all three approved medications for addiction treatment, which have been so promising in reducing overdose deaths for those leaving Rhode Island’s correctional facility.
• The call to ramp up the use of drug courts ignores that fact that many drug courts do not allow access to medication for treatment, which is crucial for many people to achieve recovery.

White House attention on the opioid epidemic is always welcome. Addiction is a disease that once hid in the dark and wasn’t talked about among families, let alone as a public health concern. We owe people who are fighting for recovery a fair chance. We owe answers and hope to parents like Jeanne and Jim Moser of New Hampshire, who spoke at the announcement and whose son died of a fentanyl overdose in 2015.

The only way we can stop this epidemic is by marshaling all our resources — from the federal government to neighborhoods. We all have a role to play to treat addiction for exactly what it is, a disease and an urgent public health concern.

The president’s plan makes headlines, but falls short of delivering all of the science- and evidence-based approaches that would make a real difference in the lives of those struggling with this epidemic.

Michael Botticelli is the executive director of the Grayken Center for Addiction at Boston Medical Center. He served as director of the White House Office of National Drug Control Policy from March 2014 until January 2017.