P

resident 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.

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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.

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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.

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  • Mr. Botticelli, I am interested in what you listed as evidence-based ideas and what you seem to be suggesting as a given positive by reducing opioid prescribing. I am not sure where you are deriving this opinion? I would suggest that this crack down on patients with chronic pain and the doctors who treat us has nothing to do with this fake news story of an opioid “epidemic” that you seem to use so freely in your article. Are the people who are prescribed pain medications the real issue or is it illicit fentanyl? You must be aware of the numbers and how low they really are when it comes to people prescribed opioid pain medications even misusing their pain medicine or the even lower number of patients who overdose on the pain medication they are prescribed.
    You seem to freely suggest that there is actually an Opioid Epidemic and that somehow people prescribed pain medication for chronic pain are a big part of an artificially inflated problem. We sir are not the issue, but we are being made to suffer by addiction specialists that either are not fully informed or just don’t care about the true statistics. Punishing people with chronic pain and their doctors will not solve the problem created by addicts seeking heroin and other drugs laced with illicit fentanyl. When people like you make such easy false claims and quote baked science you only make people with legitimate pain suffer when are not and have not ever been the problem and you know it. Opioids are a very effective treatment for chronic pain and this is proven science.

  • There are two ways to stop these deaths and deal with addiction: 1. Increase the number of treatment centers and require medical insurance to cover the treatment. 2. Decriminalize drugs. This should be a medical issue, not a legal one. We’ve done it with alcohol. We seem to be unwilling to come to grips with the problem. Meanwhile, the black market for drugs is making businesses and banks into criminals, and addicts into social outcasts and petty thieves.

  • PLEASE KNOW THAT MY EFFORTS are honest. There is no time in history that the sickening daily dialog of patrician politics should not be redirected. The major TV channels can adopt this cause and send their high priced executives some place else than Washington to report sex scandals. Billions are wasted on a Harvey Wienstien, and sex life arround the world. How about giving those who want to free America from the malignant disease of addiction an hour to organize their efforts? WW Gilman 828 329 6344

  • I will donate $50,000 today to SAVE AMERICA. I will also serve as temporary Chief Stratigist in developing an army of concerned citizens to eliminate the MALIGANT disease of addiction. I will hold meetings in thousands of communities within two weeks. This army will solicit private funding and get the opioid epidemic out of the political arena. We will be joined by professionals in treating addiction and unlimited support from insurance companies. I leave my private phone number in hopes I might hear from volunteers. I am waiting to hear from honest concerned citizens. WW Gilman 828 329 6344

  • It is fine that Trump is so concerned about the overdoses happening because of opioids. That is only one part of the purpose of opioids. Pain relief for documented, proven pain patients is another. Mental well-being of patients going through traumatic injuries and illnesses. Along with the patients mental health, the families should be taken into account. Compassionate doctors can’t feel very good with having the drug police telling them their job to alleviate pain and suffering. Giving a patient a bag of ice, or telling them the government says to tough it out does not help. People will stay away from needed operations and unsympathetic doctors, maybe that is what they want. Government meddling in health care is causing more problems then it is helping with. Without offering any suggestions on how to deal with pain for everybody in need of health care is irresponsible. The rich and famous won’t have to do without pain relief. All of us have paid in through the years for better health care. Now we are getting screwed even if our problems are legitimate and doctor approved.

  • This is a great article and falls short of answering a problem. With any other health care chrisis our country reached outside the government coffers. With the a campaign to cure polio we used The March Of Dimes. With the ease of organizing using the web we could kick off a great campaign. I will donate today and everyone in the US wil do likewise. We have a great opportunity to offer the millions in recovery a chance to repay society for their gift of sobrierty. Let’s start with the professional treatment experts to virally organize. I will personally pay for a professional to head up these efforts. Can you help me locate an expert to assume the leadership position? There are millions like myself who are ready to STOP THE CONFUSSION, END THESHAME, TREAT THE MALIGNANCY. I Will start this effort with a $50,000 donation today. There are endless funds available as well as talent to erradicate this malignant disease if we remove it from the political arena. Please know I am am a recovering addict who will step up to the challenge with 100% of my time. May I hear from you. Sincearly, WW Gilman

  • Trump doesn’t understand because he doesn’t read. Short term solution is to improve care for these addicts: make insurance companies cover addiction treatment, for example. Long term, the only solution that will work is to decriminalize drug use. It shouldn’t be a crime, but an illness. Take the profit motive out of the system and the source will dry up, or become legitimate.

    • ‘Trump doesn’t Understand These Addicts’…Sorry Harry I’m not a Drug Addict and what is not realized is Legitimate Pain Patients Are Being ‘Dumped’ Into The Same Witches Caldron AS drug Addicts And It’s Just Not Right, Fair or Human.

  • Are we falling victim to headline fatigue? The fact that there are no comments yet to Mr. Botticelli’s opinion piece indicate we may be resigned to accepting an insufficient federal response to the ongoing opioid epidemic. We shouldn’t be.
    Hearing the national opioid overdose problem described as an “epidemic” may have had a numbing effect on us over time, even as around 50,000 people are dying each year in this country from unintended opioid overdose. It’s a different kind of epidemic than, say, the flu, ebola or cholera but can you imagine the alarm and urgent call to action if 50,000 people had died last year in the US from ebola?. Opioid addiction is insidious in that it may be hidden (think: an apparently healthy, functioning user who may be your family member, neighbor or co-worker) until one day a person you know has suddenly OD’d and died.
    As Botticelli points out, there is good treatment for addiction and people can recover and rebuild their lives. But we have to 1) reject the stigma against people with substance use disorder, 2) talk openly in our communities about mental health and substance use, 3) recognize that treatment works and 4) be willing to the fund screening youth and adults for substance use and connecting them with available, accessble treatment.
    Substance use medications and addiction counseling do help people recover. Let’s demand that insurance coverage and public funding be dramatically increased ASAP to meet the needs presented by this ongoing epidemic that can unexpectedly affect any family anywhere.

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