WASHINGTON — The claps died down for a moment, but quickly came back louder than before: by the end, the assembled lawmakers, Cabinet members, law enforcement officials, and White House staff applauded President Trump and his efforts to address the opioid crisis for nearly 40 seconds.
It was a lengthy victory lap for a year of modest progress combating the opioid crisis, culminating in the president signing a sweeping but largely unambitious bill.
“Together, we are going to end the scourge of drug addiction in America,” the president said in an East Room speech. “We are going to end it or we are going to at least make an extremely big dent.”
The legislation finalized on Wednesday was one of few major bipartisan achievements in Congress this year. And the legislation contained a number of consensus reforms to the nation’s addiction treatment infrastructure and expanded prevention and law enforcement efforts — but advocates have said it fails to match the scope of an addiction crisis taking nearly 70,000 lives per year.
The bill “is an important step forward,” Dr. Kelly Clark, the president of the American Society of Addiction Medicine, said in a statement. “[But] there is much work ahead to ensure that all Americans living with addiction have access to treatment that is standardized and evidence-based, as well as comprehensive insurance coverage.”
The legislation extended the ability of nurses to prescribe addiction-treatment medications, made it easier for Medicare beneficiaries to access the addiction treatment drug methadone, and allowed more flexibility for doctors wishing to prescribe those treatments via telemedicine.
It also expanded mail screenings for drugs being smuggled via the international postal system, made larger inpatient treatment facilities eligible for Medicaid reimbursement, and took steps to reduce overall opioid prescription levels.
Between the bill signed Wednesday and spending approved earlier this year by Congress, Washington has allocated roughly $7 billion over the next two years to treat and prevent addiction. For comparison, the White House reached a deal with Boeing earlier this year to manufacture two new airplanes to transport future presidents. The cost: $4 billion.
Democrats, including Rep. Elijah Cummings (Md.) and Sen. Elizabeth Warren (Mass.) have introduced legislation that would authorize $100 billion in spending over the next decade to combat the addiction crisis.
While the event illustrated major progress on an issue Americans increasingly believe should be among the government’s top priorities, it also highlighted the president’s fondness for enforcement-side drug policy.
Trump singled out Sen. Rob Portman (R-Ohio), the author of the bill that enhanced law enforcement and mail screening at the border to guard against the entry of potent, synthetic fentanyl, which was the root cause of thousands of overdoses last year.
“Rob, I do have to thank you,” Trump said at one point. “I know how hard you’ve worked, please stand up.”
While the president showed off his penchant for enforcement-side drug policy, it was his wife who focused on treatment. In her opening remarks, First Lady Melania Trump focused her remarks on neonatal abstinence syndrome, a condition that afflicts infants born to opioid users and who carry symptoms of opioid dependency themselves.
While the president referred in specific terms to Portman’s legislation and applauded law enforcement officials for heightening border security with respect to drug smuggling, not once did he or the first lady use the phrase “medication-assisted treatment” or allude specifically to the addiction medicines that doctors say are key in reducing relapses and overdose deaths.
Also on display: the Trump administration’s persistent leadership void, at least formally, in drug policy. After Trump rattled off the names of the eight cabinet secretaries in attendance, he turned to acknowledge an advisor who, effectively, represented the ninth — his informal drug czar.
“And thank you also to Kellyanne Conway,” Trump said, “for her tremendous effort.”
Though officially Conway is a senior counselor to the president, she has continued to lead regular meetings of an “opioids cabinet,” which includes members of the administration across various executive branch department.
Trump has not yet nominated an administrator to lead the Drug Enforcement Administration. His pick to lead the Office of National Drug Control Policy and serve formally as “drug czar,” Jim Carroll, has not been confirmed by the Senate, though his nomination came in February. Nonetheless, he has run that agency in an acting capacity for nearly a year.
Approached outside the White House, Carroll declined an interview, telling STAT only: “Let me get confirmed first.”