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.”

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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.

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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.”

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  • The physicians seems to be incompetent, ignorant, or negligent. With all their evidence-based, they were not aware of the addictive side effects of opioids. The AMA needs a revamp.

  • They left the Diversion of opiates from the supply chain completely out of the Bill. These ghouls have been lying to the American people for nearly two decades, so they could increase Law Enforcement, and attack people with chronic pain. Nowhere in this Bill, does the topic of Diversion come up, and that is by design. They are still protecting the corporate entities, who tied the hands of the DEA, bribed our politicians and policy makers, and lied about this so called epidemic. A lot of people died because of these lies and omissions. There are no clear reporting guidelines so most of the data they are presenting is misleading. It looks like a lot more people will die, due to this alternative fact based rampage.
    People should really look at where this money is really being spent. The states that expanded Medicaid are way ahead of the curve. That means that the rest of the country will do the same things that did not work a decade ago. HHS was bragging about “Faith Based Treatment” even as we saw the death toll rise. That is how they handled this for 2 decades, while lying to the public.

    CVS was caught red handed, and fined for allowing opiates to be stolen from heir supply chain, while at the same time they were denying legitimate prescriptions to cancer patients. They were one of the few who got caught. As the supply was tightened they created a lucrative black market, protected by the FDA. Millions of doses were diverted to the black market, and sold on the streets, while the DEA was forced to look the other way, due to corporate pressure.

    This has been going on for decades but got worse after they started restricting medication to people with legitimate chronic pain. They are also misleading us about he number of Suicides directly related to chronic pain. People should start asking who benefited. Along the way they helped the Treatment Industry make billions, while the their clients died. They allowed Pharma to profit from expensive and ineffective “alternatives.” They ruined lives, and allowed people to die.

    https://stopthedrugwar.org/speakeasy/2007/jul/10/rudy_giuliani_hates_medical_mari

    https://blog.protenus.com/18.7m-pills-lost-due-to-healthcare-employee-misuse-and-theft

    https://apnews.com/2ca93387f6cc4c30aa71bf4ff3bca12d

    https://www.politico.com/magazine/story/2018/08/05/oxycontin-purdue-pharma-federal-investigation-dopesick-excerpt-219158

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