Washington (CNN)President Donald Trump campaigned on ending the opioid crisis in the United States. He highlighted stories of those affected in his State of the Union addresses. The first lady has made visits to neonatal clinics treating addiction recovering babies a key part of her time at the White House. And according to new federal statistics, deaths from drug overdoses declined for the first time in 28 years and life expectancy in the United States increased in 2018 for the first time in four years.
But on the verge of his final first-term State of the Union speech, a closer look at the numbers, published Thursday by the Centers for Disease Control and Prevention, reveal that despite the overall decline in overdose deaths, those numbers have still not returned to 2016 levels. And under Trump, other aspects of addiction and overdose deaths have evolved, as well.
The administration has zeroed-in on efforts to lower the body count caused by opioid overdoses, but deaths due to synthetic opioids, such as fentanyl, have continued to rise and deaths involving cocaine and psychostimulants such as methamphetamine, MDMA, methylphenidate (commonly sold as Ritalin) and caffeine are also rising.
Under Trump, the federal government has undertaken a series of efforts to combat addiction and overdose deaths from opioids — setting restrictions on opioid prescriptions, calling for a public health emergency, launching ad campaigns aimed at young people who might abuse the drugs, expanding access to the opioid overdose antidote known as Naloxone and pushing for China to cease illicit fentanyl production and exporting, among other efforts.
The Trump administration and the President’s reelection campaign have cast these efforts as political victories, but following a slow start in reacting to the crisis once Trump took office, it’s unclear how quickly the administration will adapt to the new challenges posed by the evolving landscape of drug addiction.
Trump administration officials held a White House press briefing Thursday to announce the overdose death decline. US Department of Health and Human Services Assistant Secretary for Health Brett Giroir didn’t offer specifics when asked to list policies the administration is willing to support to assist with emerging addiction trends. But he did underscore that “there is no such thing as a silver bullet to this issue.”
From the campaign to the White House
Trump’s call to end opioid addiction came early in his campaign, but he wasn’t the first 2016 presidential candidate to make tackling the crisis a part of his platform. Democratic presidential candidate Hillary Clinton, for instance, was discussing the issue as early as May 2015 and fellow Republican contender Chris Christie was talking to voters about it in the days before Trump formally announced his run.
Still, the day after announcing his candidacy, Trump called the opioid crisis “a huge problem in New Hampshire, which nobody even really knows about.”
“It’s something we’ll start thinking about very heavily,” he added.
Trump took up the issue frequently, bringing it up on the campaign trail in working class communities across the country.
The President has familial ties to addiction and has said his brother’s death, due to complications from alcoholism, was why he’s been a teetotaler throughout his adult life.
But there’s little doubt that Trump, his administration and his campaign have also seen the issue as an opportunity to earn support from the disaffected communities that have felt abandoned by the political establishment and would eventually serve as his political base. He even told a foreign leader such, claiming that he “won New Hampshire because New Hampshire is a drug-infested den.”
However, Trump’s campaign promises on the issue consisted mostly of calls to stem the flow of drugs coming into the US through Mexico by building a border wall. And when Trump got to the Oval Office, his newly formed administration appeared to be ill prepared to tackle the public health component of addiction, bungling a key nomination and missing critical deadlines.
One of the longest struggles occurred within the office charged with serving as the liaison between the White House and agencies on drug-related issues, the White House Office of National Drug Control Policy. The office ran without a confirmed director for Trump’s first two years in office, and Trump’s first nominee to lead the office, Pennsylvania Republican Rep. Tom Marino, withdrew his nomination after reporting revealed that he’d taken nearly $100,000 from the pharmaceutical lobby while sponsoring a bill that made it easier for drug companies to distribute opioids across American communities and thwart the Drug Enforcement Agency.
And while the White House Office of National Drug Control Policy was being run by a career official, one of the highest ranked staffers the Trump administration installed into the office was a 24-year-old former campaign worker with no previous drug policy experience.
Even when the administration efforts did eventually take hold, it wasn’t clear that all those efforts were effective.
For example, after Trump called the opioid crisis a public health emergency and formally declared it one months later, the Government Accountability Office concluded that the declaration didn’t make a significant impact. And earlier this year, the two-year declaration lapsed due to what a Health and Human Services spokesperson said was a “clerical error.” The emergency, they said, was renewed.
Some of the President’s priorities on health care also routinely appeared to contradict or undermine administration officials’ efforts to increase access to substance abuse treatment. Namely, the administration pushed for increased access to treatment while also attempting rollback Affordable Care Act and Medicaid coverage.
Now, three years into the Trump presidency, the administration has begun to tout some of its new federal efforts as victories.
Under Trump, China, a major exporter of fentanyl to the US, agreed to classify fentanyl as a controlled substance. The Justice Department has increased the number of prosecutions it has brought against fentanyl traffickers. And the surgeon general recommended prescribing or co-prescribing Naloxone — a drug designed to reverse an opioid overdose — alongside opioids.
But some of the largest victories in overdose death reduction have arguably come in the form of bipartisan agreement in Congress and from efforts by states.
Congress passed and Trump signed into law the SUPPORT for Patients and Communities Act (SUPPORT Act), which dedicated roughly $8 billion over five years.
And some studies have indicated that expansion of Medicaid in some states is linked to a reduction in opioid overdose deaths.
An emerging issue
Regina LaBelle, a former chief of staff and senior policy adviser at the White House Office of National Drug Control Policy, cautioned against calling the new overdose death declines a trend.
“Everyone that worked for me at ONDCP who was a data scientist would always tell me one year is not a trend. And while we are seeing a decrease in the increase, we remember that in five states we’ve still seen increases in five states and decreases in about 15 and then in about 20 we saw stability,” LaBelle, now a program director for the Addiction and Public Policy Initiative at the O’Neill Institute at Georgetown University, told CNN.
And Giroir, of Health and Human Services, speaking at Thursday’s press briefing at the White House, similarly said that “we’re at a turning point but this is a dynamic, rapidly evolving crisis.”
“It absolutely is a turning point, but we have to look at the complexity of the problem,” Giroir said, later adding, “The newest data says cocaine is starting to level off, but we still have issues with fentanyl.”
“It used to be up 30 to 40% year over year. Now it’s up under 10%, so we’re making progress. But we’re all worried about the next wave, which is evolving, and that is psychostimulants or methamphetamine. Those continue to increase across the nation. They’re being driven all almost entirely by transnational Mexican cartels, and we have been on that problem for about a year right now,” he continued.
Some public health experts, including Dr. Paul Earley, say the solutions produced by Congress and the President are not enough. Specifically, they say they want more sustained funding.
Earley, who sits on the board of directors of the American Society of Addiction Medicine, told CNN that addiction specialists are especially concerned about the rising use of meth and cocaine.
He said meth use is “just a very problematic addiction disorder. We really don’t have any medications to treat it which are nearly as effective.”
“We’re all watching what’s happening with the rise of cocaine related deaths, with the rise in methamphetamine deaths, and most likely … probably in my lifetime, if I live long enough, the heroin use will abate … but we don’t want to be stuck in the same hole (with other drugs),” he added.
Earley said that there needs to be a large scale overhaul of the substance treatment systems in the United States. And though the Trump administration acknowledged the problem, he said, it was “just a drop in the bucket.”
“I think the biggest problem for everyone, including the Trump administration, is to understand that the solutions for addiction do require a huge national will, bold sweeping moves of reform and improvement of our health care system around substance abuse disorders and we’ve made some initial steps, but there’s a lot more to do,” he said.
Office of National Drug Control Policy Director Jim Carroll told CNN in an interview last fall that he is pushing for further funding. However, the administration has not indicated that it would support specific legislation coming out of the new Congress.
Carroll said at the time that his office is focused on “getting more money to help people in the communities.”
But he maintained that the federal government is “spending more money on prevention than ever before.”
“It took us years to get here. It’s going to take us years to get out and it’s going to take a continuation by the administration to push for more money and thankfully, that has bipartisan support. And I’m able to work with members of both sides of the aisle,” Carroll said.
Democrats, including some presidential candidates, have offered their own solutions to the problem.
Sens. Amy Klobuchar and Elizabeth Warren have both proposed dedicating $100 billion toward the crisis. And last congressional session, Warren and the late Democratic Rep. Elijah Cummings introduced legislation proposing changes to the CURES Act.
The White House has not indicated that it would support any of the proposals.