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How We Will Win the War on Opioids

10 minute read

As a young man, Donald Trump witnessed the pain of addiction in his family. Now as President, he is fighting back.

The numbers around drug addiction in America are staggering. According to the Centers for Disease Control and Prevention, nearly 64,000 Americans died from a drug overdose in 2016 alone—more than three times the age-adjusted rate of drug overdose deaths in 1999. In 2016, an estimated 20.1 million Americans, or about 1 in 13 people aged 12 or older, had a substance use disorder.

For President Donald J. Trump, addiction is more than just a policy issue.

“I had a brother, Fred—great guy, best-looking guy, best personality,” President Trump told those gathered in the East Room of the White House last October. “But he had a problem. He had a problem with alcohol, and he would tell me, ‘Don’t drink. Don’t drink.’ . . . He would say it over and over and over again.”

To this day, the President abstains from drinking. “I had somebody that guided me, and he had a very, very, very tough life because of alcohol.”

As the President’s story shows, addiction is no new phenomenon for America. But the landscape of addiction today looks different. In 2016 alone, drug overdose deaths exceeded the number of Americans killed during the entire Vietnam War. And the majority of these drug overdose deaths—roughly two-thirds—now involve an opioid.

Opioids are a class of drugs that includes everything from heroin to legal prescription pain relievers such as oxycodone, hydrocodone, codeine, and morphine. The increase in deaths involving opioids is so large that it now affects average U.S. life expectancy.

One major driver of the increase in opioid overdose deaths is the growing black market trade of illicit fentanyl and fentanyl analogues, powerful synthetic drugs far more potent than morphine. Another driver is the widespread availability of prescribed opioids. As the number of prescription opioids in America quadrupled from 1999 to present day, overdoses involving these drugs have jumped virtually in lockstep.

the entire trump administration has mobilized to address this crisis

On October 26, 2017, President Trump issued a Presidential Memorandum for the Heads of Executive Departments and Agencies to use all lawful means to combat the drug demand and opioid crisis. He also directed the Secretary of the Department of Health and Human Services to declare the crisis a Public Health Emergency.

“We are already distributing nearly $1 billion in grants for addiction prevention and treatment, and more than $50 million to support law enforcement programs that assist those facing prison and facing addiction,” the President said before signing the memorandum. “We have also launched an $81 million partnership to research better pain management techniques for our incredible veterans.”

The President’s proposed Federal Budget requests $3 billion in new funding in 2018 and $10 billion in 2019 for the Department of Health and Human Services (HHS) to combat the opioid epidemic by expanding access to prevention, treatment, and recovery support services. The funding would also go toward addressing mental health concerns.

When confronting a crisis of this magnitude, the most important factor—and one where government too often falls short—is making sure that every dollar is used effectively. To this end, the Trump Administration’s aggressive and multifaceted response to opioid addiction can best be understood in terms of three categories: demand, supply, and treatment.

1. Preventing drug use initiation and reducing demand: The Administration is promoting prevention efforts and enhanced overdose tracking, helping first responders handle opioid-related incidents, and encouraging safer prescribing practices to lower misuse.

In practice:

  • The $13 billion in new funding proposed for HHS includes resources to support a media campaign aimed at those at risk of opioid abuse and addiction. This new funding would also enhance surveillance efforts and the support given to States to prevent opioid abuse and overdose, including improving state-based Prescription Drug Monitoring Programs (PDMPs).
  • The CDC launched the Rx Awareness Campaign—a large, multimedia campaign that features the real-life stories both of people recovering from opioid addiction and of people who have lost loved ones to opioid overdose.
  • The Office of National Drug Control Policy (ONDCP) administers, in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA), the Drug-Free Communities Support Program. This program strengthens coordination with key sectors and community groups that play a vital role in preventing youth substance abuse.
  • The Food and Drug Administration (FDA) updated its “blueprint” for healthcare provider continuing education, expanding information on the principles of pain management, including how to assess, treat, and monitor patients when opioids are appropriate.
  • The Department of Veterans Affairs (VA) is leading the way in accountability by becoming the first hospital system to release opioid prescribing rates publicly.
  • The Centers for Medicare & Medicaid Services (CMS) have announced several new policies that give Medicare Advantage and Part D health plans additional tools to better manage and prevent chronic and new overuse among beneficiaries.
  • The Department of Justice (DOJ) continues to expand its educational efforts to doctors and pharmacists as these professionals obtain registrations for prescribing medication. Additionally, a number of DOJ components oversee direct campaigns to educate the public, with the heaviest focus going to elementary-aged through college-aged individuals.

2. Cracking down on the bad actors fueling drug supply: The Administration is bringing its tough law-and-order approach to the drug trade by shutting down criminal websites that sell opioids, cracking down on fraudulent prescribers, stopping the production and sale of illicit fentanyl, and preventing illegal drugs from coming into the country in the first place.

In practice:

  • DOJ created the Opioid Fraud and Abuse Detection Unit (OPFAD Unit), a new program that uses data to help combat the opioid crisis. In conjunction with OPFAD Unit, DOJ assigned 12 experienced Assistant United States Attorneys to opioid “hot-spots” to focus solely on investigating and prosecuting opioid-related healthcare fraud.
  • A multi-agency and international effort led by DOJ resulted in the seizure of the largest criminal marketplace on the internet, AlphaBay, greatly disrupting the sale of fentanyl and other dangerous drugs on the internet.
  • DOJ announced a new resource to target traffickers who sell drugs online: the Joint Criminal Opioid Darknet Enforcement team, known as “J-CODE.” J-CODE will coordinate with the Drug Enforcement Administration and across the FBI’s offices internationally to effectively double the investment in the fight against online drug trafficking.
  • DOJ and HHS conducted the largest ever healthcare fraud enforcement action by the Medicare Fraud Strike Force, in which more than 120 people, including doctors, were charged for prescribing and distributing opioids and other dangerous drugs. The fraud scheme was responsible for $1.3 billion in false billings to Medicare and other insurance programs.
  • DOJ announced the first ever indictments against two Chinese manufacturers of deadly illicit fentanyl and fentanyl analogues targeted at customers in the United States.
  • The DEA held two of its National Prescription Drug Takeback Days last year, giving people the opportunity to dispose of unnecessary and potentially dangerous drugs with no questions asked. At the last of these events in October, the DEA took in 912,000 pounds of drugs in one day nationwide.
  • President Trump signed the INTERDICT Act this January, authorizing the appropriation of funds to U.S. Customs and Border Protection to prevent, detect, and interdict the unlawful importation of fentanyl, psychoactive substances, and other narcotics.
  • The DEA initiated a surge to focus on pharmacies and prescribers who are dispensing unusual or disproportionate amounts of drugs, intensifying the fight against prescription drug diversion.

3. Expanding access to evidence-based, world-class care and treatment: The Trump Administration is supporting state and industry innovation to increase access to high-quality treatment, expand the availability of treatment and recovery services, and facilitate life-saving communication between healthcare providers and family members.

In practice:

  • HHS distributed $485 million under the newly created State Targeted Response to the Opioid Crisis grant program, which supports a comprehensive array of prevention, treatment, and recovery services. The President’s Budget proposal includes resources to expand these grants.
  • The CMS announced a bold new policy that encourages States to implement demonstration projects under which Medicaid could cover services for patients in an IMD that would ordinarily not be covered by Medicaid.
  • The Office of Civil Rights at HHS published guidance to ensure that healthcare providers understand their ability to share information with patients’ family members and others involved in the care of patients to prevent and address crisis situations without violating HIPAA privacy rules.
  • SAMHSA has awarded $144 million in grants over three to five years to support opioid and other substance abuse efforts. The Health Resources and Services Administration awarded roughly $200 million to 1,178 health centers to expand mental health and substance abuse services.
  • The $13 billion in new funding proposed for HHS includes resources for increased access to treatment and recovery services in rural areas, within American Indian and Alaska Native communities, and for pregnant and post-partum women.
  • The FDA has approved Sublocade, the first once-monthly, injectable buprenorphine option for opioid use disorder.
  • The Administration is committed to kickstarting innovation to deliver tomorrow’s solutions. The National Institutes of Health (NIH), for example, have begun developing a partnership with innovator companies and the NIH to help facilitate the development of new treatments for pain, addiction, overdose-reversal, and non-addictive therapies. NIH, the Department of Defense, and VA have also announced a joint research partnership of $81 million over six years to support military and veteran pain management research.

In October, as President Trump spoke to the Nation before signing the opioid memorandum, he returned to the story of his brother Fred. The President has firsthand experience to guide his Administration’s core message on drugs: If we can reach children and young adults before they ever start down a vicious path toward abuse, we have a real chance to flip the script on opioid addiction in America.

“I learned because of Fred. I learned. And that’s what I think is so important,” the President said. “It is time to liberate our communities from this scourge of drug addiction.”