The year Donald Trump was elected president, drug overdoses killed 63,600 Americans. That was 21 percent more drug deaths than America had seen in 2015, which had been the worst year for such fatalities in our nation’s history. It was also more unnatural deaths than gun violence, HIV/AIDS, or car accidents had ever caused in the United States in a single year. The scale of devastation wrought by the opioid epidemic was so vast, life expectancy in the United States fell for the second consecutive year — the first time that had happened since the early 1960s.
The epidemic’s body count was almost certainly higher in 2017, according to preliminary data from the Centers for Disease Control and Prevention. If the use of synthetic opioids like fentanyl continues to grow at its current rate, Stat News forecasts that more than 650,000 Americans will die from drug overdoses over the next decade — which is to say, slightly more than one would expect to perish if a foreign military power incinerated the entire city of Baltimore.
And yet, in his first State of the Union address, Trump did not offer a single concrete policy proposal for combating this “public health emergency.” Instead, he promised to get “much tougher on drug dealers and pushers”; “get treatment for those in need”; and pass restrictive immigration reforms — asserting, without evidence, that building a border wall and ending “chain migration” would “support our response to the terrible crisis of opioid and drug addiction.”
Then, in one of the speech’s only memorable passages, he told a story about a police officer named Ryan Holets, who came upon a “pregnant, homeless woman preparing to inject heroin.”
When Ryan told her she was going to harm her unborn child, she began to weep. She told him she didn’t know where to turn, but badly wanted a safe home for her baby. In that moment, Ryan said he felt God speak to him: “You will do it because you can.” He heard those words. He took out a picture of his wife and their four kids. Then he went home to tell his wife, Rebecca. In an instant, she agreed to adopt. The Holets named their new daughter Hope.
This is where the story ended. Hope’s mother merited no epilogue. She was the only victim of the opioid crisis mentioned in Trump’s address — and the speech treated her fate as irrelevant. The president did not present her story as a testament to the need for congressional action on opioids, but rather as an affirmation of the fact that “the most difficult challenges bring out the best in America.” In Trump’s framing, the suffering of this opioid addict was less an evil to be remedied than an opportunity for morally upright Americans to demonstrate their virtue.
All this made the president’s anecdote a discomfiting listen — and also a fitting summation of his administration’s approach to the opioid epidemic.
The drug-overdose crisis is concentrated in white, rural America (a.k.a. Trump Country). And on the campaign trail, the GOP nominee pledged to make ending the drug crisis a top priority of his administration. But since taking office, he has put far more effort into promoting policies that would exacerbate the epidemic than into ones that would mitigate it.
The president has tried to pass trillion-dollar cuts to Medicaid, one of the top sources of funding for addiction treatment in the United States; called for reducing spending on preventative anti-drug measures; proposed slashing the budget for the Office of National Drug Control Policy by 95 percent; neglected to nominate anyone to lead the Drug Enforcement Agency; declined to implement the vast majority of his own opioid-commission’s recommendations; declared the opioid crisis a “public health emergency” — but refused to ask for a single penny in additional funding to combat the crisis, even as he called on Congress to add $1.5 trillion to the deficit for the sake of cutting taxes; and put Kellyanne Conway, a career pollster and pundit — with no experience in public health — in charge of his administration’s opioids agenda.
That last decision is working out exactly as one would expect, as Politico reports:
President Donald Trump’s war on opioids is beginning to look more like a war on his drug policy office.
White House counselor Kellyanne Conway has taken control of the opioids agenda, quietly freezing out drug policy professionals and relying instead on political staff to address a lethal crisis claiming about 175 lives a day. The main response so far has been to call for a border wall and to promise a “just say no” campaign.
Trump is expected to propose massive cuts this month to the “drug czar” office, just as he attempted in last year’s budget before backing off. He hasn’t named a permanent director for the office, and the chief of staff was sacked in December. For months, the office’s top political appointee was a 24-year-old Trump campaign staffer with no relevant qualifications. Its senior leadership consists of a skeleton crew of three political appointees, down from nine a year ago.
… The office’s acting director, Rich Baum, who had served in the office for decades before Trump tapped him as the temporary leader, has not been invited to Conway’s opioid cabinet meetings, according to his close associates. His schedule, obtained under a Freedom of Information Act request, included no mention of the meetings. Two political appointees from Baum’s office, neither of whom are drug policy experts, attend on the office’s behalf, alongside officials from across the federal government, from HHS to Defense.
The piece goes on to reveal that:
• Lawmakers “who have been leaders on opioid policy,” like West Virginia senator Shelley Moore Capito, “haven’t seen outreach from Conway or her cabinet.”
• One of the few people working on Trump’s “public education campaign” is “Andrew Giuliani, Rudy Giuliani’s 32-year-old son, who is a White House public liaison and has no background in drug policy.”
• The office’s big idea for combating the drug-overdose crisis is a “just say no”–style ad campaign, which would have premiered during the Super Bowl broadcast, if Conway’s staff hadn’t failed to put it together in time.
If one assumes that the White House sees the drug-overdose epidemic an urgent policy challenge, then these actions appear incomprehensible. Why would you make a pollster your “drug czar,” have her ignore the advice of experts, and make defrosted Nancy Reagan–ism the heart your anti-drug policy?
On the other hand, if one stipulates that the administration sees opioids as a primarily political problem, its actions are easy to understand. If your goal isn’t to reduce drug deaths, but to project the image of working to reduce drug deaths, then handing off that mission to a veteran political operative makes perfect sense; as does focusing your resources on high-visibility remedies (like national ad campaigns) instead of those favored by experts (like expanding access to methadone clinics).
The point isn’t to help Hope’s mother; it’s to mine her suffering for a comforting, politically useful story.
It’s true that there is no silver bullet for Trump to fire at this epidemic; but there is a long list of evidence-based reforms that he could implement to save thousands of Americans from its ravages. To take just one example, the most effective remedy for opioid addiction, bar none, is medication-assisted treatment (MAT). Under MAT, addicts are provided with methadone and buprenorphine — less powerful opioids that satiate most addicts’ cravings, and arrest their withdrawal symptoms, without inducing heroin’s debilitating, euphoric high. Decades of research, the World Health Organization, CDC, and National Institute on Drug Abuse have all demonstrated MAT’s efficacy. Some studies suggest that the treatment reduces mortality among drug addicts by more than 50 percent. And yet, the therapy is only available in about 10 percent of America’s conventional drug-treatment facilities.
The humanitarian case for drastically increasing federal spending to expand access to MAT — and to other forms of addiction treatment and mental health care — is overwhelming. And such an investment is even worthwhile in the most bloodlessly mercenary analysis: In 2015 alone, the opioid crisis cost the American economy $504 billion, according to the White House Council of Economic Advisers.
But, as a practical matter, the case for any policy is only as strong as the political actors behind it. And despite the obscene inadequacy of the administration’s response — and the party’s desperate need to make inroads in rural America — Democrats have devoted relatively little energy to articulating and promoting an alternative vision for combating the worst drug crisis our country has ever known.
Fortunately, that may be changing. Last week, Senators Patty Murray and Elizabeth Warren called on the Government Accountability Office to investigate the the White House’s response to the opioid epidemic.
“Given the severity of the crisis, we have grown increasingly concerned by reports that the President has done little to make use of his public health emergency declaration,” the senators wrote, “leaving state and local communities without the resources they need to fight the opioid epidemic.”
If the White House is going to treat the opioid crisis as a purely political problem, then Democrats must work to make it one of epidemic proportions.
