Trump’s Approach to Drug Addiction, the Opioid Epidemic

Days after winning the election, President-elect Donald Trump backed away from several of the hard stances he took during his presidential campaign. The future president seemed more willing to rely on advisors to help him decide how to approach a variety of topics.

That means the future of the country’s drug policy may be heavily dependent on who is appointed to lead the Department of Health and Human Services, the Department of Justice, the Department of Homeland Security, and the Office of National Drug Control Policy.

One thing is certain, though. Immigration and the securing of the Mexican border will be a big part of the next president’s policy. For more than a year, Trump said that securing the border would keep drugs out of the country and help end the opioid epidemic.

It wasn’t until the final month of the election that he offered specific strategies for preventing and treating drug addiction.

“A wall will not only keep out dangerous cartels and criminals, but it will also keep out the drugs and heroin that’s poisoning our youth,” Trump said at a New Hampshire rally on Oct. 15.

At the campaign stop, Trump praised his running mate, Mike Pence, for increasing mandatory minimum sentences for “the most serious drug offenders” while expanding treatment access for people with substance use disorders. He blamed prescription drugs, long waiting lists and missed opportunities in the criminal justice system for leading to increases in drug overdoses.

“We will not only stop the drugs from pouring in,” Trump said. “We will help all of those people so seriously addicted. We’ll get them assistance. We’ll make sure that they have the top treatment and get better.”

Trump said he would help people affected by addiction through:

Increased law enforcement and border control:

  • Stopping illegal drugs from getting into the country
  • Dismantling drug cartels within the country
  • Aggressively prosecuting drug traffickers by supporting law enforcement and prosecutors
  • Removing shipping loopholes that allow Chinese traffickers to send drugs such as fentanyl through the mail

Regulatory reform:

  • Quickening the FDA approval process for abuse-deterrent drugs
  • Ending regulations that prevent doctors from prescribing abuse-deterrent medications
  • Lifting the cap on the number of patients that can be treated for addiction if doctors follow safe prescribing practices
  • Reducing the number of Schedule II opioids that can be produced in the United States

Increased access to treatment:

  • Ending Medicaid policies that prevent patients from seeking inpatient treatment
  • Expanding access to naloxone to prevent overdose deaths
  • Holding the VA accountable for failing to monitor opioid prescriptions to veterans

The recovery community would likely be enthusiastic about expanded use of medication-assisted treatments, such as buprenorphine, expansion of naloxone access and insurance reform that allows more patients to have access to residential treatment.

But accelerating the FDA approval process could allow drug companies to claim, without adequate proof, that experimental drugs are difficult to abuse — something Purdue Pharma claimed about OxyContin in 1996. OxyContin became the most widely abused prescription drug in the United States.

It also seems unlikely that a wall at the border will completely stop drugs from entering the country, but if the president could stop fentanyl from being distributed through the mail, it would be a major victory for law enforcement.

Trump has also praised Congress for passing the Comprehensive Addiction and Recovery Act and said he would expand incentives for states to use drug courts and mandatory treatment.

“Together, these steps will ensure that every American struggling with addiction has access to the care and the help that he or she needs,” Trump said.

He also said he would combat risk factors for addiction by bringing jobs back to the community and ending poverty. Helping individuals in recovery find jobs could significantly boost recovery outcomes.

How Trump Advisors Will Shape Drug Policy

Trump has weakened his stance on several positions in the days following his presidential win. He backed away from building a wall, saying it could be a fence on some parts of the border. He shied away from assigning a special prosecutor to investigate Hillary Clinton, and he said he would keep several aspects of the Affordable Care Act.

It appears his cabinet could have a large influence on how he follows through with several promises.

Trump’s secretary of the Department of Health and Human Services would likely handle issues regarding access to treatment, FDA regulation and Medicaid reform. The new attorney general would lead efforts to reschedule drugs and pursue drug traffickers, and the new director of the Department of Homeland Security would lead border control efforts.

The new director of the Office of National Drug Control Policy, commonly referred to as the drug czar, would work with HHS, the Justice Department, DHS, the states and other agencies to coordinate drug policies across the country. Trump’s choice for each position remains unclear.

Former New York City mayor Rudy Giuliani’s name has been mentioned for several key positions. Dr. Ben Carson was once seen as a candidate to lead HHS or the Education Department, but he publicly said he will not accept a cabinet position after the election. New Jersey Gov. Chris Christie may have also weakened his chances of securing a cabinet position after his involvement in a political scandal in his state.

Amending the Affordable Care Act

Trump has swiftly backed away from his promise to completely repeal the Affordable Care Act. In a “60 Minutes” interview aired on Nov. 13, Trump said he would keep aspects of the ACA, including coverage for preexisting medical conditions.

“It happens to be one of the strongest assets, also with the children living with their parents for an extended period,” Trump told CBS’s Lesley Stahl. “We’re going to very much try and keep that.”

The ACA was praised by the recovery community because it made substance use disorders an essential health benefit. Trump hasn’t said how he’ll handle essential health benefits, but he hasn’t seemed keen on changing health insurance coverage for specific conditions.

He’s spoken more about allowing insurance to be sold across state borders and reforming Medicaid. It remains to be seen how Trump and the Republican Party’s new health care plan will affect people seeking treatment for substance use disorders.

Marijuana Legalization

The marijuana legalization movement may be just as unsure about Trump’s views on cannabis as the recovery community is about his plans to revamp health insurance.

Trump has said he supports medicinal marijuana and that he’s open to letting states decide how to handle recreational marijuana, but many of his potential cabinet members, including Pence and Giuliani, have opposed legalizing the drug.

His new attorney general could revoke the federal government’s position outlined in the Cole Memo, written under former Attorney General Eric Holder during the Obama administration. The memo told federal prosecutors to allow states that have legalized marijuana to regulate and enforce marijuana production, distribution, possession and consumption.

Trump hasn’t indicated that he wants to start a legal battle between states and the federal government over marijuana, but the Republican Party’s platform is strongly against marijuana legalization.

During the campaign, Trump was quick to stray from the party’s position on several topics. But since he was elected, he’s seemed more eager to work with the GOP establishment.

With the number of people dying of drug overdoses at an all-time high, Trump’s approach to drug addiction has the potential to save thousands of lives. The wrong approach could allow the epidemic to continue.

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