The Trump administration has so far completely botched the national response to the opioid epidemic. More than two months after President Trump described the epidemic to reporters as a “national emergency” and a week after Trump promised to declare it so, the White House stopped short of that designation. Instead, it opted to declare a “public health emergency,” waiving some health-care regulations for states and promising other initiatives in the weeks to come.
But forget for a moment all the silliness at the White House and the thoughtless, off-the-cuff promises from the president. If you want to see legitimate action that could make a significant difference in the crisis, look at the Food and Drug Administration.
FDA Commissioner Scott Gottlieb proposed Wednesday an expansion of long-term (and perhaps even lifetime) access to drugs that treat opioid addiction, such as methadone or buprenorphine. These drugs are opioids themselves, but they are designed to stave off withdrawal symptoms from other opioids — such as heroin, fentanyl and prescription painkillers.
These drugs aren’t perfect. Methadone, in particular, can lead to potentially fatal overdoses if patients take more than the dosage prescribed by doctors. As a result, the drugs have a persistently negative stigma. Critics of the treatment drugs often say that addicts are just substituting one opioid for another. For families and friends supporting addicts — as well as addicts trying to get clean — medicated treatment is just not as good as giving up drug use entirely.
This is why Gottlieb acknowledged that expanding access to non-abstinence-based treatments might make people “uncomfortable,” and why reducing stigma around them is necessary to address the opioid crisis.
But as a practical matter, these drugs are by far the best thing we have to treat opioid addiction. It’s essentially impossible for opioid addicts to walk away from drugs after becoming dependent on them. Detoxification programs almost always result in relapse. And now that highly dangerous synthetic drugs — especially fentanyl — have infiltrated the drug supply, relapse increasingly translates to death.
Study after study has shown that medication-assisted treatment works to substantially reduce opioid-related overdoses. That should be welcome news for American policymakers struggling with an estimated 142 opioid overdose deaths each day. Over the past two decades, in fact, some 500,000 people have died in the United States as a result of the opioid crisis.
Unfortunately, not everyone has the same access to this treatment. Not all insurance plans cover medication-assisted treatment. And regardless, most opioid addicts do not have health insurance, thanks in large part to states that refused to expand Medicaid under the Affordable Care Act.
Gottlieb alone can’t get life-saving treatments into the hands of opioid addicts. But he’s right that this should be the center of the administration’s efforts to address the epidemic. At the very least, Gottlieb’s plan to convene experts in the health-care industry to discuss opioid treatment and to reduce stigma around the drugs is a solid step in the right direction.
Of course, medication-assisted treatment won’t solve the epidemic by itself. The Trump administration could help by sending federal public health money to states hit hardest by the drugs. Meanwhile, lawmakers in Congress and at the state level should be working to make sure the necessary funding is available and to expand coverage to addicts who have fallen through cracks in the health-care system.
But in any case, federal action in addressing the epidemic has stalled for far too many people. It’s relieving to see somebody in the Trump administration finally take the situation seriously.