President Trump held a meeting with several administration officials on Tuesday to discuss the opioid crisis sweeping the United States. Following the meeting, Health and Human Services Secretary Tom Price told reporters that Trump called the crisis “an absolute priority of his administration, as it has been from day one.”
A priority? From day one? While Trump did sign an executive order establishing the opioid task force in March, and he's emphasized securing the border with Mexico to stem the flow of drugs, the administration has also taken actions that could undermine its ability to get a handle on the crisis.
The opioid crisis is a major issue affecting Trump's base. In 2015, more than 33,000 people died of an opioid overdose, according to the Centers for Disease Control and Prevention. In areas with the highest rate of drug, alcohol, and suicide deaths, Trump outperformed previous Republican candidates, according to a study from Pennsylvania State University. One-fifth of those deaths involved opiates, the study noted.
Last week, a nugget in transcripts from the president's Jan. 27 call with Mexican President Enrique Peña Nieto revealed an unfiltered Trump perspective on how voters in areas particularly hard-hit by the opioid crisis viewed him. On the call, Trump said he won New Hampshire because the state was “a drug-infested den.” Sen. Maggie Hassan (D-N.H.) responded to Trump's comments on Twitter, calling them “disgusting,” before saying his policies to date would prevent the state from getting a real handle on the crisis.
One of those policies is Trump's 2018 budget. The budget proposes major but unspecified cuts to Medicaid, which plays a major role in combating the crisis. Roughly 30 percent of the 2 million people in treatment for an opioid addiction are on Medicaid, according to a report from the Kaiser Family Foundation. Cutting states' funding for the program would reduce the number of people who have access to addiction treatment.
In states like West Virginia, Kentucky and Ohio, which Trump actually won in the general election, unlike New Hampshire, Medicaid accounts for 44 to 50 percent of all spending on buprenorphine, a medication used to treat opioid addiction, according to the report. Despite the White House's budget proposal, when asked by a reporter why the administration is proposing cuts to Medicaid, Price responded unequivocally:
“Nobody is interested in cutting Medicaid,” said Price. “The president's goal is to make certain that we have a health-care system that works for patients.”
If the proposed budget isn't proof enough that someone in the Trump administration wants to cut Medicaid, we can review the president's directive to Congress to repeal and replace Obamacare. Yes, that saga is over, for now. But it is important to point out that millions would have lost Medicaid coverage under the Senate's initial bill. Later versions of the bill included $45 million to address the opioid crisis after several GOP senators from opioid-ravaged states grew concerned that the cuts would make it hard for their constituents to get substance abuse treatment.
In a statement, Sen. Shelley Moore Capito (R-W.Va.) said the initial bill would “not ensure access to affordable health care in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply, and harms rural health-care providers.”
The president has been consistent about one possible solution to the drug crisis: stopping drugs from coming into the United States from the southern border by building a wall along it.
Most recently, at a rally in Youngstown, Ohio, in July, Trump raised the issue again when he assured rally-goers that he has already started making progress on the wall.
“And just so you understand, we've already started fixing much of the good wall that's already there. We've already started fixing it,” he said before adding that the efforts have reduced illegal immigration along the border. “We are cracking down hard on foreign criminal gangs that have brought illegal drugs, violence, horrible bloodshed to peaceful neighborhoods all across our country.”
Advocates for changing drug policy argue focusing on the supply side of the issue hasn't been effective.
“A supply side approach to drugs has never worked,” Bill Piper, senior director for the Drug Policy Alliance, told CNN. “That is what has been tried for decades, and it has failed for every drug it has applied to, including alcohol during Prohibition. As long as there has been [a] demand for drugs, there will be a supply.”
To deal with the crisis, advocates urge officials to focus on getting drug users (the demand side of the equation) into treatment. The president's commission on opioid addiction seems to agree. The commission released an interim report detailing measures the administration could take to deal with the crisis. One of the recommendations is to “rapidly increase treatment capacity” by eliminating Medicaid regulations that prevent states from covering patients who receive treatment in residential facilities with more than 16 beds. Doing so “will immediately open treatment to thousands of Americans in existing facilities in all 50 states,” writes the commission.
In addition to expanding treatment access, the commission also complicates Trump's claim that the central issue fueling the crisis is drugs coming into the United States. “Four out of every five new heroin users begin with nonmedical use of prescription opioids,” writes the commission. “In other words, Mr. President, this crisis began in our nation’s health-care system.”