The Washington PostDemocracy Dies in Darkness

Opinion The solutions to the opioid crisis are clear. Trump just resists them.

An example of the amount of fentanyl that can be deadly, at a June 2017 news conference in Arlington. (Jacquelyn Martin/AP)
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Correction, May 25: An earlier version of this article incorrectly stated that President Trump mentioned the drug fentanyl 57 times during his 2016 campaign, when in fact he referred to heroin.

“We have to start talking about solutions,” Kellyanne Conway, ostensibly the White House opioids policy coordinator, said this week.

Start? Really?

We can’t blame our opioid crisis on President Trump. The epidemic pre-dates not only his administration but his entire jaunt into Republican politics.

But it took Trump nine months to even mention fentanyl publicly as president, The Post reported this week. His administration has ramped up law enforcement action against the drug, but to the dismay of Trump’s own advisers on the issue, he has neglected any action on prevention or treatment. Trump also sidelined the White House’s Office of National Drug Control Policy — which is responsible for coordinating federal drug policy — and left it leaderless until early this year. He also waited until late 2017 to declare a largely toothless “public health emergency.” A year later, he and his Republican cohort in Congress signed into law a bipartisan package that almost everyone supported, but few believed would significantly address the crisis. The legislation added at most $8 billion in new funding over five years — far less than recommended by Trump’s own commission on the crisis.

The response to these facts? “It can’t all be gloom and doom,” said Conway. “You can’t just have the negative, harrowing, so-sad statistics of grief and loss and devastation. We have to start talking about solutions.”

Trump came into office at the exact time that leadership was so desperately needed. Yet he and his fellow Republicans have not only failed to take the lead, they have pretended to make the crisis a priority while offering only perfunctory policy solutions. If we take one lesson from the first three years of the president’s drug policies, it is this: Trump owns the fentanyl crisis.

As The Post’s report makes clear, Trump was well aware of the epidemic even before his administration began. He campaigned on addressing the opioid crisis, specifically mentioning heroin (not fentanyl, the potent synthetic opioid responsible for the most recent surge in overdose deaths in the United States) 57 times during his speeches and appearances.

But, of course, Trump tried to paint the drug as an issue of border security, suggesting that building a wall along the southern border would stop the problem. Most of the pure fentanyl arriving in the United States, however, comes from China. In other words, Trump used the issue as a political prop with no intention of addressing its real causes once in office.

We know what is needed to address this crisis, but the problem is that Republicans and the Trump administration have resisted it from day one.

First and foremost, we need to expand access to medication-assisted treatment. This would require a massive overhaul of the distribution system for addiction-therapy drugs such as buprenorphine (designed to reduce cravings for opioids) to make it easier for doctors to prescribe them and for patients to afford them. We would also need to expand access to health care for low-income Americans. That would involve encouraging states to expand Medicaid — not attempting to repeal the Affordable Care Act via lawsuit or adding burdensome work requirements to the program.

In other words, we need a massive investment from the government — tens of billions of dollars each year. Without it, all we will have is more “gloom and doom."

Overdoses have leveled off of late, but synthetic opioid overdoses remains so prevalent, that in areas where the epidemic has hit hardest, people almost yearn for the days when heroin was the primary drug ravaging their communities. Fentanyl has also begun to infect the supply of cocaine and methamphetamines, leading to massive spikes in overdoses among other drug users.

To be clear, President Barack Obama’s administration ignored the pleas from the health-care community as the fentanyl crisis was starting to balloon. But Trump’s inaction is not excused by his predecessor’s failures. (And Obama did enact one of the largest expansions of health care for low-income Americans in history.)

More than two years into Trump’s administration, Trump has reneged on his promise to fight for the forgotten men and women of the opioid crisis. As the body count rises ahead of the 2020 election, we’ll see whether he’ll have to answer for his failures, or whether his base will let him off the hook on the crisis, too.

Read more:

Josh Rogin: The U.S. shouldn’t take China at its word on fentanyl

The Post’s View: China promised to ban a range of opioids. The U.S. should hold Beijing to it.

John Pomfret: Why is China refusing to stop the flow of fentanyl?

Robert Gebelhoff: The opioid epidemic is no mistake. It is the result of complicity and greed.