President Trump on Monday laid out his plan to end the opioid epidemic in a speech that focused heavily on punitive measures — including executing some drug dealers — while also pledging to hold pharmaceutical companies accountable for their role in fostering addiction.

In a wide-ranging speech, Trump touched on the need for greater access to treatment, praised companies that are making “lifesaving overdose-reversing drugs” and promised a public-awareness campaign to deter youths from taking drugs. He also reiterated his call to build a wall on the U.S.-Mexico border, saying that it would help reduce the flow of illegal narcotics, a claim many experts dispute.

But the president was most animated in his advocacy to “get tough” on drug crime, saying it was central to his goal of ending “the scourge of drug addiction in America once and for all.”

“If we don’t get tough on drug dealers, we are wasting our time, and that toughness includes the death penalty,” Trump said. “We have got to get tough. This isn’t about nice anymore.”

The president’s focus on punitive measures alarmed some in the public health community. They fear that it will overshadow proposals from the White House and in Congress for prevention and treatment.

The White House is also calling for Congress to reduce the threshold needed to impose mandatory minimum sentences on people who are convicted of dealing fentanyl, a synthetic opioid that can kill people in small quantities and caused the overdose death rate in New Hampshire to skyrocket. 

“A significant emphasis of the president’s speech and president’s plan was on supply reduction and law enforcement, including enhanced criminal penalties and even the death penalty,” said Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center and the drug czar under President Barack Obama. “I think that we have known throughout the recent history of the United States that has not solved our drug problem here in the United States.”

Botticelli said a focus should be on strategies that immediately expand access to treatment.

In his remarks at a community college here, Trump said the administration is “looking very seriously at bringing litigation” against some drug companies. The Justice Department did not comment on what its plans might be on this front.

Earlier this month, Attorney General Jeff Sessions, who accompanied Trump to New Hampshire, announced that a new task force would target drug manufacturers for their roles in the opioid epidemic, raising the possibility of filing charges against them. The department also said it would file a statement of interest in hundreds of lawsuits brought against drug companies by municipalities around the country, with the federal government seeking repayment for damages. 


President Trump delivers remarks on the opioid crisis during his visit to Manchester Community College in New Hampshire. (Jonathan Ernst/Reuters)

Trump chose to make his announcement here in New Hampshire, which has the nation’s second-highest overdose death rate. He was flanked by members of law enforcement and at one point allowed the parents of a man who died of an overdose to speak onstage about their son, who became addicted to drugs after taking a prescription opioid and later died of an overdose. 

The administration is also making a marketing and education campaign part of its strategy to fight opioids. Trump spoke in front of a banner that read: “OPIOIDS: THE CRISIS NEXT DOOR.” The president said the administration will be “spending a lot of money on great commercials” to show the dangers of drugs. 

“That’s the least expensive thing we can do, where you scare them from ending up like the people in the commercials,” Trump said. “And we’ll make them very bad commercials; we’ll make them very unsavory situations.”

But there is concern about how the administration will pay for its broader plan. Funding for opioid programs was boosted by $6 billion in a budget deal passed last month, but many think that is not enough to make a dent in the crisis, and that any money should be directly allocated to the places that are hardest hit.  

“We need resources, not rhetoric,” Baltimore Health Commissioner Leana Wen said in a statement. “The President discussed funding today, but where are the resources for local jurisdictions hardest hit? Cities and counties have been fighting the opioid epidemic for years. We know what works, and any delay will cost further lives.

Speaking to reporters on Air Force One, White House counselor Kellyanne Conway acknowledged that the opioid epidemic might get worse before it gets better and that fighting it will require “a lot more money.” She said the administration wants a larger package of $13 billion.

Conway also said that Trump wants to use existing laws on the death penalty for “very specific high-level cases” involving drug traffickers. 

The Trump administration’s policies largely reflect those started under the Obama administration. Trump’s plan includes expanded access to medication-assisted treatment, where people are slowly weaned off opioids under a doctor’s supervision or given an injection of a medication that blocks opioids from working on the brain. 

The Trump administration is calling for a national prescription-drug-monitoring database, where prescriptions can be tracked across the country. Each state has its own system and some share data. The administration also wants to cut opioid prescriptions by one-third nationwide. 

“The plan contains some important steps that will increase access to effective, evidence-based treatment, particularly Medication-Assisted Treatment for opioid addiction,” Chuck Ingoglia, senior vice president for public policy and practice improvement at the National Council for Behavioral Health, said in a statement. 

Before his speech, the president and first lady Melania Trump stopped at the Manchester Central Fire Station, which is part of a “Safe Station” initiative to offer the city’s firehouses as sites for drug users to visit when they need help.

Joined by New Hampshire Gov. Christopher T. Sununu (R) and Manchester Mayor Joyce Craig (D), Trump greeted firefighters and hailed the safe station as a national model.

“You save a lot of lives,” Trump told the assembled firefighters and officials before accepting a fire helmet from the chief, which Trump termed “the real deal.”

The trip was Trump’s first to the nation’s first primary state since the 2016 election. Though it was not billed as a political visit, Trump noted at the outset of his remarks that he had held an early campaign event in the same room at the community college.

He later referenced plans to be in office seven more years, prompting some applause from the crowd. “A lot of voters in this room, I see,” Trump responded.

At another point, chants of “build the wall” rang out, as it did during his campaign rallies, when Trump referenced his long-promised plan for a border barrier.

Trump’s victory in the Granite State’s 2016 GOP primary set his campaign on a course to win the nomination. His campaign vigorously contested New Hampshire in the general election but fell short to Democrat Hillary Clinton. Trump blamed the loss on voter fraud, which was an unsubstantiated claim.