Patrick Bailey, April 9, 2019

Patrick Bailey is a professional writer mainly in the fields of mental health, addiction, and living in recovery. He stays on top of the latest news in the addiction and the mental health world and writes about these topics to break the stigma associated with them.

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 Donald Trump rode to the presidency in 2016 in part on the wave of a hard-line solution to the immigration problem on our southern border. A large part of that solution was a southern border wall that he said would greatly reduce the flow of drugs, undocumented workers, and criminals.

Trump also proposed other plans to reduce the demand for and over-prescription of legal but addictive drugs. In his 2018 , Trump expressed his commitment “to fighting the drug epidemic and helping get treatment for those in need.”

Two years into his presidency, the border wall has received vehement pushback from many across the country and internationally. Are other parts of his drug plan working as expected? Not really.

In December 2016, just before Trump took office, the number of national drug overdose deaths was almost 64,000. In 2017, the number surpassed 70,000 . This number is greater than the fatalities from road accidents, gun-related violence, terrorism, or HIV/AIDS yearly. Even worse, only about 10% of all Americans with a drug problem receive specialized substance abuse treatment.

Looking Back

The US has a relatively long history of poor response to health crises—only acting after millions have suffered and thousands of lives have been lost.

The cost of health care has been and continues to be a crisis in the medical care system in America. President Nixon, on July 10, 1969, declared a health care crisis that marked the first attempt to execute sweeping reforms across the medical care system, which would go beyond mere insurance coverage expansion. In 1974, he presented a more detailed plan.

However, the crisis continued unabated. In 2009, the national expenditure on health was 17.3% of GDP compared to 6.9% in 1970. In 2016, the Centers for Medicare and Medicaid Services (CMS) reported an additional 17.9% growth in health expenditures. Fifty years after Nixon’s first initiative, the Trump administration acknowledges that the crisis continues.

Another example was America’s slow response to the HIV/AIDS epidemic in the 1980s. It wasn’t until 1990 that the government responded by passing the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. In 1991, the federal government appropriated a $220.6 million to fight HIV/AIDS. It took twenty years to increase that amount to a robust $2.29 billion.

Slow Response

Response to the opioid crisis is following the same path as previous health crises. Rather than spending more time and resources on the actual drug problem—as declaring the Opioid Crisis a National Emergency, rather than the weaker Public Health Emergency, would have allowed—and saving many lives, the Trump administration chose to try to stop the flow of illegal drugs from Mexico by building a porous southern border wall that smugglers can go around, over, or under.

Much of America’s problems dealing with crises have been due to flagrant inaction. People with the power to effect change from above simply will not do it or are influenced by popular opinion. Perhaps because America is so large and diverse, its people express more concern for and only get personally involved in issues that affect them directly.

Participation in political and public policy debates often is limited to the portion of the populace who are affected directly by specific issues. Voter apathy, may explain why there are so few confrontations between the public and the government about the opioid crisis: it doesn’t directly affect enough people.

An economic crisis that directly affects many more people, always results in faster mobilization. (The cost of health care affects more people than the opioid crisis, too, but the costs are disguised because of employer-provided health insurance.) The opioid crisis simply generates less political action than economic issues.

Is the US Doing Enough?

Is Trump’s administration doing enough to solve the opioid crisis in this country? Despite a blue-ribbon President’s Commission on Combating Drug Addiction and the Opioid Crisis, many, including New Jersey senator and Democratic presidential hopeful Cory Booker don’t think so.

In February 2019, Booker tweeted, “The failed war on drugs has really been a war on people—disproportionately criminalizing poor people, people of color, and people with mental illness.”

Many voices have expressed similar concerns over how effective the Trump administration’s plans are at confronting the opioid threat  . Some experts believe Trump’s drug plan is a lot of talk with little action.

Any permanent solution to the drug problem in America must encompass:

• An amalgam of more treatment options, including replacement drugs and holistic practices.
• Harm reduction policies such as needle replacement and safe injection sites.
• Prescribing dangerously addictive drugs only when needed, in the right dosage, and for a limited time.
• Increased access to treatment programs and substance abuse rehabilitation centers.
• Policies that address the causes of the problem rather than just react to it.
• Mental health diagnosis programs to detect co-existing mental illness (dual diagnosis).

Some of these strategies have been advocated by the president’s opioid commission, but they have received little executive branch attention.

Perhaps most revealing, is that spending on other health concerns such as HIV/AIDS now far outstrips the budget allocated for the opioid crisis.

In 2018, Congress added $3.3 billion to programs aimed at addressing the addiction crisis through the FY2018 Omnibus Appropriations Bill. The total spending on those programs, was $7.4 billion. In comparison, in the same fiscal year, HIV/AIDS programs received $32 billion.

The opioid crisis is greatly underfunded although it is currently acknowledged as among the deadliest crises in the US.. Does this mean that more funding is the solution to this crisis? Certainly not, but it would help.