President Trump announced this week his administration’s plan to combat the opioid epidemic. The president in his speech mostly ignored the strong recommendations made by the Commission on Combating Drug Addiction and the Opioid Crisis and advocated for stricter law enforcement and increased federal drug prosecutions. Trump also called for improved prevention efforts, but suggested that the best way to prevent people from misusing opioids is to simply convey how “no good, really bad for you” they are. While Trump later announced his intention of declaring a national emergency, his emphasis on enforcement of this epidemic as a criminal matter rather than stressing the need for access to evidence-based prevention and treatment services is detrimental to the fight against the epidemic.
In a groundbreaking report released in 2016, the Surgeon General called SUD a “chronic condition that can be effectively managed with medications and other [behavioral] treatments.” That report is notable in that it called for a shift in the public response to the epidemic from an emphasis in law enforcement to public health-based interventions. It commended the previous administration’s effort to place non-violent drug offenders in treatment instead of jail, the exact same efforts that President Trump harshly criticized in his announcement. The report also emphasized the importance of early intervention and increasing access to medication-assisted treatment (MAT) for people with SUD, instead of criminal prosecutions, as the most effective way of reducing the impact of the epidemic.
Democrats and Republicans alike agree with this approach, as evidenced by the bipartisan passage of the Comprehensive Addiction and Recovery Act and the 21st Century Cures Act. These laws are expected to play a critical role in fighting the epidemic not only because they provide increased funding for expanded access to MAT and naloxone, but also because they seek to reduce the role of the criminal justice system. The statutes highlight the importance of diversion programs that direct people detained for low-level drug law violations away from the criminal justice system and into treatment services. They also provide support for training of law enforcement officials in how to manage situations involving persons with mental illnesses and SUD, and call for the establishment of drug and mental health courts. Increasing federal prosecutions for drug violations runs counter to these evidence-based approaches and would undermine the criminal justice reform sought by Congress to fight the epidemic.
An emphasis on law enforcement also fails to address the overuse of legally prescribed opioid pain relievers (OPRs). In 2014, 40 percent of all opioid-related overdoses involved the use of OPRs. Prescription opioids are also a significant risk factor for illicit drug use, as studies have shown that individuals who have an SUD involving OPRs are more likely to initiate heroin use. This underscores the importance of addressing the overprescribing of opioids for pain, with measures like the establishment of prescription drug monitoring programs (PDMP) and opioid prescribing limits. Increasing law enforcement efforts does nothing to address these issues and in fact shifts the focus away from evidence-based practices.
Trump’s statement also highlights a blatant misunderstanding of how SUDs work. Individuals with SUD experience cravings for these substances despite the fact that they know that their overuse can have devastating consequences in their lives. Simply having a discussion about the effects of opioid addiction is not an effective approach to their condition. What is needed is for individuals with SUD to be able to seek affordable treatment without fear of prosecution. Declaring a national emergency is a step in the right direction, but this declaration will be undermined if, as the president has consistently proposed, federal funding for SUD treatment is cut and if the role of law enforcement is increased. These actions will drive people with SUD underground and away from life-saving prevention and treatment services, worsening the epidemic and inevitably leading to an even higher number of overdose deaths.