President Donald Trump called for stiffer penalties for drug dealers pushing fentanyl—possibly including the death penalty—as he touted his administration’s approach to the opioid epidemic Thursday, while other administration officials emphasized the importance of treatment and public education.
“Some countries have a very, very tough penalty, the ultimate penalty, and, by the way, they have much less of a drug problem than we do,” Trump said at a White House summit attended by law enforcement, experts, and families impacted by the nation’s soaring rates of opioid overdose deaths.
The event, moderated by senior adviser Kellyanne Conway, reflected on the first year of the Trump administration’s fight against a class of drugs that killed more than 42,000 Americans in 2016 and looked ahead to steps the White House has proposed for the future.
“Our unified goal is that of helping all who have been affected by drug addiction,” said First Lady Melania Trump in her opening remarks. “And, for me, that means focusing on babies and young mothers, which is something I have been often seeing in my travels.”
Cabinet officials discussed work their agencies are doing on prevention, treatment, and enforcement.
Housing and Urban Development Secretary Ben Carson stressed the importance of housing for people trying to recover from addiction and the growing universality of the opioid problem.
“It can be any of us at any time,” Carson said. “It is so easy to get addicted. It has nothing to do with socio-economic class or anything like that.”
Attorney General Jeff Sessions spoke of criminal and civil aspects of the Department of Justice’s opioid policies, and he identified some of the successes it has already had in the interception of drugs and prosecution of offenders.
“We’re going to make a difference,” Sessions said. “I can sense it already.”
According to Debra Houry, director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention, the opioid situation is already improving in some ways but it is getting worse in others.
“When we’re seeing more fentanyl, we’re seeing more people die because the drug itself is so deadly,” she said in an interview before the summit, “but we are starting to see that prescribing is either decreasing or leveling off, so we’re not fueling the pipeline of people getting addicted.”
The CDC’s focus right now is on improving data collection and analysis to support local communities, and on preventing people from becoming addicted in the first place.
“How do we have quicker, more actionable data, so that if a community is experiencing overdoses, they know where in their community and how to target it in a timely fashion,” Houry said.
That includes using “syndromic surveillance,” technology typically utilized to track bioterrorism and food outbreaks, that Congress has now provided appropriations to fund in 32 states.
“CDC’s goal six months from now is really to expand the surveillance program and make sure that states can monitor this data, know how to use it in local communities, as well as to really expand the prescribing guideline we developed so it’s used by all health care providers,” Houry said.
The White House issued a fact sheet Thursday detailing its efforts to stem the tide of death and addiction, including:
A commission examining the epidemic headed by then-New Jersey Gov. Chris Christie produced a final report in November, and the White House said steps are already being taken to implement its recommendations.
Experts are encouraged that the Trump administration continues to shine a spotlight on the crisis, but they say more action is needed to put a dent in the damage the drugs are doing.
“I still value and respect the commitment of key members of the administration to this issue,” said Stefan Kertesz, a professor at the University of Alabama-Birmingham School of Medicine who recently briefed officials at the Centers for Medicare and Medicaid Services on prescription control. Placing responsibility on political adviser Conway rather than a public health expert has attracted some criticism, but he sees benefits in someone with ear of the president spearheading the initiative.
The shift in overdose deaths from prescription drugs to fentanyl must be met with new approaches, according to Regina Labelle, a fellow at the Duke-Margolis Center for Health Policy and former senior policy adviser and chief of staff in the White House Office of National Drug Control Policy under President Barack Obama.
“The issue of fentanyl is somewhat new, but that just means we have to continue what we had been doing and add in additional policies that will address the fentanyl deaths,” Labelle said.
President Trump declared a public health emergency last October, and that designation was recently renewed. It falls short of the national emergency that some advocates had sought and it has had relatively few tangible ramifications, but Kertesz and Labelle said it was still a significant step.
“I’m a little less cynical than some people,” Kertesz said. “I think it matters that the president and the government state that something matters. It is a problem that there hasn’t been enough action, but you cannot take action until the administration declares something to be a serious priority.”
“I think it was more of a symbolic gesture, but an important symbolic gesture for people who lost loved ones due to the opioid epidemic,” Labelle said.
The president’s recent comments on the issue have often centered on law enforcement, but experts say a balance between the public safety and public health components of the government’s response is essential.
“I think it’s pretty conventional for health care providers to say we can’t arrest our way out of this problem,” Kertesz said, “but if somebody could somehow stop illicit fentanyl from coming in in the mail, that would be very helpful.”
The Department of Justice announced this week that it intends to file a statement of interest in support of lawsuits filed by hundreds of cities and counties against opioid makers accusing them of false and deceptive marketing practices.
“President Trump and this administration have made ending this unprecedented crisis a priority, and the Department of Justice is committed to using every lawful tool at our disposal to turn the tide,” Sessions said in a statement. “We will seek to hold accountable those whose illegality has cost us billions of taxpayer dollars.”
At a meeting with state attorneys general Tuesday, Sessions also revealed DOJ will appoint a Prescription Interdiction and Litigation Task Force that will target opioid manufacturers and distributors.
“We will use criminal penalties,” he said. “We will use civil penalties. We will use whatever tools we have to hold people accountable for breaking our laws.”
Sessions said at Thursday’s summit that DOJ is looking for other civil actions it can take as well.
“The litigation is an important step toward righting past wrongs with the pharmaceutical industry,” Labelle said.
The White House is seeking increased spending to address the epidemic, including $3 billion in 2018 and $10 billion in 2019, but its proposed budget would slash funding of the Office of National Drug Control Policy by 95 percent to $17.4 million and shift its two main grant programs to different agencies.
While more money to fight opioids is welcome, Labelle warned that the unique role the ONDCP plays in coordinating policies across departments could be diminished.
“I think that office is particularly important because it is the neutral arbiter sometimes between public health and public safety,” she said.
Kertesz stressed that the amount of money being spent matters less than how it is being spent, and he has not seen detailed enough plans from the administration to judge how effective they could be.
Congress is also stepping up its effort to combat the spread of opioids after voting for $6 billion in additional spending in a two-year budget agreement last month.
Bipartisan legislation introduced Tuesday would limit initial prescriptions for opioids to three days, make it easier to prescribe buprenorphine, increase use of prescription drug monitoring programs, require the government to develop standards for addiction recovery housing, and authorize $1 billion for addiction treatment and prevention programs.
“The funding that’s been looked at on the Hill is important,” Labelle said.
Some states already have regulations limiting opioid prescriptions to three days. She expects such a policy would reduce the rate of prescriptions, but it is not yet clear what the full impact would be.
“I think that’s a topic that needs to be thoroughly vetted,” she said.
Kertesz is much more skeptical of the Senate proposal.
“I think it’s ridiculous,” he said, questioning whether the difference between a three-day supply and a six-day supply is really going to prevent addiction. Mandating restrictions on all patients could have unintended consequences, but there are legitimate concerns about prescribers giving patients too large of a supply.
“I would fully concede that many times doctors and dentists give prescriptions that are simply too large that leave pills on the shelf for teenagers and young adults to take,” he said.
That fact points back to a larger issue that doctors are not sufficiently trained to treat pain and addiction, and medical professionals need education in over-prescribing and identifying people with disorders.
“It was an issue that was kind of created through the medical community and a lot of it can be addressed in the medical community also,” Labelle said.
Kertesz also emphasized the role of job training and employment assistance for people trying to rebuild their lives during recovery, a factor sometimes overlooked amid debates over punishment and treatment.
“I would like to see significant increases in funding for treatment,” he said. “I’d like to see an insistence that there be access to medication as part of the treatment plan buttressed by social support and work opportunities.”