Like the rash of executive orders he signed in the early months of his administration, President Donald Trump’s Thursday address declaring a national public health emergency to help fight deaths linked to opioids was long on performance and short on substance.
The failure to invest new funding in the project and the vague promise that more policy specifics will be revealed in the coming weeks are symptomatic of Trump’s high-flash, low-focus approach to policymaking.
But even where Trump did offer specifics Thursday, they often stood in direct opposition to the grander policy vision he shares with the traditional GOP. Though he said the government will stop barring drug treatment facilities with more than 16 patient beds from receiving Medicaid reimbursement, for example, the Republican Party continues to seek staggering cuts to Medicaid funding as a whole.
And while Trump chose to use the Public Health Safety Act as the venue for his emergency declaration rather than the broader-reaching Stafford Act — which would have signaled a vast expansion of the criminal justice system’s role in addressing addiction — his speech also made clear he expects law enforcement agencies to be heavily involved in the opioid program.
“I am directing all executive agencies to use every appropriate emergency authority to fight the opioid crisis,” he said.
Attorney General Jeff Sessions’ teams at the Drug Enforcement Agency and the Federal Bureau of Investigation are therefore also being urged to operate in the headlong crisis mode of emergency response. Those agencies bring a specific flavor of authority to bear: more cops, more guns, more nighttime drug raids. Including them in this initiative means more stringent pursuit of those engaged in commerce made possible only by America’s continuing addiction to prohibitionist policies on narcotics.
The sharp heel of federal force may be just as slow to come down on dealers, doctors, and users as the other gradual, vague, and still-to-be-unveiled components of Trump’s big pitch, however. The president did not commit new funding to any law enforcement programs on Thursday, something Drug Policy Alliance expert Bill Piper said might serve as a tell on the White House’s true intentions.
“The other thing to look at is just the rhetoric,” Piper told ThinkProgress. “When Trump talks about opioids or drugs generally, he can get very punitive-sounding. He talks about the law, he talks about Mexican gangs, and Sessions is even worse.”
Such tough talk helps prop up state and local policy ideas that Piper says are deleterious to breaking cycles of addiction and reducing the profitability and violence of engaging in the black markets that American drug policy creates. It is a bright-green “go” sign for people like Maine Gov. Paul LePage (R), whose approach to drug deaths relies on a mix of fulminating rage and virulent, misinformed racism.
“Even though the response to opioids has been less punitive than, say, the response to crack in the 1980s, because of the perception of who’s using, it has turned very punitive in the last couple of years,” Piper said. He noted the rise of civil commitment as a tool to force addicts into court-mandated treatment settings and the increase in homicide prosecutions against drug dealers linked to overdoses.
“Anything that feeds hysteria is probably not going to be good,” said Piper.
Trump did indeed give Sessions’ team special fanfare in Thursday’s speech.
“The Justice Department is aggressively and really valiantly pursuing those who illegally prescribe and traffic in opioids both in our communities and on the internet,” he said, specifically praising the recently announced indictments of two Chinese nationals who allegedly manufactured fentanyl and smuggled it into U.S. markets. Despite the case’s dramatic scope, experts told ThinkProgress at the time, it will do as little to break Americans of their drug habits as Eliot Ness did to keep booze out of American livers in the 1920s.
Trump also rehashed the 1980s notion that the trick to curing drug harm in the United States is to teach kids to never start using in the first place. The “just say no” approach remains popular with many conservatives despite its most obvious failing: 35 years after Nancy Reagan first promoted the phrase on television, drug deaths are still high enough to prompt elaborate political kabuki in the White House East Room.
Even where the president’s remarks seem in total harmony with the consensus recommendations of most mainline public health experts, the promise of those policies is dubious.
On medically-assisted treatment (MAT) programs and research, for instance, Trump took up the public health community’s call for expanding research into new, non-addictive drugs to treat pain.
The most obvious such alternative is well-known. Early research suggests that cannabis is effective both as a step-down alternative for addicts and as a pain management tool for those as yet unafflicted by the pill’s crisis.
Yet Trump’s attorney general is vehemently opposed to even studying the possibility that pot could be a salve to this national wound. And despite promising on Thursday to pursue pharmaceutical titans in court for their role in promoting and mis-marketing opioids for years, Trump’s Drug Enforcement Agency has invited one of those very companies to start selling a synthetic form of cannabis’ active ingredient.