The Trump Administration and America’s Opioid Epidemic
Written by Adekunle O. Adejare PharmD’19
Published on October 26, 2017
For several years now, the number of opiates prescribed in America has steadily risen. With the advent of more readily available opiates, an epidemic of significant proportions has taken root in America. Since entering office, President Trump has had to figure out his current plan to deal with this epidemic.
The Trump administration started off its tenure by creating a committee to determine what possible measures could control the problem. The committee consists of Governors Charlie Baker and Roy Cooper, Congressman Patrick J Kennedy, Professor Bertha Madras, Ph. D, Florida Attorney General Pam Bondi, and is chaired by Governor Chris Christie. The mission of this committee is to: 1) reduce the number of individuals addicted to opiates; 2) prevent more people from becoming addicted to opiates; and 3) allow states more freedom towards dealing with the problem. The committee, made up of mainly politicians, could easily be criticized as ill equipped to build policies for the opioid epidemic. One criticism is the lack of healthcare experts on the team. The only qualified member of the committee to discuss addiction treatment is Bertha K. Madras. Such an oversight could easily lead to treatment strategies being ignored, dismissed or unheard. So, this could lead to more opinions determining policy than fact. However, the committee held many meetings wherein they discussed the best propositions towards dealing with the opioid epidemic with healthcare providers. The result was a document with many excellent ideas.
President Trump’s follow through on his committee’s ideas has been less than ideal. Instead of calling for a state of emergency, he has called for a national public health emergency, which does not allocate additional funds for the opioid epidemic. This is consistent with the long-term goal of the Trump administration to create a more fiscally responsible nation, but clashes with the goal of directly addressing the opioid crisis. To achieve this fiscal goal, the administration called for a complete redesign of the modern federal government via the slashing of budgets and elimination of “unnecessary” agencies. Another long-term goal of the Trump administration has been the repeal and replacement of the Affordable Care Act (ACA). These two positions run quite contrary to the healthcare initiative of dealing with the opioid epidemic. Between repealing the ACA, slashing many agencies’ budgets, and not declaring a full state of emergency, the Trump administration is taking away valuable funding to fight this national crisis. This is because one of the largest recipients of cuts would be Medicaid, which is unquestionably one of the biggest driving forces towards helping fight the opioid epidemic. Medicaid is so inherently valuable that some of the proposals given by Trump’s committee specifically advocate for the expansion of the use of Medicaid to help with substance use disorders. Here in lies the first intrinsic problem that the Trump administration is facing. While the administration wants to spend less money, if the epidemic expands, the long-term cost of addiction could fundamentally damage America. It would cost more in the long term to fix than it would be to spend the money now. At the same time, there is a reluctance to acknowledge the importance of listening to current consensus about basic facts. This is evidenced by Health and Human Services Secretary Tom Price’s remarks on medication assisted treatment. As one of the most powerful individuals in healthcare, Dr. Price’s statement shows an unwillingness to defer judgement to fellow clinicians with more expertise than he, or even examine current data with a fair and level judgement. The original trigger for the opioid epidemic came from the need to treat chronic pain. Be that as it may, the true folly of the medical community came not in the decision to use opiates, but in the mistake of not researching how to deal with pain in the first place.
With too little data, opiates were prescribed for long-term use of treating chronic pain. With too much vigor, the medication was pushed by manufacturing companies to boost profits. The fundamental lapse of judgement was not researching data to deal with the issue of chronic pain and instead relying on opinion to make life altering decisions. By not accepting the full recommendations of the committee, President Trump’s administration risks finding a novel approach to repeating the same mistake that started the opioid epidemic in the first place.
Categories: Department of Health Policy and Public Health, Public Health, Opioids, Mayes College of Healthcare and Business Policy, Department of Pharmaceutical and Healthcare Business, Health Policy, Substance Use Disorders Institute