Photo Credit: Screenshot via YouTube.com, CNN
The Trump administration has pledged to address addiction nationwide. Now they’re playing their hand and we’re not impressed. We’ve seen the president declare a national emergency without any new funding, an approach to Medicaid innovation that expands residential care but downplays prevention and recovery supports, and the administration’s own Opioid Commission offering a blueprint that focuses too much on limiting access to opioids. Most troubling is the return to old, failed policies of the “war on drugs.” Here’s a rundown of recent administrative actions:
First, the good
The Opioid Commission’s final report recommends robust youth-focused prevention to address substance use before problems develop and cites school-based screening, brief intervention, and referral to treatment (SBIRT) as a best practice. In the treatment sector, the report calls for Medicaid to pay for more residential treatment and medications for addiction and suggests strengthening enforcement of the federal Mental Health Parity and Addiction Equity Act by authorizing more rigorous federal monitoring and fining of insurance companies that violate the law. The commission also recommends federal and state agencies foster expansion of recovery housing. Separately, new guidance from the Centers for Medicare and Medicaid Services encourages states to create Medicaid demonstration projects that expand residential treatment and use of medication-assisted treatment (MAT).
Now, the bad
Half of the commission’s 56 recommendations involve monitoring prescribing and trafficking of opioids. While improvements are needed in this arena, this emphasis shortchanges the broader tactics needed to tackle all substance use disorders. In addition, the administration’s new Medicaid demonstration guidance doesn’t mention prevention strategies like SBIRT or long-term recovery supports such as transportation, employment, housing and peer support services.
The ugly
The criminal justice strategies in the commission’s report steer us dangerously close to reviving the war on drugs. The proposal calls for expanding drug courts into every federal judicial district. Despite the good intention of the model, drug courts can be coercive and force people into inappropriate or ineffective treatment and lead to harsher criminal sentences. Comprehensive pre-arrest or pre-booking diversion models are a better approach for linking people to services and supports.
Even more concerning is the call for harsher sentencing penalties for fentanyl-related offenses. It seems the commission wants to stop large-scale drug trafficking while offering compassionate treatment and support to consumers with substance use disorders. But we know it often doesn’t play out that way. We’ve seen similar policies lead to lenience for white communities and disproportionately severe sentencing in communities of color, particularly among black and Latino youth.
All of these concerns are heightened by the rhetoric from the administration. We have a president citing ineffective “just say no” approaches and Attorney General Jeff Sessions backing punitive responses to addiction.
Alcohol and drugs are responsible for 416 deaths every day in the U.S. We need a comprehensive national response, rooted in evidence-based public health approaches. Consumer advocates need to remain vigilant and fight back against misguided and dangerous proposals. We need to promote broader evidence-based strategies and listen to what consumers need through meaningful engagement with individuals who have substance use disorders, current drug users not currently seeking treatment and people in recovery.