What President Trump gets wrong about the opioid epidemic
The President's declaration of a "National Public Health Emergency" falls well short of tackling the scourge of opioid overdose deaths
President Trump addressed the nation Thursday before signing a presidential memorandum declaring the opioid epidemic, the leading cause of unintentional death, a National Public Health Emergency. Trump apparently reversed his Aug. 10, 2017 decision to declare the opioid epidemic a National Emergency.
The distinction is important. A presidential declaration of a National Emergency last occurred on Sept. 14, 2001, and carries with it the full weight of the federal government to make sweeping changes. Recall that the weeks and months after 9/11 brought an overhaul to aviation passenger screening, the creation of a new federal agency with a new cabinet secretary and massive spending on terrorism-related equipment, training and infrastructure for EMTs, paramedics, firefighters and police officers.
A National Public Health Emergency is limited in time and scope. It must be renewed every 90 days and doesn't include any new or immediate funding for the law enforcement departments, EMS agencies, hospitals, treatment centers and social service organizations that are not keeping up with the growing rates of opioid use, fentanyl availability and death.
1. Willpower is not a definitive treatment for addiction
The president told a moving anecdote about his brother's alcohol addiction and his regular admonitions of the president to never drink.
"And to this day, I've never had a drink. And I have no longing for it. I have no interest in it," Trump said about alcohol.
Trump seems to be advocating that personal choice is the treatment for addiction and that addicts, like his brother, simply need to try harder. Drug addiction is a brain disease that's not treatable with an increased dose of willpower.
First Lady Melania Trump recognized the limits of willpower in her opening remarks. Describing a man who lost a friend to an opioid overdose she said, "His friend was not weak-minded. In fact, like so many of our kids today, he was competitive and strong-willed."
Willpower must be accompanied by medical and mental health interventions.
2. "Just say no to drugs" advertising has never worked
Drug abstinence programs aimed at middle schoolers and teenagers have limited efficacy and miss the root causes of use and addiction. Prescribed medications, not street drugs, are the top entry point to opioid addiction.
The president includes advertising as a top initiative to combat the opioid epidemic.
"A massive advertising campaign to get people, especially children, not to want to take drugs in the first place because they will see the devastation and the ruination it causes to people and people's lives," Trump said.
Just a few minutes earlier, he put into stark contrast the use of heroin versus prescription opioids.
"Last year, almost one million Americans used heroin, and more than 11 million abused prescription opioids."
The money that will be spent on "massive advertising" lessens the available funds for law enforcement, prehospital care and addiction treatment services. "Just Say No" didn't work in 1982 and we can't expect it to have a significant impact on death reduction 35 years later.
3. Medicine cabinet cleanup is a drop in the ocean
The president called on all Americans to participate in this fight by "participating in the National Prescription Drug Take-Back Day this Saturday. When you can safely turn in these dangerous and horrible drugs for disposal, that will be a wonderful, wonderful period of time for you. "
I am all for a bit of household clean up and safe disposal of dangerous items. But the scope of this effort — turning over a few pills from a long-past prescription — is throwing a drop of water in the ocean. Americans are prescribed more opioids than any country in the world. Fentanyl and fentanyl derivatives are easily obtainable by mail order.
I'd encourage the president to think much bigger about how Americans can participate in the fight against the opioid epidemic, starting with:
- Accept that "some pain" is a better alternative than "pain free" after an injury or medical procedure.
- Learn to recognize the signs of an opioid overdose and activate 9-1-1 immediately.
- Learn how to use naloxone and advocate for its broad, over-the-counter, low-cost availability for first responders, addicts, and friends and family of addicts.
- Accept that addiction is a brain disease and advocate for addiction-related research and treatment to be funded like other diseases.
4. Expert leadership is needed at every level
I appreciate the first lady's involvement is this cause. The opioid crisis is more lethal and more devastating to more families than cyberbullying. The degree to which she can bring continuing and elevated awareness to the tragic consequences of the epidemic is appreciated and important.
Since the president first mentioned a national emergency, 75 days ago at the time of this writing, more than 13,650 Americans have died from an opioid overdose — more than four times the number of people killed on 9/11. The president, without a Health and Human Service Secretary or a Director of National Drug Control Policy, a.k.a. Drug Czar, is understaffing the crisis from the moment his response starts.
Trump also made the emergency declaration before receiving the final report of the presidential commission that has been studying the issue. The commission's draft report recommended a presidentially declared national emergency.
The lack of expert leadership and the president's actions taken before receiving the commission's expert-based recommendations is a very concerning launch to his efforts to combat the epidemic.
EMS keeps addicts alive until they are ready for treatment
EMS continues to be on the front lines of the opioid crisis in a way that is unrecognized, unheralded and unappreciated. Yesterday, Trump only mentioned "first responders" in passing, didn't say the word "naloxone" and has given no indication if he will follow the commission's draft recommendation to give HHS authority to negotiate reduced naloxone pricing for all governmental units.
Meanwhile, I expect EMTs and paramedics, with their colleagues in law enforcement and fire service to keep doing what they do best — keep addicts alive with naloxone, ventilation, treatment referrals and compassion until they are ready for addiction treatment.