Opioid Crisis: Critics Say Trump Fumbled Response To Another Deadly Epidemic

Oct 29, 2020
Originally published on November 2, 2020 12:43 pm

When then-presidential candidate Donald Trump spoke in Manchester, N.H., a week before the 2016 election, he said the opioid crisis was destroying lives and shattering families.

"We are going to stop the inflow of drugs into New Hampshire and into our country 100%," Trump promised.

It was a major campaign issue. Overdoses were surging in battleground states key to the election, like New Hampshire, Ohio and Pennsylvania.

In 2017 — Trump's first year in office — more than 42,000 Americans died from overdoses linked to heroin, fentanyl and prescription opioids, according to the Centers for Disease Control and Prevention.

Before coronavirus hit, opioids were widely viewed as the nation's top public health crisis.

Trump declared a public health emergency in October 2017, noting that overdoses had joined gun violence and car crashes as a leading cause of death in America.

"No part of our society, not young or old, rich or poor, urban or rule has been spared this plague," he said.

Significant accomplishments followed. Trump signed legislation in 2018 that boosted federal funding for drug treatment. During trade talks with China last year, Trump pushed to slow that country's exports of fentanyl.

"The federal government has taken some important steps to increase access to evidence-based treatment for opioid use disorder," said Beau Kilmer, who heads the Rand Corporation's Drug Policy Research Center.

Kilmer also credits Trump for "pressuring China to better regulate some of its synthetic opioids."

A public health emergency, but no clear leadership

But while some progress was made, critics point to serious missteps behind the scenes that hampered federal efforts, including the decision to sideline and defund the Office of National Drug Control Policy (ONDCP.

An internal memo acquired by NPR in 2017 found the White House was contemplating a 94% cut in resources to the agency, tasked since 1988 with developing and coordinating the nation's drug addiction efforts.

That decision was later reversed but Trump handed leadership of the opioid response to a series of political appointees, including former New Jersey Gov. Chris Christie and White House adviser Kellyanne Conway.

"This made it difficult for people to understand, you know, who's leading and coordinating the effort on opioids," Kilmer said.

Still, there seemed to be some success, with opioid deaths dipping slightly in 2018. "This sign of progress is an example of what can happen when an administration prioritizes an issue," said ONDCP director Jim Carroll in a statement earlier this year.

But in 2019, the number of overdoses surged again to a new record with more than 50,000 opioid-related fatalities. The CDC's preliminary data shows another big increase in deaths during the first four months of 2020.

U.S. went two years without a national strategy

Researchers also say fentanyl has continued to spread fast, despite interdiction efforts, contributing to more overdose deaths in the western United States where the synthetic opioid had been scarce.

In December, the Government Accountability Office issued a report blasting the administration for failing to come up with a coherent national opioid strategy as required by law.

"ONDCP did not issue a national drug control strategy for either 2017 or 2018," the GAO concluded.

The ONDCP declined an interview request for this story, but a spokesman told NPR in an email that the agency has addressed the GAO's concerns and is once again functioning in full compliance.

"ONDCP has released several documents that together address all of the statutory requirements that GAO noted as missing," the spokesman said.

But in recent months, even some members of the Trump administration have begun voicing alarm.

"Basically everything is pointed in the wrong direction," said Adm. Brett Giroir, assistant secretary for health and an opioid policy expert at the Department of Health and Human Services.

During a panel discussion in late July, Giroir described recent increases in opioid overdoses as "a nightmare," adding that "all the progress that we made has been reversed and this is even before the pandemic."

Trump attack on Affordable Care Act threatens opioid response

Drug policy experts say things could grow even worse in the months ahead if Trump is successful in dismantling the Affordable Care Act.

The program created during the Obama administration subsidizes state Medicaid programs that provide insurance coverage for roughly 40% of Americans receiving opioid addiction treatment.

"We've seen very large increases in the number of individuals going to treatment programs," said Brendan Saloner, a researcher at Johns Hopkins Bloomberg School of Public Health.

If the Supreme Court strikes down the ACA, as Trump has urged, those gains in insurance coverage and care would likely be reversed.

"The situation is bleak and it could be a lot bleaker," Saloner said.

Meanwhile, Democrat Joe Biden has released a plan of his own promising to end the overdose crisis if he's elected. His number one policy idea? Preserve and expand the Affordable Care Act.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

AILSA CHANG, HOST:

The coronavirus is not the first deadly epidemic faced by President Trump. Four years ago, Trump campaigned on a promise to stop America's growing wave of opioid overdoses. Instead, overdose deaths have risen, and critics say the drug fight has been hobbled by mismanagement and lack of planning. NPR addiction correspondent Brian Mann reports.

BRIAN MANN, BYLINE: A week before the last presidential election, candidate Donald Trump gave a speech in Manchester, N.H. The opioid crisis, he said, was destroying lives, shattering families.

(SOUNDBITE OF ARCHIVED RECORDING)

PRESIDENT DONALD TRUMP: We are going to stop the inflow of drugs into New Hampshire and into our country...

(APPLAUSE)

TRUMP: ...One hundred percent.

MANN: During President Obama's last year in office, overdoses were surging, especially in battleground states like New Hampshire, Ohio and Pennsylvania key to the election. This from ABC News.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER: In suburban neighborhoods across America, the calls are coming in...

UNIDENTIFIED PERSON: An overdose.

UNIDENTIFIED REPORTER: ...All of them heroin overdoses.

MANN: The year Trump took office, more than 42,000 Americans died from overdoses linked to heroin, fentanyl and prescription opioids. Before coronavirus hit, this was the health crisis grabbing headlines. In October 2017, Trump declared a national public health emergency.

(SOUNDBITE OF ARCHIVED RECORDING)

TRUMP: No part of our society - not young or old, rich or poor, urban or rural - has been spared this plague, drug addiction.

MANN: Some successes followed. Trump signed legislation boosting federal funds for drug treatment. And during trade talks with China last year, he pushed to slow that country's exports of fentanyl. Those actions have drawn praise from experts like Beau Kilmer, who heads the RAND Corporation's Drug Policy Research Center.

BEAU KILMER: The federal government has taken some important steps to increase access to evidence-based treatment for opioid use disorder and made some progress at pressuring China to better regulate some of its synthetic opioids.

MANN: But critics also point to serious missteps behind the scenes that hobbled federal efforts, including the decision to sideline the Office of National Drug Control Policy, which has orchestrated the country's drug response since the 1980s. Instead, Trump handed leadership of his opioid effort to political appointees, including former New Jersey Governor Chris Christie and White House adviser Kellyanne Conway.

Again, Beau Kilmer.

KILMER: This made it difficult for people to understand, well, you know, who's leading and coordinating the efforts on opioids.

MANN: Still, for a time, there seemed to be some progress, with opioid deaths declining slightly in 2018. Then the number of overdoses surged again last year to record levels. More than 50,000 people died. Researchers say fentanyl continues to spread fast, killing more and more people. Last December, Congress' Government Accountability Office issued a report blasting the administration for failing to come up with a coherent national drug control plan two years in a row, as required by law. Even some members of the administration began voicing alarm.

(SOUNDBITE OF ARCHIVED RECORDING)

BRETT GIROIR: Basically, everything is pointed in the wrong direction. You know, it's just a - it's just a nightmare.

MANN: Admiral Brett Giroir is assistant secretary of health and a senior adviser on opioid policy in the Department of Health and Human Services. He spoke during a panel discussion in July.

(SOUNDBITE OF ARCHIVED RECORDING)

GIROIR: All the progress that we made has now been reversed. And this is even before the pandemic.

MANN: As Trump's first term winds to a close, there's one more issue that alarms many drug policy experts. Trump has fought to dismantle the Affordable Care Act, but that policy subsidized the expansion of state Medicaid programs that now fund roughly 40% of opioid addiction treatment in the U.S. Brendan Saloner is a researcher at Johns Hopkins Bloomberg School of Public Health.

BRENDAN SALONER: In the states that went forward with the Medicaid expansion, we've seen very large increases in the number of individuals actually going to treatment programs.

MANN: Even if Trump loses the election, the Supreme Court he reshaped could strike down the Affordable Care Act. Critics say that would likely leave hundreds of thousands of people suffering opioid addiction without access to care at a time when overdose deaths are surging again.

Brian Mann, NPR News.

(SOUNDBITE OF MOGWAI'S "DONUTS") Transcript provided by NPR, Copyright NPR.