State of the Union: Trump shouldn’t brag about his opioid epidemic response

President Donald Trump used Tuesday’s State of the Union tackle to take credit score for a latest drop in drug overdose deaths and a reversal within the opioid epidemic.

“With unyielding dedication, we’re curbing the opioid epidemic,” Trump stated. “Drug overdose deaths declined for the primary time in almost 30 years. Among the many states hardest hit, Ohio is down 22 %, Pennsylvania is down 18 %, Wisconsin is down 10 % — and we won’t stop till we now have crushed the opioid epidemic as soon as and for all.

It’s true that the variety of drug overdose deaths within the US fell in 2018 — the primary time that occurred in 28 years, in keeping with the Centers for Disease Control and Prevention. Total drug overdose deaths declined from greater than 70,000 in 2017, the very best overdose dying toll on file, to greater than 67,000 in 2018.

After many years of a worsening drug overdose disaster that’s now tied to just about 770,000 deaths since 1999, the Four % decline is a welcome improvement. It does include caveats: 2018’s overdose dying toll was nonetheless the second highest in US historical past (after 2017), and there are crimson flags within the information that recommend issues may nonetheless get even worse. Nonetheless, it’s excellent news.

However Trump doesn’t deserve the credit score for the drop. The insurance policies that probably led to a drop in overdoses largely preceded him, and Trump, regardless of all his speak on the marketing campaign path, simply hasn’t carried out a lot on the disaster total.

Trump’s drug coverage and well being care proposals may even make the opioid disaster worse, not higher. From his requires repealing Obamacare and cutting Medicaid to his advocacy for a wall at the US-Mexico border and the death penalty for drug dealers, his administration’s concepts vary from the dangerous to ineffective in the case of addressing the opioid disaster.

That America is now seeing some excellent news within the opioid epidemic, then, could very nicely be regardless of Trump, not due to him.

The overdose numbers expose Trump’s failures

Trump’s failure is made clear within the precise overdose information.

The majority of the decline in overdose deaths appears to be linked to a drop in painkiller overdose deaths of almost 16 %. That’s probably a results of authorities and different efforts to get docs and different prescribers to cut back on opioid prescriptions. Though the US still generally prescribes far more opioids than the rest of the world, these efforts have been considerably profitable, with prescriptions steadily falling since 2010.

However that’s the factor: These efforts have been profitable since 2010 — seven years earlier than Trump took workplace. A lot of the federal government messaging relating to overprescribing, just like the CDC’s 2016 opioid prescribing guidelines, preceded Trump, even when he has stored such efforts going.

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In the meantime, overdoses in different areas are literally going up. Drug overdose deaths linked to artificial opioids excluding methadone — notably illicit fentanyl, which is more and more changing heroin on the black market — elevated by 10 %. Overdose deaths involving stimulants with misuse potential, notably meth, elevated by almost 22 %. Cocaine overdose deaths elevated by almost 5 %.

If these will increase proceed and prescription opioid overdose deaths plateau, as consultants warn is possible, the general overdose numbers may proceed their climb up once more. This wouldn’t be unprecedented; drug overdose deaths appeared to plateau round 2012 earlier than reaching new file highs within the ensuing years.

That is the place Trump’s failure turns into clear: Particularly as individuals lose entry to painkillers, a few of them, notably these nonetheless hooked on opioids, will hunt down different, cheaper highs. That’s one purpose why consultants have long advised that it’s not sufficient to drag again on opioid prescriptions however to additionally make investments in dependancy remedy, hurt discount insurance policies, and different efforts that may tackle underlying causes of drug dependancy.

But Trump has lengthy uncared for these areas. Whereas Congress did attain a deal to extend spending on the epidemic, notably remedy, by $3 billion each year and tweak some regulations to hurry up responses to the opioid disaster, that’s nonetheless removed from the tens of billions consultants say is needed to really scale up dependancy care. The efforts even have carried out little to enhance laws and oversight on the dependancy remedy system, which often fails to follow evidence-based practices but loads patients with as much as tens of thousands of dollars in payments and debt — if they can afford treatment at all.

The result’s the first protection to America’s dependancy downside is failing, with just one in 10 individuals with a drug use dysfunction looking for specialty remedy on any given yr, based mostly on federal data. And Trump hasn’t carried out a lot to alter that.

In reality, what Trump has proposed would make dependancy remedy even much less accessible. He’s repeatedly called for repealing the Affordable Care Act (“Obamacare”) and advocated for cutting Medicaid. The ACA alone expanded access to well being care, together with dependancy remedy, to tons of of 1000’s of individuals with addictions. A recent study in JAMA Community Open linked Obamacare’s Medicaid growth to a 6 % discount in opioid overdose deaths.

On hurt discount, Trump’s file is as weak. His surgeon basic, Jerome Adams, has pushed extra individuals to hold the opioid overdose antidote naloxone — step. However Trump’s administration hasn’t carried out something important to increase needle exchanges, some of the confirmed hurt discount methods with many years of proof behind it. And his administration has actually fought some cities and states on their plans to ascertain the primary legally sanctioned protected injection websites within the US (though, in equity, the proof for these websites is still a bit weak, if promising).

Different Trump concepts can be largely ineffective

One factor Trump has carried out is declare a public well being emergency over the opioid disaster. However that led to nearly nothing, because the Authorities Accountability Workplace concluded in a report. (The emergency declaration even lapsed for 9 days in January, as Dan Diamond reported for Politico, and nobody appeared to note.)

In any other case, Trump has boasted in regards to the capability of a wall on the US-Mexico border to cease the circulate of medicine into the US — an concept that consultants have widely panned, not least as a result of most medication really come by authorized ports of entry {that a} wall does nothing about. He additionally known as for using the death penalty on high-level drug dealers, which is discredited by the body of research displaying more durable legal penalties don’t sluggish the circulate of medicine into the US.

Mandel Ngan/AFP through Getty Photos

Trump’s administration has carried out some good issues in regards to the opioid disaster. The Meals and Drug Administration specifically has taken steps to extend oversight and analysis on opioid painkillers, whereas encouraging extra entry to dependancy remedy and extra improvement of anti-addiction medicines. The White Home’s opioid epidemic fee additionally put out some good recommendations for addressing the overdose disaster, a few of which had been adopted in subsequent laws.

Requested for remark, the White Home additionally referred me to a list of the administration’s coverage efforts previously three years, together with regulation enforcement applications and regulatory adjustments in addition to the launch of FindTreatment.gov.

However what the administration has really applied and carried out falls in need of the large response that advocates and consultants argue is critical to reverse the deadliest overdose disaster in US historical past. After we’re speaking a couple of public well being disaster that kills extra individuals within the US yearly than gun violence, automotive crashes, and HIV/AIDS ever did, just a few billion {dollars} and a few regulatory tweaks and legal guidelines “tinkering around the edges” of the difficulty simply aren’t going to chop it.

So it’s excellent news that drug overdose deaths fell in 2018. But it surely doesn’t mean victory over the opioid epidemic yet. And Trump can’t actually take credit score for what occurred, anyway.