How We Will Win the War on Opioids
March 1, 2018
10 minute read
As a young man, Donald Trump witnessed the pain of addiction in his family. Now as President, he is fighting back.
The numbers around drug addiction in America are staggering. According to the Centers for Disease Control and Prevention, nearly 64,000 Americans died from a drug overdose in 2016 alone—more than three times the age-adjusted rate of drug overdose deaths in 1999. In 2016, an estimated 20.1 million Americans, or about 1 in 13 people aged 12 or older, had a substance use disorder.
For President Donald J. Trump, addiction is more than just a policy issue.
“I had a brother, Fred—great guy, best-looking guy, best personality,” President Trump told those gathered in the East Room of the White House last October. “But he had a problem. He had a problem with alcohol, and he would tell me, ‘Don’t drink. Don’t drink.’ . . . He would say it over and over and over again.”
To this day, the President abstains from drinking. “I had somebody that guided me, and he had a very, very, very tough life because of alcohol.”
As the President’s story shows, addiction is no new phenomenon for America. But the landscape of addiction today looks different. In 2016 alone, drug overdose deaths exceeded the number of Americans killed during the entire Vietnam War. And the majority of these drug overdose deaths—roughly two-thirds—now involve an opioid.
Opioids are a class of drugs that includes everything from heroin to legal prescription pain relievers such as oxycodone, hydrocodone, codeine, and morphine. The increase in deaths involving opioids is so large that it now affects average U.S. life expectancy.
One major driver of the increase in opioid overdose deaths is the growing black market trade of illicit fentanyl and fentanyl analogues, powerful synthetic drugs far more potent than morphine. Another driver is the widespread availability of prescribed opioids. As the number of prescription opioids in America quadrupled from 1999 to present day, overdoses involving these drugs have jumped virtually in lockstep.
THE ENTIRE TRUMP ADMINISTRATION HAS MOBILIZED TO ADDRESS THIS CRISIS
On October 26, 2017, President Trump issued a Presidential Memorandum for the Heads of Executive Departments and Agencies to use all lawful means to combat the drug demand and opioid crisis. He also directed the Secretary of the Department of Health and Human Services to declare the crisis a Public Health Emergency.
“We are already distributing nearly $1 billion in grants for addiction prevention and treatment, and more than $50 million to support law enforcement programs that assist those facing prison and facing addiction,” the President said before signing the memorandum. “We have also launched an $81 million partnership to research better pain management techniques for our incredible veterans.”
The President’s proposed Federal Budget requests $3 billion in new funding in 2018 and $10 billion in 2019 for the Department of Health and Human Services (HHS) to combat the opioid epidemic by expanding access to prevention, treatment, and recovery support services. The funding would also go toward addressing mental health concerns.
When confronting a crisis of this magnitude, the most important factor—and one where government too often falls short—is making sure that every dollar is used effectively. To this end, the Trump Administration’s aggressive and multifaceted response to opioid addiction can best be understood in terms of three categories: demand, supply, and treatment.
1. Preventing drug use initiation and reducing demand: The Administration is promoting prevention efforts and enhanced overdose tracking, helping first responders handle opioid-related incidents, and encouraging safer prescribing practices to lower misuse.
In practice:
The $13 billion in new funding proposed for HHSincludes resources to support a media campaign aimed at those at risk of opioid abuse and addiction. This new funding would also enhance surveillance efforts and the support given to States to prevent opioid abuse and overdose, including improving state-based Prescription Drug Monitoring Programs (PDMPs).
The CDC launched the Rx Awareness Campaign—a large, multimedia campaign that features the real-life stories both of people recovering from opioid addiction and of people who have lost loved ones to opioid overdose.
The Office of National Drug Control Policy (ONDCP) administers, in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA), the Drug-Free Communities Support Program. This program strengthens coordination with key sectors and community groups that play a vital role in preventing youth substance abuse.
The Food and Drug Administration (FDA) updated its “blueprint” for healthcare provider continuing education, expanding information on the principles of pain management, including how to assess, treat, and monitor patients when opioids are appropriate.
The Department of Veterans Affairs (VA) is leading the way in accountability by becoming the first hospital system to release opioid prescribing rates publicly.
The Centers for Medicare & Medicaid Services (CMS) have announced several new policies that give Medicare Advantage and Part D health plans additional tools to better manage and prevent chronic and new overuse among beneficiaries.
The Department of Justice (DOJ) continues to expand its educational efforts to doctors and pharmacists as these professionals obtain registrations for prescribing medication. Additionally, a number of DOJ components oversee direct campaigns to educate the public, with the heaviest focus going to elementary-aged through college-aged individuals.
2. Cracking down on the bad actors fueling drug supply: The Administration is bringing its tough law-and-order approach to the drug trade by shutting down criminal websites that sell opioids, cracking down on fraudulent prescribers, stopping the production and sale of illicit fentanyl, and preventing illegal drugs from coming into the country in the first place.
In practice:
DOJ created the Opioid Fraud and Abuse Detection Unit (OPFAD Unit), a new program that uses data to help combat the opioid crisis. In conjunction with OPFAD Unit, DOJ assigned 12 experienced Assistant United States Attorneys to opioid “hot-spots” to focus solely on investigating and prosecuting opioid-related healthcare fraud.
A multi-agency and international effort led by DOJresulted in the seizure of the largest criminal marketplace on the internet, AlphaBay, greatly disrupting the sale of fentanyl and other dangerous drugs on the internet.
DOJ announced a new resource to target traffickers who sell drugs online: the Joint Criminal Opioid Darknet Enforcement team, known as “J-CODE.” J-CODE will coordinate with the Drug Enforcement Administration and across the FBI’s offices internationally to effectively double the investment in the fight against online drug trafficking.
DOJ and HHS conducted the largest ever healthcare fraud enforcement action by the Medicare Fraud Strike Force, in which more than 120 people, including doctors, were charged for prescribing and distributing opioids and other dangerous drugs. The fraud scheme was responsible for $1.3 billion in false billings to Medicare and other insurance programs.
DOJ announced the first ever indictments against two Chinese manufacturers of deadly illicit fentanyl and fentanyl analogues targeted at customers in the United States.
The DEA held two of its National Prescription Drug Takeback Days last year, giving people the opportunity to dispose of unnecessary and potentially dangerous drugs with no questions asked. At the last of these events in October, the DEA took in 912,000 pounds of drugs in one day nationwide.
President Trump signed the INTERDICT Act this January, authorizing the appropriation of funds to U.S. Customs and Border Protection to prevent, detect, and interdict the unlawful importation of fentanyl, psychoactive substances, and other narcotics.
The DEA initiated a surge to focus on pharmacies and prescribers who are dispensing unusual or disproportionate amounts of drugs, intensifying the fight against prescription drug diversion.
3. Expanding access to evidence-based, world-class care and treatment: The Trump Administration is supporting state and industry innovation to increase access to high-quality treatment, expand the availability of treatment and recovery services, and facilitate life-saving communication between healthcare providers and family members.
In practice:
HHS distributed $485 million under the newly created State Targeted Response to the Opioid Crisis grant program, which supports a comprehensive array of prevention, treatment, and recovery services. The President’s Budget proposal includes resources to expand these grants.
The CMS announced a bold new policy that encourages States to implement demonstration projects under which Medicaid could cover services for patients in an IMD that would ordinarily not be covered by Medicaid.
The Office of Civil Rights at HHS published guidance to ensure that healthcare providers understand their ability to share information with patients’ family members and others involved in the care of patients to prevent and address crisis situations without violating HIPAA privacy rules.
SAMHSA has awarded $144 million in grants over three to five years to support opioid and other substance abuse efforts. The Health Resources and Services Administration awarded roughly $200 million to 1,178 health centers to expand mental health and substance abuse services.
The $13 billion in new funding proposed for HHSincludes resources for increased access to treatment and recovery services in rural areas, within American Indian and Alaska Native communities, and for pregnant and post-partum women.
The FDA has approved Sublocade, the first once-monthly, injectable buprenorphine option for opioid use disorder.
The Administration is committed to kickstarting innovation to deliver tomorrow’s solutions. The National Institutes of Health (NIH), for example, have begun developing a partnership with innovator companies and the NIH to help facilitate the development of new treatments for pain, addiction, overdose-reversal, and non-addictive therapies. NIH, the Department of Defense, and VA have also announced a joint research partnership of $81 million over six years to support military and veteran pain management research.
In October, as President Trump spoke to the Nation before signing the opioid memorandum, he returned to the story of his brother Fred. The President has firsthand experience to guide his Administration’s core message on drugs: If we can reach children and young adults before they ever start down a vicious path toward abuse, we have a real chance to flip the script on opioid addiction in America.
“I learned because of Fred. I learned. And that’s what I think is so important,” the President said. “It is time to liberate our communities from this scourge of drug addiction.”
LEARN MORE ABOUT THE TRUMP ADMINISTRATION’S RESPONSE TO THE OPIOID CRISIS
ECONOMY & JOBS
Issued on: March 1, 2018
Cabinet Room
12:17 A.M. EST
THE PRESIDENT: Thank you very much everyone. We have with us the biggest steel companies in the United States. They used to be a lot bigger, but they’re going to be a lot bigger again.
And we have the big aluminum companies in the United States. And they’ve been very unfairly treated by bad policy, by bad trade deals, by other countries. They’ve been horribly treated by other countries, and they have not been properly represented. More importantly, because of that, workers in our country have not been properly represented.
So we’re going to build our steel industry back and we’re going to build our aluminum industry back. And I just want you to hear from a couple of the folks in the room. We’ll have a few speak.
But I might want to start with Dave Burritt from U.S. Steel. It was a massive company years ago, and got smaller and smaller and smaller. And Dave was with Caterpillar for 35 years —
MR. BURRITT: Thirty-three years, yeah.
THE PRESIDENT: Thirty-three years. And did a great job. They brought him in. He’s been there for a short while, and he wants to build it back up.
Dave, maybe you could say a little bit to the room and to the press about U.S. Steel and where they were, where they’re going, and what you think of what we’re going to do.
MR. BURRITT: Well, thank you, Mr. President.
THE PRESIDENT: Thank you.
MR. BURRITT: And thank you very much for your leadership on this issue. And also, Commerce Secretary, thank you, sir, very much. This is vital to the interests of the United States. This is our moment, and it’s really important that we get this right.
The alternatives that the Commerce Secretary presented were all good alternatives, and we trust your judgment, in terms of the ones to be selected. We believe that the leadership that this administration has shown on tax reform is simply outstanding. The elimination of bureaucracy is simply outstanding. We trust your judgment on this issue.
And having been somebody that has global views and believes in free trade, we know when it’s completely unfair. We are not protectionists. We want a level playing field. It’s for our employees; to support our customers. And when we get this right, it will be great for the United States of America. We have to get this done.
THE PRESIDENT: And for your company and for your workers and for so much else, even the security of our own nation.
MR. BURRITT: Absolutely.
THE PRESIDENT: You like the tariffs that we’re talking about. You like the tariffs where they won’t be dumping on our country. What they do is they dump massive amounts of product on our country, and it just kills — it destroys our companies and our jobs. And it’s been happening for so many years, and we are not the beneficiary.
You feel tariffs are the answer?
MR. BURRITT: Yes, sir. The transshipments that go on, which you are well aware of — we call it the Whac-A-Mole game. It’s time for Whac-A-Mole to end. It’s time for some fairness here. It’s past time.
THE PRESIDENT: People have no idea how badly our country has been treated by other countries, by people representing us that didn’t have a clue. Or if they did, then they should be ashamed of themselves because they’ve destroyed the steel industry, they’ve destroyed the aluminum industry, and other industries, frankly, when you look at all the plants, the car plants, automobile plants that moved down to Mexico for no reason whatsoever, except we didn’t know what we were doing.
So we’re bringing it all back. John, could I ask you to say a few words?
MR. FERRIOLA: Absolutely. We believe very strongly — first of all, thank you —
THE PRESIDENT: Thank you.
MR. FERRIOLA: — for the work that you’ve done as Secretary. We appreciate all the work that’s been done on this issue. We believe very strongly that it’s time for decisive and meaningful action to stem the flow of illegally traded imports into this country. And we are counting on the administration to fulfill the promises that were made and to give us that level playing field to compete.
We are confident — we have 25,000 teammates that — I always say, we’re confident, if they are given a level playing field, they will out-compete any company and any country in the world. All we want is a level playing field. And, today, we’re not getting that. The cheating is phenomenal. The amount of circumvention that takes place is incredible.
Just look at last year. Last year, Mr. President, the imports increased 15 percent in 2017, over 2016. Once we initiated the beginning of the 232, other countries saw this as the need to get in before it went into effect.
So what we’re asking for today is fast action and action that will last.
THE PRESIDENT: Well, you know, I tell the story that, a couple of months ago, we put tariffs on washing machines coming into the country, because they were dumping the machines all over the place and we had lost our manufacturing abilities for washing machines. Now we have plants being built; put a 30 percent tariff on. And we have plants being built, and nobody has seen that in many, many years, and it’s happening at a rapid pace.
Same thing with the solar panels. We had 32 companies, of which 30 of them were out of business, they were closed. And the two were on mouth-to-mouth resuscitation. They were finished. They would have closed pretty quickly.
And now, the two are doing much better and they’re talking about opening seven or eight of the old plants that were closed. And they weren’t even so old — the solar panels.
So, a lot of good things could happen. The fact is, we weren’t treated, and we haven’t been treated fairly by other countries. But I don’t blame the other countries. When I was in China, I said, “Listen, President Xi” — I have a lot of respect for President Xi. I said, “I don’t blame you.” If you’re able to get away with making almost $500 billion a year off of our country, how could I blame you? Somebody agreed to these deals. And those people should be ashamed of themselves, what they’ve let happen.
So we’re bringing it back, and we’re going to bring it back relatively rapidly, and we’re going to be instituting tariffs. Next week, we’ll be signing — perhaps some of you folks will be here. When you have Nucor, when you have U.S. Steel, you have the great aluminum companies represented at this table. And they’ve been decimated. Aluminum has been decimated in the country.
Perhaps you would say something, as a great aluminum company that’s been in business for a long time. How about —
MR. LAPIDES: Thank you, Mr. President.
THE PRESIDENT: — a few words on aluminum?
MR. LAPIDES: Thank you, Mr. President. Thank you, Secretary Ross and the other members here, Secretary Mnuchin. We’re in a situation where competing unfairly has meant that there’s been capital depletion in our business, a lack of investment. And that lack of investment is reflected in a loss of jobs in America. And it’s all been a matter of unfair competition.
And we need a level playing field, or we’re going to lose our manufacturing infrastructure and the national security issues that surround having a vibrant, capable manufacturing sector.
THE PRESIDENT: Okay. We’re going to take care of the situation, okay? So steel and aluminum will see a lot of good things happen. We’re going to have new jobs popping up. We’re going to have much more vibrant companies. And then the rest is going to be up to management to make them truly great. If you could ever make U.S. Steel like it used to be, we’d be very happy. And I actually think it’s possible. But you have a long way to go.
I remember when I was growing up, U.S. Steel, that was the ultimate company. And today, you have so many closed plants. And the NAFTA deal was a disaster for our country. The WTO has been a disaster for this country, for our country. In fact, the rise of China, economically, was — if you look at it — directly equal to the date of the opening of the World Trade Organization. It has been great for China and terrible for the United States, and great for other countries. But terrible for the United States.
So we’re talking about it, and two of the groups that I want to do some very fast action will probably have everything completed by next week. We’ll be imposing tariffs on steel imports, and tariffs on aluminum imports. And you’re going to see a lot of good things happen. You’re going to see expansions of the companies.
I know that, David, you said you’d be expanding. Tim, I know you said you were expanding.
MR. TIMKEN: Absolutely.
THE PRESIDENT: You’re all — pretty much all of you will immediately be expanding if we give you that level playing field, if we give you that help. And you’re going to hire more workers, and your workers are going to be very happy. They’re going to be very, very happy.
And again, what’s been allowed to go on for decades is disgraceful. It’s disgraceful. And when it comes to a time when our country can’t make aluminum and steel — and somebody said it before, and I will tell you, you almost don’t have much of a country. Because without steel and aluminum, your country is not the same. And we need it.
We need it even for defense, if you think. I mean, we need it for defense. We need great steelmakers, great aluminum makers for defense.
So we’ll probably see you sometime next week. We’ll be signing it in. And you will have protection for the first time in a long while, and you’re going to regrow your industries. That’s all I’m asking. You have to regrow your industries.
Mr. Secretary, thank you very much for being here. We appreciate it. Mr. Secretary, thank you very much. And we’ll see you next week.
Thank you, everybody. Thank you very much.
Q How long, do you think, on the tariffs?
THE PRESIDENT: Unlimited period. Unlimited.
Q Twenty-five on steel?
THE PRESIDENT: Twenty-five percent for steel. It will be 10 percent for aluminum. And it will be for a long period of time.
Q Do you have comment on Jeff Sessions, sir?
THE PRESIDENT: Thank you very much, everybody. Thank you.
Q Twenty-five for steel and ten for aluminum?
THE PRESIDENT: Twenty-five for steel and ten for aluminum.
Q (Inaudible.)
THE PRESIDENT: It’s being written now.
Q Thank you, sir.
END
12:28 P.M. EST
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