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POV: Trump’s Opioid Efforts Don’t Go Far Enough

Additional resources are needed to fight the epidemic

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Last week, President Trump announced a national health emergency regarding the opioid epidemic. As physicians who practice addiction medicine, we’re encouraged to see the White House bring the opioid epidemic into the national spotlight. While we’re pleased to hear about Trump’s plans regarding implementation of evidence-based treatments for opioid addiction, we are concerned that without a large influx of resources and monetary support into expanding opioid addiction treatment and prevention programs, these efforts may be unsuccessful.

Trump correctly identified that gun homicides and deaths related to motor vehicle accidents have in fact been outpaced by deaths related to opioid overdose. He noted that the United States is the largest consumer of opioid pain medications and that opioid use disorder has spared no corner of this country. He also brought to light the difficulties of neonatal abstinence syndrome in babies born to mothers who suffer from opioid use disorder.

With regard to combating the opioid epidemic, Trump recognized the efforts of first responders and medical providers who struggle to confront the magnitude of this health crisis. He proposed a multipronged approach that includes allocating efforts and resources towards medication treatment for opioid use disorder, overdose prevention, drug courts, public health campaigns promoting abstinence, and reducing inflow of illegal drugs into the United States.

These approaches are to be applauded. But without the availability of basic health benefits that allow for people to access medication for treatment of opioid addiction or overdose, these efforts are unlikely to meet the needs of the most vulnerable. Trump’s decision to cut critical health care subsidies only undermines our efforts to provide this treatment. In addition, there are too many barriers to accessing treatment for opioid use disorder; we need to promote same-day access to treatment for anyone who seeks it. Trump also plans to allocate funding towards developing “nonaddictive pain medication.” Almost any physician would agree with that goal, but there has already been a long search for these medications, and the likelihood that this approach would be successful is low. In addition, many effective pain treatment strategies, such as physical therapy, are underutilized by both patients and providers due to access and cost, problems that the administration’s current health care plan would only exacerbate.

We would have preferred if Trump had included mention of expanding needle exchange or discussing safe injection facilities, which are evidence-based but admittedly more controversial topics. An additional concern centers around the idea that a “border wall” along Mexico or indicting Chinese drug traffickers will stop the inflow of drugs; we are skeptical that reducing illicit drug supply will reduce the demand for these drugs. Instead, as he stated in his speech, we need to focus on drug demand reduction.

Last, we are concerned about Trump’s focus on abstinence and his personal example of never using drugs or alcohol because of his willpower, and his goal to simply teach youth about drugs by demonstrating “it’s really easy not to take them.” Unfortunately, we know this approach does not work in youth; instead, we need sophisticated, evidence-based prevention programs that teach about drugs, life and social skills, and self-efficacy. In addition, such dismissive and simplistic language about the disease of addiction and how it develops undermines the suffering of those currently struggling with the disease and only adds to the stigma we desperately need to combat as a society.

Overall, while Trump appropriately labeled the opioid epidemic a national emergency, this announcement is long overdue and was not paired with any real-time additional resources to fight the epidemic besides empowering many overstretched federal agencies to do more with the same amount of funding. More federal attention on this deadly disease is a welcome relief. However, there are still multiple layers to addiction and overdose treatment, as well as to prevention, that were not addressed by Trump. We fear that without a more comprehensive strategy, including affordable and accessible health care, our country will struggle to stem the tide of deaths that is killing six Massachusetts residents per day.

Payel Roy, a School of Medicine instructor in medicine, can be reached at Payel.Roy@bmc.org. Zoe Weinstein, a MED assistant professor of medicine, can be reached at zoeweins1@bu.edu. Richard Saitz, (CAS’87, MED’87), a School of Public Health professor and chair of community health sciences and a MED professor of medicine, can be reached at rsaitz@bu.edu

“POV” is an opinion page that provides timely commentaries from students, faculty, and staff on a variety of issues: on-campus, local, state, national, or international. Anyone interested in submitting a piece, which should be about 700 words long, should contact Rich Barlow at barlowr@bu.eduBU Today reserves the right to reject or edit submissions. The views expressed are solely those of the author and are not intended to represent the views of Boston University.

8 Comments

8 Comments on POV: Trump’s Opioid Efforts Don’t Go Far Enough

  • Dan on 11.02.2017 at 7:28 am

    I expect any actual measures that are implemented by the Trump ‘government’ will focus on shifting responsibility onto the victims and the allocation of funds to fight foreign boogymen.
    Meanwhile the government will not do a thing about the drug companies making this stuff, making more and more potent drugs and delivery systems, and recklessly marketing the heck out of it.

  • A bucket of fish on 11.02.2017 at 8:53 am

    Lets be real here: nothing he could have ever done will have made the majority of people at this university happy. Dan (another comment) hasn’t even seen it implemented but is already convinced it will do the opposite of the stated intent.

    Basivally, the point I’m trying to get across is that when the POV is coming from a liberal university in one of the most liberal states in the US I find it hard to believe that anyone is giving Trump a fair shake. Rather, it seems popular to just not give anything a chance in favor of shouting into an echo chamber of hate (looking at you Dan).

    • Tom on 11.02.2017 at 9:59 am

      You’re absolutely correct. It would be great if the far left liberal hate could be shelved on this one issue since Trump really is trying to make a difference. But I suppose liberals preferred Obama’s opioid addiction plan that he launched during his administration when he saw abuse skyrocketed in this country…oh wait that’s right Obama did nothing to address this at all.

    • Dan on 11.02.2017 at 10:55 am

      My opinion is mostly based on Trump’s attempt to appoint Tom Marino as the Director of National Drug Control Policy. And his rejection of that nomination after publication of Marino’s legislative actions in favor of removing power from the DEA to regulate domestic opioid manufacturers.

      • Dan on 11.02.2017 at 11:24 am

        Critics of Obama’s handling of the drug crisis need only to look at who was pushing legislature that favored the people making this stuff and spending millions of dollars marketing it around the country. That’s right, Marino again, and his ally Orrin Hatch, and the Republican majority Congress. Look at Arizona, home of Trump’s pardon pal Joe Arpaio, and their addiction treatment policy of “buy them a one way bus ticket to California.

  • drug war hater on 11.02.2017 at 8:55 am

    What I see coming from this announcement is another war on drugs, which will focus on the suppliers with a search and seizure mentality. The Feds love its war on drugs, big profits with confiscation of property and assets. This is free money for law enforcement, and they love it! and they even get to live out the cops and robbers fantasy whereby they are no longer really protecting and serving, they are at war with those that commit the crimes. Conservatives will seize this opportunity to get this rolling again. Did you know the federal government can seize everything you own after you’ve been arrested for drug dealing? I didn’t say convicted, but rather simply arrested. Aren’t we innocent until proven guilty? This is shameful and it is still going on today. I recently watched a frightening video of a medical marijuana user who’s home was ransacked and everything taken, then after she was found innocent, she had to fight tooth and nail to get her belongings back, with some things somehow gone forever and destroyed, that should have never been taken in the first place.

    Next in line is the money that will be funneled into big pharma. Money for this ‘so called’ research, which as the author has pointed out, is already exhausted. This won’t stop the money mongers though. They will accepted it with hands out and eyes wide open.

    Finally, this is likely to pave the way for the Feds to start pitching how evil marijuana is all over again. Siting no studies at all, they will point to how marijuana is the gateway to these opioids. And after all these years of fighting the good fight to stop the needless punishment for using marijuana, there is a good chance that this war will begin again as well.

    Finally, despite the above statements, I’m going to say that I’m not in favor of any program that allows for the continued use of these substances. I can remember countless times when friends from my youth were arrested for Marijuana and forced to deal with the judicial system. I am not in favor of giving addicts a free pass from punishment because some felt this should be labeled as a disease. Its not fair to those I just mentioned above who were arrested for less and forced to pay the consequences, which often included fines, loss of drivers licenses, and even jail time.

    Which brings me to my final stance, nothing you can ever say will convince me addiction to opioids is a disease. Its nothing more than a poor choice. That’s right, a choice, not a disease. I would have dared any addict to walk into my fathers hospital room where he lie dying of cancer at the age of 31, and tell him “I too have a disease.” I think I would have thrown the person out of the hospital window (if I was old enough). If you can’t identify addiction under a microscope its not a disease, its a condition. One that needs to be treated for sure, but not a disease.

    I believe the only real way to get this epidemic to end, is to arrest the addicts and incarcerate them. Addicts need to be held responsible for their choices. However, I don’t believe they should be incarcerated in a prison, but rather a treatment facility where they can dry out, get personalized attention and counseling, and do time in a program where they learn to live normal again, become educated, and become contributing citizens. A confined environment that fosters positive re-enforcement and doesn’t perpetuate the condition, or create learned behaviors that are negative and destructive, which is what happens when people go to jail for minor crimes. Good luck getting the funding for this, it will never happen. Bipartisan politics will take its toll on this epidemic and leave it stalled without solutions.

  • Bill on 11.02.2017 at 10:08 am

    Here’s a link to the most interesting article I’ve read about the opioid addiction. http://www.esquire.com/news-politics/a12775932/sackler-family-oxycontin/ if for some reason the link doesn’t work Good “Esquire Opioid” it’s an in depth look at the family behind the pharma company making billions off of Oxy. About how they try and distance themselves publicly from the chaos they are causing and also their new focus on addicting Europe.

  • Michael on 11.02.2017 at 10:13 am

    Read the Esquire magazine article about opioid addiction (can find online). You may be surprised to learn that Boston University is one of the schools mentioned in the article as having taken money from the family responsible for this epidemic in exchange for favorable research results on Opioids.

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