Friday, August 11, 2017

Trump Opts For Failed Methods To Control Opioid Epidemic

(Photo of opioid medications is by Alexander Raths/Shutterstock is from

Since the "war on drugs" was initiated in the Nixon administration, well over a trillion dollars has been spent to stop drugs from entering and being sold and used in this country. That money was spent on border interdiction, more police action against drug users and dealers, and longer prison sentences for users and dealers. Then, during the Reagan administration, Nancy Reagan started the "Just Say No" campaign. Have any of these efforts been effective? Not even a little bit. Drugs are just as plentiful in the United States -- maybe even more plentiful than they were when the "war on drugs" was started.

The past (and current) method to fight drugs has been to make drug use a criminal problem. And the effect of that has been an abysmal failure -- on the national, state, and local level. Now we are told that there is an opioid epidemic in this country. Most might think this is from illegal heroin, and while heroin is still a problem, much of the current problem is from legal prescription drugs (as pictured above).

Donald Trump promised to address the opioid epidemic, and to find solutions he appointed a committee to study the problem (with the committee chaired by Chris Christie). That committee has now reported its findings, and surprisingly, it makes some good suggestions. The committee recommended Trump declare an emergency and do the following:

Rapidly increase treatment capacity. Grant waiver approvals for all 50 states to quickly eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases (IMD) exclusion within the Medicaid program. This will immediately open treatment to thousands of Americans in existing facilities in all 50 states.

Mandate prescriber education initiatives with the assistance of medical and dental schools across the country to enhance prevention efforts. Mandate medical education training in opioid prescribing and risks of developing an SUD by amending the Controlled Substance Act to require all Drug Enforcement Administration (DEA) registrants to take a course in proper treatment of pain. HHS should work with partners to ensure additional training opportunities, including continuing education courses for professionals.

Immediately establish and fund a federal incentive to enhance access to Medication- Assisted Treatment (MAT). Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient. Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.

Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions; we must equip all law enforcement in the United States with naloxone to save lives.

Prioritize funding and manpower to the Department of Homeland Security’s (DHS) Customs and Border Protection, the DOJ Federal Bureau of Investigation (FBI), and the DEA to quickly develop fentanyl detection sensors and disseminate them to federal, state, local, and tribal law enforcement agencies. Support federal legislation to staunch the flow of deadly synthetic opioids through the U.S. Postal Service (USPS).

Provide federal funding and technical support to states to enhance interstate data sharing among state-based prescription drug monitoring programs (PDMPs) to better track patient-specific prescription data and support regional law enforcement in cases of controlled substance diversion. Ensure federal health care systems, including Veteran’s Hospitals, participate in state-based data sharing. 

Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law.

Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses. 

How many of these recommendations is Trump going to adopt? Well, he recently held a news conference to let us know -- and it turns out that he's not adopting any of them! He basically tossed the report in the trash.

What is he going to do? He's going to continue all of the policies that have been proven in the past to be abject failures. He's going back to border interdiction (with the addition of a new wall). He seems to think all drugs come across our Southern border and are carried by poor people coming to this country without documentation. That's a sad joke. The wall won't stop even a bit of drugs -- they enter  by trucks, autos, planes, and ships, or come out of our own drugstores.

He also wants to increase police actions and make prison sentences longer -- neither of which has impacted the availability of drugs. And he wants to revive the "Just Say No" program -- another abject failure.

It is said that one definition of insanity is to keep doing the same old thing and expecting different results. If that is true, then Trump is a magnificent example of it. And that means that we will be throwing good money after bad, and very little will be done to control the opioid epidemic.

Isn't it time we admitted that the drug problem in this country is not a criminal one? It is now, and always has been, a medical problem. Until we realize that, our "war on drugs" will continue to be a failure of huge proportions.

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