President Trump has indicated that he will declare the opioid epidemic a national emergency in a “major announcement” next week. While the president called the epidemic a national emergency in August, he has not yet issued a formal declaration, leaving many to wonder: if a national emergency is declared, what type of approach will the president actually take? Will the president embrace the public health approach outlined in the Surgeon General’s report or revert to a “war on drugs” strategy? Unfortunately, signals from the president’s administration have been conflicting.
A return to the war on drugs won’t solve our opioid epidemic
As the opioid epidemic has worsened, police forces and local governments around the country have realized that more compassionate drug policies are needed. Many police officers have taken on a new role in their communities by helping individuals with addiction receive treatment and administering the opioid reversal drug naloxone.
But, this compassionate approach has not yet been endorsed by the nation’s chief law enforcement officer, Attorney General Jeff Sessions, who has advocated cutting treatment funding and reviving the war on drugs.
For nearly 50 years, the war on drugs has been the government’s main strategy for controlling drug use in the U.S. The theory behind it is that by prohibiting drugs and reducing the illegal drug trade through police and military intervention, we can reduce illegal drug use and presumably addiction. It is clear this approach has failed, largely because it does not recognize addiction as the disease it is.
Addiction researchers understand that this approach comes at a heavy cost
In the war on drugs, drug use often leads to prison sentences rather than treatment. Yet, an analysis by the Pew Charitable Trusts found no statistical relationship between states’ rates of drug use, drug overdose deaths, and drug-related arrests. This suggests that a criminal approach to drug use and addiction is not an effective means of preventing people from using drugs.
Further, putting people in prison does nothing to curb the disease and the associated health and social consequences. Instead, it contributes to our skyrocketing prison population and criminal justice and healthcare costs. The scarce resources available are spent on the consequences of untreated addiction, instead of being invested in prevention and treatment. All this strategy has done is reinforced the stigma around addiction – one of the largest barriers to effectively dealing with this crisis.
The war on drugs: 2017
On the campaign trail, Trump repeatedly promised to engage communities suffering from the opioid epidemic, providing treatment – instead of jail time – for individuals with addiction.
Trump’s promises have not been met. He has spent much of his time in office attempting to dismantle the Affordable Care Act (ACA) and Medicaid, programs that provide millions of people addiction care and needed health care services, and address the many physical and mental health conditions that typically accompany drug use.
The President has repeatedly endorsed a “tough on crime” approach, even though more people die from drug overdoses than homicides. He has baselessly proposed the border wall as a solution to the opioid epidemic and appointed Jeff Sessions to the role of attorney general. It is widely known that Sessions is an advocate for the war on drugs, who seeks to “create a cultural climate that is hostile to drug abuse.” These actions signify that Trump’s approach to addiction may be similar to his predecessors who first put the war on drugs into effect.
Last summer, the President’s Commission on Combatting Drug Addiction and the Opioid Crisis issued interim recommendations and the final report is expected soon. To-date, the commission’s recommendations have aligned more closely with a public health approach than a war on drugs strategy. However, the president has not yet adopted any of these recommendations, including the appeal to declare a national emergency.
We need treatment, not prisons
Drug overdoses are now the leading cause of death among Americans under age 50. Despite significant evidence that the practices associated with the war on drugs are ineffective in reducing addiction rates or even limiting access to drugs, many people still see these disciplinary policies as a solution.
The possibility of resuscitating old, ineffective strategies is concerning to addiction experts. Incarcerating people for a chronic, relapsing disease is not the solution. President Trump indicated that he wants to be “absolutely right” in addressing the opioid epidemic. In order to do that, his administration must invest in evidence-based addiction prevention and treatment strategies and bolster, rather than dismantle, a health care system that allows individuals with addiction access to the help they need. We hope that this is reflected in the President’s “major announcement” on the drug crisis.
Lindsey Vuolo, JD, MPH
Lindsey is the associate director of health law and policy at The National Center on Addiction and Substance Abuse