The Republican National Convention on Tuesday spent more time on the opioid epidemic than the entirety of the Democratic National Convention.
In a touching speech, Ryan Holets, a police officer in New Mexico, told a story about how he adopted a child from a person struggling with homelessness and drug addiction. “Today, our beautiful daughter, Hope, is a thriving 2-year-old,” Holets said. “Crystal [the biological mother] is approaching three years of recovery. She is a dear friend and a constant inspiration to me and others.”
Since this was a political convention, Holets used the speech to support President Donald Trump’s reelection, boasting about Trump approving $3 billion a year in new funding to help combat opioid misuse and launching efforts to reduce opioid painkiller prescriptions.
“And it’s having an impact,” Holets claimed. “Drug overdose deaths decreased in 2018 for the first time in 30 years. Many of the states hardest hit by the opioid crisis are seeing the largest drop in deaths. We’re seeing that doctors are writing fewer prescriptions for opioid pain drugs. These are significant improvements that have a meaningful impact.”
The reality, however, is not so great. While drug overdose deaths did dip from a record high from 2017 to 2018, preliminary federal data shows overdose deaths increased in 2019, and local and state data suggests that 2020 will be even worse due to problems caused by the Covid-19 pandemic and the continued spread of fentanyl, a dangerous synthetic opioid, in illegal drug markets.
In fact, experts broadly agree that Trump and the federal government simply haven’t done anywhere near enough to address the opioid crisis. Referring to the 2018 drop in overdose deaths, Stanford drug policy expert Keith Humphreys recently told me, “I’m not sure that’s because of anything we did.”
Instead, the same structural problems that led to the opioid crisis and allowed it to fester remain: America still doesn’t support addiction treatment anywhere near enough, the treatment facilities that do exist are often detached from evidence and even fraudulent, harm reduction services like needle exchanges remain underused, and there’s still far too much opioid prescribing. For years, experts have called for a significant investment — including health care reform and tens of billions of dollars — to fix these problems, but nothing from the federal government, including under Trump, has approached the scale warranted.
So overdose deaths increased again in 2019 and are set to increase further in 2020.
But you wouldn’t know Trump’s failure from the Democratic National Convention. Based on the transcripts for all four nights of the DNC, Democrats didn’t mention “addiction,” “opioid,” or “overdoses” a single time at their convention.
It’s not because they don’t have a plan. Former Vice President Joe Biden, the Democratic nominee, has a very good plan — one that would make a serious investment into treatment and harm reduction as well as crack down on opioid prescriptions.
It’s also not because the issue isn’t politically salient. Several swing states, including Ohio and Pennsylvania, are among the most affected by the drug overdose crisis. An analysis by historian Kathleen Frydl found that the Ohio and Pennsylvania counties that flipped from Barack Obama to Donald Trump in the 2016 presidential election were hit particularly hard by opioid overdose deaths.
Yet Democrats seem ready to let Trump own the issue, even as many experts and activists say Trump has failed on it.
Trump’s approach to the opioid crisis has failed
Based on the preliminary federal data, drug overdoses spiked in 2019 to more than 72,000. That was higher than the previous record high for a single year, of less than 72,000 in 2017, meaning, if the early data is right, that all of the gains from 2018’s decline were erased and then some.
At the same time, there are several signs that things will be even worse in 2020. Fentanyl, which has increasingly supplanted heroin in illegal drug markets, appears to be spreading to the West of the US — a huge point of concern because fentanyl, as a more potent opioid than heroin, is more likely to cause overdoses. Overdoses involving stimulants, like cocaine and meth, are also going up.
All of this, experts say, is a result of federal inaction. It’s not that Trump and Congress have done literally nothing, but what they’ve done has been far too little: The single-digit billions they’ve put toward the issue fall short of the tens of billions experts say is needed, and their regulatory tweaks to improve access to treatment amount to too little, too late. The addiction treatment system remains not just underfunded but under-regulated, allowing fraud and abuse to take root in many facilities and a failure to follow any evidence-based practices in others.
Leana Wen, a health policy expert at George Washington University, summarized much of the expert consensus when she described the federal moves so far as “tinkering around the edges.”
On these fronts, Trump hasn’t suggested going much bigger — and has at times proposed significant cuts to agencies involved in fighting the opioid epidemic.
So the crisis continues and, in most years, keeps getting worse, contributing to a decline in life expectancy in recent years.
The other actions Trump has proposed wouldn’t do much about the issue, either. He’s said his wall at the US-Mexico border would help keep drugs out, but the evidence suggests it wouldn’t. He’s called for tougher prison sentences and the death penalty for high-level drug dealers, but that’s discredited by a body of research finding that tougher criminal penalties don’t slow the flow of drugs into the US.
In fact, Trump has put out multiple proposals that would make the overdose crisis worse. For one, he’s repeatedly called for repealing the Affordable Care Act (“Obamacare”) and advocated for cutting Medicaid. The ACA alone expanded access to health care, including addiction treatment, to hundreds of thousands of people with addictions. A recent study in JAMA Network Open linked Obamacare’s Medicaid expansion to a 6 percent reduction in opioid overdose deaths.
Trump did declare a national emergency over the opioid crisis. But that led to almost nothing, as the Government Accountability Office concluded in a report. (The emergency declaration lapsed for nine days in January, as Dan Diamond reported for Politico, and no one seemed to notice.)
These failures were in some ways a prelude to the Covid-19 pandemic. The opioid crisis is an issue Trump should have taken seriously — it’s important to the country, but particularly his base of white voters without a college education, whom the crisis has hit especially hard. Yet Trump simply hasn’t taken the issue seriously or made it a major priority throughout his administration. As with Covid-19, the political incentives are there, but the president’s magical thinking and refusal to do the tough work of policymaking and governing has left a void of federal inaction on a serious public health issue.
Democrats aren’t talking about the opioid epidemic. They should.
Meanwhile, Democrats aren’t bringing attention to Trump’s failures. At their convention last week, they didn’t mention the opioid crisis at all.
Biden does have a plan. It would put $125 billion over 10 years — the largest commitment of any 2020 campaign — to scale up addiction treatment and other prevention and recovery programs, paid for with higher taxes on pharmaceutical companies’ profits. It would take steps to stop the overprescription of opioid painkillers while encouraging better care for chronic pain, and it would try to slow the flow of illicit drugs from China and Mexico. It would also move to “reform the criminal justice system so that no one is incarcerated for drug use alone.”
It’s a plan that could help a lot of people. It could help from a purely cynical political perspective: Ohio and Pennsylvania, two swing states, are among the hardest hit by the crisis in recent years.
It’s also a plan that could actually happen. While Democrats have spent a lot of the campaign talking about sweeping health care reform, a Green New Deal, and massive economic investments, these are proposals that are, frankly, not very likely to become law even if Biden wins the White House, especially if Republicans keep control of the Senate.
The opioid crisis is different. Several Republican senators, including Rob Portman (OH) and Shelley Moore Capito (WV), have shown a lot of interest in getting work done on the crisis. It’s telling that one of the few major pieces of legislation Trump has done was related to the opioid epidemic, even if experts agree it was too little, too late.
Simply put, starting from a place in which some Republicans and all Democrats are willing to work on an issue is certainly much better than a place in which no Republicans and not even all Democrats are willing to do something significant.
The issue could become even more relevant in the next few years. As Covid-19 (hopefully) fades, the overdose crisis will, unfortunately, stick around — and, based on the data, may even get worse as fentanyl spreads and stimulants make a comeback. With the right leadership, that could push the federal government to more action.
There are good reasons to be skeptical about whether Biden could get the full $125 billion he’s proposing to fight the opioid crisis. One thing I’ve heard consistently from sources in Congress is Republicans in particular are skeptical of spending too much money on addressing the overdose crisis. That will continue into a Democratic administration, likely even more so as Republicans become resistant to giving a Democratic president a victory.
But that’s all the more reason for Democrats to highlight the issue. There are substantial differences here between the parties, on top of Biden versus Trump, that could make a big difference in people’s lives.
Democrats so far aren’t doing that. So Trump gets to own the issue, despite his poor performance.
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