After a long delay, President Donald Trump finally took steps to address the opioid epidemic, calling it a public health emergency. His speech on Thursday raises the profile of an issue that is gnawing away at communities across the country.
But it will take more action than he has called for to meet the challenge.
Before getting into the reason, here is the problem, as outlined by the President’s Commission on Combating Drug Addiction and the Opioid Crisis, which issued a report in early August saying the death toll was tantamount to a “September 11th every three weeks”:
More than 52,000 Americans died of drug overdoses in 2015, according to the Centers for Disease Control and Prevention, with 33,000 deaths coming from opioid overdoses. The toll has risen every year since 2000.
The opioid epidemic is much worse than the crack cocaine problem, which was largely confined to cities. It was during the 1980s that the government responded with draconian laws and aggressive prevention pitches, such as the “Just Say No” campaign spearheaded by first lady Nancy Reagan.
Trump alluded to prevention and advertising in his speech, but the opioid problem isn’t that simple. People don’t say “yes” to addiction; they say “yes” to pain relief, which is legally administered after consultation with medical professionals. Many uses of pain medication are valid, indeed essential. Once a prescription runs out, people may turn to cheap heroin to satisfy the powerful addiction.
The Trump administration hasn’t mentioned money, but it’s going to take billions. Any plans to cut Medicaid will undermine a response to the crisis. Spokane’s largest opioid treatment program is run though the Spokane Regional Health District. Many patients gained coverage via Medicaid expansion.
On a positive note, Trump did allude to a policy relic that has hampered treatment. It’s a long-standing exclusion for Medicaid payments to facilities with more than 16 beds. Governors have been begging the feds to drop it.
As Trump’s commission wrote: “This exclusion makes states entirely responsible for Medicaid-eligible patients in inpatient treatment facilities, including patients undergoing withdrawal management in addiction treatment facilities rather than hospitals.”
The commission recommended a 50-state waiver on this exclusion. Better still, Congress could rescind it.
(Speaking of relics, the feds need to update laws regarding marijuana, which can be useful in pain management and is less addictive. It’s absurd that pot is grouped with heroin, and that a federal law from 1970 suggests it has no medicinal purpose. Furthermore, the feds should lift restrictions on the legal availability of pot for scientific research.)
Trump’s speech is a start, but as long as treatment is more difficult to access than pain pills and heroin, the opioid crisis won’t abate.
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