Trump needs more than fire and fury to defeat US opioid addiction
Source: FT
by: Edward Luce in Washington
August 11, 2017
He may have been going off-script about North Korea, but Donald Trump’s declaration of war on opioids this week came with the foreknowledge of his advisers. Instead of threatening “fire and fury”, as he did on North Korea, Mr Trump proclaimed a national emergency to defeat America’s galloping drug epidemic.
Last year an estimated 60,000 Americans died from drug overdoses – more than the total US death toll in the Vietnam war, which lasted more than a decade. Opioids are now the leading cause of death for Americans under the age of 50. This year’s toll looks set to be higher.
Can Mr Trump reverse the trend? It would be in his interests to do so. The US counties with the highest drugs mortality rates were far likelier to vote for Mr Trump than for Hillary Clinton. Mr Trump has even attributed part of his success to the opioid epidemic. In a leaked transcript of a phone call with his Mexican counterpart earlier this year, Mr Trump said he had won the state of New Hampshire because it was a “drug-infested den”. Part of his pitch to build a wall with Mexico was to keep out the drugs dealers who are “poisoning our communities”. The surprise is how long it has taken Mr Trump to declare his war.
Yet his administration betrays few signs of having devised a strategy to win it. Chris Christie, the Trump ally and governor of New Jersey, who authored a report on the epidemic this week, has urged Mr Trump to treat the epidemic as a public health crisis rather than a war. This would involve using medical substitutes to treat opioid addicts – an avenue disallowed under the strict abstinence regime imposed on drug users. It would also mean lifting restrictions on Medicaid funding of drug treatment centres.
In both cases, Mr Trump has been heading in the opposite direction. Medicaid spending would have been slashed had Mr Trump succeeded in abolishing Obamacare. Meanwhile, Jeff Sessions, his hardline attorney-general, is reviving the “just say no” approach championed by Nancy Reagan in the 1980s. Her “war on drugs” had no more success than alcohol prohibition did in the 1920s and 1930s.
Yet Mr Trump is limited in the degree to which he can criminalise the problem. More than a third of Americans took opioid prescriptions in 2015, according to federal statistics. Of these, at least 2.6m are addicted. A large majority of those are white. In contrast, the war on drugs in the late 20th century primarily targeted African-Americans, who were worst blighted by the crack cocaine epidemic. Unlike opioid users, none of them was introduced to crack by their family doctor or local hospital. Many came to the habit in prison. It would be political suicide for Mr Trump to visit the same levels of incarceration on his electoral base. About three-quarters of America’s heroin users first became addicted from prescriptions.
What, then, can be done? Unlike the enemy in an actual war, America’s opioid problem is homegrown. Much of the cheaper heroin that substitutes for pills such as OxyContin does come across the Mexican border. Likewise, synthetic drugs such as fentanyl, which is mixed into the black market for opioids and accounts for a large share of the fatalities, comes from China. But the biggest culprits are within. These include the US pharmaceutical industry, which is being sued by a number of states, including New Hampshire, for false marketing. It also includes America’s post-industrial economy, which has left many former middle-class families in the state of despair that Mr Trump so skilfully harnessed in the election.
You cannot vanquish despair with fire and fury. Nor can you solve it with tweets. Fixing America’s opioid epidemic would entail a degree of policy sophistication Mr Trump has yet to exhibit anywhere.