US administration to use ‘all appropriate authority’ in response to opioid crisis

The US president, Donald Trump, has instructed his administration to use ‘all appropriate emergency and other authorities’ to respond to the country’s opioid crisis. He later told reporters that the situation was a ‘national emergency’.

The move follows the recommendations of an interim report from the President’s Commission on Combating Drug Addiction and the Opioid Crisis, which also calls for a rapid expansion of treatment capacity as well enhanced access to ‘medication-assisted treatment’ and increased naloxone dispensing. The number of opioid overdoses in the US has quadrupled since 1999, says the report, with more than 560,000 people dying as a result of a drug overdose between 1999 and 2015. ‘Not coincidentally’, the level of opioid prescribing quadrupled over the same period, it states.

‘Americans consume more opioids than any other country in the world,’ says the document. ‘In fact, in 2015, the amount of opioids prescribed in the US was enough for every American to be medicated around the clock for three weeks. We have an enormous problem that is often not beginning on street corners; it is starting in doctor’s offices and hospitals in every state in our nation.’

As access to prescription opioids has been tightened, however, people have increasingly turned to street drugs, it points out, with just 10 per cent of the almost 21m people with a ‘substance use disorder’ receiving any type of specialist treatment – a factor that is ‘contributing greatly’ to the increase in overdose deaths. More than 40 per cent of people with a substance problem also have a mental health problem, the report adds, but ‘less than half’ receive treatment for either.

A return to ‘Just say no’? Nancy Reagan speaking at a rally in 1987.

‘Nobody is safe from this epidemic that threatens young and old, rich and poor, urban and rural communities,’ Trump told a press briefing. ‘Drug overdose is now the leading cause of accidental death in the United States, and opioid overdose deaths have nearly quadrupled since 1999. It is a problem the likes of which we have not seen.’ He added, however, that the best way to ‘prevent drug addiction and overdose is to prevent people from abusing drugs in the first place’ and that ‘strong law enforcement is absolutely vital to having a drug-free society’. Earlier this year his administration signalled that it intended to intensify the ‘war on drugs’ with a return to 1980s-style prevention campaigns (DDN, May, page 5).

‘An emergency declaration can be used for good but President Trump has given every indication so far that he and his administration want to escalate the failed war on drugs,’ said deputy director of national affairs at the Drug Policy Alliance, Grant Smith, who stressed the ‘stark contrast’ between the president’s preferred law enforcement approach and the health-based response prioritised by the opioid commission’s report.

‘Trump’s emergency declaration is likely going to amount to very little in the way of greater access to treatment and other help from the federal government,’ Smith continued. ‘President Trump made repeal of the Affordable Care Act a top priority, which would threaten healthcare and access to treatment and mental health services for millions of people living with substance use disorder. People who are looking for this administration to use a national emergency to ramp up access to treatment and step up a health-based response to the opioid crisis are going to need to be vigilant that this indeed happens, and that the emergency declaration doesn’t give the Trump administration more licence to escalate the drug war.’

President’s Commission on Combating Drug Addiction and the Opioid Crisis: draft interim report at