Trump's budget proposal does nothing for the epidemic of opioids

President Donald Trump's budget proposal shows his administration does not want to spend more on fighting the opioid epidemic, even though drug overdoses were associated with more than 70,000 deaths – a record – in 2017.

The budget plan proposes new funding to combat the opioid crisis, including $ 245 million over 10 years to allow states to "extend coverage of Medicaid to pregnant women with substance use disorders." of substances one year after childbirth ". But he also proposes to cut programs, especially at the Ministry of Justice. At best, the budget may add a few tens of millions of dollars a year to solve the problem.

Tens of millions of dollars can seem huge, but it's almost nothing in a budget estimated at $ 4.7 billion for 2020.

In addition, experts estimate that tens of billions more dollars are needed to deal with the opioid crisis. As a reference, the White House Council of Economic Advisers in 2017 linked the opioid epidemic to $ 500 billion in economic losses – so that spending tens of billions would only represent 39, a fraction of what the White House says the crisis is costing the United States.

Trump's budget plan implements the spending and laws passed by Congress in recent years to deal with the opioid crisis, including $ 3 billion a year approved by Congress early last year.

But Trump himself seemed to recognize that it was not enough money. Last year, his budget plan provided an additional $ 7 billion for 2019. This year's budget proposal removes this request, without explaining why this money is no longer needed.

In addition to the lack of money to fight the opioid epidemic, Trump also proposes to drastically reduce national programs, which could worsen the current crisis. He calls for Medicare and Medicaid to reduce hundreds of billions of dollars – two programs that, as health insurance programs, can help people get treatment. Medicaid, in particular, pays a quarter of drug treatment in the United States.

The proposed budget provides $ 8.6 billion for the construction of several walls on the US-Mexico border, which, according to Trump, would help fight the flow of illicit drugs into the country and thereby alleviate the crisis opioids. But experts say this would be ineffective since most illicit drugs go through legal entry points, not through illegal border crossings that a wall wants to stop.

The White House did not immediately respond to questions regarding the draft budget.

It is very unlikely that the president's budget proposal will be passed by Congress, especially since the Democrats control the House. But the budget plan provides an overview of Trump's priorities. The opioid epidemic is apparently not one of them, even though statistics suggest that much more action is needed.

Trump has to go bigger

The epidemic of opioids is a truly massive crisis. Since the 1990s, more than 700,000 people in the United States have died from overdoses, mainly due to the increase in the number of opioid-related deaths. It's comparable to the number of people currently living in big cities like Denver and Washington, DC. According to some estimates, hundreds of thousands of other people could die from the only overdose of opioids over the next decade.

When experts talk about the current epidemic, they compare it to previous public health crises such as HIV / AIDS, which also killed tens of thousands of Americans each year.

"To stem the flow of overdose deaths, we need funding and innovation commensurate with our response to HIV / AIDS," said Sarah Wakeman, addiction physician and director. Medical at the Addiction Initiative associated with Massachusetts General Hospital. me. This will require "a massive injection of funds and a fundamental restructuring of the way we treat drug abuse in this country," she said.

Last year, the New York Times asked 30 experts how they would spend $ 100 billion over five years to fight the opioid epidemic, a figure comparable to that expended by the United States. United to fight against HIV / AIDS. This may seem like a lot, but some experts warned that even this amount of money may not be enough.

This is largely because of the poor condition of much of America's drug treatment infrastructure.

Federal data suggest that only one in 10 people with substance use disorder and one in five with opioid use disorder seek specialized treatment. Even when an addiction treatment clinic is available, less than half of the facilities offer one of the opioid addiction medications, such as methadone or buprenorphine, as an option, even though the medications are widely regarded as the gold standard for the treatment of opioid addiction. In other words, the treatment is sufficiently inaccessible that most people who need it do not get it and, even when treatment is available, it does not meet the highest standard of care.

To change that, Congress needs to invest a lot more and in the long run. In response to the HIV / AIDS crisis, for example, Congress has put in place the Ryan White program to provide long-term, sustainable resources to fight HIV / AIDS, particularly in the most affected communities. Unlike the time-limited grants that legislators have allocated to the opioid crisis so far, Ryan White's funding is something that people on the ground know they can count on for many years.

Some lawmakers have called for similar actions in response to the opioid crisis, such as the CARE Act proposed by Rep. Elijah Cummings (D-MD) and Senator Elizabeth Warren (D-MA). But these proposals have not advanced in Congress, largely because of Republican concerns over additional spending.

Instead, Congress passed limited measures such as the Patient and Community Support Act, which Trump enacted last year. As Keith Humphreys, Stanford's drug policy expert, said when the law was passed, good things must be done, but that is not enough: demand. In the absence of this, Congress did the best thing: to reach agreement on as many second-tier issues as possible.

Experts tell me for a long time that there is no quick fix to solve the epidemic of opioids overnight, but that there is a set of policies likely to help: more treatments (especially drugs such as methadone and buprenorphine), more harm reduction (such as better access to naloxone), fewer prescriptions for painkillers (while ensuring that drugs are available for those who really need them) and policies that can help fight the root cause of addiction (such as mental health issues and socio-economic despair).

A recent study by Stanford researchers revealed that a combination of these options could save at least tens of thousands of lives over the next decade.

But Trump did not take a comprehensive approach. He did not call for tens of billions of dollars in treatment infrastructure. His administration declared a public health emergency related to the opioid epidemic, but nothing significant came out of it. When he spoke of the crisis, he did so to advocate for ineffective policies such as the wall and the increased use of the death penalty.

This is shown by the Trump budget, in which the opioid epidemic is almost relegated to the background.