Trump campaigned to defeat the opioid crisis. It's hard to say if he wins.

President Donald Trump's attention to the opioid crisis could strengthen his ties with poor and discontented voters in hard-hit places like the Appalachians, which are one of the foundations of his base. But the administration, despite all its efforts, has not yet reversed the trend of the deadly epidemic.

L & # 39; asset The administration's response to the addictions crisis and overdoses of painkillers poses an unusual challenge to Democrats, who have otherwise claimed the electoral health advantage in Trump's day. The White House can accurately point to signs of progress: opioid prescriptions have dropped significantly from their 2012 record level, early data suggests that overdose deaths are slowing and the crisis is causing more and more more attention and attention.

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"We will never stop until our work is done," Trump told an opioids summit in Atlanta this spring. "We have incredible results … We are making tremendous progress."

However, some of these gains could be attributed to work started under previous administrations. It is also not known which criterion measures success. For example, the decrease in the number of deaths does not necessarily mean that fewer people overdose; this may mean that the campaign to make antidotes widely available saves lives, but does not necessarily force people to seek treatment to end their addiction.

Democrats are not giving up on the issue – presidential candidates like Elizabeth Warren and Amy Klobuchar have called for a much more aggressive counterattack and much more spending. However, the White House drug cartoonist, Jim Carroll, said Trump 's approach finally responds to a crisis that has not faded during the Bush and Obama years.

"We are making absolutely progress," Carroll told POLITICO in a recent interview. "It is too early to say that we are turning the corner, but we now have national attention and the spotlight on this issue. We are reducing stigma, we are asking more people to provide drug-assisted treatment. "

"We make a difference," said Carroll. "We just need to keep pushing hard."

Among the health officials in charge of the response, there are several people who were not in office when Trump declared a national opioid emergency in 2017. Among them, the Secretary of Health and Social Services , Alex Azar, who took office in January 2018, and Carroll, who sworn in January 2019. This is a contrast with a year ago when the White House had no Tsar of the confirmed drug and that Kellyanne Conway, a political strategist with no history in public health, was at the center of the crisis.

And while most of Trump's speeches on the crisis focus on "building a wall" and the punishment of salespeople, his administration has focused on a public health approach, treating addiction as a disease rather only as a crime.

Congress also responded, and it was bipartisan. Legislators have adopted two main laws focused on all aspects of the crisis, from public health to law enforcement. Billions of dollars went to the states to put the crisis under control.

But as the epidemic improves, another one gets worse. Deaths from prescription drugs and heroin may be slowing down, but fentanyl and drugs like methamphetamine and cocaine are on the rise, alarming public health experts who say An opioid-centered response misses the broader challenge of addiction. Progress is slow in expanding access to safe and affordable treatment for more than 2 million Americans suffering from opioid addiction and countless other substances.

"We have disabled opioid accessories, but we now see methamphetamine making a comeback," said Mark Drennen, chief executive officer of the West Virginia Behavioral Healthcare Providers Association. The federal government's focus on opioids is helping people with other substance abuse issues, he said, but "they're sort of going into the background."

Deaths related to methamphetamine have been on the rise since 2010 and have increased by 37% between 2016 and 2017, according to the latest figures from the CDC.

Preliminary federal figures indicate that West Virginia is one of 28 states that have experienced a decline in overdose deaths in the past year.

Trump's stress on opioids in 2016 helped him establish a base in West Virginia, Ohio and Pennsylvania – states that also appreciate his call to the displaced working class and his exuberant support for the revival of the coal industry. Conway calls the opioid crisis a "legacy problem" for Trump. His drug czar has crisscrossed the country praising the efforts of the president and his early successes.

But Carroll's recent trip to Minnesota illustrates just how difficult the task is. He went there on June 5, in the midst of a massive outbreak of state-wide overdoses, with 175 overdoses, including 17 deaths, over a two-week period. Officials attribute it to a bad batch of heroin, potentially laced with fentanyl.

According to the CDC, the number of deaths related to fentanyl has increased by 47% between 2016 and 2017. Legislators Capitol Hill Thursday sent letters to officials of Trump, distributed in six different agencies, asking what they to stop the flow of fentanyl and other illicit opioids.

Democrats running for president have put their own strategies in place on the larger problem of opioids. Warren and Klobuchar have both proposed significantly higher funding: $ 100 billion over 10 years, compared to $ 6 billion that the Trump administration and Congress have directed to the states over the past two years.

Read more: How Amy Klobuchar and Elizabeth Warren would deal with the opioid crisis and addiction.

They say that Trump fails for a crisis of this magnitude. They also point to the contradiction in his government calling for greater access to drug treatment as it tries to roll back the Affordable Care Act and Medicaid, the biggest payer of behavioral health care.

According to the Centers for Disease Control and Prevention, more than 70,000 people died of drug overdoses in 2017, the highest number ever recorded. Trump's advisers, including Carroll, are touting preliminary figures for 2018, showing that overdoses are down 4% nationwide. But the improvements are not uniform: 21 states have seen no improvement or even a slight increase in the number of deaths.

"We do not have enough [medication-assisted treatment] Alexander Billioux, Assistant Secretary of Health, Public Health Office, Louisiana Department of Health. "We start from very small capacity and try to grow as quickly as possible."

Even with an injection of about $ 82 million from the federal government last year, Louisiana is struggling to develop its treatments. This is one of the states where the number of overdose deaths has increased slightly.

Lawyers say that the overdose mortality rate is an important parameter, but it does not tell the whole story. The administration does not have data on whether access to drug treatment has increased in the last two years or how many people are currently receiving treatment. It is also unclear whether slowing deaths mean fewer people are overdosing or more people are being saved through national efforts to arm the public with naloxone, an antidote for overdose.

"People will count the number of overdose deaths because this is the most serious indicator," said Regina LaBelle, program director of the OW Institute of Neill for Global and National Health Law. Georgetown University and former ONDCP leader under the Obama administration. "It's the worst consequence, but it's not the only consequence."

Public health experts generally say that the opioid administration's efforts are doing good. But these measures do not address the basic problem of addiction, they say. Most of the administration's policies target opioid people, while the number of drug-related deaths is also rising.

"It's still a very acute approach to a chronic problem," said Andrew Kessler, founder and principle of Slingshot Solutions. "I still do not see a complete answer to the disease of addiction."

The office of Trump's drug control policy, usually responsible for coordinating the federal drug control strategy, has recently been criticized by lawmakers and the non-government Government Accountability Office for failing to be acquitted effectively of its role and for not having provided the parameters required by the law the strategy works.

"We have reported serious problems with what they need to do and what they have actually done," Triana McNeil, Acting Director of the Office of Government Accountability, said in an interview. "I do not think that the GAO, based on the work we have done today, can say that we feel that the PNDC fully assumes its statutory role."

For example, the GAO stated that while the administration aims to expand access to medication-assisted treatment, it does not have data on the number of providers and facilities currently managing ART, which makes it difficult to fully assess the increase in their access.

The addiction service recently released its own goals, including reducing overdose deaths by 15% in five years and doubling access to assisted drug treatment. He did not specify how he intends to do it or at what price.

A study published in the journal Health Affairs found that in 2016, only 36% of drug treatment facilities offered some form of drug-assisted treatment and only 6% offered the three options approved by the Food and Drug Administration. Drug Administration. Many facilities and providers choose not to prescribe these drugs because of low reimbursement rates and stigma.

Some federal officials have also acknowledged gaps in communication with ethnic and racial minorities. According to the CDC, the death rate among African-Americans fentanyl has increased by 141% on average each year between 2011 and 2016 and by 118% among Hispanics, compared to 61% for their white counterparts.

"African Americans are less likely to be prescribed naloxone," said Nora Volkow, director of the National Institute for Drug Abuse, citing the antidote to overdose and the studies that his agency had done on racial lacunae in the administration of this drug. "Some communities are more successful than others and this requires a certain resource structure to make them available," she said. The Trump administration, for its part, is working to fill these gaps, she said, through demonstration programs and grants.

Public health experts are optimistic about the administration's efforts, but warn that it will take years and lasting solutions to reverse the trend.

"We really have to be very careful and not hit the ball," said LaBelle of Georgetown.

"These cities and towns across the country will face the wreckage of the opioid crisis for a long time."