US Government’s Plans to Tackle Opioid Crisis Seem Set to Worsen It

An estimated 2.4 million individuals in the US are currently experiencing problematic opioid use (Source: Wikimedia)

A US government commission has urged President Donald Trump to implement a set of health-oriented measures to tackle the country’s opioid crisis, but his administration’s plans seem set to worsen it.

As of September 2016, an estimated 2.4 million individuals in the US were living with an opioid use disorder. Every day around 91 people die following opioid overdoses - including from heroin, prescription pain relievers, and illegal synthetic opioids - in the country. In an attempt to reduce this, the newly-established Commission on Combating Drug Addiction and the Opioid Crisis (“the Commission”) published an interim report with recommendations of action to be taken. The report, published on 31 July, made several recommendations to the president, including urging him to “declare a national emergency”, and to use every tool at his disposal to prevent further deaths.

The allocation of significant national funding lies at the crux of almost all the recommendations put forward in the report.

Notably, the Commission wants the government to rapidly increase treatment capacity to help reach those who problematically use drugs; specifically, the report calls on Trump to “grant waiver approvals for all 50 states to quickly eliminate barriers to [opioid] treatment”. This would involve the expansion of Medicaid, a joint federal and state programme that helps with medical costs for people with limited income and resources. According to data from IMS Health, Medicaid pays for around one in four prescriptions for buprenorphine, an addiction treatment medication.

The report also recommends increasing funding and access to Medication-Assisted Treatment (MAT) – including methadone treatment - and equipping all law enforcement officers with naloxone, a medication that rapidly reverses opioid overdoses.

Despite President Trump being responsible for creating the Commission, his administration’s healthcare plans seem to oppose many of the report’s recommendations.

The government has previously published proposed plans to reduce funding for addiction treatment, research, and prevention. Additionally, the administration has proposed a 10-year plan to shrink the spending of Medicaid and repeal the Affordable Care Act (“Obamacare”) which would leave thousands of people at risk of having their opioid treatment withdrawn.

Whilst many of the Commission’s recommendations advocate positive evidence-based steps for reducing the harms of the opioid crisis, the report does not go far enough - as it fails to mention several key harm reduction measures.

For example, the report does not refer to the introduction of supervised drug consumption rooms, which have been successfully operating in Canada and several European countries for decades. These facilities would help reduce the transmission of infectious diseases through unhygienic injecting, prevent overdose deaths, and allow people who use drugs problematically to gain access to treatment. Furthermore, decriminalising the possession of all opioids could encourage people who use them problematically to seek help and treatment, as they would not fear prosecution; perhaps unsurprisingly, this was not recommended by the Commission.

Additionally, the Commission’s call for a national emergency to be declared has garnered some controversy. Grant Smith of the Drug Policy Alliance expressed worry that such a declaration could lead to an abuse of power by law enforcement authorities in policing people who use drugs.

Drug overdoses are now the leading cause of death for Americans under 50, exceeding deaths from car crashes and gun violence. It is imperative for the government to consider recommendations made by the Commission, as well as the host of other successful harm reduction measures that have been implemented outside of the US. Tragically for those affected by the opioid crisis, Trump’s government appears to be moving in the opposite direction.

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