The White House is touting progress in the battle against the country’s opioid epidemic, but health policy researchers warn the Trump administration against claiming credit, and say planned cuts to Medicaid funding could exacerbate the crisis.
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Trump counselor Kellyanne Conway said last week that progress has been made since the president unveiled his plan last year to combat the epidemic. President Donald Trump‘s plan included stricter punishments for drug dealers and a pledge to cut opioid prescriptions by a third by 2021.
Conway, who leads anti-drug efforts on Capitol Hill, pointed to the decline in prescriptions for opioid painkillers, a slower growth rate for overdose deaths and government efforts to combat illicit use of drugs like fentanyl. Prescriptions for painkillers have dropped 25 percent over the past year, and 1.4 billion people have seen ads teaching young people about the dangers of opioids, according to the White House.
“In President Trump’s first year in office, overdose deaths grew by 10 percent, having grown by 22 percent the year before,” Conway said during a media call. “So the rate of death increased at a rate less than half of what had increased just the year before.”
But health experts say there’s little evidence to show that recent progress is a result of the White House’s efforts. They noted that prescriptions have been declining since 2012, before Trump became president, and argued that a slower growth rate for overdose deaths cannot be clearly connected to White House efforts.
They also said the president’s proposed cuts to Medicaid would be harmful for patients seeking addiction treatment, and anti-drug funding over a two year period is inadequate.
“There are some positive signs, but I don’t believe the Trump Administration deserves credit for them,” said Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University. “In fact, there is a lot more the Trump administration and the FDA [Food and Drug Administration] could be doing to promote more cautious prescribing and properly regulating opioid makers.”
Health policy researchers pointed out that the administration’s National Drug Control Strategy report was not released until January 2019. Findings from the Government Accountability Office this month said the administration’s plan failed to include a budget projection or “annual objectives that are quantifiable and measurable.”
At a hearing this month, House Oversight Committee Chairman Elijah Cummings, D-Md., condemned the administration’s plan as a “23-page pamphlet” that “fails to meet even the most basic requirements in the law.”
Keith Humphreys, a Stanford professor and former senior policy adviser at the White House Office of National Drug Control Policy, said the Trump administration’s report had “no central direction” and that there is no proper spokesperson for the epidemic. While the declining trend in prescriptions is encouraging, over-prescribing is still a problem, he added.
“No matter who is president, this is a problem,” he said.
Amie Goodin, a researcher at the University of Florida College of Pharmacy, said she was discouraged by the lack of clearly articulated budget priorities within the administration’s strategy. For example, the report encourages states to apply for Medicaid waivers to expand treatment but doesn’t specify how waivers could be funded in the face of proposed Medicaid cuts, she said.
“The vagueness of the strategy on all fronts — from the absence of measurable objectives to the omission of specific administrative authority, oversight, and funding plans for these missing objectives — is frustrating to all who desire improvements,” she said.
Humphreys added that the president’s budget proposal, which includes cuts to Medicaid, would also be a “disaster for the crisis,” especially for people who rely on Medicaid for addiction treatment.
The number of opioid prescriptions has been falling since 2012. Prescriptions dipped substantially from 214.8 million in 2016 to 191.2 million in 2017, according to the Centers for Disease Control and Prevention.
There were a record 72,237 opioid overdose deaths in 2017, which was 9.6 percent higher than the 2016 rate. While there’s no 2018 data yet, experts expect that provisional counts will show that 2018 death rate will be similar to 2017, and might even decline for the first time since 1996.
The Support for Patients and Communities Act, signed in October, was the most recent bipartisan push against the drug epidemic. The legislation includes provisions to boost access to addiction treatment, ramp up law enforcement efforts against illicit drugs and expand addiction treatment access. Critics of the bill have argued it lacks federal money for addiction treatment.
Peter Hoffman, the National Drug Control Policy’s press secretary, told CNBC that administration’s strategic plan demonstrates “an in-depth understanding of the steps needed to fight the addiction crisis” and “deploys a whole-of-government approach.”
“At the end of the day, our number one goal is to save American lives and we now have a president, with an entire government behind him, committed to achieving that goal,” he said.
The president has secured $6 billion in new funding over two years to fight opioid abuse, according to a press release, and has funneled $1.5 billion for state opioid grants. The 2020 national drug control budget request seeks $34.6 billion for counter-drug efforts, an increase of more than $1 billion from the previous year, according to Hoffman.
But experts argue that the funding timeline is inadequate.
“It has to be a commitment to at least 10 years of funding. A two-year period doesn’t work because states cannot build out new systems unless there’s a commitment to long term funding,” Kolodny said. “This problem won’t get better overnight.”