For someone who touted himself as an agent of change, President Trump’s opioid policy announced in New Hampshire last month is profoundly disappointing. The president wants to reduce opioid prescriptions by another third over the next three years and press for longer prison sentences and death penalties for drug‐related crimes.
Doubling down on the same policy that has failed to work — and has made things worse — is not what one expects from a change agent.
Trump’s proposals are a product of the echo chamber in policy circles that won’t rid itself of the false notion that the opioid overdose crisis is primarily a result of doctors prescribing opioids to their patients, condemning them to a life of addiction. Member of this echo chamber ignore data from the National Survey on Drug Use and Health consistently showing less than 25 percent of nonmedical opioid users obtain a prescription, with over 75 percent getting it from a friend, relative, or drug dealer. They refuse to see that over 90 percent of overdoses involve multiple drugs — in New York City 46 percent of 2016 opioid overdoses also featured cocaine.
Study after study, including a January 2018 study of more than 568,000 patients over 10 years by researchers at Harvard and Johns Hopkins, has shown that prescription opioids given to patients with medical conditions under medical supervision have a very low addictive potential. Even Dr. Nora Volkow, the Director of the National Institute on Drug Abuse, has acknowledged this. Yet policymakers continue to enact limits on the dose and amount of opioids doctors can prescribe to patients.
High dose opioid prescriptions are down 41 percent since 2010, yet the overdose rate continues to climb — last year it was up 20 percent over the previous year. And the majority of those deaths are from heroin and fentanyl, not prescription opioids. In fact, according to the Centers for Disease Control and Prevention, fentanyl overdoses increased at a rate of 88 percent per year since 2013, heroin overdoses increased at rate averaging 31 percent per year during that same time period, yet the overdose rate increase for prescription opioids stayed stable at 3 percent per year since 2009. Clamping down even further will not make one IV drug abuser pull the needle out of their arm.
What that clampdown will do is continue to drive desperate patients to the illegal market in search of relief, and it is exacerbating shortages of adequate pain medication for seriously ill patients in hospitals.
The president’s call for longer prison sentences and more death penalties for drug dealers is also doing the same thing. Numerous studies have shown the death penalty to be ineffective as a deterrent. Most major drug dealers have already factored in the risk of their business and are more afraid of being killed by a rival drug kingpin than by the criminal justice system. A Pew Research study released in early March examined all 50 states and found no relationship between prison terms and drug misuse. It also found that only 11 percent of prisoners were “high level” drug dealers. The rest were either small‐time street dealers, couriers, or “mules,” who are rapidly replaced.
If President Trump really wants to try a new approach, he should end the victimization of patients and the doctors trying to help them. He should stop filling our prisons with young people whose futures could otherwise be salvaged. Instead, he should switch the focus to harm reduction. The CDC and the Substance Abuse and Mental Health Administration endorse “syringe service programs” such as needle‐exchange and supervised injection facilities, as well as medication‐assisted treatment with substitute drugs such as methadone and buprenorphine. He should push the Food and Drug Administration to make the overdose antidote naloxone available over‐the‐counter, like it is in Europe and Australia. And since there is increasing evidence that marijuana may reduce opioid use and abuse, and can be useful for treating chronic pain, he should rein in Attorney General Sessions and, at the very minimum, let states continue to go their own way on marijuana laws.
President Trump has shown no fear of breaking with precedent and forging new approaches in other policy areas when he has concluded an approach isn’t working. It is time for him to break with a half‐century old drug policy that has not been working.