Addiction Treatment Policy Under President Trump

It’s the day after Election Day as this article is being written, and Donald Trump has won the American presidency. Some believe he will make America great again and others believe he is evil incarnate. There almost seems to be no in-between. Regardless of how you feel, the presidency is in the hands of Donald Trump. Among the many influences Trump will have on American policy, addiction treatment is one of them. Up until October 28^th, eleven days before being elected, Trump had only one outlook on drug policy: build a wall along our southern border.

Trump’s stance on curbing drug addiction is centered almost exclusively on stopping the flow of drugs from entering the country through Mexico. Then in late October, Trump released a four-point plan to fight the American drug epidemic.

1. Create a wall along the US-Mexico border to prevent illegal drug smuggling. This point also includes aggressive prosecution of both drug dealers and traffickers, including deportation if applicable. Drug smugglers are already creating tunnels in anticipation.
2. Shut down all shipping of fentanyl and related chemicals from China. There are numerous Chinese factories that sell unregulated amounts of fentanyl, and the chemicals needed to make fentanyl, to any buyer. Cartels from Mexico are ordering fentanyl from China and bringing it into the US. Currently there is a fentanyl epidemic in America as death rates from the powerful opioid are skyrocketing.
3. Increase access to drugs used in addiction recovery. Limit the amount of Schedule II drugs manufactured. (This includes most opioid medications.) This could be great. However, the DEA already sets limits on manufacturing, and from 2014 to 2015, most limits increased.
4. Continue to help recovering addicts with the Comprehensive Addiction and Recovery Act (CARA). Also, provide more access to naloxone, a drug that can reverse the effects of an opioid overdose. This is the big one. CARA has the capability to make some real, positive changes in the world of addiction recovery. However, the Republican party has recently removed some funding.

Building a wall, stopping international drug shipping, being harder on drug dealers, increasing access to recovery drugs, manufacturing less opioid medication, and providing more anti-overdose drugs are all straightforward means of fighting the drug epidemic. Only time can tell if these policies will be effective. However, regarding CARA, the situation is a little more complicated.

Let’s take a deeper look at CARA and how Trump may affect it. Then let’s compare the drug policies of Trump and Democratic nominee Hillary Clinton, to see what will be versus what could have been. Last, let’s evaluate Trump’s drug policies and stances to see where we will be in the world of addiction recovery for the next four (or eight) years.

CARA (and Trump’s Effects)

The Comprehensive Addiction & Recovery Act, CARA, is the most expansive federal, bipartisan legislation designed to ensure the devotion of federal resources toward evidence-based education, treatment and recovery programs for addiction. First introduced in March, CARA passed through the Senate with a 94-1 vote, and has since been put into law. The reason for CARA is a sad one.

“…according to the most recent estimates, nearly 9 out of 10 people who need drug treatment don’t get it,” says Senator Whitehouse of Rhode Island in a discussion published here. He continues, saying, “The idea that we are still letting 9 out of 10 people who need treatment not even get it, not have access to it, is a terrible failing.” Like Trump’s proposed drug policies, CARA comes in four parts:

• Prevention efforts and drug education, particularly for children, parents, and the elderly.

• Make naloxone more available to law enforcement and first responders.

• Identify and treat those who are incarcerated and afflicted with substance addiction with evidence-based treatment.

• Fortify prescription drug monitoring and eventually significantly decrease the amount of opioid medications in the hands of Americans.

CARA was made into law by the Obama administration but the Republican party prevented Democratic efforts to maximize funding for CARA. He said, “I am deeply disappointed that Republicans failed to provide any real resources for those seeking addiction treatment to get the care that they need. In fact, they blocked efforts by Democrats to include $920 million in treatment funding.” Still, many millions of dollars have already been used in CARA’s name. However, the debate regarding future funding will be held in 2017, which means the debate will be held during the presidency of Trump.

Seeing as much of the points laid out by CARA are also points laid out by Trump’s drug policy, one can only assume that Trump will support the funding of CARA. However, he is after all Republican and therefore part of the political party that cut funding for CARA. Only time will tell. Regardless, though, of your political stance, it is inarguable that Hillary Clinton had much more concise of a plan regarding addiction recovery and drug policy in America.

Drug & Addiction Treatment Policy Comparison: Trump & Clinton

Had Clinton been elected yesterday; things would be a lot different. Drug policy is included here. Not to say that Trump doesn’t care about the drug epidemic, because surely he does, but Clinton offered a much more detailed plan than Trump. Outside of support for CARA, Trump “has not proposed any specific spending,” as stated in an article on the topic published by ABC. Clinton, however, proposed spending $10 billion in five specific areas of drug policy: prevention, treatment, aiding first responders, reforming prescription, and reforming applicable criminal justice.

Funding is just one of the four major differences between Trump’s and Clinton’s drug policies. Aside from the money, both differ on how to stop the drug supply, how to increase prevention and treatment, and how to crack down harder on the drug criminals.

The Money

As stated, Trump offers no clear plan as to how to fund his policies. Although he supports many facets of the war on drugs, he does not have a clear funding process.

Clinton proposes spending $10 billion, three-quarters of it on the individual states and the remaining $2.5 billion on the Substance Abuse Prevention and Treatment Block Grant program, which provides funding for addiction recovery research and centers.

The Supply

Trump says the wall he’s going to build will prevent drugs from entering America from Mexico. The DEA has said that 79% of heroin analyzed in 2014 came from Mexico. Also, Trump notes that he will attempt to end the Chinese shipping of fentanyl and related chemicals. Lastly, he believes “the DEA should limit production of Schedule II opioid painkillers,” as said in the ABC article. They already do, but perhaps not as stringently as they should.

Clinton does not focus at all at stopping the drug supply, but rather on the other aspects of drug policy.

Prevention & Treatment

Trump wishes to expand the reach of naloxone and “make it easier for doctors to prescribe ‘abuse-deterring drugs.’” He believed the process of approval for such drugs is too slow. As part of this section on drug policy, Trump also mentioned while campaigning in New Hampshire that he wants to establish drug courts.

Clinton’s policies are focused almost entirely on this section of drug policy. She wants to improve the existing treatment facilities and build new ones. She wants more health care providers, and to reduce childcare costs for those in addiction recovery treatment. She wants insurance companies to cover the costs of addiction recovery treatment.

Clinton’s $10 billion plan would also include the promotion of medically-assisted treatment, stricter laws regarding drug prescriptions, making naloxone more widely available, and funding educational programs regarding drug prevention for schools.

Stopping the Criminals

Trump, in a speech delivered October 15^th, pledged to “aggressively prosecute traffickers of illegal drugs.” Also, Trump wants to follow in the footsteps of his Vice President, Mike Pence, who created mandatory minimum sentences for drug offenses in Indiana.

Clinton wants to “prioritize treatment over incarceration for low-level offenders.” She supports drug courts, and wants to use them an alternative for prison when it comes to low-level drug offenders who need help.

Again, no matter how you feel about Trump or Clinton, it’s hard not to see how Clinton’s proposed drug policies are much more clear and evidence-based than Trump’s. However, with China and Mexico combining to provide the US with an overload of fentanyl, maybe Trump’s wall will be effective. Also, Trump clearly will get behind drug policy. With CARA, addiction treatment will only get better from here, right?

A Review of Trump’s Policy

The 45^th president is focusing on the supply of drugs more than any other aspect. This method is known as interdiction, and per Theodore Cicero, substance abuse expert and psychiatry professor at Washington University in St. Louis, it doesn’t work.

“All interdiction attempts have failed,” said Cicero. “It is hard to see how re-emphasizing attempts to reduce supply will make much of dent in an important problem. We need to reduce demand, not simply the supply of these drugs.” While Clinton offered a 1,500 page paper outlining her drug policies to be, Trump “apparently has no position paper at all.” In fact, what he does have is a video less than one minute long.

Here is an exact-word transcript of Trump’s words in the short video:

“New Hampshire has a tremendous drug epidemic. Every time I go there, people come up to me and say, ‘Mr. Trump, what are we gonna do?’ Drugs are pouring in. I’m gonna create borders. No drugs are coming in. We’re gonna build a wall. You know what I’m talking about. You have confidence in me. Believe me, I will solve the problem. They will stop coming to New Hampshire. They’ll stop coming to our country. And the people that are in trouble, the people that are addicted, we’re going to work with them and try and make them better. And we will make them better.”

All we can do is wait, and pray that Trump truly does make them better.