President Donald Trump and Attorney General Jeff Sessions attend a panel discussion on opioid and drug abuse in the Roosevelt Room of the White House on Wednesday. | Getty After pledging to solve opioid crisis, Trump’s strategy underwhelms

As a candidate, Donald Trump promised rural towns and states hit hard by opioid addiction that he'd solve the epidemic ravaging their communities. "We will give people struggling with addiction access to the help they need," Trump vowed in October.

Trump won many of those communities — often overwhelmingly. But as president, he's proposing deep cuts to research and treatment in favor of funding a border wall to stop drug traffic, while hinting at bringing back policies like criminalization of drug misuse — and announcing Wednesday yet another big presidential commission to study the problem.


Public health advocates say those plans at best duplicate those of the Obama White House and at worst could set back efforts to tackle a problem that contributes to more than 47,000 deaths per year. Many experts advocate treatment and support services over jail for drug abusers, saying they reduce the risk of a person committing another crime.

The emerging Trump strategy, including failed plans to repeal Obamacare protections that enabled millions to get substance abuse treatment, "doesn't bode well for the public health approach, such as it is," said Leo Beletsky, a law professor at Northeastern University who specializes in health and drug policy. He points to Republican rhetoric about criminalizing the crisis, as well as proposed funding cuts to research and treatment.

"This new shift will certainly make the situation much worse," Beletsky added.

Trump will sign an executive order Wednesday creating a high-level opioids commission led by New Jersey Gov. Chris Christie, who has spoken about the need to prioritize treatment for opioid addiction. It includes Attorney General Jeff Sessions, who has suggested more of a crime-and-punishment approach.

Public health experts question the value of the commission. It was just last November when Surgeon General Vivek Murthy released his office's first-ever report on opioids and addiction, which included tools and recommendations collected from more than a year of research. The CDC also released prescribing guidelines after thorough study.

"These people don’t need another damn commission," said a former Obama administration official who worked to address the opioid crisis and asked not to be named. "We know what we need to do. … It's not rocket science."

The White House on Tuesday also shuffled the leadership at the Office of Drug Control Policy, replacing acting head Kemp Chester — a compromise pick between the outgoing Obama and incoming Trump administrations — with acting head Rich Baum, a former Hill GOP staffer who's been critical of legalizing marijuana and wants to tackle drug cartels abroad.

Baum specializes in what's called the "supply side" of drug policy — cracking down on the flow of illegal drugs — as opposed to "the demand side," or treating the end user. Baum is close to GOP policy experts who worked to enact the "war on drugs" tactics under previous Republican presidents, several sources told POLITICO.

But many officials are doubtful about the supply side approach.

“Our hope is they would take a public health approach to addressing this epidemic," said Laura Hanen, chief of government affairs at the National Association of County and City Health Officials. She pointed out that while there have been inroads to clamp down on over-prescribing of prescription opioids, there's been a corresponding uptick in heroin and fentanyl. “You squeeze one end of the balloon and the air goes to the other end. … If we’re only going to use a supply side approach I doubt it ‘ll be very effective.”



Drug-policy experts also worry about Sessions' punitive view of drug abuse and his skepticism about treatment, which he believes seldom works. “We can wish that we could just turn away and reduce law enforcement,” he said in a speech last year. “But I do believe that we're going to have to enhance prosecutions. There just is no other solution.”

Pam Garozzo holds up a photograph of her late son Carlos during a listening session Wednesday at the White House on opioid and drug abuse. | AP Photo

The White House issued a budget request recently that would siphon billions of dollars from NIH research and CDC public health work this year while steering about $2 billion toward construction of Trump's border wall with Mexico.

The president has promoted the wall as a linchpin of his strategy to fight the opioid epidemic. "A wall will not only keep out dangerous cartels and criminals, but it will also keep out the drugs and heroin poisoning our youth," Trump said in October in New Hampshire — a state hard-hit by the opioid crisis.

"We must ... focus on prevention and law enforcement," Trump said at a Wednesday event showcasing the effort. "That is why I have issued previous executive actions to strengthen law enforcement and dismantle criminal cartels. Drug cartels have spread their deadly industry across the nation and the availability of cheap narcotics — and by cheap, some of it comes in cheaper than candy — has devastated our communities."

But Trump's own homeland security czar said the border wall "in and of itself will not do the job" and drug-policy experts warned cartels would be motivated to find a way around it. In any case, it may be a non-starter this year; Congress will rebuff the request, Sen. Roy Blunt (R-Mo.), a senior appropriator, signaled on Tuesday.

Democrats on the Hill also blasted Trump for a plan that they say prioritizes optics like a border wall and a political commission over investing more dollars in caring for people who are addicted to opioids, recovering or are at risk. They also said that the ill-fated American Health Care Act — the House Republican plan to strike down Obamacare — would have dealt a critical blow to coverage for millions of substance misusers.

"I’d take President Trump’s proposed efforts on opioids more seriously if he hadn’t spent the last two months trying to derail the historic steps forward on substance abuse treatment through the Affordable Care Act — and if his budget didn’t also include a 20 percent cut to mental health services, which are so important in the fight against this epidemic," Sen. Patty Murray (D-Wash.) said in a statement.

"I was pleased to see then-candidate Trump recognize this issue on the campaign trail," Sen. Maggie Hassan (D-N.H.) told POLITICO. "[But] I am concerned that rather than show a commitment to increasing resources to boost treatment capacity, President Trump has so far pushed policies that would harm our efforts to combat the crisis."

Several advocates pointed out that the failed House Republican bill to repeal Obamacare would have significantly hindered access to addiction treatment. The legislation was not only projected to lower coverage but also would have eliminated essential health benefit guarantees — including mental health — for millions of Americans covered through various ACA-related programs.

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The bill would have slashed Medicaid expansion, which experts have concluded helped nearly 1.3 million low-income Americans gain access to substance-use treatment.

Trump's budget proposal for next year keeps the $500 million allotted to states through the 21st Century Cures Act to fight opioid addiction and proposes $175 million more to fight drug trafficking. But it would cut funding by 14 percent for the Coast Guard, whose maritime interdiction efforts are necessary at a moment when cocaine production and trafficking is at an all-time high.

Drug policy experts across the federal government say they weren't consulted on the executive order to create the opioids commission.

"The first time I learned about this was when I saw it in the press" on Sunday night, one said.

Policy experts stressed that the Obama administration made its own blunders in fighting the opioid epidemic, such as failing to increase access to drugs like naloxone, which can keep addicts from dying from overdoses. The same experts are nervous to see the current administration potentially repeat the last one's mistakes.

"Paradoxically, the [opioid] crisis also helped to get us here," Beletsky added. "The failure to curb overdoses — and address the deep structural issues that have fueled them — also helped Trump make the case that government wasn't working."

Brent Griffiths contributed to this report.