The President correctly cited the urgency of the opioid epidemic Thursday in his remarks on the administration's plans to curb the opioid epidemic. More Americans died in 2016 from drug overdose than during the entire Vietnam War. The President made his own war comparison stating "we have fought and won many battles and many wars before, and we will win again." The President included recommendations from the Commission on Combating Drug Addiction and the Opioid Crisis, including an agency rule change that will permit Medicaid to reimburse inpatient facility with more than 16 beds.
But, the President also highlighted multiple law enforcement based policies in the address. There is concern from the public health community that additional funding to law enforcement reduces resources for opioid prevention, treatment, harm reduction, and overdose reversals.
In August, the President stated he would declare the opioid epidemic a national emergency. Instead, the President yesterday declared a public health emergency. Semantics aside, the biggest difference is funding. Declaring a national emergency would have made funds available immediately. In contrast, the public health emergency fund is essentially empty. While signing the order puts pressure on Congress to put money back into this fund, the President made no direct call to do so. There is no additional federal funding to combat the epidemic today than there was last week.
Beyond the lack of funding is the proposed direction of future funding. Among the law enforcement-based approaches included in the plan are securing the southern border, cracking down on gang activity, and improving systems that inspect packages coming into the country to reduce the importation of fentanyl.
The drug trade is a booming enterprise. A wall – mentioned as essential in the address – is hardly a deterrent from the massive heroin profits of Mexican cartels. Further, fentanyl is incredibly concentrated. A single first class envelope can contain 50,000 doses of the drug.
And now, carfentanil – an opioid designed for elephants – has become more prevalent in communities. While fentanyl is 50x more potent than morphine, carfentanil is 100x more potent (10,000x morphine). The detection of carfentanil in the mail is virtually impossible. The investment in "protecting the borders" would be a massive investment and likely to have little effect. This is funding that would not be directed toward getting individuals into treatment, preventing the spread of associated diseases, or preventing initial opioid use.
The War on Drugs that began in the 1970s has failed. Under it, spending on domestic and international law enforcement has consistently received more federal funding than treatment and prevention. Yet, despite over $1 trillion in spending since 1970 and $10-15 billion spent annually, illicit drug use and drug overdose death prevalence in the United States is one of the highest in the world.
Federal policies have failed to recognize that opioid use disorder is a chronic disease. It is time to let public health take the lead on the opioid epidemic. The country must implement evidence-based public health policies that end the war and start the healing.
Matt Miclette, MSSP, BSN, RN-BC is a Policy Associate at the Leonard Davis Institute for Health Economics of the University of Pennsylvania and Policy Director of Action Tank, a Philadelphia-based nonprofit.