WASHINGTON — Drug addiction experts battling soaring overdose rates worry President Trump has not lived up to repeated campaign pledges to curb opioid abuse, favoring a tough-on-crime approach rather than the treatment programs he promised.
While the White House heralds a new opioid addiction study commission, advocates said they wanted action — not further study. The epidemic, largely triggered by legal prescription drugs, is already clearly defined, they say, and remains by most accounts out of control.
The desires of these drug treatment advocates run headlong into the more severe approach backed by Attorney General Jeff Sessions, who has expressed interest in returning to the era of stronger prison sentences for nonviolent drug offenders.
“The administration’s current priorities, which include an emphasis on enforcement over treatment, are not going to help turn the epidemic around,” said Caleb Alexander, co-director of the John Hopkins Center for Drug Safety and Effectiveness in Baltimore.
Senator Maggie Hassan of New Hampshire, whose state has seen nearly 200 percent increase in opioid deaths over the past five years and where Trump made his clearest promises to treat addicts, also urged him to invest in treatment.
“While the establishment of a commission is a good first step, we need urgent action because people are dying,” the Democrat said in an interview.
In Massachusetts alone, nearly 2,000 died from opioid-related incidents in 2016, according to the state Department of Public Health.
In an emotional moment from then-candidate Trump in Portsmouth, N.H., he pledged to push for a broad program to stem the tide of addiction and fatal overdoses, in a speech proclaimed in a press release titled, “DONALD TRUMP OUTLINES PLAN TO END OPIOID EPIDEMIC IN AMERICA.’’
“We will help all of those people so seriously addicted get the assistance they need to unchain themselves,’’ Trump declared in the Oct. 15 speech.
“We’re going to set up programs. . . . We’re going to try everything we can to get them unaddicted,” Trump promised a crowd of hundreds in Manchester, N.H., in another speech.
But Trump’s policies have fallen short of those promises. His proposed budget did not contain more money for the treatment programs he discussed on the campaign trail. In his most specific action, he set up the special study commission, which is being led by New Jersey Governor Chris Christie and includes Massachusetts Governor Charlie Baker, both Republicans.
Advocates contend Trump is passing up opportunities to crack down on the pharmaceutical industry, which reports have said fueled the prescription opiate epidemic. They were again angered by the administration’s willingness to remove mandatory coverage provisions from the Affordable Care Act that forced insurers to pay for mental health and addiction treatment.
There are other complaints: Trump’s proposed budget requests cuts to the National Institutes of Health, which could harm critical research into the brain science of addiction, experts said. And the budget also would gut the Community Development Block Grant program, which helps fund many local treatment centers.
“It’s very worrisome,” said Dan McCormick, executive director of Phoenix House, a national drug treatment consortium that serves 20,000 people across 15 states. “I don’t think yet there is a coherency around effective drug policy.”
The White House did not respond to a request for comment. Baker’s office did not respond directly when asked about complaints on Trump’s approach to combatting opioids. Baker said publicly Thursday that he sees his role on the opioid commission as one of sharing information about work by states to combat abuse.
According to reports published last week, Trump will tap Representative Tom Marino of Pennsylvania as “drug czar,” the informal name given to the head of the Office of National Drug Control Policy. Marino is a law-and-order hard-liner who once said nonviolent drug offenders belong in some sort of “hospital-slash-prison.”
Trump has also selected Dr. Scott Gottlieb, a former federal official with financial ties to pharmaceutical and biotech companies, as his choice to run the Food and Drug Administration. Gottlieb has funded several health care startups and has received millions of dollars for his work with large pharmaceutical companies. After the work was disclosed, Gottlieb promised to recuse himself on future FDA decisions involving his former clients.
Conservative policy groups have praised both picks for their no-tolerance approach to drug users and openness to drop regulations on drug companies.
But Senator Ed Markey, the Massachusetts Democrat who has been on the forefront of opioid legislation in Congress, said the choices reveal Trump has not taken to heart what he claimed to have learned on the campaign trail.
Addiction is a disease, Markey said, and a holistic, treatment-based approach is needed.
“We don’t need lip service, we need recovery services,” he said. “This is an emergency. It’s a crisis. It’s the worst epidemic to hit the state in generations, and the whole country is going to have this problem in depth unless we provide the funding.”
In the latter stages of former president Obama’s administration, the White House pushed for a more tolerant approach to treating drug addicts. Congress approved $1 billion over two years for treatment in a broader prescription drug bill called the 21st Century Cures Act.
Markey said he and others are still waiting for the Trump administration to make the first $500 million installment available to states.
On Monday, one of the nation’s largest summits regarding opioid abuse will convene in Atlanta. Last year, Obama attended the gathering, signaling the administration’s commitment. The White House will send Tom Price, secretary of the Department of Health and Human Services.
In his March 30 announcement of the opioid study group, Trump said he had held a “listening session” with former addicts and other lawmakers.
“We’ll work directly with representatives from state and local governments, law enforcement, medical professionals, and victims,” Trump said at the time. “We must get our citizens to help, and we need help.”
But based on the text of that executive order, the commission seems to have few policy directives. It is tasked with producing two reports by Oct. 1 on “how the Federal Government can address drug addiction.” The commission will cease to exist 30 days after submitting the report and will not hold any power to implement its recommendations.
Representative Katherine Clark of Melrose, a Democrat, has called the group a “smoke screen.” Baker defended his involvement in a statement.
“The deadly heroin and opioid epidemic can only be broken with a comprehensive effort from all levels of government focused on increasing access to treatment, prevention. and recovery services, and I am pleased to support this bipartisan commission,” Baker said.
He later touted his role during a meeting with a New England business alliance. “We’re not going to get out of this mess overnight,” Baker said. “But I do think that absorbing some of the best practices and best ideas being pursued at the state level around the country and incorporating that into a national strategy could end up being a really effective way to continue the work.”
Baker’s office did not answer questions on whether the president’s other policy proposals, such as the construction of a border wall or Sessions’ tough-on-crime approach, would affect opiate addiction rates in Massachusetts Previously, Baker has said he opposed cuts to NIH.
If the current pace of opioid-related fatalities continues, by the time Trump’s new commission releases its final report in October, about 1,480 people would have died this year.