Public health experts say Donald Trump's plan to curb opioid addiction sounds like a throwback to the war on drugs that some say resulted in mass incarceration instead of treatment.
The Republican presidential nominee unveiled several initiatives during a speech in New Hampshire, which has been hit hard by the opioid epidemic. Among the ideas is increasing mandatory minimum prison sentences for serious drug offenders. Trump's running mate, Indiana Gov. Mike Pence, has instituted similar policies in his state. Experts say the idea has not worked there and instead has disproportionately incarcerated minorities.
“That's going against everything we've learned—that mass incarceration of people with addiction is not the way to solve a drug problem,” said Dr. Andrew Kolodny, executive director for the advocacy group Physicians for Responsible Opioid Prescribing.
Trump also said the wall he has proposed building along the U.S.-Mexico border to stop illegal immigration would also interrupt the flow of heroin into the country.
For months, Democratic nominee Hillary Clinton has been touting a public health approach to fighting opioid abuse. That approach has been gaining bipartisan support from lawmakers, leading to the passage of the Comprehensive Addiction and Recovery Act in July.
Kolodny said several of Trump's ideas might be helpful, such as expanding access to medication-assisted treatment by lifting the cap on how many patients can be treated with buprenorphine by a physician certified to distribute the medication. In July HHS issued a final rule that increases the number to 275 from 100.
Trump also advocates expanding incentives for state and local governments to use drug courts and mandated treatment; increase access to the overdose-reversal drug naloxone for first responders and caregivers; and ending Medicaid policies that obstruct inpatient treatment. Last year HHS attempted to address the issue when it proposed a rule that would cover 15 days of inpatient rehabilitation services a month for beneficiaries covered by Medicaid managed-care plans.
“I do agree that it is important to make more access to MAT,” said Cynthia Moreno Tuohy, executive director for NAADAC, the Association for Addiction Professionals. “Let's give medication to people where it's appropriate and always counseling and family support in order to be in recovery.”
A number of the proposals in Trump's plan for expanding treatment and prevention are similar to ones Clinton detailed last year as a part of a proposed $10 billion plan to address addiction.
But Trump also blamed the Obama administration's criminal justice and immigration policies for an increase in the flow of illegal drugs coming into the U.S. The Drug Enforcement Administration said in a June report (PDF) that drug traffickers from Mexico have expanded their heroin operations in recent years, with the number of seizures increasing by 80% between 2011 and 2015.
“Over the last few years, this administration has been steadily dismantling the federal criminal justice system,” Trump told the crowd. “Tens of thousands of drug dealers have been released from prison early, including many illegal immigrants—regardless of their history of violence or ties to transnational gangs and cartels.”
But Moreno Tuohy said certain elements of Trump's plan focus too much on stopping the supply of drugs rather than addressing factors that create the demand. Trump also proposed closing shipping loopholes that he claimed allow China and other countries to send drugs like fentanyl into the U.S. by mail. Trump also called for the DEA to reduce the amount of Schedule II opioids that can be made and sold in the U.S.
Moreno Tuohy said such proposals would do little to reverse an epidemic that has caused as many as half a million overdose deaths between 2000 and 2014. According to the Centers for Disease Control and Prevention, 78 Americans die each day from an opioid overdose.
“The only way you're going to stop the flow of heroin is by (cutting) demand,” Moreno Tuohy said. “The problem is that we throw money at ways to show the public that we're trying to do something to help this epidemic when the core of the epidemic is the person themselves, and we need to be treating the people instead of building a wall.”