President Donald Trump on Monday said he believes the impact of the opioid abuse epidemic can be curbed by cutting opioid prescriptions by a third over the next three years. He also called for the death penalty for large-scale drug traffickers.
The president's "Initiative to Stop Opioid Abuse" calls for more aggressively prosecuting drug traffickers who deal fentanyl, a synthetic opioid that can be 50 to 100 times more potent than heroin.
"This scourge of drug addiction in America will stop; it must stop," Trump said Monday while announcing the administration's response. "Failure is not an option; addiction is not our future."
The most controversial aspect of Trump's initiative involves how the administration plans to cut the supply of illicit drugs such as fentanyl; figures indicate fentanyl surpassed prescription opioids in 2016 as the leading driver of drug overdose deaths. Fentanyl caused 19,000 out of the nearly 64,000 deaths that year.
Trump said the administration would take a tougher stance on drug trafficking but that tactic has had limited success in the past.
The plan calls for the U.S. Justice Department to seek the death penalty for large-scale drug traffickers under current federal law, which allows for capital punishment in drug-related cases that involve murder with the use of a firearm or the killing of a law enforcement officer.
"We can have all the blue-ribbon committees we want, but if we don't get tough on drug dealers we're wasting our time," Trump said. "And that toughness includes the death penalty."
Advocates lauded some aspects of Trump's plan, such as establishing a national prescription-drug-monitoring program. It also seeks to boost drug abuse prevention efforts, improve opioid prescription practices and expand access to treatment.
But the question of additional funding remains unanswered.
Trump said his administration has worked with Congress to include $6 billion over the next two years in the spending bill that passed in February.
Still, many of the agencies such as the Substance Abuse and Mental Health Services Administration that would carry some of the plan's heavy lifting have had their budgets slashed.
"They're going to have to make sure that their fiscal policies align with their outcomes and goals if they're going to be successful," said Dr. Georges Benjamin, executive director of the American Public Health Association.
Public health leaders also condemned Trump's call for tougher law enforcement measures as a throwback to the tactics of the 1980s and '90s, which focused on criminalizing drug abuse rather than expanding treatment options.
"The War on Drugs approach has not worked and has disproportionately incarcerated minorities and the poor," Dr. Leana Wen, Baltimore city health commissioner, said in a written statement. "Creating additional criminal penalties and ratcheting up enforcement continues a failed strategy: addressing the supply of drugs alone is not going to be effective unless equal attention is paid to reducing the demand for them."
On opioid overprescribing, the plan asks that 75% of opioid prescriptions that are reimbursed by federal healthcare programs over the next three years be written using best practices. That would increase to 95% of all such prescriptions within five years.
All federally employed healthcare providers would be part of an interoperable Prescription Drug Monitoring Program national network.
"Having interoperability between states particularly in areas where there is high traffic in order to be able to track that and monitor that is tremendous," said Dr. Shalini Shah, head of the pain medicine department at UC Irvine Health system in California. "I think this is going to really improve patient accountability when it comes to opioid use and where they're getting it from."
Trump said he'd like to see research and development of new non-addictive pain treatments and a vaccine to prevent opioid addiction.
Some credited the White House for coming up with a plan at all. The administration was criticized for not doing enough after declaring a public health emergency five months ago.
But others weren't impressed.
"Promises of funding without concrete commitments will not help address the crisis," Wen said. "We need resources, not rhetoric."
Want to continue the conversation about opioids? Join Modern Healthcare on April 25-26 at its Opioid Crisis Symposium.