Baltimore health commissioner: Trump’s opioid announcement yesterday was deeply troubling

Yesterday, President Trump announced his plan to curb the opioid epidemic. While it is laudable that he is devoting time and attention to this issue, much of his announcement is deeply troubling.

First, I worry about the focus on punishment. Addiction is a disease. Research has shown time and time again that treating addiction as a crime or a moral failing is ineffective, unscientific, and inhumane. The “War on Drugs” approach has not worked, and has disproportionately incarcerated minorities and the poor.

{mosads}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.

In Baltimore, we partner with public safety agencies to treat addiction as the disease that it is. For example, our Law Enforcement Assisted Diversion (LEAD) Program refers individuals caught with small amounts of drugs to treatment, rather than incarceration. We recognize that many individuals who deal drugs are doing so to support their own addiction.

While research has shown that getting people into treatment reduces crime and cuts overdose deaths, only one in ten people with the disease of addiction are able to obtain treatment. Treatment works and recovery is possible. Just like for other chronic illnesses, relapse is part of the recovery process, and must be met with compassion, rather than criminalization.

Second, I question the lack of specific, sustained commitment for funding that is directly allocated to communities with the greatest need. Five months ago, President Trump declared a state of emergency around the opioid epidemic, yet there has been no effect for those of us working on the front lines.

Promises of funding without concrete commitments will not help address the crisis. We need resources, not rhetoric. The president discussed funding, but where are the resources for local jurisdictions hardest hit? Cities and counties have been fighting the opioid epidemic for years. We know what works, and any delay will cost further lives.

In Baltimore, I issued a blanket prescription for the opioid antidote naloxone (Narcan) in October 2015. Since then, everyday Baltimoreans have saved the lives of over 1,600 of their fellow residents. But we are having to ration naloxone because we simply don’t have the resources to purchase this medication and increase evidence-based treatment. We have saved thousands of lives — imagine how many more we could save if only we had the resources to do so.

I look to President Trump to assist us by directly negotiating the price of naloxone with drug manufacturers. Local officials should not be priced out of the ability to save lives. The president can also change regulations to ensure that all three forms of Medication-Assisted Treatment (methadone, buprenorphine, and naltrexone) are available without prior authorization or duration limits. Furthermore, the president should do everything possible to ensure healthcare access, including by expanding Medicaid and upholding the protections in the Affordable Care Act.

Third, I am concerned that the other prongs of the president’s proposal do not use evidence-based interventions. Studies have shown that “just say no to drugs” campaigns are not effective unless they are accompanied by a comprehensive approach to youth health and wellness.

Where is the announcement for school-based health services and other community and social resources? Where is the support for women, children, and families to break the cycle of intergenerational poverty, trauma, and addiction? We must invest in communities so that the lives our youth are living are not lives they want to escape from.

I implore President Trump to engage in evidence-based best practices and to heed the call for help from those of us on the front lines of the epidemic. This is a time of national crisis. We know what works. We need the commitment of the president to truly treat this devastating disease.

Dr. Leana S. Wen is an emergency physician and the commissioner of health in Baltimore City. Follow her on Twitter @DrLeanaWe.