Issues of addiction became more and more central to me as they came at my family like a tsunami over the last decade. Most of the details of this are too private to share. Personally, I celebrated three years without a sip of alcohol last month, but I waged far more difficult battles, some of which were won (for now) and most of which were lost. What began as a knife-fight in a narrow alley expanded into a much broader universe as my focus expanded to helping other families deal with the addiction problems in their extended families. As a result, I got a crash course in how opioids are decimating our communities and in the inadequacies of our national response. It has been a very rewarding experience to become involved in the broader recovery community, but it comes with constant sorrow as death announcements arrive as steadily as the rain.
Thanks to some connections I had at the Obama White House, I was able to communicate my concerns fairly directly to them and to get invitations to sit in on both off and on the record conference calls about how they were moving forward on the opioid problem. I watched them deal with their own learning curve, so I know that it isn’t easy to get your head around the gap between what we have and what is needed to deal with the scale of opioid addiction we now have in America. And once you do get it, the next problem is that you can’t do much politically until everyone else also gets it. I was not satisfied with the Obama administration’s approach, but I did feel like I was dealing with people of good faith who had a sincere desire to learn and to find resources and solutions that would save lives. They were often just as frustrated as I was, and there was no sense for me that they weren’t taking the issue very seriously.
The Trump administration is much different. They’ve made all kinds of vague promises, and they’ve taken some steps to show that they’re working on the problem, but there’s a basic lack of seriousness. Nowhere is this more clear than with the president:
President Donald Trump overrode his own advisers when he promised to deliver an emergency declaration next week to combat the nation’s worsening opioid crisis.
“That is a very, very big statement,” he said Monday. “It’s a very important step. … We’re going to be doing it in the next week.”
Blindsided officials are now scrambling to develop such a plan, but it is unclear when it will be announced, how or if it will be done, and whether the administration has the permanent leadership to execute it, said two administration officials.
“They are not ready for this,” a public health advocate said of an emergency declaration after talking to Health and Human Services officials enlisted in the effort.
Trump’s off-script statement stunned top agency officials, who said there is no consensus on how to implement an emergency declaration for the drug epidemic, according to interviews with officials from the White House, a half dozen federal agencies, state health directors and lobbyists.
I know this is another example of Trump understanding absolutely nothing, but I have to wonder why the people in his administration don’t have a plan worked out yet. New Jersey Gov. Chris Christie headed the so-called “opioid commission” for Trump, and they recommended an emergency declaration that was originally planned for August. Apparently, the plan was opposed by budget director Mick Mulvaney and former HHS Secretary Tom Price who had legal and cost concerns. Other than some meetings that were informally chaired by Kellyanne Conway, it doesn’t appear like any actual work has been done:
Multiple sources in and out of relevant federal agencies said key leaders on the opioid issue had not been asked to draw up strategies and tactics.
A senior FDA official said she did not know who was in charge of the emergency declaration efforts and described the effort as “such a mess.”
“I would hope that the agency heads had been asked to formulate a plan, and if they haven’t by now it’s hard to believe there will be substance to any announcement made next week,” said Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, which advocates for state and federal policies to combat opioid misuse.
Yes, I can and do blame President Trump for the lack of action, and for making an announcement that demonstrates his lack of focus on opioids more than his commitment to saving lives. But I would have thought it was clear that he wanted people working on the issue. How is it possible that nothing was set up by his chiefs of staff Reince Priebus or John Kelly? This is incompetence on a much wider scale than just at the very top.
But, then we have to remember that there is presently no head of the Drug Enforcement Administration, no head of the Office of National Drug Control Policy, and no secretaries of the Health and Human Services or Homeland Security departments.
It’s hard to coordinate an interagency response to a public health crisis when you have a bunch of substitute teachers in the classroom.
Ideology is an obstacle here, too, as there is a basic resistance to spending money on public health of any kind, and the main focus of the administration has been to destroy the Affordable Care Act, including the provisions in it that are helping people afford and get access to treatment.
Ultimately, we need Congress to act because all the administration can presently do is shift money around. But it is not encouraging that the administration hasn’t been doing the work they should have been doing so that the president can take some action without it being an empty promise and a joke.
