April 10th, 2017

Trump’s Opioid Commission: A First Step

During the presidential campaign, Donald Trump identified opioid addiction and the rising numbers of overdoses as an issue he would address if elected. The framework is beginning to take shape: New Jersey Governor Chris Christie will head an opioid commission charged with deciding how to proceed.

The commission will be located in The White House Office of American Innovation, to be led by Jared Kushner, President Trump’s son-in-law. According to the Washington Post, that office will be “viewed internally as a SWAT team of strategic consultants,” and “will be staffed by former business executives and is designed to infuse fresh thinking into Washington.” I hope they will be able to integrate new ideas about effective addiction treatment.

Governor Christie, in recent TV interviews, has said opioid addiction should be addressed with treatment rather than punishment. While this is encouraging, I hope that as he becomes more knowledgeable about addiction, he will consider an alternative to calling for “more beds” to expand access to treatment.

Inpatient treatment is much more expensive than intensive outpatient treatment, which a recent study found “as effective as inpatient treatment for most individuals.” Financial resources for treatment became a political issue in the recent attempt to reform healthcare. The last iteration of the aborted bill eliminated addiction treatment as an essential service for all insurance policies.

Substance use disorders are a bipartisan issue that has been a focus for all recent presidents — both Republican and Democrat. President Nixon was the first to recognize the need for a coordinated effort, appointing Dr. Jerome Jaffe as the first “drug czar” in response to heroin use by American troops in Vietnam. Increasing access to treatment was the initial focus with the balance shifting over the next 46 years between law enforcement and treatment in the agency now known as The White House Office of National Drug Control Policy (ONDCP).

Under President Obama, treatment was emphasized, and the seeds of those efforts continue to bear fruit. Obama’s last drug czar, Michael Botticelli, will join the faculty at the Johns Hopkins Bloomberg School of Public Health, thus keeping his considerable skills and energy in our region. Richard Baum, a veteran of ONDCP, has been named its new acting head and coordination with the new opioid commission has fortunately been taking place.

There are indications, however, that this appointment may be only temporary. Moreover, the new opioid commission is reportedly temporary as well. Much, therefore, remains uncertain, and I will continue to track decisions taken by the Trump administration.

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