During the 2016 Presidential campaign, when Donald Trump was asked about the opioid crisis he often mentioned that he first learned about the severity of the situation in New Hampshire, which he visited several times ahead of that state’s primary. In 2014, after West Virginia, New Hampshire had the second-highest rate of death from opioid and heroin overdoses, at twenty-two out of every hundred thousand fatalities. (In 2015, there were more than thirty thousand such deaths nationwide, and the rate is projected to rise.)
As Trump heard more about addiction, he began speaking about it at rallies and, sometimes, in personal terms. Five days before the New Hampshire primary, at an event in Manchester, Trump talked about his older brother, Fred, who died in 1981, following a long battle with alcoholism. “He had everything,” Trump said. “I mean, the most handsome guy. And then he got hooked and there was nothing—and by the way, nothing you could do about it.” A woman sitting behind him nodded in agreement, as others in the room listened, rapt. Yet, as much as people empathized with Trump’s conclusion that he was, on an individual level, powerless in the face of his brother’s addiction, some of them voted for him because he also claimed, with increasingly sweeping rhetoric, that he, and perhaps only he, could “solve” the national crisis.
Last Tuesday, the President attended a “major briefing” on the epidemic with the Secretary of Health and Human Services, Tom Price, and other aides, at his golf club in Bedminster, New Jersey. They had with them a draft report that had been prepared by a special commission chaired by Governor Chris Christie, of New Jersey. The draft is rich in recommendations for channelling additional resources to the crisis. One is that naloxone, an anti-overdose drug known commercially as Narcan, be provided to first responders at a lower cost. Another would expand the definition of the kinds of in-patient facilities that are eligible for reimbursement under Medicaid, which the authors say is the quickest way to get help to a large number of people. In fact, the report demonstrates the crucial role that Medicaid plays in addressing the crisis, and the program’s still greater potential for combatting it. (The report also helps explain why Senator Mitch McConnell had a hard time getting colleagues from states hit hard by opioids to sign on to an Obamacare repeal that called for gutting Medicaid.)
Trump, however, gave no sign of rethinking his approach to funding these public-health initiatives. Instead, before he upended the briefing with his threat to consume North Korea with “fire and fury,” he had focussed his remarks on finger-pointing and punitive measures. The opioid crisis, he said, is the fault of the Mexicans and the Chinese, who allow drugs to be sent from their nations to ours. The metric that he offered for success in handling the problem domestically was the number of federal drug prosecutions brought and the average length of prison terms they produced. Both have dropped since 2011, which the President sees as evidence not of a bipartisan consensus on the need for sentencing reform but as proof of the laxity and the bad faith of members of the Obama Administration, who, he said, had “looked at this scourge, and they let it go by.”
Attorney General Jeff Sessions has already instructed federal prosecutors to pursue charges yielding the maximum possible prison terms, and revoked earlier guidelines designed to avoid harsh mandatory minimum sentences in cases involving nonviolent drug offenders. This promises to expand the practice of mass incarceration, with people cycling in and out of prison without receiving treatment, and further generations of children being exposed to disruption, broken families, and, potentially, their own susceptibility to what painkillers seem to offer.
At the briefing, the President pointed out, again, that once a person starts using drugs it is “awfully tough” to get him off, but suggested that the problem might be avoided by telling young people that drugs are “no good, really bad for you in every way.” His wife, Melania, sat beside him, as if to echo Nancy Reagan’s support of the “Just say no” campaign during her husband’s Administration. But that message seems particularly inappropriate, given the epidemiology of this drug crisis: the first person many addicts would have to say no to is a health-care provider.
The commission’s report notes that the number of opioid prescriptions for treating pain has quadrupled during the same period in which overdoses have skyrocketed, and that although some of those prescriptions may have been fraudulent, the great majority were not: “We have an enormous problem that is often not beginning on street corners; it is starting in doctor’s offices and hospitals.” That reality is fuelling a different kind of legal response. On the day of Trump’s briefing, New Hampshire filed a lawsuit against Purdue Pharma, the maker of OxyContin, for mismarketing and misbranding the drug, leading doctors to prescribe it in ways that encouraged dependency and, ultimately, abuse. (The company has pleaded guilty to related federal charges.)
In other ways, too, Trump’s actions have been at odds with the goal of taking a serious approach to the crisis. The report calls for more work by the National Institutes of Health and the Centers for Disease Control and Prevention, while Trump has proposed slashing the budgets of both organizations. It also asks for a declaration of a national emergency, which would expedite various practical measures and show that the Administration has a coherent plan. Trump, following a familiar pattern, first ignored that recommendation, leaving Tom Price to explain why it didn’t make sense (basically, opioids aren’t a “Zika outbreak”), and then, on Thursday, reversed himself in a statement in which he expressed nostalgia for the days when, as he saw it, Americans only had to worry about drugs like L.S.D. Then he returned to threatening North Korea.
It’s enough to make one wonder what, exactly, Trump learned in New Hampshire. Last January, in a phone call with President Enrique Peña Nieto, of Mexico, the transcript of which was obtained by the Washington Post earlier this month, Trump said, “I won New Hampshire because New Hampshire is a drug-infested den.” He didn’t win the state in the general election; Hillary Clinton did. But he got his first primary win—after an embarrassing loss in Iowa—which propelled his campaign forward. The state, however, is still waiting for something to be done. ♦