Vital Signs Blog

Trump's long-awaited opioid declaration was a rehash of old ideas

President Donald Trump's long-awaited declaration that the opioid epidemic is a public health emergency was panned by providers and patient advocates who were looking for a solid and funded plan. Supporters say the president's address on its own brings attention to the crisis. But critics say Trump's comments were a rehash of old ideas.

"Just Say No" 2.0?

Trump on Thursday said his administration would launch a "massive" advertising campaign aimed at preventing children from trying drugs in the first place. "This was an idea that I had, where if we can teach young people not to take drugs, it's really, really easy not to take them," he said.

But the plan sounded reminiscent of a 1980s "Just Say No" anti-drug campaign led by former First Lady Nancy Reagan.

"It's very wrong-minded, and it's just an ill-conceived idea," said Tom Hill, vice president of Addictions and Recovery for the National Council for Behavioral Health. "It didn't work 40 years ago, it hasn't worked since, and it won't work now."

Studies have shown that "Just Say No" was ineffective in curbing drug abuse while ushering in policies that increased law enforcement efforts instead of treatment opportunities.

Hill said Trump's approach to addressing opioid abuse seems to veer away from policies supported by addiction medicine experts and championed by many lawmakers in recent years. Last year, Congress overwhelmingly passed the Comprehensive Addiction and Recovery Act that focused on expanding access to treatment, increasing first-responder training and addressing criminal justice issues.

"We have come a long way in addressing opioid abuse as a public health condition rather than a law enforcement issue," Hill said. "It's bitterly disappointing to be turning back to law enforcement strategies that even law enforcement officials say don't work."

"The evidence is clear that if you do a good job with primary prevention, then it is helpful," said Dr. Corey Waller, chair of the Legislative Advocacy Committee of the American Society of Addiction Medicine. Waller favors the president's strategy and referred to public health campaigns against tobacco that smoking rates from 40% in 1965 to just over 16% in 2014.

"I think it needs to be left up to the experts in prevention to develop the message and doesn't need to feel catchy from a non-expert view," Waller said.

He added that "Just Say No" lacked focus and scientifically based strategies. In fact, have shown that one of the campaign's most popular youth programs, Drug Abuse Resistance Education, or DARE, may have increased the likelihood of some kids trying drugs.

In July, U.S. Attorney General Jeff Sessions voiced his for bringing back DARE.

An effective drug use prevention campaign must be comprehensive and address root causes, according to Calondra Tibbs, senior adviser for public health programs for the National Association of County and City Health Officials. That effort could benefit from the healthcare industry's focus on identifying social determinants of health and treating the mind, body and spirit, she said.

Tibbs said what might be helpful are prevention programs that focus on promoting positive reinforcement and building self-esteem that enable kids to make a range of good choices rather than initiatives that focus solely on telling kids "no".

"Programs that are more complex and address multiple issues around the reasons why young people start taking drugs or continue to use drugs tend to be more effective in helping kids make better decisions," Tibbs said.

Removal of painkillers

Trump highlighted his administration's work to remove Endo Pharmaceuticals' Opana ER opioid, which he referred to as "evil," from the market over concerns that its addictive risks outweighed its benefits.

Endo pulled Opana ER from the market in July at the request of the Food and Drug Administration. Opana was easy to crush and was cited as the drug that was injected by people in Scott County, Ind., sparking an HIV outbreak in 2015.

Trump's mention of the FDA's move against Opana seemed to suggest that the agency and the administration may look to take similar measures against opioid-based painkillers deemed too dangerous to be on the market.

But with so many opioid alternatives currently available, Opana's removal had a minimal effect on prescribing rates, according to Dr. Edward Michna, an anesthesiologist and pain specialist at Brigham and Women's Hospital in Boston and board member of the American Pain Society.

Michna said he wasn't concerned that the Trump administration may seek to remove more opioids from the market, since other drugs have been reformulated to reduce the risk of abuse.

"That wouldn't be a rational approach to this," Michna said.

Privacy issues

Trump didn't mention on Thursday if he would call for regulatory changes to relax patient privacy rules that many healthcare providers say hinder their efforts to integrate care for patients with substance abuse disorders.

Current federal law requires addiction treatment providers to obtain written consent from patients in order to share their information with other clinicians.

"The current law kind of impedes integration and can lead people with an opioid addiction to get prescribed opioids," said Pamela Greenberg, CEO of the Association for Behavioral Health and Wellness. "You could be being treated for an opioid use disorder and go to the dentist for some type of major dental work, and the dentist could prescribe an opioid not knowing that you are being treated for an addiction because they don't have access to your records."

Trump's opioid commission recommended changing the law in its in July. The commission will release its final recommendations Wednesday.


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