Trump’s opioid crisis declaration draws optimism, concerns

Aug. 21--BOSTON -- President Donald Trump's declaration of a national crisis to combat opioid abuse could unleash a massive federal response to curb addiction, but some worry that new policies will focus more on locking people up than getting them into treatment.

Trump issued the edict following a recommendation from a 10-member opioid commission -- which included Gov. Charlie Baker -- to declare a national emergency.

Dr. Bertha Madras, a commission member and researcher at Harvard Medical School and McLean Hospital who studies addiction, said the panel's myriad recommendations are focused on tackling opioid addiction from both the supply and demand sides.

"It's an overwhelming challenge to treat opioid addiction properly, and this is going to require a robust federal response," she said in an interview. "It's a national crisis."

Among the panel's recommendations: expand drug treatment under Medicaid, increase the use of medication-assisted treatments, and broaden "good Samaritan" laws to shield individuals from prosecution when they report an overdose to law enforcement.

The panel also called for improving training on painkiller prescribing for doctors, forcing state prescription tracking programs to share information, and getting tough with insurers who illegally restrict benefits for mental health or addiction treatment.

Madras said some of the panel's recommendations -- such as Medicaid waivers for health care facilities to add treatment beds and directing the Drug Enforcement Agency to mandate physician education -- can be dealt with by executive action.

Others will require congressional approval and funding that doesn't yet exist.

Some proposals, such as lifting federal restrictions on the sharing of medical records among substance abuse counselors and physicians, will face resistance, she said.

"Some things may look good on paper but may be difficult to implement," Madras said. "But from the feedback I've received, I'm confident there's a commitment to do it."

John Rosenthal, co-founder of the Police Assisted Addiction and Recovery Initiative, said he was encouraged by Trump's crisis declaration though it lacked specifics.

"His announcement had no teeth," he said. "His message was 'just say no, talk to your kids and go after drug dealers.' That doesn't work. We need to deal with demand."

For one, Rosenthal said the federal government should stockpile and distribute the overdose-reversing drug naloxone. He cited federal responses to other health emergencies such as polio, swine flu and, more recently, the Zika virus.

"The threat to public health from the opioid epidemic is at least on the same scale as these past emergencies," Rosenthal said. "Naloxone should be in the hands of every first responder in the country."

Massachusetts, which declared a public health crisis to combat opioid abuse in 2014, has become a national leader in the effort to fight addiction.

Baker, a Republican who has spent much of his first term wrestling with the problem, has also pushed the focus toward treatment and prevention over incarceration.

He signed a landmark law in 2015 that limits the first round of a painkiller prescription to a seven-day supply, requires follow-up evaluation of overdose patients brought to emergency rooms, and boosts funding for state-run treatment facilities.

Fueled by prescription painkillers and cheap heroin, opioid addiction has reached historic levels. The U.S. Centers for Disease Control and Prevention say more than 100 Americans die from drug overdoses every day.

Massachusetts and New Hampshire have been hit particularly hard, with skyrocketing numbers of overdose deaths from heroin and other drugs, such as the synthetic fentanyl.

Trump has not offered any specific policy on how he'll handle the federal response, but he has said a wall he plans to build on the Mexican border will stop the flow of drugs.

Attorney General Jeff Sessions, a former Alabama senator, has talked repeatedly about expanding the use of mandatory minimum sentencing for drug crimes and seizing more cash and property from individuals suspected of drug crimes to combat opioid abuse.

Some worry that Trump's declaration will expand the powers of the president and attorney general in a way that could allow abuse of law enforcement authority.

Phil Lahey, a former Methuen city councilor who oversees the Merrimack Valley Prevention and Substance Abuse Project, said heavy handed approaches just won't work.

"I don't care if you build wall or put a bubble over the whole country, you're not going to stop it from coming in," Lahey said. "For those of us who have been dealing with this for years, the solution is, and always has been, prevention, education and treatment."

State Rep. Ann-Margaret Ferrante, D-Gloucester, said she is waiting to see what federal policies and proposed legislation follow the president's declaration.

"It's all well and good that he is acknowledging that this is an enormous problem for the country and wants to do something," she said. "But the devil is always in the details."

Ferrante said she shares concerns that a federal response might focus too much on law enforcement and not treatment and prevention. She said that would be a mistake.

"Some of the people we see in my district who've become addicted didn't get it from something that came over the border," she said. "It was because a doctor prescribed them pills that transformed them into an addict."

Madras, a former deputy director of the Office of National Drug Control Policy, said the federal response needs to include a focus on trafficking as well as overprescribing.

"If we don't reduce the supply we're not going to get a handle on this," she said. "If we ignore the supply side, we'll just be increasing the number of people who are entering the pipeline for treatment, and that could bankrupt the country's health care system."

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group's newspapers and websites. Email him at [email protected]

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