Trump's war on drug users: Column
Obama made headway in ending failed war-on-drugs policies, but Trump is undoing that.
During the campaign, President Trump committed to addressing America’s drug crisis. He called it “a crippling problem” and “a total epidemic,” which it is. An average of 144 people a day die of drug overdoses. Trump promised increased funding and comprehensive Medicaid coverage for treatment. In March, he said, "This is an epidemic that knows no boundaries and shows no mercy, and we will show great compassion and resolve as we work together on this important issue."
Trump’s rhetoric suggested a continuation of President Obama’s approach, which was founded on a rejection of the failed 45-year-old war on drugs, which treated drug use and addiction mainly as criminal problems. Obama called that war “counterproductive” and an “utter failure.” His administration emphasized treatment-and-prevention programs based on scientific advances that have demonstrated that addiction is a brain disease with biological, psychological and environmental determinants. Obama championed landmark legislation that funded mental health and addiction treatment programs and research. He signed the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act, which provides resources for state and community prevention and treatment efforts. A godsend to sufferers of substance-use disorders, Obamacare mandated that insurance plans cover mental health, including addiction care, in parity with other diseases.
The administration made headway toward ending the war-on-drugs approach. Obama’s attorney general, Eric Holder, reversed wartime policies, including draconian mandatory minimum sentencing that filled prisons with people convicted of non-violent drug crimes. His surgeon general, Vivek Murthy, released a historic report — as significant as the 1964 surgeon general’s report on smoking — on alcohol, drugs and health, which made science-based prevention and treatment a national priority. The report is a progressive set of evidence-based policy recommendations for preventing substance use, intervening early in cases of drug misuse, and improving addiction treatment. The recommendations were the result of a 24-month review of the past 30 years of science and policy in this field. In addition, Obama’s recent drug czar, Michael Botticelli, spearheaded a movement that rejected the "failed policies and failed practices" of the past and championed prevention, treatment and harm reduction. For the first time, the drug czar's budget was tipped in favor of prevention and treatment over interdiction and policing.
Trump’s initial comments regarding addiction appeared to reflect both a personal passion and a sensible policy. However, the president is systematically abandoning the addicted and their families. Last month, Trump abruptly fired Murthy and announced that the odd couple of his son-in-law, Jared Kushner, and Chris Christie will lead an effort to create policies to combat the opioid epidemic.
Fine, but meanwhile, though Trump promised to fund treatment, he has proposed slashing almost $6 billion from health agencies that, among other priorities, address drug use and addiction. He specifically targeted $100 million in block grants for the Substance Abuse and Mental Health Services Administration.
Of immediate concern to the 20 million Americans who meet the diagnostic criteria for the disease of addiction, and the 40 million regularly misusing alcohol and other drugswho are at risk and may require some form of treatment, the president has said that one way or another he’ll end mandates included in the Affordable Care Act.
Trump has said that he'd sign the bill the House passed Thursday that will, if it makes it through the Senate, do just that by allowing states to apply for waivers of ACA-required benefits, including mental health and addiction care. Without that mandated coverage, it’s likely that millions of Americans will lose coverage for an illness that could kill them.
Meanwhile, Trump’s team has begun a re-escalation of the drug war. Attorney General Jeff Sessions, an old-school drug warrior, criticized Holder’s policies and suggested that he’ll reverse them. “You have to able to arrest people and then you’re intervening in their destructive habit,” Sessions said. “Many people never ever recover from addiction — except by the grave.”
They would recover if they had proper treatment.
It’s unsurprising that an administration that has vowed to be tough on crime plans to use battering rams rather than science-based public health efforts — ignoring evidence that the former doesn’t work and that the latter does. In the past, tough on crime was a boon to the prison system, which is filled with hundreds of thousands of people incarcerated for non-violent drug crimes. Any policy that throws sick people in prison is inhumane, never mind counterproductive.
And how about killing them? Doubts about Trump’s compassion toward the addicted were confirmed last weekend when he cozied up to a dictator whose idea of treating drug users is murdering them. According to USA TODAY, his new friend, the Philippines’ Rodrigo Duterte, had at least 6,000 people killed for drug crimes in six months. Duterte doesn’t distinguish between users and dealers. He has exhorted Philippine citizens: “If you know any addicts, go ahead and kill them.”
It’s critical that the Trump administration reverse directions and focus on a public health approach. Science has demonstrated that addiction isn’t a choice made by people without willpower who only care about getting high, no matter the impact on society, their loved ones and themselves. It’s a brain disease. We punish people who make bad choices. But people who are ill don’t need censure, stigmatization or jail time. They need quality care for an illness that can, if it isn’t treated, kill them.