On Tuesday, President Barack Obama attended and spoke at the National Rx Drug Abuse and Heroin Summit in Atlanta, Georgia.
By his own admission, he was there to bring the “cameras” and draw attention to a problem he called “a top priority.”
One would hope Americans’ addiction to prescription drugs and heroin would be a priority for the administration.
Drug poisoning deaths outnumbered traffic deaths and reached a new high in 2014 — totaling 47,055 people, according to a January report from the Centres for Disease Control and Prevention (CDC).
Obama’s appearance seemed designed to herald the position that his administration has come to over the last several years: That the criminal justice tactics that marked the decades-long “War on Drugs” are no longer the most effective policy.
“For too long, we have viewed the problem of drug abuse generally in our society through the lens of the criminal justice system,” Obama said at the summit on Tuesday. “The only way that we reduce demand is if we are providing treatment and thinking about this as a public health problem and not just a criminal problem.”
Obama’s appearance at the Summit coincided with an announcement by the White House of the latest steps in their plan to fight the epidemic. As expected, these steps were mostly of the public health variety:
- The Department of Health and Human Services (HHS) is issuing a proposed rule to increase the patient limit for physicians who prescribe buprenorphine to treat those suffering from addiction to opioids. Buprenorphine has been heralded by doctors, drug policy advocates, and addicts as a life-saving drug that is indispensable in helping people come back from addiction. The proposed rule increases the limit from 100 to 200.
- $94 million in funding to community health centres to increase substance use disorder treatment services, especially those using the assistance of medications like buprenorphine.
- An additional $11 million in grants for up to 11 states to expand substance use disorder treatment using the assistance of medications.
- $11 million to help states buy and distribute naloxone, a life-saving drug that can reverse overdoses instantly. The grant will also help train first responders on the use of naloxone and other overdose-prevention strategies.
- HHS is issuing guidelines for programs using federal funds to implement syringe-services and syringe-exchange programs. Up until last year, syringe services programs could not receive federal funds.
- The formation of a new task-force aimed at ensuring private health plans offer comparable coverage for substance use treatment and mental health services as they do for medical and surgical benefits.
- A rule from HHS that ensures the same for Medicaid and the federal Children’s Health Insurance Program.
The plan comes on the heels of Obama’s announcement in February that he was asking Congress for $1.1 billion in the FY2017 budget to help address the epidemic. That breaks down to: $920 million to expand medication assisted treatment, $50 million to expand access to substance-use treatment providers, and $30 million to evaluate the effectiveness of medication-assisted treatment. There is an additional $500 million allocated to expand prescription drug-overdose prevention strategies like access to naloxone.
Make no mistake: this plan is a major — if incremental — step forward.
Daniel Raymond, the policy director of the Harm Reduction Coalition, a national advocacy group, put it this way:
“Obama laid down a marker about what he thinks are the most important things we can be doing [to fight the epidemic]: treatment and overdose prevention. That is the culmination of a big shift. At a different time, we would be talking about law enforcement locking people up. The president’s announcement is saying that we are not going to solve the problem this way.”
Obama’s rhetoric at the Summit reflected this shift. He repeatedly referred to addiction as a “disease” that must be “treated” medically. He also denied the idea that addiction is a “moral flaw” of those who succumb to it.
When speaking of his own history with marijuana and cocaine, Obama was blunt.
“Friends of mine who ended up battling addiction were not less worthy or more morally suspect than I was,” said Obama.
That’s a far cry from the tone of President Ronald Reagan’s “national crusade against drug abuse” and Nancy Reagan’s plea to the American people to be “unyielding and inflexible in your opposition to drugs” in 1986.
The administration’s new tactic was reflected in the people Obama shared the stage with on Tuesday: CNN’s chief medical correspondent, Dr. Sanjay Gupta, recovering addicts Justin Riley and Crystal Oertle, and Baltimore City Health Commissioner Dr. Leana Wen. Notably absent: anyone from the Drug Enforcement Administration (DEA) or in law enforcement.
That absence was significant because it showed how far we’ve moved from the law enforcement-centered approaches of the 1980s and 1990s. But that doesn’t mean Obama is taking law enforcement out of the solution. Throughout the summit, Obama was careful to tip his hat to the DEA, “smart on crime” strategies, and the criminal justice system. By his own admission, the US is putting “enormous resources into drug interdiction.”
Grant Smith, the deputy director of national affairs at the Drug Policy Alliance, lauded the president’s plan as “a reflection of how far the administration” has moved toward a health-centered approach. But he was disappointed that the plan still relies heavily on law enforcement.
“The plan continues to pour resources into using law enforcement to address the heroin crisis,” Smith said. “We know from decades of relying on law enforcement to address substance use that we aren’t going to get the results we want.”
Specifically, Smith took issue with funding to create “Anti-Heroin Task Forces” to take down high-level heroin traffickers. According to Smith, in practice, such task forces primarily arrest low-level drug offenders with small possessions of heroin and opioids, effectively marginalizing some of the people Obama’s plan aims to help.
“[The Administration is] saying that they want to treat drug use as a health issue,” Smith said, “but this plan doesn’t fully achieve that.”
Obama’s rhetoric and the administration’s actions reflect a political reality: Politicians, and perhaps the American public, are not yet ready to give up their reliance on criminal justice tactics. No one is willing to admit that law enforcement efforts to cut off the drug supply have had a negligible effect, while burning through billions and criminalizing huge populations of drug users — including a disproportionate number of blacks and Hispanics.
To be clear, the Obama and the administration speak a lot about public health initiatives and offer funding for modern solutions to drug abuse that no president has been willing to put forward before. However, the police and the DEA are still a huge part of the fight against the opioid epidemic — no matter how many presidential memorandums are issued or times Obama comes out to speak on the topic.
That’s reflected in the funding for the DEA, whose projected FY2017 budget is $2.1 billion. That dwarfs the $1.1 billion proposed — and not yet approved by Congress — by the Obama administration that is itself divided between public health measures and law enforcement strategies to fight the epidemic.
The budget plan put forward by Obama is an admission that the epidemic is a big problem that will require big investments. Even in the best-case scenario, though, the disparity in money reflects America’s continued commitment of law-enforcement resources to attacking the drug supply even though it’s added public health to the mix of solutions.
Perhaps the most heartening part of Obama’s announcement may not be the measures around naloxone access, the expansion of medication assisted treatment, or funding guidelines for syringe exchanges, but something that has almost gone unnoticed: an initiative to accelerate “local partnerships between law enforcement and their counterparts in public health to combat heroin use and overdose.”
In other words, law enforcement may still be fighting the epidemic, but at least they will have the benefit of an added public-health perspective.
That may be the biggest sign yet that the old “Drug War” is over — at least domestically.
Beyond the funding and the initiatives announced to fight the epidemic, the biggest impact of Obama’s appearance at the summit may be his announcement that the epidemic and public health efforts to fight it are a high priority for him and the country.
“It’s easy to write off [Obama’s appearance] as symbolic or spectacle, but there were almost 2000 people in the audience that were energised and hanging on Obama’s every word. They are going to leave the summit and go back to their elected officials and push for the kinds of resources and the public health strategy that he is calling for,” said Raymond. “If his goal was to rally the troops, he was successful at that.”
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