It might have appeared as if President Trump actually did something of heft and merit last week when he formally declared a public health emergency to tackle the burgeoning opioid epidemic in this country.
Unfortunately, as is all too often the case with this administration, the casual observer who thought the president was taking positive action to curb the spread of opioid misuse would have been hoodwinked by a White House that has repeatedly shown that it does not prioritize the health and well-being of the American people.
The declaration of a public health emergency (PHE) seems plenty serious. But, just as a declaration of war means nothing without the resources to mobilize a powerful army, a PHE declaration means nothing without the requisite funding for a robust public health response to the emergency in question.
No New Money
Let's be clear: President Trump's PHE declaration contained no new money for fighting the opioid epidemic. This was to be expected, given recent efforts to pass Affordable Care Act (ACA) repeal-and-replace plans that would cut Medicaid spending by 26% over the next 10 years and allow states to waive some ACA-mandated essential health benefits requiring insurers to cover substance use disorders.
However, even the most cynical and jaded of HIV advocates might be shocked to learn that the Trump administration's PHE declaration would allow the Department of Health and Human Services (HHS) to take away federal HIV funding and reallocate it for use in fighting the opioid epidemic. This portion of the PHE declaration -- which Think Progress cleverly called "robbing Peter to pay Peter" -- would allow acting HHS Secretary Eric Hargan to shift up to 5% of unexpended funding for Part A and Part B of the Ryan White HIV/AIDS Program to programs aimed at fighting the opioid epidemic. That 5% of Ryan White Part A and Part B would amount to roughly $21 million -- a pittance when it comes to addressing the health care of 2.6 million Americans dealing with opioid addiction, but a small fortune for HIV/AIDS service organizations that are already underfunded.
The White House was vague about its plans for potentially redistributing Ryan White monies to help respond to the opioid crisis, and it is unclear whether such a redistribution is even possible, as the Ryan White grant money for the current fiscal year has already been allocated. In response to this unnecessary and damaging attack on HIV funding, five of the largest advocacy organizations in the country that focus on HIV and sexually transmitted infections released a statement expressing "solidarity with all working to end the opioid epidemic" and strongly opposing the Trump administration's divisive and insufficient plan to redirect funding from HIV programming.
To be fair, while the Trump administration's PHE declaration doesn't direct any new federal money toward combatting the opioid epidemic and could raid Ryan White's coffers to fund opioid programming, it did open up a new pot of money by allowing the federal government to access the federal Public Health Emergency Fund.
The only problem is that the fund currently has only $57,000 left in it.
Or, to put it another way, the Public Health Emergency Fund has enough funding to give every person in America living with opioid addiction 2 cents to help with their treatment.
"Just Say No" Looks Sophisticated by Comparison
Lieutenant Commander Diane Goldstein (Ret.) is a board member of Law Enforcement Action Partnership, a group of law enforcement officials working to promote the use of evidence-based, public health interventions by law enforcement in responding to the nation's drug problem. Goldstein told TheBody.com that she was appalled by President Trump's words:
The emphasis on tough law enforcement actions and a failed "just say no" ideology will simply result in more crime, death, disease and addiction. ... If this administration is serious about solving the opioid epidemic, they would fund harm-reduction programs that have resulted in positive health outcomes while enhancing public safety across countries that actually use science, evidence-based practices and compassion for drug users.
But instead, the Trump administration seems poised to take us back to the heyday of the Reagan '80s with drug misuse prevention messaging that makes "Just Say No" sound sophisticated by comparison. During his cringe-worthy speech prior to his signing of the PHE declaration, President Trump used his brother Fred's struggles with alcohol as a cautionary tale and doubled down on the sort of abstinence-only anti-drug prevention strategies that have failed miserably over the past few decades.
In fact, Trump not only endorsed Just Say No-ism. He also suggested that he was the one who invented it:
"This was an idea that I had, where ... we can teach young people not to take drugs -- just not to take them," Trump told an audience predominantly comprising administration officials, Republican politicians, law enforcement personnel and individuals who had lost loved ones to opioid use disorders. "The fact is, if we can teach young people -- and people, generally -- not to start, it's really, really easy not to take them," he added.
This promotion of discredited and counterproductive abstinence-centric drug prevention strategies was not one of the president's impromptu tangents. Apparently, it's a major part of the Trump administration's approach to dealing with the opioid epidemic.
Everything about Trump's speech, from his peddling of blatant falsehoods about the appeal of drugs --"There is nothing desirable about drugs" -- to his portrayal of prescription opioids as "evil," reeks of the sort of moral absolutism and willful ignorance that can only serve to accelerate the progression of the opioid epidemic.
Make no mistake about it. We are on the cusp of a full-fledged return to the War on Drugs.
During the 10 months that he has been in office, President Trump has shown an aversion to proven public health interventions and a craving for a militaristic, authoritarian response to our nation's issues. There is no reason to believe these preferences will now change.
The Trump administration features Attorney General Jeff Sessions, who once remarked that "good people don't smoke marijuana," and a president who recently encouraged police brutality and praised Philippines President Rodrigo Duterte's murderous attacks on his country's drug users. This declaration does nothing to assuage well-grounded fears of a worsening outlook for people who use drugs and the members of their communities.