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White House Opioid Addiction Summit: An Update

March 2, 2018
Can funding, legal action, and public education end the opioid addiction and abuse emergency? A brief look inside the Trump Administration's evolving plans.
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The White House hosted an Opioid Summit to address the public health emergency  on opioid addiction, abuse, and misuse on March 1, 2018. Speakers included: Presidential Advisor Kellyanne Conway, Department of Health and Human Services (HHS) Secretary Alex Azar; Department of Housing and Urban Development Secretary Ben Carson; the Department of Veterans Affairs Secretary David Shulkin; and the President and First Lady.

To get the public discussion going, NPR reporter David Green aired an interview with US Surgeon General Jerome Adams, MD, MPh, prior to the summit’s opening to better understand the administration’s take on the issue. Dr. Adam’s youngest brother has struggled with substance use disorder, untreated mental health issues, and related incarceration for several years. Our goal is to “make sure folks are getting the treatment that they need, because we can’t arrest our way out of the problem. … we want to give people the option to get better and not just punish them,” Dr. Adams said in the interview.

While law enforcement must remain engaged, noted Dr. Adams, public health education is also crucial to fighting the issue, he said. Specifically, he said that he hopes the summit will help the country’s struggle with opioid addiction in three ways:

  • Americans will realize the opioid epidemic is a problem in all communities
  • The country will see that there is hope – the administration has prioritized the issue and is implementing strategies (see below) around saving lives and lowering opioid demand as well as supply 
  • The public will get engaged by talking about addiction in their communities and working to understand pain better.

The latter point – understanding pain – was listed as core knowledge gap, even among the medical community, in the Federal Pain Research Strategy released by the Interagency Pain Research Coordinating Committee in November 2017.  “The paucity of large data sets and prospective registries of well-characterized patients has delayed our understanding of acute and chronic pain and development of safe and effective pain management,” according to the report.

Many organizations, universities, and companies are already working to fill this clinical gap through research projects, grants, and more. Purdue Pharma, for instance, is placing a large focus on pain assessment research. In addition, the American College of Physicians (ACP) announced a $50,000 grant—coincidentally the same day as the summit—to combat the nation’s opioid crisis with evidence-based programs aimed at prevention, treatment, and recovery. Those funds are being provided by the American Academy of Addiction Psychiatry as part of the HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) $24 million, two-year budget.  

In fact, funding seems to be a core solution in the administration's eyes for putting an end to the overall opioid public health emergency. However, when NPR’s Green questioned Dr. Adams about an existing, on-the-ground treatment program available right now for Americans in need, Dr. Adams could only point to the Trump administration’s requested funding – most of which has yet to be allocated to communities.

Dr. Adams did share that Rhode Island and Massachusetts (which had a fatal overdose rate double that of the national average in 2014) have been able to reverse their opioid-related death curves, but it is unlikely that the US’s current push to end opioid abuse and misuse had any impact on those improvements. Rhode Island’s action plan launched in May 2016 and Massachusetts launched efforts to address its opioid overdose crisis in 2015. 

To recap the actual summit agenda, President Trump offered the audience two major strategies:

  • The administration would be rolling out policy and may toughen legal action against “opioid companies" (presumably manufacturers)
  • The administration may seek the death penalty for "drug pushers" (presumably those distributing and selling illegal opioid-based products). (Editor's note: While targeting the distributors, not the users/abusers, this plan seems to contradict Dr. Adam's determination to avoid using jail as a solution.)

It is unclear from the President’s remarks whether he plans to address - in any way - the importance of making addiction treatment programs available for those in need, or the role of physicians and patients using legal, prescribed, adequate dosages of opioids for the management of chronic, intractable pain. The distinction between street drug overdoses, and those arising from prescriptions, for example, seemed to be sorely overlooked throughout the summit sessions.

A press briefing issued in connection with the summit primarily served to highlight previous actions taken by the administration (ie, budgeting) but did provide a bit more clarity on action items. For example, it noted the nation-wide panels involved in fighting the public health emergency: Prevention, Treatment, and Recovery; and Law Enforcement and Interdiction. Regarding the latter committee, US Attorney General Sessions has created a Prescription Interdiction and Litigation Task Force aimed at targeting opioid manufacturers and distributors, as well as a Joint Criminal Opioid Darnet Enformcent Team to disrupt online sales of illicit opioids. And Secretary Azar shared that state waivers may be issued soon to aid in the provision of addiction recovery and treatment.

Overall, whether the follow-up to the White House summit moves “the ball a little bit further down the field” -  an analogy Dr. Adams used - to help turn around the public health emergency on opioid addiction and abuse, remains to be seen. 

Last updated on: March 6, 2018