According to the National Institute on Drug Abuse (NIDA), opioid overdose claims more than 115 Americans every day with more than 33,000 succumbing to an opioid overdose in 2015 alone (NIDA, 2018). About 2 million and 591,000 Americans suffered from substance abuse disorders and suffered heroin use disorder as a result of using prescription opioid pain relievers and heroin that year (NIDA, 2018). It is estimated that the “total economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year” (NIDA, 2018). In response to the opioid epidemic, President Donald Trump’s administration has suggested a comprehensive approach to addressing this public health crisis and related devastating consequences such as opioid misuse and resulting overdose and mortality.
First, President Trump’s administration seeks to enhance education and awareness to curb opioid abuse. Decreasing access to and abuse of opioids has been described as “an intuitively reasonable approach to reducing fatal overdoses” (Hawk, Vaca, " D’Onofrio, 2015). To achieve this end, the government seeks to launch a nationwide evidence-based campaign to help the public, particularly vulnerable populations, to recognize and better understand the devastating consequences of prescription and illicit opioid use and other drug use (White House, 2018). This strategy is consistent with previous educational interventions for primary prevention which have focused on creating more awareness in target high-risk individuals such as teenagers and patients suffering from or with a history of substance abuse disorders (Hawk, Vaca, " D’Onofrio, 2015). Other campaigns have targeted close contacts like family members with the aim of educating them on the dangers involved in sharing prescribed opioid, the need to keep them locked up, and how to dispose of unused drugs in a safer manner. Primary prevention strategies are more potential. For example, an anonymous mail-in program and a biweekly collection program helped recover large quantities of unused medications in Maine and Florida, respectively (43). Through nine countrywide medication take-back days since 2010, the U.S. Drug Enforcement Administration (DEA) managed to collect 2,411 tons of controlled medications (DEA, 2014). Therefore, the proposed primary prevention strategies have a great potential for reducing fatal opioid-related overdoses and mortality.
Second, the government intends to support research and development (R"D) initiatives aimed to develop innovative technologies and more effective therapies particularly designed to enhance prevention of opioid addiction and decrease the reliance on prescription opioids in pain management (White House, 2018). Notably, the government is looking forward to supporting R"D for a vaccine designed to stop opioid addiction and non-addictive pain management options (White House, 2018). This proposal acknowledges the potential role of science and technology in combating the opioid crisis in the country. There has been an increase in the development of innovative medical technology solutions for combating opioid addiction and overdose (NIDA, 2017). Researchers have developed solutions with a greater capability of reducing dependence on prescription opioids such as implants and apps and diagnostic tests designed to help healthcare providers and patients to not only manage pain a more effective manner but also help them curb the misuse, abuse and overdose opioids (NIDA, 2017). Moreover, medical technology companies are developing minimally invasive innovations to help patients to recover and resume their routine activities in a shorter period (NIDA, 2017). By making investments in such R"D projects, the US government can realize a significant reduction in opioid overdose deaths.
Third, the government will introduce a robust prescription monitoring program to decrease over-prescription and non-medical opioid use. The government will implement a safer prescribing plan to cut opioid prescription throughout the country by one-third within three years. The plan will also foster the use of best practices in the reimbursement of federal healthcare programs and among all Federally-employed healthcare providers (White House, 2018). Improving prescription monitoring is an effective approach considering that unparalleled access to prescription drugs is hugely attributed to the full-scale epidemic in the U.S. (Hawk, Vaca, " D’Onofrio, 2015). The use of hydrocodone, oxycodone, and fentanyl increased by 500% between 1999 and 2011 (Jones, 2013).
Fourth, the federal government seeks to crack down on international and domestic illicit drug supply chains by tightening law enforcement (White House, 2018). The Congress announced “tough on crime” policies emphasizing the need to scale up law enforcement actions. President Trump called for securing land borders, all ports of entry, and waterways against illegal smuggling, strict inspection of all types of shipments, and engagement with China and Mexico to cut down on controlled substances (White House, 2018). President Trump also called for the strengthening of criminal penalties for dealing and trafficking in fentanyl and other opioids, including the death penalty and reduction of mandatory minimum sentence threshold for smuggling illicit substances “that are lethal in trace amounts” (White House, 2018). Such tough policies are necessary if the country needs to zero on opioid abuse.
Lastly, the government seeks to support victims battling with opioid addiction by enhancing access to evidence-based treatment and recovery support services. The complex nature of the opioid crisis requires a comprehensive approach that encompasses primary prevention, strict enforcement, and harm reduction strategies. President Trump’s strategy would improve opioid prescription, increase access to safer, more effective treatment and recovery support services, and reduce opioid misuse, abuse, and overdose.
DEA (November 5, 2014). DEA And Partners Collect 309 Tons Of Pills On Ninth Prescription Drug Take-Back Day. Available at https://www.dea.gov/press-releases/2014/11/05/dea-and-partners-collect-309-tons-pills-ninth-prescription-drug-take-back
Hawk, K. F., Vaca, F. E., " D’Onofrio, G. (2015). Focus: Addiction: Reducing fatal opioid overdose: Prevention, treatment and harm reduction strategies. The Yale journal of biology and medicine, 88(3), 235.
Jones, C. M. (2013, June). Trends in the distribution of selected opioids by state, US, 1999–2011. In National Meeting, Safe States Alliance.
Maron, F. (March 20, 2018). Is Trump's Opioid Strategy a "War on Drugs" Relapse? Scientific American. Available on https://www.scientificamerican.com/article/is-trumps-opioid-strategy-a-war-on-drugs-relapse/
National Institute on Drug Abuse (March 2018). Opioid Overdose Crisis. Available at https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
National Institute on Drug Abuse (October 25, 2017). Federal Efforts to Combat the Opioid Crisis: A Status Update on CARA and Other Initiatives. Available at https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2017/federal-efforts-to-combat-opioid-crisis-status-update-cara-other-initiatives
White House (March 19, 2018). President Donald J. Trump’s Initiative to Stop Opioid Abuse and Reduce Drug Supply and Demand. Available at https://www.whitehouse.gov/briefings-statements/president-donald-j-trumps-initiative-stop-opioid-abuse-reduce-drug-supply-demand/