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Trump calls for new action, not new money, to tackle opioid crisis
President Trump has officially designated the opioid epidemic as a public health emergency. Besides the symbolism, what does the declaration mean for tackling the crisis? William Brangham speaks with Bertha Madras of the President’s Commission on Combatting the Opioid Crisis and Dr. Andrew Kolodny of Brandeis University about the underlying impediments and what needs to be done.
We return now to our lead story, President Trump's declaration of a public health emergency over the opioid epidemic.
William Brangham is back with a look at what it could mean.
And for that, we're joined by two people who've studied this epidemic for a very long time.
Dr. Bertha Madras sits on President Trump's opioid commission. She's a professor of psychobiology at Harvard Medical School. And Dr. Andrew Kolodny, he's co-director of opioid policy research at Brandeis University's Heller School and is executive director of Physicians for Responsible Opioid Prescribing, a group dedicated to reducing the overprescription of painkillers.
Welcome to you both to the NewsHour.
Dr. Andrew Kolodny:
Dr. Bertha Madras:
Thank you. Delighted to be here.
Andrew Kolodny, I would like to start with you.
I wonder if you could just give me your reaction to the president's initiatives today?
We heard from the president last August that he considered the opioid crisis to be an emergency. Back in August, I would have expected the president to announce what he was going to do about the problem and to begin taking action.
If you call a problem an emergency, you expect to see immediate action to address it. And then months went by, and, today, we heard again that he considers this an emergency. He's giving it an official designation as a public health emergency, but we're still not really receiving a detailed plan about the actions that will be taken.
And I'm especially disappointed that the president isn't announcing that he is seeking an appropriation from Congress. I believe we need billions of dollars invested in building out a treatment system that doesn't exist yet if we're going to see overdose deaths start to come down.
Dr. Madras, what do you make of this? This is a criticism that a lot of people have said, that it is obviously hugely symbolic for the president to talk about it as personally and as movingly as he did today, but that, absent money behind it, it may not be enough.
Well, I — my lovely colleague Dr. Kolodny and I disagree on the take on this.
First of all, this opioid crisis has festered for almost a decade. The upsurge was in 2010. And I think to expect the president to solve the problem within a few weeks or months of declaring it a national emergency is unrealistic, especially since the report of the commission is coming up next week.
That report is going to have far greater detail in terms of areas that need funding, areas that need dramatic reform, and areas, of course, that need prevention.
My take on the president's speech today is that it was one of the finest presentations on the overview of what drugs do to people, what the consequences are, and it presents a national philosophy on drugs that we haven't heard in recent times.
Dr. Kolodny, let's say that next week the president does come forward with the billions of dollars you would like to see put towards this epidemic. What are we to do with that money? What are the big challenges that need funding and need attention?
Yes, if we want to see overdose deaths begin to come down, what will have to happen is, we need to be in a place where someone who is opioid-addicted, when they wake up in the morning — and if you are opioid-addicted, when you wake up in the morning, you are going to need to use opioids pretty quickly, or you are going to be feeling very sick.
That individual needs to be able to access effective outpatient treatment more easily than they can access pain pills, heroin or fentanyl. If that person is going to be feeling sick soon, and they have got $20 in their pocket, they are going to go out and they are going to use heroin.
We need that person to be able to walk into a treatment center, and get treated that same day, regardless of their ability to pay for it.
Wouldn't you agree that that is really the central issue here, that people who want treatment oftentimes don't have access to it?
Treatment on demand.
And, Andrew, if you could wait until the report comes out, there is clearly a recognition of the need for people who are motivated. The biggest problem that I see in dealing with people who have an opioid use disorder is that a large proportion of them do not come forward.
And I'm more concerned that these are the people who are moving into an overdose crisis, as much as the people who are people who are motivated. People who are motivated should be able to access high-quality treatment.
That's another issue. What is high-quality treatment? There is no national consensus. We talk about addiction as a brain disease, and yet we don't treat it as a medical problem. We have treatment centers that are completely divorced from the medical community.
We have medications-assisted treatment in one part of a community and then methadone in another part. Nothing is converging into a holistic approach to an individual with an opioid use disorder.
Dr. Kolodny, some others have pointed out that, even if the money were to come and the guide lines were crystal-clear on a plan of action, that there are still many officials within the government themselves — we don't have a head of HHS, we don't have a drug czar right now.
Are those impediments, in your mind, to tackling this crisis?
I believe that's the reason we don't have a plan.
I think for the president to give an address with vague information about what he is going to do to tackle a problem might be OK if the administration had a detailed plan ready to release to the public. But there is no plan.
I don't believe that the administration agencies that should be tackling this problem, that should be putting out a detailed proposal, I don't believe that they're doing it.
And although there is a commission that President Trump has put together to make recommendations, it's not the commission's job to come up with the plan for tackling the crisis. It should be coming from the agencies.
And with all respect to Dr. Madras, we have waited a very long time for a response from the federal government for tackling this problem. We haven't seen it.
And it is true that this problem began before — began a while ago. And it's true that the Obama administration neglected the opioid addiction epidemic. It really wasn't until President Obama's last year in office that he began speaking about the problem or seeking funding from Congress to address it.
What we need to do to tackle this problem has been pretty clear for a while. And it isn't something that the federal government can solve on its own. But we have counties doing everything they can to tackle the problem, and there has yet to be real help from the federal government.
Dr. Andrew Kolodny, Dr. Bertha Madras, thank you both very much.
Thank you for having us.
You can find all of our coverage of the opioids crisis, America Addicted, on our Web site, PBS.org/NewsHour.
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