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Will Trump’s focus on prosecution, not treatment, make a dent in opioid addiction?

President Trump announced his plan to combat nationwide opioid drug addiction at an event in New Hampshire on Monday, calling for aggressive prosecution for traffickers, including using the death penalty. William Brangham discusses these proposals with Sam Quinones, author of "Dreamland: The True Tale of America's Opiate Epidemic," and Dr. Andrew Kolodny of Brandeis University.

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  • Judy Woodruff:

    President Trump announced his plan to combat nationwide opioid drug addiction today, among other things, calling for stronger punishment for drug dealers, including the death penalty for some.

    William Brangham reports.

  • William Brangham:

    The president flew to New Hampshire to make his announcement, a state he once called a drug-infested den. It has the nation’s third highest death rate from opioid overdoses.

    But in Manchester today, Mr. Trump vowed more aggressive prosecution, including the death penalty for traffickers.

  • President Donald Trump:

    If we don’t get tough on the drug dealers, we’re wasting our time. Just remember that, we’re wasting our time. And that toughness includes the death penalty.

  • William Brangham:

    Federal law already allows for executions in cases that involve murders committed during drug-related crimes. The human rights group Harm Reduction International, based in London, says the United States and 31 other countries have the death penalty for drug crimes, but only seven routinely carry out executions.

    Earlier this month, Mr. Trump cited two of those, Singapore and China, as examples.

  • President Donald Trump:

    But if you go to Singapore, I said, Mr. President, what happens with your drugs? No. We don’t have a problem, President. I said, really? Why? We have a zero tolerance. And he is not playing games. These guys don’t play games.

  • William Brangham:

    Beyond the death penalty, the president also called for other initiatives to tackle the opioid crisis. They include new laws making it easier to impose mandatory minimum sentences on opioid drug dealers, increased education and awareness programs, broader access to medically assisted treatment options, and more aggressive prosecutions of doctors, pharmacies and opioid manufacturers.

  • President Donald Trump:

    Our Department of Justice is looking very seriously into bringing major litigation against some of these drug companies.

  • William Brangham:

    The president is also setting a goal of cutting opioid prescriptions by a third in three years, and boosting research into non-addictive painkillers.

    Opioid prescriptions have declined somewhat in recent years, but an average of 115 Americans still die each day from opioid-related overdoses. The Centers for Disease Control and Prevention reports opioids killed more than 42,000 Americans in 2016, the most ever recorded.

    Many states, like New Hampshire, are overwhelmed. Last month, the Granite State’s largest drug rehab provider announced it’s closing, for want of funds. While Congress promised $6 billion over two years to help battle opioids, few specifics have been offered as to how and where the money will be spent.

    So, we take a closer look now at what the president’s new proposals could mean for the opioid crisis with Sam Quinones. He’s a journalist and author of “Dreamland- The True Tale of America’s Opiate Epidemic.” And Dr. Andrew Kolodny, he’s co-director of opioid policy research at Brandeis University’s Heller School, and he is also executive director of Physicians for Responsible Opioid Prescribing.

    Gentlemen, thank you both very much for being here.

    Andrew Kolodny, I would like to start with you first.

    Could you just give me your reaction to the proposals that the president laid out today?

  • Dr. Andrew Kolodny:

    Well, what we heard from the president, I think, is a list of ideas, some of which sound good, others which sound like a step backward.

    What we still have not received from the Trump administration is a plan of action. And we have yet to hear President Trump request funding from Congress, a multiyear, multibillion-dollar funding request, to address the problem.

    Until we build out a treatment system that doesn’t really exist yet, so that people who are opioid-addicted can more easily access treatment than they can access painkillers, heroin or fentanyl, until we get there, I think we’re going to continue to experience record high levels of opioid overdose deaths.

  • William Brangham:

    Sam Quinones, the headline out of the president’s announcement was death penalty for drug dealers, for drug traffickers.

  • Sam Quinones:

    Right.

  • William Brangham:

    Do you make of that?

  • Sam Quinones:

    Well, first, kind of half-facetiously, I was wondering, is he referring to doctors? Is he referring to drug company executives drugs salesmen?

    Because, of course, this epidemic is unlike any other that we have had, which it begins with those folks, not with drug traffickers, street gangs and mafiosos.

    I welcome the idea that the president is getting behind this. I welcome — as Andrew said, there are some ideas that a lot of people have been calling for, for a long time. I find the idea of a death penalty is kind of like the — it’s like the silver bullet, right, the idea of like, well, this will solve our problem.

    This is how we got into this problem in the first place. Everybody wanted a silver bullet, an answer to all human pain, and the answer was narcotic painkillers, and supposedly they’re nonaddictive.

    I think, as a country, we really are playing with fire when we begin to look to easy answers. It’s a complicated problem. It needs a lot complicated and small solutions all across the country.

    And what it also does is divert attention from the place where this work is really going on, which is in a lot of counties, where folks have just banded together. It’s beautiful to watch. It’s exhilarating, very American thing to watch. I love it.

    You go to these counties and people are coming together, county task forces, working groups, learning to work together. For so long, we have been so isolated. These groups have not worked together very well.

    And now — and I was hoping part of what he would say would be, I’m going to go these areas. I’m going to tell them what a great job they’re doing. I’m going to put the focus on them, not on me.

  • William Brangham:

    Right.

    Andrew Kolodny, let’s talk about some of those specifics.

    One of the things that the president mentioned was that he wants to cut opioid prescriptions by a third in three years. Is that an important thing to do? How realistic is that? What did you make of that part of the president’s proposal?

  • Andrew Kolodny:

    I think it’s a worthwhile goal.

    And it can be hard to understand why it’s still important to focus on the overprescribing problem, when deaths involving illicitly synthesized opioids like fentanyl are soaring, but it is very important.

    We’re not going to be able to bring the opioid addiction epidemic to an end unless we prevent more Americans from becoming opioid-addicted.

    And we know that the vast majority of people who have become opioid-addicted over the past 20 years, their addiction began taking prescription opioids. Since 2012, prescribing has started to come down a bit, but we are still massively overprescribing.

    Canada is number two in the world. And Canada also has a serious opioid problem. But we’re almost double Canada, so we have a very long way to go. Setting a target makes sense, but what we haven’t heard from the administration is how they intend to achieve that target.

  • William Brangham:

    It seems, Sam Quinones, that when — if you talk about reducing the number of the prescriptions, just this ocean of pills that are out there, it’s also very difficult, in the absence of good treatment, in the absence of alternatives to painkillers, we’re kind of stuck if we just start pulling people off the meds.

  • Sam Quinones:

    One of the things I think they really need to focus on — and I didn’t hear it today, but I think is an important thing to do — is begin to focus on what insurance companies reimburse for, because if you just simply drop the number of pills, you will have lots of people out there who will transition to the black market.

    They need other pain treatments that don’t involve narcotics, acupuncture, diet, a variety of things like this, various therapies, that people were — that insurance companies were reimbursing for before, and they stopped years ago when they figured that, well, the pills are cheap, they’re easy, they’re non-addictive, so we’re just going to go that route.

  • William Brangham:

    Right.

  • Sam Quinones:

    That’s another thing that I would have liked to have heard, is, we’re going to focus on insurance companies and what they reimburse for and what they are not reimbursing for today.

  • William Brangham:

    Andrew Kolodny, there’s also the $6 billion that’s been appropriated, but we don’t really know the details of where that money is going to go, how it might be spent.

    If you were advising the president and he said to you, OK, I have got $6 billion, what do I do with it, what would you tell him?

  • Andrew Kolodny:

    Well, what we’re hearing as a figure, $6 billion over two years, I don’t think it’s an adequate amount.

    And we also need a multiyear commitment. The Obama administration, President Obama on his way out the door, signed a law that has made $500 million available for the past two years. But even that money, because it’s not a long-term commitment, the states have had trouble using that money, because if you’re going to hire staff to build out a treatment program, it’s difficult to just hire them for one or two years.

    We need a commitment for, I believe, 10 years of funding, and I would say about a $60 billion commitment over the next 10 years, or $6 billion a year for 10 years, so that we can create a system where someone who’s opioid-addicted can walk into a center and receive outpatient treatment for their opioid addiction, regardless of their ability to pay for it.

    That treatment has to be easier to access than a bag of dope if we want to see overdose deaths coming down.

  • William Brangham:

    All right, Andrew Kolodny, Sam Quinones, thank you both very much.

  • Sam Quinones:

    Thank you.

  • Andrew Kolodny:

    Thank you.

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