Treatment advocates find Trump's speech lacking

Oct 31 2017

Treatment advocates find Trump’s speech lacking

Reacting to President Trump’s speech on Thursday declaring the opiate epidemic a public health emergency, some prominent addiction-treatment advocates are saying the announcement fell far short of what is needed. Others are taking a “wait and see” approach.

Andrew Kessler, a Washington-based advocate for behavioral health organizations, says he is concerned that the president did not mention additional funding.

“Obviously, the president can’t just declare funds; he has to go through Congress. Usually, with an emergency public health request, the president will say, I’m going to ask Congress for ‘X’, then Congress comes back with ‘How about Y?’ and then they work out a deal,” Kessler told The Influence.

That is how President Obama and Congress provided funding to deal with the Ebola crisis, Kessler points out. “Trump did not say anything about funding and how much he believes would be needed to deal with the crisis. So, addiction treatment and recovery advocates are wondering ‘Where are they starting from?’” Kessler says.

Kessler’s other concern goes beyond the emergency to next year’s federal budget. The fiscal 2018 budget produced by the White House soon after Trump took office proposed major cuts to the Substance Abuse and Mental Health Services Administration, he notes.

“We can’t have that again. The president can’t say, on one hand, “This is an emergency and I’m bringing all resources to bear, and then produce a budget in February that says, “We’re cutting these agencies that are important to fighting addiction. The fiscal 2019 budget will have to be robust if they want to back up this effort.

“The president himself said ‘This is going to take years and decades.’ If that is the case, an emergency declaration is not enough. When you are talking about years and decades, you need a strong foundation – SAMSHA block grants and Medicaid.

“We all know from the health care and tax cut debates in the past few months, that Medicaid has been a target for Congress. Thirty percent of all substance abuse treatment funding is Medicaid. You can’t say you are serious about this emergency and try to blow holes in Medicaid at the same time.”

Kessler says he was encouraged to hear the president mention prevention as part of his plans, but is concerned about a possible return to the “just say ‘no’” approach of the Reagan years.

“I’m hoping his focus on prevention is based on evidence-based practices and moves past the ‘Just say no’ rhetoric. We need the CDC involves; it evaluates and collects data, and they know what works. If the president is serious, he will work with Congress on a substantial investment. I’m expecting some action.”

Mark Dunn, director of public policy for the National Association of Addiction Treatment Providers, pointed that, while the President’s Commission on Addiction and the Opioid Crisis had recommended that he declare a national emergency, the President chose to issue the public health emergency declaration instead.

“The difference between the two declarations is the funding sources that would be available following each declaration. The health crisis designation does not provide additional funding and relies on existing sources of revenue. It does allow Health and Human Services (HHS) and other government agencies to redirect existing funds for the purpose of dealing with this crisis.”

Dunn expects  Congress will be asked to provide additional resources before they adjourn for the year in December.

Dunn expressed support for the president’s announcement that states may request a waiver for the federal rule that prohibits Medicaid reimbursement to most patients in mental health and substance abuse facilities larger than 16 beds. “This is a major step forward, long supported by the National Association of Addiction Treatment Providers,” Dunn said.

Michael Botticelli, drug czar under President Obama and executive director of the Grayken Center for Addiction at Boston Medical Center, told CBS news that President Trump’s announcement didn’t go far enough.

“Without any additional resource allocation, it doesn’t really make a difference what we call it,” Botticelli said. “I unfortunately think it’s largely rhetoric and very shallow in terms of really taking major actions against the epidemic.”