What impact will Trump’s opioid commission have?

“How does heroin work with these beautiful lakes and trees?” then–presidential candidate Donald Trump asked during a campaign stop in New Hampshire in September 2016. “More than any place, this state, I’ve never seen anything like it with what’s happening with the drugs.” He promised to “stop the heroin from pouring in.”

Experts say Trump was accurate in his observation. The rippling White Mountains and sparkling blue lakes of New Hampshire offer a stark contrast to the ravages of a heroin epidemic that has torn through the state’s quintessential small towns, with the “Live Free or Die” state landing at the forefront of the crisis. It continually ranks among the states with the most opioid overdoses in the U.S.

Yesterday President Trump, in an apparent attempt to make good on his promise to tackle what’s become a national epidemic, held a listening session on the opioid crisis, where he announced that New Jersey Gov. Chris Christie would take a leading advisory role in a commission to fight the scourge. “I’m just so honored that the president would ask me to take on this task,” Christie said during the meeting.

President Donald Trump speaks during an opioid and drug abuse listening session. (Photo: Evan Vucci/AP Photo)

“We want to help those who have become so badly addicted,” Trump said during the session, which included family members of those who have experienced an opioid overdose. “This is a total epidemic, and I think it is probably un-talked about compared to the severity we are witnessing.” The president went on to say that the commission will work with local officials, along with law enforcement and victims of the crisis, to combat the issue.

“Solving the drug crisis will require cooperation across government and across society, including early intervention to keep America’s youth off this destructive path,” the president said.

In a statement to NH1, a local news station, New Hampshire Democratic Sen. Jeanne Shaheen expressed disappointment that not one official from her state was at the session but said she welcomes the federal government’s aid in fighting the problem. Still, Shaheen said, the Trump administration’s policies are in “desperate need of a course correction.”

“I hope this commission will help facilitate a turnaround before New Hampshire’s efforts are severely undermined,” she added. “There is a massive gulf between President Trump’s promises to tackle this crisis and the policies this administration has proposed during his first two months in office.”

New Hampshire Gov. Maggie Hassan echoed Shaheen’s sentiment, saying she’s ready to work with the administration to combat the crisis but that officials need “more than just window dressing.” Both Shaheen and Hassan argued that the attempt to dramatically cut funding to addiction recovery programs and ending Medicaid expansion in the now-defunct Obamacare repeal would have had dire consequences for people battling opioid addiction. Experts estimated that nearly 1.3 million Americans would have lost access to substance-abuse treatment under Trump’s failed health care bill.

The New Hampshire leaders and addiction experts also criticized Trump’s proposed budget plan, which includes an unprecedented $1.2 billion cut to research grants from the National Institutes of Health. The budget proposal has already been met with bipartisan resistance and will likely be rejected by Congress. Experts say the cuts would greatly undermine rehab efforts.

The listening session also included high-profile White House officials, such as Education Secretary Betsy DeVos, Defense Secretary James Mattis and Attorney General Jeff Sessions, who has argued for harsher penalties for drug users. Sessions also has voiced the opinion that the answer to the drug problem might be a return to the 1980s-era abstinence programs spearheaded by Nancy Reagan, when the U.S. government urged people to “Just Say No.”

But those on the front lines of the battle don’t agree that those tactics would be the most effective.

Dr. John Kelly, director of Harvard’s Recovery Research Institute, noted that some of the most innovative solutions have come from law enforcement, such as facilitating the rehabilitation of drug users, rather than arresting and prosecuting them. Other efforts that have seen success include greater prescriber education, prescription monitoring programs, medication take-backs and disposal efforts, and increased availability of, and training for, naloxone, the opioid overdose-reversal drug.

“We must look to the causes of this epidemic, which have included the vastly underrecognized potential for harm from opioids, which has been directly related to overprescribing by medical professionals,” said Kelly.

President Donald J. Trump delivers remarks during an opioid and drug abuse listening session in the Roosevelt Room of the White House in Washington, DC, USA, 29 March 2017. (Photo: Shawn Thew / Pool via CNP /MediaPunch/IPX/AP)

Opioids — both prescription medications and street drugs like heroin — are now the leading cause of accidental death in the U.S., killing more than 33,000 people in 2015, more than any year on record, according to the Centers for Disease Control and Prevention. About half that number involved prescription opioids.

Experts acknowledge the complexity of the crisis, in which many users often are legally prescribed a painkiller for a medical treatment, but then turn to a cheaper, more potent high from illicit drugs like heroin, fentanyl and carfentanil.

“The opioid crisis is different than other drug crises in our history in that abusers have a different pathway to addiction — through pain medication, pharmacies — than other addicts,” said Faye Taxman, professor of criminology, law, and society at George Mason University. “The new strategy must reduce the barriers to treatment and also provide for a path to deal with the stigma of having a drug addiction problem.”

Dr. Dominic Gaziano, an internist who treats opioid addicts in Chicago, praised the new commission’s multidisciplinary approach, which includes the Departments of Justice, Health and Human Services, and Veterans Affairs. He noted, however, that it’s imperative for the medical community — pharmacists, nurses and doctors — to come together to create robust inpatient and outpatient rehab programs.

Currently, there are areas the coalition needs to address within a medical setting, said Gaziano. National programs must be implemented to help doctors identify prescription drug abuse more quickly in hospitals and other medical settings. In addition, he said, a multidisciplinary approach to rehabilitation — including the involvement of psychiatrists, psychologists, internists and drug rehab specialists — would make “a huge difference” in overall recovery and sobriety.

“There used to be many programs years ago for inpatient illicit and prescription drug addiction,” said Gaziano. “These are practically nonexistent now.” He argued that there needs to be greater expansion and accessibility of treatment facilities. “I presently have a patient who is begging for a heroin-inpatient program. Insurance will not pay for it.”

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