When it comes to the opioid epidemic, President Trump talks the talk.
Such as when he promised last year to roll out a “really tough, really big, really great” advertising campaign to spread awareness about addiction.
But some health experts and politicians are concerned that his administration’s “walk” is looking pretty weak right now, even as the epidemic continues to affect the health of millions of Americans.
One of the biggest worries is Trump’s less-than-enthusiastic embrace of the Office of National Drug Control Policy (ONDCP), home of the nation’s “drug czar.”
The ONDCP was established by Congress in the 1980s, at the height of the nation’s cocaine epidemic. With its own budgetary authority and access to the Oval Office, the ONDCP has brought high-profile attention to the country’s war on drugs.
The office coordinates antidrug programs at other federal agencies and supports the president’s efforts to tackle the opioid epidemic.
But the Trump administration recently proposed to slash the ONDCP budget… for the second time since his inauguration.
Last week Politico reported that the administration planned to cut $340 million, or 95 percent, of the ONDCP’s budget.
This would be done by moving two of the office’s grant programs — the High Intensity Drug Trafficking Areas grant and the Drug Free Communities Act — to the Departments of Justice and Health & Human Services (HHS), respectively.
Last May, the administration proposed cutting $364 million from the ONDCP’s budget and eliminating half of the office’s staff, according to the Washington Post. Funding was ultimately left in place after objections from a bipartisan group of senators.
In an email to employees when the first cut was on the table, Richard Baum, the acting director of the office, wrote that the cuts are “at odds with the fact that the president has tasked us with supporting his Commission on Combating Drug Addiction and the Opioid Crisis.”
The ONDCP has also suffered from a lack of leadership under the Trump administration.
The Washington Post reported that nearly a year after Trump moved into the Oval Office, the ONDCP still lacks a permanent director.
And at least seven of the administration’s appointees to the ONDCP have left.
One of these was the acting chief of staff… leaving some of his duties to be filled in by the deputy chief of staff — a 24-year-old whose only professional experience after college and before joining the ONDCP was working on Trump’s presidential campaign.
After The Post contacted the administration about Taylor Weyeneth’s lack of relevant experience, an official told the paper that he had been moved back to the ONDCP White House liaison position, a job he held when he first started at the agency.
Public health emergency underfunded
Another concern about Trump’s response to the opioid epidemic is that funding worthy of a public health emergency has been slow to materialize.
The declaration last October was itself a big moment because past public health emergencies have all involved natural disasters or infectious disease outbreaks, not a drug crisis.
Last week, HHS Acting Secretary Eric Hargan renewed the emergency declaration for another 90 days.
The initial declaration freed some money to address the opioid epidemic, but not much — $57,000 from the HHS Public Health Emergency Fund.
Additional funding would either have to come from existing agency budgets — which would take away money from those programs — or be approved by Congress.
The Hill reported that in December, a HHS spokesperson said that Trump would not send a formal funding request for the opioid emergency. Instead, the administration passed the buck to Congress to come up with resources on its own.
Before Trump’s emergency declaration, Congress approved $1 billion for states to fight the opioid epidemic, according to Politico.
About half of this was authorized by Congress while Barack Obama was president. Only $500 million has been distributed to states so far, with the rest expected to be doled out later.
Some experts, though, say that $180 billion over 10 years would be needed to even begin to address the epidemic.
Trump did recently sign a bill into law that gives border patrol agents $9 million to help detect the opioid fentanyl coming into the country in packages, mail, or with travelers.
This fits with the administration’s law-and-order approach to tackling the opioid epidemic, but this bill was introduced last year before the emergency declaration.
Some steps taken, more needed
Other steps have been taken to address the opioid epidemic, but many have come outside of the emergency declaration.
The Food and Drug Administration approved a once-monthly buprenorphine injection for the treatment of opioid use disorder.
The National Institutes of Health is working with the pharmaceutical industry to come up with new treatments for pain.
The Centers for Disease Control and Prevention (CDC) launched a new awareness campaign to help states fight the prescription opioid epidemic.
While Trump waits for Congress to walk the walk, many are dismayed by the lack of forward progress in addressing the opioid epidemic — which the CDC estimates killed more than 42,000 people in 2016.
“Unfortunately, we have seen too little action taken relative to the magnitude of the problem,” wrote 10 Senate Democrats and one Independent in a January 12 letter to the president.
And that advertising campaign that Trump promised?
It has yet to be seen in public.