Then in November, Donald Trump's election and Republican return to power in Congress met new uncertainties on the question of how best to deal with opioid use disorders. Over the past decade, pushes to expand access to treatment for opioid addiction have enjoyed bipartisan support. However, during his campaign, Trump outlined a dramatic vision for addressing the issue of opioids, threatening the death penalty to drug dealers and smugglers and pledging to “seal” the border. On February 1, he signed an executive order to collect tariffs on China, Mexico and Canada. Some have put pressure on these countries to stop the flow of fentanyl to the United States. (Suddenly, he compromised for 30 days with Canada and Mexico.)
Keith Humphries, a professor of psychiatry and behavioral science at Stanford University who studies the opioid crisis, said the idea that strengthened border control could stop or significantly reduce fentanyl flow to the country is simply false. They say there is. Fentanyl is highly concentrated, he estimates that the amount required to supply nationwide demand for a year is up to 10 tons. Law enforcement must find these 10 tons (the weight of a small number of cars) among the more than 7 million trucks carrying goods across borders each year. To significantly hinder the flow of fentanyl, he believes the border must be completely closed. And even if the borders are closed, drones, planes and tunnels can continue to supply the market easily. Birthday card size letters mailed from overseas can supply one week of opioids for someone. “We cannot keep fentanyl out of such a large country,” he says.
Trump's expressed desire to cut government spending also worries about supporters of medication treatment. Some Republicans, along with other federal programs, are actively sought ways to cut Medicaid. Trump can also try to undo or simply undermine his favorite target, Affordable Care Act. Both developments could be disastrous for the distribution of drugs treating opioid addiction, reversing profits, even if they were dilute under the Biden administration. Medicaid covers an estimated 40% of non-elderly adults with opioid use disorders in the United States, with about two-thirds of whom are being treated for addiction through the program.
But it is also possible to expand the public health approach that Trump embraced during his first term. The requirement for physicians who want to prescribe buprenorphine is said Kassandra Frederique, executive director of the Drug Policy Alliance, a nonprofit advocating for low drug drug policies. And uniquely among Republican presidents, Trump supported the use of harm reduction practices, such as making clean syringes available, according to his first surgeon general. Frederick told me he hopes the current administration will continue to be built on the work Trump and others have done to expand access to treatment.
The important thing to remember is how much evidence exists that buprenorphine can help people with opioid addiction. Sarah Wakeman often points out this against what is considered a popular sense of pessimism around the opioid crisis. The problem is that this drug has not reached people who need it quickly enough. “Most people think this is a problem that is badly rejected, untreated and insurmountable,” she says. “It couldn't be far from the truth.”
