The Opioid Crisis reached critical mass in 2015 when the public was made painfully aware that addiction to opioid-based painkillers was far more prevalent than originally thought. Not only have efforts to address the crisis stalled under Trump, but he has actually exacerbated the problem by reversing policies and slashing programs vital to tackling this rampant public health crisis.

Wasting on the wall

The administration requested $18 billion to build a wall along the Mexican border because it is “critical to impeding and denying the flow of illicit drugs into our country,” according to the White House. However, most drugs trafficked into the U.S. are smuggled through legal ports of entry, something a border wall could never mitigate. The New York Times asked 30 experts about solving the Opioid Crisis; none listed a border wall as a recommended course of action. Although a wall could affect the way drugs are trafficked, border enforcement wouldn’t reduce the volume of drugs entering the country.

“Charade” of a presidential commission

In November 2017, President Trump established the President’s Commission on Combating Drug Addiction and the Opioid Crisis, led by former New Jersey Governor Chris Christie. After just two months, Patrick Kennedy, former congressman and a member of the commission, referred to the panel as a “charade.” Kennedy, a recovering addict himself, said, “I’m as cynical as I’ve ever been about this stuff.” The panel’s proposals mainly focused on funding, increasing access to treatment, behavioral workforce development, and awareness. Most of the commission’s recommendations were not implemented, as its work fell on deaf ears.

Cutting Medicaid cuts treatment

One of the leading sources of treatment and resources in regions severely affected by the Opioid Crisis is Medicaid. Medicaid covers almost 4 in 10 adults with an opioid addiction, and adults with Medicaid are more likely than any other group to receive substance use disorder treatment. Medicaid provides inpatient and outpatient treatment services for people addicted to opioids, including naloxone, a prescription drug that stops the lethal effects of an overdose. Medicaid programs also cover Medication Assisted Treatment like Naltrexone, Buprenorphine, or Methadone.

Despite Trump’s 2015 promise not to cut Medicaid, the president’s proposed budget for 2019 would cut Medicaid by $1.4 trillion dollars over the next decade and eliminate vital funding for Medicaid expansion. Under the two-faced public policy of the Trump Presidency, millions will struggle and fail to find the help they need to overcome addiction.

Undermining the ACA undermines health

The Trump administration dealt critical blows to treatment access by dismantling the Affordable Care Act (ACA). The fewer people with adequate health insurance, the more difficult it becomes for them to seek treatment for substance use disorders. The Urban Institute projects that due to the recent loss of the individual mandate, withdrawal of cost-sharing reduction payments, and a drop in federal enrollment assistance, an additional 6.4 million people will be uninsured in 2019. The Trump administration also expanded short-term, limited-duration insurance policies that don’t meet ACA requirements, allowing the market to cherry-pick healthy people. The Urban Institute estimates this will increase ACA premiums by 18.2%, while raising government spending by 9.3%.

Killing the Office of National Drug Control Policy

Since it was created by the Anti-Drug Abuse Act of 1988, the Office of National Drug Control Policy (ONDCP) has led federal policymaking on drug control as one of the few offices where law enforcement and scientists could work together on policy.

The Office of Management and Budget proposed a 95% cut to ONDCP’s budget in January 2018, including moving grants for the High Intensity Drug Trafficking Areas (HIDTA) and Drug Free Communities (DFC) to other departments. HIDTA assists law enforcement in areas with a higher propensity for drug trafficking, while DFC supports efforts to reduce substance abuse among youth. Over 150 organizations opposed these cuts.

Beyond the budgetary changes to ONDCP, the office generated negative headlines when a 24-year-old with almost no relevant work experience outside the Trump campaign was promoted to deputy chief of staff. In February, Trump finally nominated someone to lead the office, but his nominee James Carroll, a lawyer for the Ford Motor Company, has little relevant experience, and already faced criticism over his qualifications.

Missing in action

President Trump promised to do something about the Opioid Crisis. Instead, he has left millions of Americans paying more money for less treatment while over 64,000 people die as victims of addiction each year. Medicaid, the main lifeline for communities reeling from addiction, faces unprecedented challenges going into the 2019 fiscal year, while the ONDCP will be virtually eliminated. Despite his promises, Trump has shown time and time again that he does not view prevention and drug control as a priority.