The Trump administration is finalizing a long-awaited plan that it says will solve the opioid crisis, but it also calls for law enforcement measures — like the death penalty for some drug dealers — that public health advocates and congressional Republicans warn will detract from efforts to reverse the epidemic.
The ambitious plan, which the White House has quietly been circulating among political appointees this month, could be announced as soon as Monday when President Donald Trump visits New Hampshire, a state hard hit by the epidemic. It includes a mix of prevention and treatment measures that advocates have long endorsed, as well as beefed-up enforcement in line with the president’s frequent calls for a harsh crackdown on drug traffickers and dealers.
The White House's most concrete proposal yet to address opioids comes after complaints from state health officials and advocates that Trump has moved too slowly to combat the epidemic after his bold campaign promises to wipe out the crisis touching all parts of the country.
However, the plan could cost billions of dollars more than Trump budgeted — and likely far more than any funding package that Congress would approve — raising questions about how much of it can actually be put into practice. Trump's emphatic embrace of the death penalty for some drug dealers has also alarmed some advocates, who say the idea has been ineffective when tried in other countries and resurrects the nation’s unsuccessful war on drugs.
Under the most recent version of the plan, which has gone through several revisions, the Trump administration proposes to change how the government pays for opioid prescriptions to limit access to powerful painkillers. It also calls on Congress to change how Medicaid pays for treatment, seeking to make it easier for patients with addictions to get inpatient care. It would also create a new Justice Department task force that more aggressively monitors internet sales.
The administration claims its plan will reduce opioid prescriptions by one-third within three years and that the initiative will fulfill Trump's campaign promise to "stop opioid abuse."
However, that will be a tall order. There were more than 64,000 drug overdose deaths in 2016, mostly involving opioids, according to the most recent federal mortality data. The CDC last week reported that emergency rooms recorded a 30 percent spike in opioid overdoses last summer, indicating that the devastating crisis is worsening.
POLITICO obtained two versions of the White House plan and spoke with four individuals who have reviewed it. The White House confirmed that a plan was in development but didn’t respond to multiple requests for further comment.
Many of the measures in the plan were recommended by the president’s opioids commission last fall or discussed at a March 1 White House opioid summit. For instance, it endorses a long-promised priority: greatly expanding first responders' access to naloxone, a medication used to reverse opioid overdoses. It also calls on states to adopt a prescription drug monitoring database that health care providers can access nationwide to flag patients seeking out numerous opioid prescriptions.
On the policing side, the plan would ramp up prosecution and punishment, underscoring the tension in how public health advocates and law enforcement officials approach the crisis. Public health advocates say the nation's opioid epidemic should be treated as a disease, with emphasis on boosting underfunded treatment and prevention programs. But some law enforcement officials back tougher punishments as a deterrent, especially for drug dealers. The two camps don’t always see eye-to-eye, at times pitting HHS and DOJ officials against each other.
“There is a lot of internal dissension between the health folks and the enforcement folks,” said an official involved in the crafting of the plan.
While Trump this month repeatedly suggested using the death penalty to deter drug dealers and traffickers — an idea roundly opposed by public health advocates — many lawmakers have said they weren’t sure whether to take the idea seriously.
“I would have to strongly evaluate and look at any proposal like that,” said Sen. Dan Sullivan (R-Alaska) on Wednesday. “I don’t know if the president was serious or just said it off the cuff. … It’s a big issue when you decide to bring a capital case or pass a law that allows for capital punishment.”
According to language circulating this week, the Trump administration will call for the death penalty as an option in "certain cases where opioid, including Fentanyl-related, drug dealing and trafficking are directly responsible for death."
Sen. Shelley Moore Capito (R-W.Va.), whose home state is one of the hardest hit by the opioid epidemic, said she doesn't support the death penalty for drug cases.
“I mean, I get the message he’s delivering: We’ve got to treat it seriously,” she said. “I don’t see that that’s going to solve the problem.”
The White House plan also calls for making it easier to invoke the mandatory minimum sentence for drug traffickers who knowingly distribute illegal opioids that can be lethal, like fentanyl. It also proposes a new Justice Department task force known as “Prescription Interdiction and Litigation,” or PIL, which would be empowered to step up prosecutions of criminally negligent doctors, pharmacies and other providers.
The White House is also backing new health ideas, such as calling for 75 percent of opioid prescriptions reimbursed by government health programs like Medicare and Medicaid to be issued by using “best practices” within three years. That would be scaled up to 95 percent of prescriptions in five years.
It also calls on Congress to formally repeal a rule barring Medicaid payment to residential treatment for opioid addiction at large facilities, which could cost tens of billions of dollars. The rule, implemented about 50 years ago, was meant to discourage mass institutionalization of people with mental illness, but states say it has been a barrier to addiction treatment. Some states under the Obama and Trump administrations have received federal permission to waive the rule for substance abuse treatment.
The plan also includes measures favored by progressive drug policy reformers like changing the nation's prison system so all federal inmates would be screened for opioid use upon arrival and steered toward treatment at residential re-entry centers as necessary. It also calls for improving tracking systems to rapidly steer resources to areas struggling with the opioid epidemic.
Trump could announce the plan, or aspects of it, on Monday, when he is scheduled to return to New Hampshire with HHS Secretary Alex Azar. It will be Trump's first trip to New Hampshire as president after numerous campaign trips to the state to highlight the opioid epidemic.
Some administration officials hoped to announce the long-developing opioid plan — including the death penalty for drug dealers — at the March 1 opioid summit, but it wasn't ready in time. However, Trump still riffed that day about the need to use the death penalty to fight the opioid epidemic.
"If you shoot one person, they give you life, they give you the death penalty," Trump said at the time. "These people can kill 2,000, 3,000 people and nothing happens to them."
Brianna Ehley, Sarah Karlin-Smith and Adam Cancryn contributed to this report.