White House aides and a bipartisan group of lawmakers on Capitol Hill are cheering $6 billion in new funding to fight the opioid crisis in the recently approved budget deal, but treatment advocates and drug policy experts are concerned the uptick in funding won't be spent wisely and isn't nearly enough.
Those concerns stem from the tough-on-crime rhetoric that the Trump administration has employed in recent months, leading treatment advocates in states to worry that opioid addiction -- something President Donald Trump seized on during the 2016 campaign -- will be treated as a law enforcement, not a health, issue. If money is diverted from treatment to tackle crime, advocates said, the already small amount of money going towards the problem will do even less.
Trump fed these concerns on Monday during a speech in Cincinnati when he disparaged "blue ribbon committees" and said he had a "different take" on combating opioid abuse.
"My take is you have to get really, really tough, really mean with the drug pushers and the drug dealers," he said.
A White House official told CNN on Thursday that the Trump administration has told appropriators in Congress, who are now tasked with spending the $6 billion, that they would like to see the influx of cash spent on both treatment and law enforcement priorities.
"It is a law enforcement issue," the official said. "We have a supply problem and a demand problem. ... It is all of the above."
That worries Grant Smith, deputy director of national affairs for the Drug Policy Alliance.
"President Trump and his administration, in many ways, are pushing a more punitive approach. And there has been a lot of rhetoric about making this a law enforcement issue," Smith said. "Favoring enforcement over treatment would be a major misstep, a huge missed opportunity."
He added: "For decades, this country has poured billions into enforcement and billions into the war on drugs at the expense of our treatment infrastructure."
The official dismissed concerns that the Trump administration will prioritize law enforcement over treatment, arguing that 80% of of the money the administration has spent on the crisis since Trump took office has focused on treatment.
But the public rhetoric coming out of the Trump administration has recently been less caring than advocates would like, including a speech on Thursday, Attorney General Jeff Sessions suggested people addicted to opioids needs to get tougher.
"I mean, people need to take some aspirin sometimes," Sessions said of the over-prescription of opioids. "Tough it out."
Since 1999, the number of American overdose deaths involving opioids has quadrupled. More than 63,600 lives were lost to drug overdose in 2016, the most lethal year yet of the drug overdose epidemic, according to a new report from the National Center for Health Statistics.
The issue became central in the 2016 presidential election, with both Trump and Democratic rival Hillary Clinton promising communities affected by overdose deaths to focus the federal government on the issue.
Trump's efforts as President, though, have left some advocates concerned, including those who felt Trump could stem the tide of opioid abuse in the United States. The Office of National Drug Control Policy, those advocates say, has seen its role diminished under Trump, and even though the President declared the opioid crisis a public health emergency in 2017, he didn't back up the declaration with any increase in direct funding. An official for the drug office declined to comment on the funding boost.
Melania Trump has made opioid treatment a focus of her platform as first lady. She traveled to a West Virginia opioid treatment center in October 2017, her first visit to a drug treatment center to visit families since her husband took office.
Concerns over funding
The White House official said the money in this bipartisan agreement should be considered funding for the public health emergency, calling the agreement a "huge and important victory."
Some lawmakers on Capitol Hill, particularly those in states deeply affected by the opioid crisis, agree, but are now eager to ensure the money flows to their states.
Sen. Joe Manchin, a West Virginia Democrat, responded to the deal by saying he had been "relentlessly pressuring congressional leadership to make sure that West Virginia gets the funding it needs to end the opioid epidemic."
But a spokesman for the senator said Manchin is concerned about making sure states like West Virginia -- a place dramatically affected by the opioid crisis -- gets much of the funding recently approved.
"He believes we need more treatment families, and he wants a fair allocation of the money so that West Virginia, a state thetas ground zero for this, is receiving a majority of the funds," the spokesman said. "He has made clear that he wants that."
The White House official said the Trump administration understands those concerns, adding that Trump "is committed to actual hard targets and because of that, we are going to have to go where the targets are."
"We are not ruling in or out any place or any approach, except for the approach that brings down the numbers," the official said.
The other concern treatment advocates have with the new agreement is that $6 billion -- while welcome -- is not nearly enough to tackle the issue.
"It's a good start," said Tym Rourke, the former chairman of the New Hampshire governor's commission on alcohol and drug abuse prevention. "The question of what is enough is always a big one. Is it enough? Probably not."
In 2017, when $45 billion over 10 years was proposed in a Senate budget for states to spend on opioid addition treatment, many senators said the money wasn't nearly enough.
Sen. Maggie Hassan, a New Hampshire Democrat, said the money was "a drop in the bucket that would not come close to making up for the damage" done by the Republican healthcare bill.
Hassan and her counterpart, Democratic Sen. Jeanne Shaheen, cheered the passage of the budget on Friday, but both noted that far more funding was needed.
"Much more needs to be done to provide substance use disorder treatment to those who desperately need it," Shaheen said. "We still need a federal response to this epidemic that matches the national public health emergency we are facing."
Hassan agreed in a statement on Friday: "We also know that we will ultimately need far more funding beyond this measure over the years to come to truly address this crisis."
The White House official didn't disagree that more could be done, but said the $6 billion in funding "is the right number that can be spent well (now) and can bring the numbers down of people who are dying."
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