Trump Won't Reduce the Ravages of Drug Addiction
His proposed recovery programs mean nothing while people are in despair.
Posted March 30, 2017
A strange thing happened when MSNBC's "All In" host Chris Hayes interviewed New Hampshire Senator Maggie Hassan about the unending growth in opioid-related deaths at which New Hampshire is an epicenter. As Democrat Hassan recited all of the great things she, public health, and police in New Hampshire were doing to prevent and treat addiction, liberal Hayes uncharacteristically pointed out, "According to the data, the crisis isn't improving. It's worsening."
That truth hardly caused Hassan to pause as she promoted her state's recovery programs, which she didn't actually describe. She no doubt meant the standard 12-step disease programs that are wholesaled in this country, which have never indicated that they are successful, least of all in combating the surge in heroin and painkiller deaths over the last dozen years.
I have reviewed the steady growth, simultaneously, in deaths due to heroin, opioid painkillers, synthetic painkillers like fentanyl, and tranquilizers, that has occurred under the watchful eyes of National Institute on Drug Abuse chief Nora Volkow. Volkow has held this job since 2003, leaving us to ponder whether doing more of the same thing is likely to lead to better results. (Volkow propounds the updated brain disease theory whose roots are in the same Americana as AA's 12 steps.)
The cause for all of this breast beating was the meeting in Washington of Donald Trump and New Jersey governor Chris Christie to form an opioid crisis task force. But the committee will never get to the bottom of this public health conundrum: why, in the country that already devotes the most resources to fighting drug addiction and narcotic fatalities, do these continue to grow?
It is tempting to quote Albert Einstein at this point: "You can never solve a problem using the same thinking that created it."
Trump, meanwhile, displayed his usual substance-free, bombastic, messianic mantras at the meeting:
Trump called the increasing number of Americans addicted to opioids “a total epidemic. Drug cartels have spread their deadly industry across our nation, and the availability of cheap narcotics, some of it comes in cheaper than candy, has devastated our communities. It’s really one of our biggest problems our country has, and nobody really wants to talk about it.”
But, just as he outsourced health care to Paul Ryan and America's destiny to Steve Bannon, Trump is relying on Chris Christie to come up with a solution for drug addiction. When Trump pointed to him, Christie trumpeted his mantra, "addiction is a disease that can be treated." Nevermind that the law school friend Christie repeatedly cites to in support of his assertion was "in and out of rehab" for over a decade.
And Hassan, Hayes, and the liberal establishment cling to this disease myth as much as, or more than, conservatives. So politically, Trump has little to lose with this mindless initiative (Hassan more or less endorsed it).
We are trapped in that thinking—that addiction is best approached as a medical problem—which is the tar baby of American public health. We keep pounding that dummy harder and harder until we can never extricate ourselves from its fatal grasp.
At virtually the same time as liberal Hayes was questioning Hassan, conservative New York Times columnist Ross Douthat, was pointing out a startling finding about Obamacare. I agree that the Affordable Care Act is ridiculously superior to the Rube Goldberg contraption that the Republicans proposed to replace it. However, as Douthat showed, ACA has not actually reduced mortality among the most needy populations where it is being deployed—largely due to narcotic-related deaths, along with accidents, suicides, and other sequela of despair.
As Douthat reports:
despite confident liberal expectations about how many lives Obamacare would save each year, the only noticeable recent shift in the American mortality trend has gone in the opposite direction—upward, likely thanks to the opioid epidemic [this is true for the noncollege—educated white population].
Nor has Obamacare’s Medicaid expansion been a bulwark against opioid-related misery...the mortality rates in states that expanded Medicaid rose faster in 2015 than in the states that did not. This correlation also shows up when you drill down in county-level data...Overall, areas that have implemented the Affordable Care Act in full have seen more deaths from drug overdoses than areas where the Medicaid expansion didn’t take effect.
Douthat wonders how this occurs. Here's the answer: focusing on addiction and drug fatalities as a medical problem is a cause, and not a remedy, for addiction and drug-related deaths. Thus, the Surgeon General's "updated" program for fighting the epidemic of addiction, which simply recycles all the old disease fables, won't just fail—it will exacerbate the epidemic.
Which brings us back to the overall Trump program for this country. As Trump eviscerates training, housing, basic health et al. programs for the poor, he then turns to Christie to laud and promote addiction treatment as the cure for what ails us. It isn't. It's a sign of the addictive malaise that shrouds our land.
Personal note: Mayor de Blasio just waked in Colson's as I finish this—too bad I can't explain it to him (his daughter entered recovery from marijuana and depression at age 19).