To end substance use disorder, whether drugs or alcohol, you must stop the supply and/or the demand.
Stopping demand means reducing the number of people who want the drugs, even if they are available, even if they are legal. This is accomplished through drug abuse rehab treatment, prevention programs, medication-assisted treatment (MAT), and after-care for relapse prevention. This can be expensive, but it means you have healthy and productive citizens and less drug-related crime.
Stopping supply means there are no drugs available, even if someone wants them. This is accomplished by interdicting supplies before they reach our shores, confiscating drugs that do make it across the border, arresting the drug traffickers, the dealers and maybe the users. This can be even more expensive, and it means you have crowded jails and prisons, bloodshed and gun violence as criminals protect their product, turf, and freedom.
During a 2016 campaign stop in Portsmouth, New Hampshire, in opioid ravaged New England, Donald J. Trump offered a three-pronged approach to ending the opioid crisis:
- A wall on the U.S.-Mexico border to “stop the flow of illegal drugs into the country.”
- Reducing how much opioids (oxycodone, methadone, and fentanyl) can be made and sold in the U.S.
- “Give people struggling with addiction access to the help they need,” including “access to treatment slots.”
Since then he has:
- supported a Patient Protection and Affordable Care Act (“ObamaCare”) repeal that would have repealed its mental health and substance use disorder requirements,
- formed and dissolved a special commission on fighting opioid addiction and ignoring most of its recommendations,
- neglected to fill posts and proposed funding cuts to departments and programs that help with substance use disorder,
- declared a public health emergency (that comes without additional funds) rather than the National Emergency (that would have come with additional funds) recommended by many experts.
To be fair, he did sign a budget deal that included $6 billion for the opioid crisis — prevention, law enforcement, and treatment — but without specifying how much will go to each approach. According to Bob Davis, a spokesperson for the American Society of Addiction Medicine, Senate Majority Leader Mitch McConnell has said: “the funds would be used for new grants, prevention, and law enforcement.”
Most recently Trump has suggested that focusing on law enforcement — perhaps, extending the death penalty to “pushers and drug dealers” like they do in the Philippines and Singapore — might be the best approach.
It isn’t. If there is a product people want, they will always find someone to provide it. If they can’t get OxyContin, they may opt for heroin or fentanyl, or find something new that hasn’t been outlawed or regulated yet. That doesn’t mean you don’t make it hard for them, that you don’t attempt to stop the drug traffic, but overly harsh methods don’t work alone. They might drive up the price, and hence the interest of criminal gangs. Prevention, Trump’s favored fallback position, also is necessary, but that does nothing for the many who are already addicted.
Without drug rehab, if you remove the supply of drugs, you create a greater demand that is willing to do anything and take anything that might prevent withdrawal. Withdrawal needs to be gradual, medically monitored, possibly assisted by MAT, and with follow-up aftercare.
