President Trump unveiled proposals to deal with the opioid overdose epidemic in a speech in New Hampshire on Monday.
Trump's proposals — to fund public service announcements about the dangers of opioids, expand treatment and cut down on opioid prescribing — were largely overshadowed by the president's insistence that drug crimes should be more harshly punished, including his vocal support of the death penalty for some drug traffickers.
"We will not rest until the end," Trump told the crowd. "And I will tell you, that this scourge of drug addiction in America will stop. It will stop."
Tens of thousands of Americans are killed by opioid overdoses each year. It's a number that has risen steadily for the past decade and a half. Opioids are a family of drugs that include everything from street heroin to prescription painkillers like oxycodone to synthetic drugs like fentanyl.
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It's not unusual for a drug policy to focus heavily on law enforcement, said Jeremiah Gardner, manager for Hazelden Betty Ford Institute for Recovery Advocacy. But he's encouraged by the president's proposals that expand access to treatment and make the anti-overdose medication naloxone more widely available.
"That sort of rhetorical direction and attention from the bully pulpit is valuable," Gardner said. "We're talking about a health condition that for decades has been marginalized and neglected and to a certain degree ignored, by both policy makers and the mainstream health care industry."
Trump also pledged to make more medication-assisted treatment options available, cut opioid painkiller prescriptions by one-third within three years and transition states to a national system for tracking opioid prescriptions.
The president can't introduce legislation, but he can try to influence where lawmakers allocate the $6 billion in funds they recently approved to fight opioids. In Congress, there are dozens of bills dealing with opioids or drugs, some of which mirror proposals Trump supports.
"The good news is there seems to be an obvious attention and focus on this problem from policymakers throughout Washington," Gardner said. "I think they're going to move pretty rapidly."
U.S. Sen. Amy Klobuchar of Minnesota has introduced a number of bills related to opioids. In an emailed statement, she urged Trump to support a bill she's authored to create a national prescription monitoring hub and another that would restrict the mailing of synthetic drugs from outside the country.
"Curbing the kind of 'doctor shopping' that facilitates addiction and closing loopholes in our postal system that allow foreign manufacturers to ship dangerous synthetic drugs into the country are just a few steps we can take to end this epidemic," Klobuchar said in the emailed statement. "In addition, we must increase funding for addiction and recovery services and invest in proven prevention strategies to stop addiction before it starts."
Trump also has some control over policies at federal agencies. He has pledged that inmates leaving federal prison who are dependent on opioids will now be offered treatment. Gardner said this could prevent inmates who get clean in prison from dying of overdoses after they get out.
"Proposals like that make so much sense and it's really good to see people begin to acknowledge that," Gardner said.
But the president's comments that drew the most attention were his repeated statements supporting the death penalty for convicted drug traffickers.
"We can have all the blue-ribbon committees we want, but if we don't get tough on the drug dealers, we're wasting our time," Trump told the crowd. "Just remember that, we're wasting our time. And that toughness includes the death penalty."
There are some concerns that the president's rhetoric signals a return to the harsher criminal penalties associated with the "War on Drugs," said Sarah Walker, a criminal justice lobbyist who successfully advocated for Minnesota to reform its drug sentencing in 2016.
"We're just going to end up and create and continue the cycle of mass incarceration: release, re-entry and then reincarceration, which doesn't make sense," Walker said. "It's not responsible for our tax dollars and it's also not responsible for our communities."
Walker said harsh sentences for drug crimes haven't historically been effective in reducing drug use, and that Trump's proposal to increase penalties also wouldn't solve the opioid epidemic.
"The reality is that states all across the country — red states, blue states — have been moving in the opposite direction," Walker said. "They've been moving toward re-evaluating our sentencing guidelines of different states and reducing sentencing."
Ramsey County Attorney John Choi also doesn't support the president's statements on the death penalty.
"But if he's talking about cracking down, and getting tougher on drug traffickers, I think that's part of the equation," Choi said. "We can't kid ourselves though. We're not going to prosecute and arrest our way to a solution. That's just a small part of the overall equation."
Choi said it has become more common recently for county attorneys in Minnesota to file charges against people who provide drugs that cause a fatal overdose on a third-degree murder charge.
Republican State Rep. Dave Baker of Willmar has spearheaded a number of bills in the state Legislature about overdose and opioids. Baker, whose son Dan died of an opioid overdose in 2011, said he appreciates the prevention and educational aspects of the president's plan, but noted that the discussion of the death penalty isn't helpful.
"To have somebody that's going to get a higher penalty or longer jail term or if we're going to throw a switch on somebody, it might sound good publicly," Baker said, "but we've got to put drug dealers out of business because people are smart enough to know that this is not what people need in their life. That's where I'm going."
Baker said he was hoping the president's plan would include more support for state efforts, and more details about where the funding that already exists is to going to go.
"I do hope the federal government starts to listen to the states about what we really need. I haven't heard a lot of that coming my way," Baker said. "But I do appreciate Trump's efforts to put more attention on this crisis."
A bill Baker has proposed in the state House would raise an estimated $20 million for anti-drug efforts and treatment. It has two hearings scheduled in the state House this week. The state Senate version of the bill, which still includes a fee on pharmaceutical companies that produce opioids, has also been advancing.