In Manchester, N.H., on Monday the Trump administration rolled out its new opioid plan and a campaign rally broke out.
The long awaited Trump opioid policies promise three focuses: prevention and education, improving access to treatment and recovery, and enhanced law enforcement and interdiction.
But those elements were overshadowed by the president's insistence on including the death penalty for drug dealers under existing federal law. "The thing that these drug dealers understand is violence, and toughness," President Trump said. "If we don't get tough with these drug dealers, we are wasting our time. And that toughness is the death penalty."
Trump backed up his call for the use of the death penalty by pointing to unnamed countries that don't have drug issues because of the use of the death penalty. As he spoke of the use of the death penalty tied to existing laws, the president received a partial standing ovation.
As with many of the administration's policy announcements, this was long on broad strokes and short on detail. One detail the president did include was to increase education about opioids through a large ad campaign. "We will do great commercials during the right shows. This is the least expensive thing we can do and we will do commercials where you scare them so they see they don't want to end up like the people in the commercials," the president said.
The program would also include supporting the accelerated development of effective non-opioid meds, including a vaccine to prevent addiction. Again, there were no details on how that might be done nor a timeline for the vaccine.
The president called for a reduction in the over-prescribing of opioids with the goal of cutting prescriptions by one-third in five years.
With an eye towards treatment, the program would seek legislation to allow Medicaid to pay for residential treatment, make naloxone, an O-D reversing drug, available to first responders, and make federal funding available to state and local treatment programs.
The administration had the most detail on cutting off the supply of drugs. Trump wants lawmakers to drop the minimum amount of drugs needed to trigger mandatory minimum sentences for those trafficking in opioids. The program would also move to shut down illicit opioid sales online.
A significant focus on enforcement during Trump's speech was on immigration and securing the southern border. Trump said that 90% of the heroin entering the U.S. comes from Mexico, "we have to keep the damn drugs out!" He then went on to cite Democrats for failing to deliver on building a wall as well as allowing drug dealers and traffickers to avoid jail or deportation via sanctuary cities.
Besides talking of immigration's relationship to opioids, the president went into rally mode by asking an ICE agent to speak as well as the parents of a young man who died of a fentanyl overdose. He also brought up Seamus Mulligan, the CEO of Adapt Pharma, which is donating free boxes of Narcan to qualifying high schools and colleges. Narcan is an anti-overdose nasal spray.
But the rally wasn't over yet. HHS Secretary Alan Azar spoke about lowering drug prices, promising a big meeting in a month where details of how prices would be pushed down would be revealed. He did offer one clue, saying that savings that are now going to pharmacy benefit managers would be rerouted to consumers.
And the president took time to talk about how the House and Senate would take another swing at a new right-to-try law.
Opioid use in the United States has grown both for approved medical use as well as on the street for recreational purposes. According to the Centers for Disease Control and Prevention, deaths due to opioids including heroin and synthetically produced fentanyl totaled more than 64,000 in 2017.
Last year, the Council on Economic Advisors estimated that the opioid epidemic had an economic cost of $504 billion in 2015.
While today's announcement was about policy, as with most things coming out of any administration, politics are in the mix. There are a few reasons Trump rolled this out in New Hampshire and all of them are political. During the campaign, Trump promised from the stump to take action to curb the onslaught of opioids in the Granite State.
But months later in a call with Mexican President Enrique Pena Nieto in January 2017, Trump said, "We have a massive drug problem where kids are becoming addicted to drugs because the drugs are being sold for less money than candy. I won in New Hampshire because New Hampshire is a drug-infested den."
That remark was greeted with plenty of heat in the state. At the time, Senator Maggie Hassan, D- N.H. said, "To date, @POTUS has proposed policies that would severely set back our efforts to combat this devastating epidemic," she tweeted. "Instead of insulting people in the throes of addiction, @POTUS needs to work across party lines to actually stem the tide of this crisis."
Trump has already announced his reelection campaign, and in 2016 he lost New Hampshire by just 2,732 votes to Hillary Clinton. And while the state only carries four electoral votes, Trump understands he is an underdog in the place with the motto of Live Free or Die.
Trump's opioid visit to Manchester Community College is as close to a mea culpa as New Hampshire is likely to see. It's the first time the president has been back to the state since the election.
Following Trump's State of the Union address Jan. 30, Senator. Jeanne Shaheen demonstrated that patience was running thin in New Hampshire saying, "The president must finally begin fulfilling his promise to deliver treatment resources. Over the past year, President Trump has only devoted lip service to respond to the opioid epidemic."
It remains to be seen if Monday's policy rollout will move beyond the promise stage. Trump formed the President's Commission on Combating Drug Addiction and the Opioid Crisis and received their recommendations but didn't make any moves. He had a national listening tour in May 2017 that included Attorney General Jeff Sessions and now-departed HHS Secretary Tom Price. Trump declared a National Health Crisis over opioids in August 2017 and again in October but didn't include any funding.
On Feb. 27 Sessions announced a "Prescription Interdiction & Litigation Task Force" which will team up with civil and criminal law enforcement officials to focus on how opioid manufacturers and distributors contribute to the crisis.Sessions also promised that the federal government would join litigation against pharmaceutical companies and distributors as the government has had to pay millions in expenses tied to opioids. A federal court in Cleveland has joined hundreds of lawsuits brought by cities, counties and states against companies that include Purdue Pharma LP, Teva Pharmaceutical Industries Ltd. (TEVA) , Johnson & Johnson (JNJ) , Endo International Plc (ENDP) McKesson Corp. (MCK) , Cardinal Health Inc. (CAH) , Allergan Plc (AGN) , and AmerisourceBergen Corp. (ABC) .