"6 Months Since Trump Declared an Opioid Emergency, What's Changed?" ... other than AG Sessions "strongly" encouraging capital prosecutions?
The quoted portion of the title of this post is the headline of this notable new Governing article, which provides this answer via a subheadline: "Some health officials say nothing. Members of Congress, meanwhile, are taking matters of money for the drug crisis into their own hands." Here are excerpts:
On Oct. 26 last year, President Donald Trump declared the opioid epidemic -- which took more than 64,000 lives in 2016 -- a national emergency. More specifically, he declared it a public health emergency, which can be used to ease some federal rules for the U.S. Department of Health and Human Services (HHS) to, among other things, make more people eligible for Medicaid or dispatch more medical professionals to the areas hit hardest by the drug crisis.
The declaration has already been extended twice, most recently on Tuesday. But health policy experts say it's unclear what -- if any -- HHS rules have been waived since the declaration. Moreover, Trump did not directly offer state and local governments more money to combat the drug crisis. Because of this, some say the declaration has been nothing more than an empty promise. "We’ve seen no effect here in Baltimore from the emergency [declaration]," says Leana Wen, the city's health commissioner. "We could save so many more lives if we had more resources. We don’t need any more rhetoric." Wen worked with members of Congress to take matters of money into their own hands....
There are at least seven other bills floating around Congress to address the opioid epidemic. The most comprehensive with the most bipartisan support is the Comprehensive Addiction and Recovery Act (CARA) 2.0. It offers $1 billion more than current federal funding for treatment and prevention programs and would mandate a three-day limit for first-time opioid prescriptions.
Frustration over federal inaction is even boiling over within the president's own party. Before Trump traveled to New Hampshire to talk about opioids, the state's Republican governor, Chris Sununu, reportedly confronted White House officials about the lack of funding to back up the emergency declaration. "The president cannot come to New Hampshire without a plan that has substance," Sununu told White House aides, according to CBS News.
Trump still gave his scheduled speech there in March to unveil new initiatives to fight the opioid epidemic. He focused on cracking down on illegal immigration and drug dealers. Since then, Attorney General Jeff Sessions has directed federal prosecutors to seek the death penalty for some drug traffickers....
His focus on law-and-order tactics exasperated many health officials. "I'm deeply concerned with the focus on incarceration. It goes against what science says, which is that addiction is a disease. We know that treatment works. The war on drugs doesn't," says Wen.
The plan the White House released after Trump's New Hampshire speech did include several bipartisan, health-focused efforts to combat the crisis -- but most of the ideas weren't new and there were few specifics about how to pay for them. Before the emergency declaration, Trump assembled an opioid commission to explore the best tactics the federal government could deploy to stem the tide of overdoses. A final report was released in November, with some bipartisan recommendations, such as removing barriers to treatment and increasing access to drug courts that divert people struggling with addiction from jail.
But even those who worked on the commission's 138-page report have said that the administration has no plan to systematically address the epidemic.... There have been some encouraging signs, however, that the federal government is serious about addressing the opioid epidemic. The Trump administration has continued an Obama-era policy of approving waivers to let their Medicaid programs pay for addiction and mental health treatment in facilities larger than 16 beds -- which is normally prohibited under federal law. So far, the Trump administration has approved waivers from Indiana, New Jersey, Utah, Virginia and West Virginia. Five states -- Arizona, Illinois, Kentucky, Michigan and Wisconsin -- have pending waivers still.
And last month, Congress passed a federal spending bill that includes a $3.3 billion increase in funding for the opioid crisis. The $3.3 billion will go toward prevention, treatment and law enforcement activities across the Centers for Disease Control and Prevention (CDC), Substance Abuse and Mental Health Services Administration (SAMHSA), Department of Veterans Affairs and other entities that help state and local governments. Many health policy experts, however, argue that it still isn't enough to make a meaningful impact. To put that in context, the federal budget for HIV care in 2017 was $32 billion.
The other part of the title of this post is a reminder that it was a full five weeks ago that AG Jeff Sessions issued a "Memo to U.S. Attorneys on the Use of Capital Punishment in Drug-Related Prosecutions" (full text here) which "strongly encourage[d] federal prosecutors" bringing federal drug prosecutions to "include the pursuit of capital punishment in appropriate cases." I keep wondering if and when we will see that memo having any real tangible impact.
Roughly speaking, federal prosecutors bring about 400 federal drug prosecutions per week, meaning that there have likely been around 2000 federal drug prosecutions since the AG issued his capital punishment memo. Even if AG Sessions means by "strongly" encouraging capital prosecutions that only the very worst 0.1% of federal drug defendants should be subject to federal capital charges, we should perhaps have expected to have seen by now two federal drug defendants being subject to a federal capital indictment. (I am inclined here to recall frequent statements by groups like NAUSAA that that federal system is focused only on "the most dangerous and serious drug traffickers." If this is true, perhaps AG Sessions thinks 1% or even 10% of federal drug prosecutions should include capital charges. If so, we ought to already be seeing dozens of federal capital prosecutions by now.)
As of this writing, I am not aware of a single new capital drug case since the AG's March memo, though it is certainly possible that some are in the works and that is only a matter of time before we see a lot more federal capital cases. I know I will be continuing to wonder if, when and how the capital prosecutions that AG Sessions has strongly encouraged will become a reality.
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