With the votes counted and the concessions establshed, America woke up on November 9th with a new President-Elect. Though many were surprised with the choice their fellow Americans made, there is a general consensus that it is now time to examine policy and look toward the future. For many who have been impacted by drugs and alcohol, this examination starts with finding out what addiction treatment access and drug-related crime enforcement would look like in a Donald Trump Administration. With overdose-related fatalities hitting record numbers in 2014 and prescription opioid addiction now the largest public health issue facing the country, it’s important to understand what the future of addiction care looks like, going forward.
A Mixed Bag
Both candidates were comparatively silent on the issue when they took to the stump during the grueling, and often bizarre, 18-month campaign; however, there were a few indicators along the way that told a rather illuminating story. At an October 15th speech in New Hampshire, a state that has been devastated by prescription opioid addiction, Trump revealed an intention to increase mandatory minimum sentences for serious offenders, a policy echoed and in fact implemented, by his running mate and Vice President-Elect, Mike Pence in his home state of Indiana. Many experts have argued for years that mandatory minimums are counter to national substance abuse prevention, and are not a deterrent to what is now universally identified as a medical issue rather than a legal one.
In contrast to this seemingly hardline approach, however, Trump has also proposed increasing access to medication-assisted treatment. He revealed a belief that the Food and Drug Administration is too slow to approve potentially craving-reducing drugs and that there are too many regulations placed on doctors in dispensing them. Trump also proposed further incentivizing drug courts for state governments and local municipalities. He has, thus far, been silent on an approach to dealing with low-level and non-violent offenders. A reading of Mike Pence’s record on this issue reveals a decidedly enforcement-first approach, specifically for violent offenders.
ACA and Indirect Impact
One of Trump’s fundamental campaign promises was to repeal and replace the Affordable Care Act (ACA), an effort that is likely to be fast-tracked by the same-party House and Senate who have made no secret of their dissatisfaction with the legislation.
The ACA has considerably increased access to addiction treatment for those who need it. Its current language removes addiction as a pre-existing condition for insurance purposes and designates substance abuse as one of its ten elements of essential health benefits. This means that all health insurance sold on Health Insurance Exchanges or provided by Medicaid to certain newly eligible adults must include services for substance use disorders. It also modernizes the management of patient’s records so their substance abuse can be managed and addressed in primary-care settings. Although it’s still unclear as to how much of this law is slated to change, modify or disappear, it’s worth mentioning that fundamental changes can turn back the clock on treatment access for many patients that need it.
Ultimately we will have to wait and see exactly what a Trump presidency means for the current and future recovery population. If you or a loved one are struggling with substance abuse or addiction, however, the stakes couldn’t get much higher or more immediate.