Meth and cocaine complicate Trump's war on drugs

President Donald Trump will tout his response to the opioid crisis when he signs a sweeping bipartisan bill this week, but other drug-related deaths are on the rise and little is being done to address the broader scourge of addiction. Fatalities from misuse of methamphetamine, cocaine and benzodiazapines have surged while Washington’s latest efforts to fight drug addiction funnel new money and resources almost exclusively to localities ravaged by the opioid crisis or pay for treatments and overdose-reversal drugs that don't work for stimulants. Trump on Wednesday will sign a 660-page bill Congress passed to combat the opioid crisis during a White House event aimed at showcasing his administration’s work on the issue. And while those efforts will direct around $4 billion to fight the epidemic, public health experts warn they miss an opportunity to address the broader issue of addiction, including the 80,000 Americans who die every year from alcoholism. “I think it’s fairly obvious that focusing on one drug at a time is not the best approach and this is not the first time we’ve done this,” said Andrew Kessler, founder of Slingshot Solutions, a consulting firm focused on addiction issues. The legislation largely focuses on expanding access to opioid-specific treatments that don't work on people with other types of addiction, experts say. It also includes such opioid-specific prevention measures as Medicare policies to help detect seniors at risk of misusing painkillers and more oversight of opioid prescribing. Trump administration officials say opioids are the logical target, citing the crisis' staggering death toll. According to the CDC, 72,000 people died of a drug overdose in 2017 and about two-thirds involved opioids. Though new preliminary data shows overdose deaths fell slightly at the end of last year and the beginning of 2018, fatalities are still alarmingly high. “The focus has been on opioids, because we have so many people dying of opioid overdose,” said Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz. She acknowledged being “pretty worried about a lot of other substances,” noting increases in meth use among young adults, but added that the federal government has programs that are appropriately addressing such concerns. But skeptics argue policymakers are repeating past mistakes by addressing addiction one drug at a time, instead of building up the capabilities to respond simultaneously to the misuse of multiple substances. “Meth has snuck up behind us,” said Alaska Public Health Director Jay Butler. His state saw a four-fold increase in meth-related deaths in the past decade, according to Alaska figures. “We have been saying we have an opioid crisis and we do, but we also have an ongoing addiction issue.” Deaths increased for every common drug, including but not limited to opioids, according to 2017 preliminary numbers from the CDC. There were 14,556 cocaine-related overdose deaths — a 40 percent increase since 2016. And the government recorded 10,721 meth-related deaths — a 42 percent increase over that same time period. The data also showed an uptick in deaths where two or more substances were involved like cocaine and fentanyl — a sometimes lethal combination. Another 80,000 Americans die every year from alcoholism. “We had a drug problem when I started and we continue to have a drug problem today… I started 40 years ago,” said Daviess County Sheriff Keith Cain, whose northwestern Kentucky county has been devastated by meth for the better part of two decades, while the eastern part of the state grapples with the opioid crisis. “The prevalent drug of choice here has been and continues to be meth,” he said, adding that it’s cheaper and more readily available than any other drug in the area. Cain said his department received $50,000 to $70,000 grants every year in the late 1990s and early 2000s to help respond to the meth problem, adding it hasn't received any federal funding for more than five years since most of that is now being directed to the part of the state gripped by opioid addiction. Some states like North Dakota that are grappling with meth addiction have found ways to use the new opioid cash to address their own problems. Pamela Sagness, the state's director of the Human Services' Behavioral Health Division, said officials have used the money to build addiction treatment infrastructure, for any type of substance, that largely didn't exist before. "The struggle for us comes down to even having access to services," Sagness said, noting that there are areas lacking certain types of inpatient or outpatient care where individuals have to leave in order to get the treatment. Crack cocaine and meth epidemics have come and gone since the 1980s, and failed efforts to contain them and build up a lasting treatment infrastructure have made their resurgence inevitable. The Reagan-era war on drugs emphasized a law-and-order approach that favored incarceration over building treatment centers and adding hospital beds. That lack of infrastructure still exists today. As of 2016, only about 10 percent of people seeking addiction treatment reported receiving it, according to a Surgeon General’s report. The latest efforts have emphasized the need for public health and treatment services. Congress earmarked about $1.5 billion this year for opioid addiction treatment. Meanwhile, the block grant used to fund all other substance use treatment services combined was kept flat at around $1.9 billion. Experts say it hasn’t kept pace with the growing demand for treatment. Most experts agree the unique challenges of the opioid crisis call for targeted measures. For example, the Trump administration’s effort has been especially focused on the prescription drug supply to root out misuse. Since Trump declared the opioid crisis a public health emergency last October, his administration has cracked down on illegal opioid prescribing and rolled out a prevention-geared media campaign to warn young people about the dangers of prescription opioids. He’s also made a goal of reducing opioid prescriptions by one-third over three years, and the FDA is clarifying federal prescribing guidelines to treat acute pain that have widely been misinterpreted by doctors. The measures have limited use for other kinds of addiction, though. The overdose antidote naloxone doesn't work for stimulants like meth or cocaine. Likewise, there is no medication assisted treatment, meaning people addicted to the substances may need intensive inpatient treatment followed by counseling and other support services. McCance-Katz says the Trump administration is working to research and develop other options, though most of the new research funding has been earmarked for opioids. Amanda Myers, the drug court coordinator for Colorado’s 18th Judicial District, where officials are dealing with multiple sources of addiction, predicts drugs like meth won't get the attention that the opioid crisis has received. “The opioid crisis is affecting a population with a voice but meth has always been here,” she said. “It’s always been a nightmare and it’s always been a mess.” source: https://www.politico.com/story/2018/10/23/trump-war-on-drugs-876633 #Headlines by: behley@politico.com (Brianna Ehley)

Original Post: https://www.politico.com/story/2018/10/23/trump-war-on-drugs-876633