President-elect Donald Trump has vowed to curb America’s heroin epidemic by cracking down on the Mexican border. That sounds terrific to DuPage County, Ill., State’s Attorney Robert Berlin, who has seen the drug ravage his suburban jurisdiction.
The U.S. Drug Enforcement Administration “is seizing more and more, but the reality is there’s more that can be done,” he said. “If we can reduce the amount that comes into the country, we’ll limit the supply and, I think, reduce the number of users. That’s a public safety win.”
But Trump has also promised to repeal the Affordable Care Act, the federal health insurance program many people have used to access treatment. That sounds bad to Chelsea Laliberte, leader of a nonprofit dedicated to combating heroin.
“I truly believe this could be a disaster,” she said. “I’m an optimistic person but I’m having a hard time being optimistic here.”
Trump frequently mentioned the opioid crisis during his campaign, and according to some post-election analyses, he performed especially well in Rust Belt counties devastated by the drugs. But his policy prescriptions remain vague, and to some observers, contradictory — a grab bag of tactics alternately embraced by the right and the left.
Treatment specialists, anti-heroin advocates and law enforcement professionals are unsure of what to expect from the Trump administration.
“(Trump’s strategy) is both sides of the coin,” said Dan Bigg of the Chicago Recovery Alliance, which does outreach work with people with addictions. “It’s not just (a law and order approach). It says some of the most enlightened stuff, too. I don’t know what to think of it. It’s all over the place.”
Representatives of Trump’s transition team did not respond to requests for comment. In in an October campaign speech in New Hampshire, Trump laid out what he called a plan “to end (the) opioid epidemic in America.”
He started by saying he would stop the flow of drugs into the country by building a wall at the Mexican border. But author Sam Quinones, whose book “Dreamland” chronicles how small-time Mexican drug dealers brought heroin to Middle America, said a draconian crackdown on the already heavily-secured border would likely be ineffective.
“We have walls and they’re still smuggling that stuff in,” he said. “They’re smuggling it in because we have millions of trucks every year crossing back and forth, and heroin is the easiest drug to smuggle. … You can smuggle in a very, very significant amount of heroin in a backpack or a purse.”
He said a more productive approach would be to forge close ties with Mexican law enforcement rather than treat the country as “a wayward child.” Given the antagonism Trump displayed toward Mexico during the campaign, though, Quinones doubts that will happen.
Trump also pledged to fight the opioid crisis by deporting illegal immigrants taking part in the drug trade. Lake County State’s Attorney Michael Nerheim said federal officials have always been cooperative when his office has sought to expel people
His larger concern is getting help for those who fall prey to the drugs.
“My opinion is that the new way we need to deal with this epidemic is not only reducing supply but reducing demand,” he said. “While I certainly support being aggressive with trafficking, I also support being aggressive with getting people into treatment.”
Trump addressed that, too, saying he plans to “dramatically expand access to treatment slots” without providing many details on how that would happen. Some, such as Kathie Kane-Willis, director of the Illinois Consortium on Drug Policy, question his sincerity, pointing to what they call the outdated thinking of some of his appointees.
Jeff Sessions, Trump’s choice for attorney general, has advocated harsher punishment for drug sellers, a step that runs counter to policies pursued by President Obama’s administration. Tom Price, a Georgia congressman who is the nominee to head the U.S. Department of Health and Human Services, opposes the Affordable Care Act and has voted to block funding for needle-exchange programs.
And Vice President-elect Mike Pence, whom Trump credited for being a strong leader on the opioid crisis, has been criticized for being slow to act last year after Indiana was struck by an outbreak of HIV infections tied to drug use.
“If you’re going to say this is a health crisis, then holding up Mike Pence as a hero is probably not the best way (to earn trust),” Kane-Willis said.
Others like some of what they see in Trump’s promises. Sheriff Mike Downey of Kankakee County, where there have been more than two dozen overdose deaths this year, said Trump’s pledge to reduce the amount of prescription painkillers sold in America was overdue.
“I agree wholeheartedly,” Downey said. “I’ve talked to a number of heroin users who’ve ended up in jail who are hardworking people (but) were prescribed painkillers. The addiction to that is what brought them to where they are. I’ve seen it ruin families and relationships and everything else.”
Harold Pollack, the Helen Ross Professor at the University of Chicago’s School of Social Service Administration, approved of Trump’s pledge to lift the cap on the number of patients a doctor can treat with buprenorphine, a habit-forming medication used to curb opioid cravings.
“Right now we have people who are addiction specialists who should be able to prescribe buprenorphine to lots of patients,” Pollack said. “There are lots of ways to monitor the quality of that, but we have a real access problem.”
While Pollack also found plenty to criticize, he said Trump’s thinking appears to reflect the growing bipartisan consensus that drug addiction should be treated with compassion. That trend has given Pamela Rodriguez of Treatment Alternatives for Safe Communities, a Chicago-based nonprofit that helps people in the criminal justice system who have drug problems, confidence that the federal government will pursue humane solutions.
“The opioid epidemic and criminal justice reform are such powerful forces, even in a new administration, that we can look forward with hope for resources for our clients,” she said.