President Donald Trump has visited West Virginia -- one of the states hit hardest by the opioid crisis -- twice in the last two weeks. Although his presidential commission on opioids urged him Monday to declare the epidemic a public health emergency, Trump has been relatively quiet on the issue.
"You have a big problem in West Virginia, and we are going to solve that problem," Trump said at a rally Thursday night before moving on to rehash the 2016 presidential race.
Trump held the rally in Huntington, West Virginia, where Mayor Stephen Williams estimates one in 10 residents of the city and surrounding county are addicted to opioids. According to the Centers for Disease Control and Prevention, overdose deaths involving prescription opioids have quadrupled since 1999. From 2000 to 2015, more than half a million people died of drug overdoses, the opioid commission reported, and opioids account for the majority of those deaths.
"We have a 9/11-scale loss every three weeks," New Jersey Governor Chris Christie, chair of the President's opioid commission, said Monday. That's 142 American deaths from drug overdoses every day, according to the commission.
But Trump has yet to act on the commission's recommendations. So what has the Trump administration done to address the crisis?
Trump's success in the New Hampshire primary -- which ignited his ascent to the Republican nomination -- was driven, in part, by his forceful promises to tackle the state's escalating opioid epidemic. Just days before New Hampshirites headed to the polls to vote in the nation's first primary, Trump assuaged their concerns in a Facebook video, saying his proposal to build a wall on the US-Mexico border would stem the tide of illegal drugs.
He also promised to try to help those struggling with addiction.
"(T)he people that are in trouble, the people that are addicted, we're going to work with them and try and make them better," he said in the video. "And we will make them better."
Trump won the contest, besting his closest opponent by nearly 20 percentage points, and went on to press the urgency of the opioid crisis during the campaign through the lens of what he learned about in New Hampshire.
A recently leaked transcript of Trump's January phone call with Mexican President Enrique Peña Nieto, which was obtained by The Washington Post, shed light on how the President thinks about the epidemic's role in his political success.
"I won New Hampshire because New Hampshire is a drug-infested den," Trump told the Mexican leader.
Trump laid out his plan to tackle the crisis at a rally in New Hampshire just weeks before the general election. He promised to provide more resources for opioid treatment services, speed up FDA approval for drug treatment and stop the flow of illegal drugs coming into the country by building the proposed border wall and empowering law enforcement officials.
Two months into his presidency, Trump issued an executive order to establish the Presidential Commission on Combating Drug Addiction and the Opioid Crisis, a five-member panel tasked with proposing solutions to the drug epidemic.
"This is a total epidemic, and I think it's probably almost untalked about compared to the severity that we're witnessing," Trump said in late March.
But in his first six months in office, the President has barely mentioned the word "opioid" on Twitter -- a favorite mode of communication -- doing so on the day he signed his executive order, and tweeting mentions of heroin and the drug epidemic at large in relation to border control.
The commission, meanwhile, started out on productive footing. Trump marked the occasion with a "listening session" -- a roundtable with representatives from the Drug Enforcement Agency, Office of National Drug Control Policy, Department of Health and Human Services, and Harvard Medical School, among others -- and gave the commission a late-June deadline for its preliminary status report.
But the commission missed its first deadline, and then its second one in July, spurring 19 Democratic senators to sign a letter last month criticizing the delay. Two weeks later, the commission finally released its interim report.
"Our citizens are dying. We must act boldly to stop it," the commission wrote in the report, unveiled Monday. "The first and most urgent recommendation of this Commission is direct and completely within your control. Declare a national emergency."
An emergency declaration would provide logistical help, funding and public policy initiatives in communities across the country, according to Dr. Guohua Li, a professor of epidemiology and anesthesiology at Columbia University who has been studying the epidemic for over a decade.
Some critics, however, have argued that having the commission study the issue is misguided, wasting time in solving the epidemic; what is needed, they say, is more funding.
Members of the President's opioid commission did not immediately respond to a request for comment. The White House stressed in a statement to CNN that Trump has tasked his administration with prioritizing the opioid crisis.
"The President directed multiple agencies, including the Office of National Drug Control Policy and the Department of Health and Human Services, to prioritize this issue," the statement said. "He created the Commission on Combating Drug Addiction and the Opioid Crisis to ensure our country's response to this horrible epidemic is comprehensive and effective. We appreciate the Commission's hard work on this important interim report. We are reviewing its recommendations, and eagerly await its final report."
But in early May, a draft White House memo provided to CNN outlined a 2018 budget proposal that would have gutted the Office of National Drug Control Policy, which coordinates the federal government's drug control efforts. A few weeks later, the White House backtracked from that plan, instead proposing more modest cuts to the office.
Prosecuting bad actors
The Department of Justice, meanwhile, had been conducting its own investigation into the causes and scope of the crisis. Attorney General Jeff Sessions, joined by Health and Human Services Secretary Tom Price and then-acting FBI Director Andrew McCabe, announced last month that more than 400 people had been charged in health care fraud schemes resulting in $1.3 billion in "false billings" for services, including unnecessary narcotic prescriptions.
Sessions went further on Wednesday when he introduced an Opioid Fraud and Abuse Detection Unit, which assigned 12 federal prosecutors to focus solely on investigating and prosecuting opioid-related health care fraud cases in a dozen locations around the country.
Funding for treatment
The Department of Health and Human Services has provided opioid-related funding, administering grants totaling $485 million to all 50 states in April, $70 million in grants for treatment in May, and about $80 million for drug court treatment services in July.
But as the Trump administration funded state programs to combat the opioid crisis, the President pressured Republican lawmakers to repeal and replace the Affordable Care Act, a move that would have dramatically cut funding for addiction treatment -- a key pressure point for Republican Sens. Shelley Moore Capito of West Virginia and Rob Portman of Ohio, two states hit hard by the epidemic.
With the exception of the Senate's final "skinny" repeal bill, each GOP health care plan would have substantially rolled back the ACA's Medicaid expansion. Medicaid now pays for one-fourth of all substance abuse treatment, up from about one-tenth in 1986.
Trump has yet to propose specific legislation to combat the crisis.