Trump Channels Nancy Reagan in Drug Speech

Donald and Melania Trump gave speeches today on the Opioid crisis. I watched and listened to it. You can read the transcript here. The White House Press Release is here. Donald Trump sounded just like Nancy Reagan and her "Just Say No" campaign. He's going to create an advertising campaign to tell kids how bad drugs are and not to use them.

He's going to fund law enforcement programs. (Anyone remember "DARE"? These programs don't work.

He's going to limit prescriptions to 7 days supply. One unnamed opioid will be removed from the approved drug list and become illegal.

He said this will take years if not decades (I guess so he can't be blamed when there's no huge reduction of overdose deaths during his term.)

He talked about his brother Fred, who told him over and over, don't drink, don't smoke and he listened. That's his plan for kids, just tell them don't do it. [More...]

Then there was Melania, looking like she just came from the hair salon, still wearing her cape.

She told the stories of three or four people who lost loved ones to drugs. Trump gave her kisses at the end.

Back to Donald: Of course, he tied opioid use to the need for the border wall.

He discussed everything but the few things that might make a difference: Decriminalization and Legalization.

From the Drug Policy Alliance:

“In the face of a devastating overdose crisis, President Donald Trump today made clear his strategy: to stick his head in the sand and point the finger at immigrants. While a couple of his proposals might help mitigate overdose, his speech today revealed a profound and reckless disregard for the realities about drugs and drug use in the United States.

Trump seemed to be saying that prevention boils down to ads encouraging young people to "just say no" to drugs, ignoring the utter failure of that strategy when the Reagan administration started it in the 1980s. He made a big deal about completely taking a certain opioid off the market, even though the opioids involved in overdoses are mostly coming from the illicit market.

He blamed immigrants for bringing drugs across the border, ignoring that immigrants are overwhelmingly more law-abiding than U.S. citizens, and that the illicit drug trade has always found ways to get around the walls and barriers the U.S. has put up to block it.

He held up drug courts as a solution, ignoring all the evidence showing they do more harm than good. And he continued talking about criminal justice answers to a public health problem, even though the war on drugs is itself a major factor contributing to the overdose crisis.

Trump had a chance to do something meaningful to help stem the tide of overdose deaths in the country, including by pushing for greater access to naloxone and adopting other health-based recommendations from his own opioid commission. Instead, he is condemning even more people to death, imprisonment, and deportation in the name of his war on drugs.”

Also from the Drug Policy Alliance:

One idea gaining traction: Supervised consumption facilities. From The Nation:

From Seattle and Philadelphia to Baltimore, San Francisco, and Ithaca, New York, a cohort of cities across the country are embracing the idea of supervised-consumption facilities, as they are sometimes called, to combat the opioid epidemic. Already widely used in Europe and Canada, these facilities provide places where drug users can consume narcotics in the presence of doctors and nurses and social workers trained in addiction treatment, disease prevention, and overdose mitigation.

If they take root in the United States, they will provide a potent new tool in reducing addiction’s most harmful effects and fighting the overdose crisis that is currently the leading cause of death for Americans under 50. In 2016, overdoses killed approximately 64,000 people in this country—and the number is expected to keep rising in 2017, notwithstanding Donald Trump’s announcement that the opioid crisis is a public-health emergency.

The War Against Drugs have failed time and time again. Yet we keep throwing money at it and its holy global warriors, the DEA. It's time to abolish the DEA.

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    Limiting prescriptions to a 7-day supply (5.00 / 1) (#3)
    by Anne on Fri Oct 27, 2017 at 10:28:09 AM EST
    is one of those ideas that may not translate well to reality, and will have additional consequences.

    Aside from the reality of cancer patients, the elderly and those whose conditions are such that they cannot or should not be driving being subjected to the additional stress of the fear of running out of their medication, it's going to end up costing more money, as providers have to re-authorize prescriptions on a weekly basis - there will be more forms and procedures and it's just going to drive costs up.

    Anyone who's had an injury or surgery can tell you that rarely does pain relief and management start with non-opioid medication.  When my mother had her hip replaced, they loaded her up with morphine in recovery and continued to give it to her when she got back to her room.  She, like me, does not respond well to opiates: they tend to nauseate us and give us pounding headaches.  I finally had to convince my mother that since she said the pain from the surgery was less than the pain she had before the replacement, she could refuse the morphine and ask the nurses to give her Tylenol.

    When I had a c-section with my second child, my nurse brought another nurse in to show her the patient who didn't want morphine for the post-surgical pain.  I'd finally managed to convince the nurse to let me start with extra-strength Tylenol, and if it wasn't enough, I'd consider something stronger.

    When I dislocated and broke my shoulder in 2005, the ER doc and the nurse kept trying to get me to take something strong for the pain - but I'd been given Dilaudid 5 years earlier when I injured the other shoulder, and Fentanyl for conscious sedation, and I hated the way they made me feel - yes, I had pain, but it wasn't so bad that I couldn't deal with it.  In the 2005 incident, I finally agreed to let them give me some Valium so they'd stop pestering me to take the opiates.

    So, it seems to me that the medical profession needs education and training on pain relief and management, and should stop reflexively prescribing drugs in quantities and strength out of proportion to the anticipated duration of the need for opiate-based pain relief.  

    I believe that studies have shown that most acute pain is short-lived and probably doesn't require more than a week's worth of medication - but those who have chronic, and debilitating, pain need less restrictive protocols to accommodate their particular situations.

    Who knew addiction and pain relief could be so complicated?

    not sure (none / 0) (#4)
    by CaptHowdy on Fri Oct 27, 2017 at 10:47:23 AM EST
    if i have discussed this here before but if i have, im old.  its what we do.

    i have deep and extensive experience with this "opioid thing".
    my sister was an opioid addict before it was cool.  fo decades there would be grim conversations between me, my two broters and the husband about what to do to stop it.
    it happens that my sister was struck by a very serious (unrelated) health crisis.  she came very very close to death.  but one of the results of that months long ordeal was that she got off the opioids by being either comatosed or raving for long enough, about 3 months, to detox.
    i have viced to some of my friends here how nice and strange it was to have my sister back even tho her short memory was gone.
    so there is that.
    thee current problem is my sisters daughter.  as deeply lost in the opioid crisis as anyone.   she has been addicted for years beginning years ago when my sister was very sick for the first time.
    today she is a ruined sole.  she never leaves the house.  she is rushed to the emergency room at least once a month for either an over or in some cases UNDER dose of whatever.  at least i finally got them to admit there was a problem when her totally in denial husband walked in on her crushing and snorting hydros.
    this is a very complicated situation.  do not tell me there are other solutions.  my head will explode.  finding solutions is easy. its implimenting them.
    and please no sympathy replies.  not looking for sympathy and i know how everyone here i care about will feel when reading this.

    the POINT is that i understand this.

    Trumps performnce yesterday was like a knife in the heart.  

    oddly i thought it was smart to open with the furst lady because she has for more credibility when it comes to empathy not to mention a better knowkedge of the subject.  which considering she is a former beauty queen make me want to vomit.


    Those of us who have seen addiction in (none / 0) (#6)
    by Anne on Fri Oct 27, 2017 at 11:59:09 AM EST
    our families probably had the same reaction to Trump, who, as per usual, thinks solving the problem is as simple as "just say no."

    It's maddening.

    And it is complicated.  For all the studies and what-not, I'm not sure the so-called experts still understand why under seemingly identical circumstances, one person will develop an addiction and another won't.

    My brother, for example, was clean for years, until he had a pretty bad motorcycle accident that broke bones, required surgery and a lot of physical therapy.  He knew that going on the pain meds was risky, but he did it anyway - I mean, he did have significant pain over many months - and it wasn't long before he was going through his prescriptions well before he should have needed them refilled.  Soon after, he was buying them on the street, went through a lot of his family's savings, and landed in rehab.  It didn't matter that the docs wouldn't write him the prescriptions often enough - he could get all the drugs he wanted on the street.

    For someone like my brother - and I know there are others just like him - I'm not sure legally available drugs would be a solution.  In fact, he originally started out with an alcohol addiction, quit drinking, but wouldn't you know it, the drugs could give him the same feeling (the one I happen to hate) - he could medicate away his psychic pain and never deal with the real reasons he was doing it.

    I guess we have to decide if we are going to expand the acceptable and legal uses for opiates from strictly medical/surgical, to recreational, and how that would work.  If that would work.

    Treat addicts, don't just throw them in jail.  

    But whatever problems these drugs are creating, they are not going to be solved with words - not even if they are the "best words" coming out of Trump's mouth, or wherever it is they emanate from.


    people react differently (none / 0) (#5)
    by Jeralyn on Fri Oct 27, 2017 at 11:07:35 AM EST
    I have never had a problem with getting the same drugs you mentioned administered I-V during surgery or in a pain pump after or in pill form for recovery. Some significant surgeries require months of use. I never had a problem switching to Tylenol and then nothing at the right time. Without adequate pain meds during aftercare, I might skip a needed procedure. Pain, in my opinion, is the enemy, not pain pills.

    This should be a matter between us and our doctors and surgeons, not between us and the Government. I think they should keep their laws off our bodies.


    It's never been a problem for me, but (none / 0) (#7)
    by Anne on Fri Oct 27, 2017 at 12:05:57 PM EST
    with my brother - he told his doctors and his surgeon that he was a recovering addict, but I don't believe they explored with him other ways to deal with his pain.

    He didn't want to start that cycle all over again, but he just didn't have the control to limit his intake or stop them when they weren't needed.

    I think he convinced himself he had ongoing pain in order to get the drugs - and who was anyone to say he didn't?  When you mangle your leg and ankle, have multiple surgeries, and months of PT, who isn't going to believe you have genuine pain?

    But if he'd had unfettered access, he would either have eventually OD'd, or made the drugs the purpose for his existence - not exactly something that lends itself to being a good husband and father, or a good employee.


    this is a common path im sure (none / 0) (#11)
    by CaptHowdy on Fri Oct 27, 2017 at 03:24:39 PM EST
    the one in my family is i think equally common.  that is the path of total and complete denial.   addiction occurring in a family of rigid religious zelots who would no sooner accept that any one of them could be an addict than they would be a satan worshiper.  
    these people do not see it as addiction.   that seems unbelievable but it is.  to this day, after catching his drowsey wife crushing and snorting hydros my nieces husband would never EVER admit she is an addict.
    which when it comes to treatment, which can only be done with his consent,  is as you might imagine a real problem.
    ive tried to tell him his wife is young.  mid 40s.  she could still have a life.
    i might as well be trying to convince him evolution or global warming is real.

    so for many the "simple" questions of how best to treat addictions are not even the point.

    i have no answers. i only know what i heard yesterday was nothing even close.


    There are already reports of dying folks (none / 0) (#8)
    by jondee on Fri Oct 27, 2017 at 12:14:16 PM EST
    in hospice care who are having trouble getting pain medication..

    Are there really people out there who care whether someone who's terminal might possibly "abuse" opioids? Really?


    Morphine, the prototype (5.00 / 1) (#9)
    by KeysDan on Fri Oct 27, 2017 at 02:07:06 PM EST
    of opiods, alter the way the brain perceives pain and..as a side effect, affects areas of the brain that control emotions (i.e., euphoria, a sense of well-being.)  Morphine (and its derivatives) is a miracle drug in its capabilities to relieve severe acute and chronic pain due to such conditions as myocardial infarction, surgeries, kidney stones, and injuries.  

    As a few minutes of TV watching will instruct, the uses of the prescription drug take half of the commercial, the other half, the side effects..from nausea or, death.  But, when used right, risks can be avoided or minimized.

    In the case of morphine (opiods) the scare tactics and dire consequences of medical use outshine the benefits...to the extent that hospice care givers,and, in some cases, the patients, themselves, deny the comfort afforded in pain management, for fear of becoming "addicted."  Morphine does have among its risks dependence and addiction, but some medical, if not common, sense needs to be deployed in use and the avoidance of misuse.

    The risks of addiction in the treatment of acute pain are in balance with their value and short term need; and, risks in chronic pain, should be balanced with the patient, cause of pain and life prognosis.  Moreover, a distinction needs to be made between dependence (state of body) and addiction (state of mind).  Chronic pain patients may be more likely to be dependent than addicted. All potent drugs are double edged swords.

    The opiod problem, whatever its individualized provenance, is one of abuse...abuse that brings along the side effect of the properties of CNS depression, physical dependence and the compulsion of addiction.

    As everyone knows, including Trump from the first hand knowledge of losing his own brother, addiction brings morbidity and mortality.  And, much else along the way, affecting the addict, friends and family.  Accordingly, his warmed over and antiquated program is part of his larger picture of making America great again, as it was in years past.

     "Its really, really easy not to take them." Trump says about opiods.  "His idea" he says, further, is to say no to taking drugs. In fairness, education is a part of it all, but just a part and a small part at that when you understand the impact of the environment for addiction and that the drive to getting high matches or exceeds, the moments of being high. And, of course, drug education is not helpful to those already addicted.

    Trump goes for the tried and untrue, he needs some creativity, science and experience.  Decriminalization, physical therapy and medical marijuana in the management of pain; comprehensive treatment plans for addicts. It was reassuring, however, that he will immediately ban the "truly evil" drug "Opana," the drug the FDA banned last summer.

    In what way is Opana more "evil" (none / 0) (#10)
    by jondee on Fri Oct 27, 2017 at 02:30:20 PM EST
    than Fentanyl?

    Which one is reponsible for more overdose deaths?


    Or, even, (none / 0) (#13)
    by KeysDan on Fri Oct 27, 2017 at 04:10:51 PM EST
    more so:  "truly evil."  The FDA's reason on Opana was risk/benefit ratio, with pain management benefits unquestioned, but the risks related to misuse and abuse unacceptable.

     Evil and truly evil bring in the idea of immorality into the evaluation.  Maybe, this was Pence whispering in Trump's ear. first explaining the concept and then an application...Opana was the drug associated with the HIV outbreak in Southern Indiana.

    It was not so much the drug itself but its formulation that took it from snorting to injection; the sharing of needles that led to the outbreak. (Pence very reluctantly, because of God, agreed to an effective needle exchange program.)  

    From my point of view, the basic problem was the unnecessary time release formulation of Opana.  Morphine derivatives/analogs, such as Opana, in medical use should be managed on the basis of pain need, rather than attempting a sustained blood level.

    Fentanyl is, for sure, a big and dangerous contributor to the opiod overdose problem (apparently involved in the death of Prince), with its potency in the range of 100 times that of morphine. The drug is lipophilic, dissolving readily in fat and, therefore,  more easily penetrating the central nervous system.  From a misuse/abuse perspective, all opiods are a chose your poison.


    i agree!! (none / 0) (#1)
    by linea on Thu Oct 26, 2017 at 07:59:26 PM EST
    seattle has been very progressive on this issue.
    • seattle has nurse-supervised safe drug-injection sites with clean syringes and other supplies.
    • seattle police are required to carry naloxone and the bicycle patrols, active downtown and in my neighborhood, frequently use it to save people living on the street from overdose.
    • pharmacies have been issued naloxone kits as have social service workers who deal with addicts.
    • state law prohibits prosecution of people for drug possession when the are seeking medical assistance and that includes anyone assisting that person or when they have called 911.
    • the administration of naloxone is covered under the state good-samaritan laws.
    there is more that can be done but all solutions need to address this as a public health issue not a law enforcement problem. for example, one major cause of opiod overdose are people court-ordered to attend one-month abstinence rehab/detox programs who relapse and use too high a dose. it must be mandated that rehab and detox programs explain the dangers of tolarance-reduction and these abstinence-only programs must be replaced with (publically financed) methadone-maintenance programs.

    He's going to limit prescriptions to 7 days supply.
    i am opposed to this. the elderly and people suffering from chronic pain already have a difficult time receiving adequite medication and already have difficulty going to medical appointments. it seems particularely onerous given that `the opioids involved in overdoses are mostly coming from the illicit market'.

    Some good points linea. (5.00 / 1) (#2)
    by fishcamp on Fri Oct 27, 2017 at 09:43:27 AM EST
    The Methadone situation needs to be restructured since the sickening effects of heroin are usually ended after three days, but not the desire to continue.

     As you know Methadone is also highly addictive and even with the taper down method used everywhere, addicts usually stay with the low level for years since they are now addicted to Methadone.  We now have other drugs available for addicts when they finish their course with Methadone, which IMO should be part of the program.


    Many years ago (none / 0) (#12)
    by NYShooter on Fri Oct 27, 2017 at 03:39:58 PM EST
    My father and I were watching a TV program that featured an interview with a, "recovering" heroin addict. After a few minutes of listening to the woman, and, her efforts at kicking her habit, Pop turned to me and said, "if she succeeds in getting off heroin she'll switch and become addicted to chocolate milk." He went on to explain that many drug addicts have "addictive personalities," and, that focusing just on the drugs will, generally, lead to failure. (Oh, my dad was a psychiatrist, specializing in the worst of the worst: psychosis, schizophrenia, addiction, and, returning POW'S)

    Drug addiction has two components: The feeling the drug induces, and, the ritual of the drug experience/phenomenon. Fixing the first without addressing the second will often lead to ultimate failure. The reason for so much recidivism among addicts having gone through rehab is that they tend to concentrate on only cleansing the body from the drug. The "hole" that's left in the psyche must be addressed if true success is to be achieved.

    Now, fixing that psychological "hole" can take many forms. Accepting that it exists is step #1. One way of dealing with it is through psychoanalysis with a trained therapist. The drawback with that, however, is that it can take many years to be successful. The more expedient remedy is to replace one addiction (drugs) with another. And, that can take many, many forms: religion, exercise, sports, any activity that will fill that "hole."

    Finally, let's not poo poo the, "just say no," approach, out of hand. It may not be the complete solution, but, if offered smartly, it could be useful for many young folks considering these things. Look at how advertising, "Madison Avenue," has affected youngsters, and, gotten them "addicted" to cosmetics, clothes, entertainment, websites, cell phones, etc. Rather than using a "scolding" approach, why not try suggesting the many things they had hoped to achieve in life, and, which would be unattainable, if they go down the drug addiction road. It worked with me. As a teenager and young adult I had done the usual stuff: MJ, uppers/downers, even mescaline. But, when my father explained to me all about his research on LSD, and, the flashbacks they could produce, that did it for me. I was training for my pilot's license at the time and the last thing I needed, when attempting a night time instrument approach into JFK airport was a flashback. My joy of flying exceeded the fun/thrill of dropping acid.

    Thank you, I'm done.

    "Just Say No" (none / 0) (#14)
    by KD on Sun Oct 29, 2017 at 12:03:03 AM EST
    Trump's approach is all about money. He doesn't want to spend any, and "Just Say No" is the next best thing to free. Declaring a national emergency opens up FEMA money. If the government spends money, it blows a bigger hole in the deficit, which risks support for the tax cuts. Trump doesn't care about actually solving problems. He's all about making a big show while actually doing nothing.