ATLANTA — Build the wall. Cut taxes. Repeal Obamacare. End opioid abuse.
Of all these top priorities for President Donald Trump, it's addressing the opioid crisis that's gotten the least attention and the most bipartisan support. But Trump on Wednesday provided an update of sorts, including progress in creating and bolstering several federal initiatives to combat the crisis.
There were a record-breaking 70,237 drug overdose deaths in 2017 and opioids were involved in 67.8% of them, according to the US Centers for Disease Control and Prevention. But these deaths may be on the decline. Complete data has yet to be released, but provisional data from the CDC show an overall 3.2% decline in overdose deaths from September 2017 through September 2018.
Some in the Trump administration have called the initial numbers a victory stemming from White House-led efforts to combat the crisis, such as the creation of a commission to provide recommendations to the federal government, the declaration of a national public health emergency and the signing of a sweeping opioids package into law.
Trump highlighted his administration's efforts in a speech at the Rx Drug Abuse and Heroin Summit in Atlanta on Wednesday.
He promoted his administration's border security efforts as part of the solution to the crisis and praised China's recent decision to schedule fentanyl. Trump also claimed that opioid prescriptions have gone by more than a third since he took office.
"Already during my time in office, we have reduced the total number of opioids prescribed by 34%. That's a pretty amazing number," he said.
However, a large reason opioid prescribing has dropped is because the CDC issued opioid prescribing guidelines in early 2016, which resulted both in doctors prescribing fewer opioids as well as insurers providing less coverage for opioids.
And while opioid prescriptions have dropped during Trump's term, fentanyl-related overdose deaths continued to rise, according to CDC data.
Counselor to the President Kellyanne Conway touted the decline in overdose deaths on a call with reporters last month to commemorate the one-year anniversary of the White House launching an initiative to stop opioid abuse and reduce drug demand. She also called a slow-down in growth in overdose deaths, which still accounted for the highest level of overdose deaths in the country, as its own type of victory.
"In President Trump's first year in office, overdose deaths grew by 10%, having grown by 22% the year before. So the rate of death increased at a rate less than half of what had increased just the year before," Conway said.
She also hailed opioid prescribing levels falling over 25% in the first year of the Trump administration's safer prescribing initiative.
As part of ongoing efforts outside the West Wing, the first lady and the White House Office of National Drug Control Policy have continued public awareness efforts at the White House related to the opioid crisis -- with the first lady making the opioids issue a pillar of her "Be Best" initiative and ONDCP facilitating a youth ad campaign to prevent opioid abuse. Both Melania Trump and ONDCP Director Jim Carroll addressed the summit on Wednesday.
The drug control policy office released the Trump administration's first drug control strategy earlier this year -- meant to streamline the administration's priorities on combating drug abuse and addiction prevention. The strategy, much thinner than those published under the Obama administration and panned by the House Oversight Committee for not meeting its legal requirements, focused mostly on combating the opioid crisis.
Agencies, meanwhile, are simultaneously providing more federal assistance those facing addiction and continuing to prosecute individuals involved in opioid-related crimes.
Last week, the Department of Health and Human Services announced that the National Institutes of Health had selected four research sites for its HEALing Communities Study in states hardest hit by the opioid crisis. The goal of the multi-year, $350 million study, HHS said in a statement, is " to reduce overdose deaths by 40% over three years in selected communities by testing a set of proven prevention and treatment interventions, such as distribution of naloxone to reverse overdose and linking individuals in the criminal justice system with treatment for opioid addiction."
And at the Justice Department, Attorney General Bill Barr plans to move forward from delivering the Mueller report to Congress by focusing on matters he deems more pressing, including the opioid crisis, a source close to Barr told CNN.
While the full extent of Barr's efforts has yet to be revealed, he's signaled that he's interested in continuing efforts to seek federal prosecution against drug offenders and has touted the expansion of medicated assisted treatment made available through the First Step Act.
Most recently, the Drug Enforcement Administration has been pushing Congress to permanently ban all forms of illegally trafficked fentanyl. An emergency scheduling of the drug is set to expire in early 2020. Typically, Congress leaves scheduling processes to federal agencies or to the Justice Department to initiate a review process. The DEA claims these processes aren't designed to address an entire class of drugs, such as all of the fentanyl analogs in the illicit drug market. But critics say that granting DEA's wish of scheduling of an entire class may undermine other agencies', such as HHS', input in the schedule-making process.
Experts say the slight one-year decline, which Trump will likely bring up in his Atlanta speech, doesn't constitute a concrete trend yet.
And one point of concern for many public health advocates is continued access to addiction treatment provided through the Affordable Care Act, which Trump wants to strike down.
Regina LaBelle, a former chief of staff and senior policy adviser at ONDCP during the Obama administration, told CNN that though prescribing rates are going down, the White House should also be emphasize that individuals struggling with addiction still need access to medication-assisted treatment and some still need treatment to address their chronic pain.
"I'm a little concerned with hearing about, how, (they're) kind of patting themselves on the back for decreasing opioid prescribing rates," LaBelle, now at the O'Neill Institute for National and Global Health Law at Georgetown University, said. "It's too soon to declare victory. And we haven't seen two years of decreasing overdose rates so there's no trend yet."
During his speech in Atlanta, the President bolstered his administration's border security efforts, including a southern border wall, as a great deterrent to drug smuggling -- attempting to connect the issue to opioids.
Trump said Customs and Border Protection seizures of meth and cocaine and heroin and fentanyl at the southern border are up 45% in the last two years.
"They're going up much higher. We are seizing it all over. You probably saw the numbers today. We are detaining, capturing, call it anything you want, more people than ever before," Trump said.
"A lot of it is drugs and drugs are being gotten by us. We are stopping the drug flow as much as we can. Soon we're going to have a wall that's very powerful ... it will have a tremendous impact on drugs coming into our country," the President added.
But experts in the drug policy space say border security isn't an integral part to combating the opioid overdose epidemic.
"The way that Trump has approached this, his single-minded approach to drug policy ... is building a wall," Michael Collins, the director of National Affairs at the Drug Policy Alliance, a nonprofit aimed reducing drug harms, said. "There's nobody in the drug policy field or public health field or the border security field who'll say that building a wall will reduce overdose deaths. Nobody. You won't find a single person who'll say that."