Trump May Defund Drug Control Agency During Opioid Crisis

May 10, 2017

A federal drug control agency that the Trump administration may essentially defund played a big role in bringing together some 150 clinicians in Newton, New Jersey, last month to learn more about prescribing much abused opioid painkillers.

Gathered in a conference center on the campus of the Newton Medical Center, attendees of a Do No Harm symposium listened to experts discuss nonopioid therapies for managing pain. They reviewed a new state law that limits an initial dose of opioid painkillers to 5 days. And they learned how addiction to prescription opioids can morph into a heroin habit.

The Do No Harm symposium, like the 20 or so that have proceeded it in New Jersey, was funded in part by the Office of National Drug Control Policy (ONDCP), created by the Anti-Drug Abuse Act in 1988 during the Reagan administration. Angelo Valente, executive director of the Partnership for a Drug-Free New Jersey, a cosponsor of the symposia series, said federal support has played an important role in making this educational experience possible. More than 3500 clinicians have attended it since 2014.

"If the money wasn't available, we'd have to seek it from other sources," Valente told Medscape Medical News. "We would hope there'd be a continued effort to provide this opportunity to prescribers."

Such worries have multiplied in Valente's field of drug-abuse prevention since the surfacing last week of a White House budget document that proposed cutting ONDCP's line from $380 million in fiscal 2017 to $24 million in fiscal 2018, a 94% decrease. The reason? "To reflect a smaller, more streamlined organization that can more effectively address drug control issues," states the budget document, first obtained by Politico.

Most of the savings would come from eliminating two ONDCP programs that make up the lion's share of the office's work. The first, the High Intensity Drug Trafficking Areas (HIDTA) program, budgeted for $250 million in 2017, assists law enforcement agencies, federal to municipal, in curbing the manufacture and sale of illegal drugs. An HIDTA for New Jersey and New York together with Valente's organization and the Drug Enforcement Administration created the Do No Harm symposia series.

The other program slated for extinction is Drug-Free Communities (DFC) Support Program. DFC funds local coalitions of schools, businesses, parents, young people, religious organizations, law enforcement agencies, and other community groups that attempt to prevent youth substance abuse. In 2017, the DFC program was allocated $95 million.

The White House budget document said that these two programs duplicate drug control efforts in other federal agencies, such as the Department of Health and Human Services (HHS) and the Department of Justice (DOJ). In addition, DFC and HIDTA "supplant state and local responsibilities."

What may be going on is a governmental turf war. In 2006, the George W. Bush administration proposed placing the HIDTA program under DOJ control. The Washington Post reported at the time that many lawmakers opposed the move because they feared the program's mission would become less of a priority. The HIDTA program stayed put where it was.

Website for Agency Blanked Out

The proposed budget cut to the federal drug control agency quickly kicked up bipartisan criticism that President Donald Trump was retreating from his earlier promises to step up the war against opioid abuse.

Sen. Rob Portman (R-Ohio) and Rep. Sander Levin (D-Mich), coauthors of legislation that created the DFC program, wrote the White House last weekend that "amidst the most severe opioid epidemic in decades, it is reckless and senseless to eliminate an effective, evidence-based, community-oriented drug prevention program." They cited research showing that the use of alcohol, tobacco, and prescription drugs among young people decreases in communities where DFS-funded coalitions operate.

In turn, White House officials such as HHS Secretary Tom Price, MD, said that no budget numbers have been set in stone.

More reassurances came yesterday from New Jersey Governor Chris Christie, who heads a new presidential opioid commission. "I have good reason to believe that's not going to happen," Christie told ABC's Good Morning America about the plan to reduce the ONDCP's budget by 94%. "I think there will be funding, and that funding will take different forms as well."

In a less reassuring sign, the website for the ONDNP, once abounding in documents and links, now is stripped down to a single message: "Check back soon for more information."

One expert on substance abuse fears the worst.

Corey Waller, MD, a Distinguished Fellow of the American Society of Addiction Medicine, believes that by almost wiping out the ONDCP budget, the Trump administration is attempting to shift the cost of drug control to state and local governments — hence the White House's reference to the DFC and HIDTA programs supplanting "state and local responsibilities." And lower levels of government are in no financial shape to make up the difference.

"No one will pick up the slack," Dr Waller told Medscape Medical News, "at a time when...overdoses are the number one cause of injury-related deaths in the country."

He disagrees with the White House that the DFC and HIDTA duplicate other federal efforts to curb drug abuse. "They're misunderstanding the specifics of what's being done at those other agencies," said Dr Waller, the senior medical director for education and policy at the National Center for Complex Health and Social Needs in Camden, New Jersey.

Medscape Medical News asked the White House for examples of duplicative programs as well as what it meant by the DFC and HIDTA programs supplanting state and local responsibilities. A White House spokesperson did not provide answers but said, "It would be premature for us to comment — or anyone to report — on any aspect of this ever-changing, internal discussion before the publication of the (budget) document."

Back at the Partnership for a Drug-Free New Jersey, Angelo Valente is gearing up for the next Do No Harm symposium on opioid prescribing, set for June 12.

"We have an epidemic," said Valente, "and some people were introduced to this innocently through the prescription pad."

Follow Robert Lowes on Twitter @LowesRobert


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: