Tough Talk, Few Details in President’s Opioid Plan

MANCHESTER, N.H. — President Donald Trump made his first visit to New Hampshire since the 2016 campaign Monday, unveiling a plan to combat the opioid epidemic that includes a push for the death penalty for drug dealers and a crackdown on unauthorized immigrants.

Trump spoke in a state with the nation’s third-highest rate of deaths from overdoses and where opioids are a potent political issue. In a speech at a community college here, he offered up more tough talk than he did specifics about his plan, or how he would pay for it.

The president said that most of the heroin in the country comes in from the southern border, “where eventually the Democrats will agree with us and build the wall to keep the damn drugs out”; he denounced sanctuary cities, which he blamed for an uptick in overdoses; and he called for harsher penalties for drug dealers.

“If we don’t get tougher on drug dealers, we are wasting our time,” Trump said, later adding, “That toughness includes the death penalty” — a position that was at odds with what White House officials told reporters Sunday.

The president said that he had spoken to leaders of Asian countries “where they don’t play games,” an apparent reference to conversations he has described having with President Xi Jinping of China and President Rodrigo Duterte of the Philippines, who told him that the death penalties in their countries meant there was less of a drug problem.

White House officials would not answer what type of hypothetical case would involve the death penalty, referring questions to the Justice Department.

Trump also urged Congress to lower the threshold to use mandatory minimum sentences on opioid dealers, and said he will look for tougher criminal sentences on traffickers of certain drugs, such as fentanyl. He brought a series of people to the podium, including an ICE agent and parents whose eldest son died of a fentanyl overdose, to tell their stories.

The plan the president described, which was based on recommendations by an opioid commission the president appointed last year, has the goal of reducing the supply of illicit drugs with better interdiction and tougher penalties, reducing opioid prescriptions and overall demand for opioids, and expanding access to treatment and recovery tools like the overdose-reversing drug naloxone.

The plan seeks to cut the number of opioid prescriptions filled by a third within three years, a restriction that will face opposition from critics who argue it could have unintended consequences for people with chronic and even acute pain, and that it instead could force some users to seek more dangerous drugs, like heroin and synthetic fentanyl.

Officials were vague about how the prescriptions would be reduced, saying only that a main goal would be for prescribers for Medicaid, Medicare and other federal health programs to follow guidelines that the Centers for Disease Control and Prevention published two years ago. Those guidelines recommended that doctors first try ibuprofen and aspirin to treat pain, and that opioid treatment for short-term pain last no more than a week.

The plan says little about how addiction treatment would be expanded besides a vague goal of expanding access to “evidence-based addiction treatment” in every state, particularly for members of the military, for veterans and their families and for people leaving jail or prison.

Drug overdoses killed roughly 64,000 people in the United States in 2016, according to initial estimates from the CDC, and have become the leading cause of death for Americans younger than 50.

Trump has declared the opioid crisis a public health emergency and in his budget plan last month proposed spending $10 billion on the epidemic over the next two fiscal years. But he did not put a specific price tag on the plan’s cost. Congress recently allotted $6 billion to address the epidemic over the next two years, which public health experts have described as a good start but not anywhere near enough.

The president also called for repealing the Affordable Care Act, which expanded Medicaid to cover much of the addiction treatment provided around the United States over the past few years.

In his State of the State address last month, Gov. Chris Sununu of New Hampshire, a Republican who was on hand for the president’s speech, called the opioid crisis the state’s “most serious challenge.”

Voters have agreed, with 53 percent saying in a Granite State poll last year that drugs were the biggest problem facing the state — the first time in the poll’s history that a majority labeled a single issue the most important.

Trump’s push for the death penalty for drug traffickers could play well with voters here, as New Hampshire is the only state in New England that still allows capital punishment, though it has not executed anyone since 1939. In statements after Trump’s speech, the state’s two Democratic senators — Jeanne Shaheen and Maggie Hassan — said they generally supported many of Trump’s proposals. Neither senator’s statement directly addressed the president’s call for the death penalty for traffickers, but Hassan’s aides said that in comments earlier in the day, she had opposed the death penalty for traffickers.

“I think it reflects a lack of a broader understanding of the factors in this crisis,” Hassan told Fosters.com, a news site. “We have to go after demand as well as supply, and law enforcement have been the first people to tell us we can’t enforce our way out of this.”

Asked for clarification of her view Monday, Shaheen — who, when she was governor of New Hampshire in 2000, vetoed a bill that would have repealed the state’s death penalty — said through her spokeswoman: “Frankly, whether a drug dealer, after exhausting all of their legal appeals, gets the death penalty 20 years from now has no impact on our immediate crisis.”

She said Trump should be providing more money for police, emergency medical workers and families in need of treatment.

Civil liberties lawyers were highly critical of Trump’s endorsement of the death penalty for traffickers and said it would be unworkable.

“There has never been an execution under the one part of United States law that allows the death penalty as a punishment for traffickers,” said Ames Grawert, a senior counsel at the Brennan Center for Justice in New York. “The Supreme Court has consistently refused to sanction the use of the death penalty in crimes other than homicide.”