The Opioid Epidemic, the Border Wall, and Magical Thinking

President Trump’s confounding approach to drug policy

President Trump knows that the United States is suffering through one of the worst drug epidemics on record. Its breadth was captured well by Christopher Caldwell, who looked back for comparisons. “A heroin scourge in America’s housing projects coincided with a wave of heroin-addicted soldiers brought back from Vietnam, with a cost peaking between 1973 and 1975 at 1.5 overdose deaths per 100,000,” he began by way of context. “The Nixon White House panicked. Curtis Mayfield wrote his ballad ‘Freddie’s Dead.’ The crack epidemic of the mid- to late 1980s was worse, with a death rate reaching almost two per 100,000. George H. W. Bush declared war on drugs. The present opioid epidemic is killing 10.3 people per 100,000, and that is without the fentanyl-impacted statistics from 2016. In some states it is far worse: over thirty per 100,000 in New Hampshire and over forty in West Virginia.”

Roughly 52,000 Americans died of drug overdoses in 2015.

And drugs came up in Trump’s interview with the Associated Press. This is how they came up:

TRUMP: Well, first of all, the wall will cost much less than the numbers I'm seeing. I'm seeing numbers, I mean, this wall is not going to be that expensive.

AP: What do you think the estimate on it would be?

TRUMP: Oh I'm seeing numbers — $24 billion, I think I'll do it for $10 billion or less. That's not a lot of money relative to what we're talking about. If we stop 1 percent of the drugs from coming in — and we'll stop all of it.

But if we stop 1 percent of the drugs because we have the wall — they're coming around in certain areas, but if you have a wall, they can't do it because it's a real wall. That's a tremendously good investment, 1 percent. The drugs pouring through on the southern border are unbelievable. We're becoming a drug culture, there's so much. And most of it's coming from the southern border.

The wall will stop the drugs.

This is a remarkable amount of nonsense to pack into one answer. There are so many layers to it.

1. As this MIT analysis persuasively shows, there is no chance that Trump can build a wall of the sort that he promised his voters for anything close to $10 billion.
2. At one point Trump suggests that the wall—or perhaps the wall plus other measures—will stop all of the drugs entering the United States from Mexico. There is zero chance that Trump will achieve anything close to that and he knows it.
3. That is why, for most of the answer, he makes a much more plausible claim: that his border wall with Mexico will stop 1 percent of drugs coming across the border. I have my doubts about that claim.
4. Trump then strays into the absurd again, arguing that stopping 1 percent of drugs flowing across the border would alone justify a $10 billion price tag. That would, of course, be substantially less than 1 percent of total drugs entering the country, since drugs enter in so many ways besides from Mexico by land. For that minuscule total, which would do virtually nothing to help Americans with drug abuse or addition, Trump thinks $10 billion is a steal.

Meanwhile, elsewhere in Trump administration drug policy, “The top government lawyers from 19 states, including Illinois Attorney General Lisa Madigan, are telling President Donald Trump and the Republican leaders of Congress not to pass health insurance changes that would stop the flow of federal drug treatment money.”

The Associated Press story continues:

The attorneys general’s letter said that a bill that died last month could have eventually cut more than $13 billion a year in treatment funding through a combination of direct cuts and caps on Medicaid. Medicaid changes could have ended coverage for an estimated 24 million people; for many with addictions, the taxpayer funded health insurance program is the only way to pay for treatment. They attorneys general warned any plan like that would be a blow to a country dealing with an epidemic of addiction to opioids including heroin, fentanyl and prescription pain drugs.

Taken together, this is quintessential Trump. He persuaded his credulous base that he really cares about addressing the “drug culture” that has devastated so many communities.

Yet he is so ignorant of policy, or duplicitous, or obsessed with building a wall, or perhaps all three, that $10 billion to stop a fraction of 1 percent of illegal drug imports strikes him as a deal, so long as that sum comes in the form of a wall—even as he joined Republicans in pushing a bill that would cut $13 billion to help addicts get off drugs.

Amid a national catastrophe as serious as the opioid drug crisis, Trump lacks the knowledge and discipline to pursue the sorts of policies that would save more lives or do more good, even when the flaws of his alternative approach are glaringly obvious. The full consequences of his frustrating shortcomings may prove terrible, indeed.