Donald Trump hasn’t talked about the opioid epidemic much recently. So when he used the peerless pulpit of the Oval Office to discuss it on Tuesday night, it could have been an opportunity to rally the public and to provide meaningful solutions.
His words framed the urgency of the situation, which for many Americans may have been out of sight in the past few months. “Our southern border is a pipeline for vast quantities of illegal drugs, including meth, heroin, cocaine, and fentanyl,” he said. “Every week, 300 of our citizens are killed by heroin alone, 90 percent of which floods across from our southern border. More Americans will die from drugs this year than were killed in the entire Vietnam War.”
The president isn’t wrong about the yearly death toll. Opioids like heroin and fentanyl killed more than 70,000 people in 2017, higher than the more than 50,000 Americans who died in Vietnam. If the 2018 and 2019 numbers are similar, the total number of Americans killed by opioids since 2014 will rival the number killed in World War II. The Centers for Disease Control and Prevention recently confirmed that opioid deaths have become such a burden, they’ve reduced the overall American life expectancy.
But Trump presented the same fix for the crisis as for every other problem in his speech: the border wall that he’d gone on TV to pitch. The epidemic, in that way, was only a convenient means to an end, fuel for an argument the president has been making for years. The wall is the only proposal that Trump has genuinely fought to enact as president, but it’s the one that will almost surely do the least to halt the epidemic.
The Trump administration has already admitted as much. A 2018 assessment from the Drug Enforcement Administration noted that most of the heroin flowing into the country comes through “legal ports of entry, followed by tractor-trailers, where the heroin is co-mingled with legal goods.” Only a “small percentage” comes through areas of the border between ports of entry—the places a border wall could theoretically cover. When it comes to fentanyl, the other major driver of the opioid epidemic, the DEA says it’s not certain that Mexico is the main front, though large quantities of the drug are seized at the border. Fentanyl can be ordered through the mail from China, and it is typically much purer, and thus more potent and deadly, than Mexican-sourced fentanyl.
The DEA’s conclusions make sense: Opioids are a big business. Their production is industrialized and sophisticated. Sending ad hoc groups over the border with fentanyl and heroin, in the no-man’s-land between ports of entry, is likely not efficient enough to meet intense American demand. No wall could help stop the flow, in other words, no matter how well it’s funded and no matter what it’s made with.
The White House knows that. Yet, as on Tuesday, the occasions when Trump has mentioned the opioid crisis have usually been connected to the wall. In a major anti-opioid campaign announced last year, he falsely blamed undocumented immigration and so-called sanctuary cities for sparking the epidemic. Even in October 2017, when the president declared a national public-health emergency to confront opioids head on, the wall was part of his argument. Though he proposed measures championed by the public-health community—such as tightening prescription guidelines and qualifications, and helping states with substance-abuse programs—his standard bluster on the wall and immigration followed quickly behind. “For too long, dangerous criminal cartels have been allowed to infiltrate and spread throughout our nation,” Trump said during that declaration. “An astonishing 90 percent comes from across the border, [for] which we are building a wall which will help in this problem.”
According to federal reports, even Trump’s public-health emergency hasn’t amounted to much. A Government Accountability Office audit of the response found that the Department of Health and Human Services activated just three of the 14 authorities made available by the declaration. While those three measures have accelerated substance-use treatment and research and have promoted medication-assisted treatment—all items recommended by a federal opioids commission—they amount to minor bureaucratic tinkering in the face of a titanic problem. In all, between White House initiatives and Republican-passed legislation over the past few years, the federal response to opioids has acted mostly on the margins. The most recent moves have involved legislation to make it more difficult to ship fentanyl by mail. But there is no massive mobilization.
Facing the biggest drug crisis any American president has ever faced, Trump has not publicly fought for that mobilization. He has gone to the mat on the issue of the border wall, grinding the gears of government to a halt for what might be the longest shutdown ever in hopes of receiving $5 billion for the wall’s construction. This is the president’s big idea, the one he is clearly willing to expend political capital on to force Congress’s hand. It’s a fight that he might yet win. But it’s also one that he likely knows—as his own administration has made plain—will not save many lives from overdoses.