The biggest sign of progress showcased by President Donald Trump’s opioid epidemic commission, which released its final report on Wednesday, isn’t a specific recommendation that the group made or a particular sentence or paragraph in the final report.
What’s key is what the commission didn’t focus on: Instead of acting as a document reinvigorating an old war on drugs all about “tough on crime” policies, its final report largely treats the opioid crisis as a public health issue.
Consider the context: The commission was focused on a big drug crisis, established by a Republican administration, and chaired by a Republican governor — a recipe that just a few decades or even years ago would have guaranteed that much of the report would have focused on how to punitively crack down on drugs through the criminal justice system.
Yet only one of 56 recommendations gets close to traditionally “tough on crime”: a proposal to increase penalties for the deadly synthetic opioid fentanyl and its analogs. There are also a few recommendations that ask federal law enforcement to “expressly target” drug trafficking organizations, beef up mail security to detect fentanyl, and continue monitoring of opioid painkiller prescriptions to ensure they don’t fuel the black market for drugs — but none of these explicitly call for greater punishment.
The rest of the commission’s proposals have little to nothing to do with punishment, from a proposed expansion of drug courts — an attempt to make the criminal justice system less punitive by diverting people to treatment instead of jail or prison — to breaking down barriers for addiction treatment. (For all the recommendations, check out the full report.)
I looked for a state that’s taken the opioid epidemic seriously. I found Vermont.
In fact, the commission didn’t seem to approach drug addiction as a criminal justice issue at all. Its report notes, “Addiction is a chronic relapsing disease of the brain which affects multiple aspects of a person’s life.” Many of the commissioners and speakers at commission meetings repeatedly said that addiction is a disease, not a moral failure. They went to great pains to paint people with addiction as victims, not as culprits — with the commission’s final meeting colored by the stories of people dying as a result of their drug addiction.
Compare this to a previous anti-drug document: the Office of National Drug Control Policy’s first strategy blueprint, which was released in 1989 during the crack cocaine epidemic. The first chapter of the “National Priorities” section is titled “The Criminal Justice System.” Although the report does have a chapter on drug treatment, most of it is dedicated to domestic and international law enforcement efforts against drugs.
The 1989 report states, “We should be tough on drugs — much tougher than we are now.” The day of the report’s release, President George H.W. Bush used his first televised address in the Oval Office to warn about the dangers of drugs and blamed, among others, “everyone who uses drugs” for the drug crisis at the time. People with addiction were framed as a primary culprit, not the victim.
The opioid commission’s report, in comparison to the rhetoric of 1989, is a total 180.
The commission represents a step forward, even if it’s not perfect
This is a move in the right direction: The research shows that tougher punishment has little to no effect on drug use. As Jon Caulkins, a drug policy expert at Carnegie Mellon University, previously told me, “It presumably has some effect. But you have to squint to see it.” Meanwhile, the criminalization of drug use has led to stigmatization that can make it very difficult to get help for addiction.
That’s not to say the opioid commission’s recommendations are perfect. For one, the report did not propose a big new investment into addiction treatment programs — which many experts and advocates say is necessary. It also neglected innovative evidence-based policies to mitigate the harms of opioid use, such as needle exchanges, supervised injection sites, and prescription heroin.
Baltimore City Health Commissioner Leana Wen, a major advocate on the opioid crisis, summed up much of the expert and activist reaction to the report in her statement: “While the final report issued today by the President’s Commission on Combating Drug Addiction and the Opioid Crisis addresses critical aspects of the fight against the nation’s opioid epidemic, it does not go nearly far enough.”
I also don’t want to overplay the report’s significance. It is an open question whether Trump and his administration will adopt any of the report’s proposals. After all, Jeff “Just Say No” Sessions is still attorney general, and he recently asked prosecutors to impose tougher sentences on even low-level drug offenders. And Trump himself seems to follow the same playbook as Sessions, previously calling himself “tough on crime” and praising Vice President Mike Pence for increasing prison penalties for drugs as governor of Indiana.
But progress doesn’t have to be perfect to be good. That’s what the Trump opioid commission’s report represents: a step forward, even if there’s still a long way to go.