Speaking in New Hampshire on Monday, President Donald Trump laid out his long-awaited plan for addressing addiction and overdose deaths in the United States. Among the proposed policies: sentencing drug dealers in some cases to the death penalty.
While this punitive strategy has dominated the headlines, Trump also spoke on Monday about a wide mixture of policies meant to tackle the overdose epidemic from every angle. Some of these ideas have research to support their implementation; others don't. Below, we've created a brief rundown of some of Trump's most interesting ideas, and whether they're expected to work.
1. Death for Drug Dealers
This seems to be one of the president's favorite solutions. To him, it's key. "This is about winning a very, very tough problem and if we don't get very tough on these dealers, it's not going to happen, folks," he said during Monday's speech. (He had earlier clarified "that toughness includes the death penalty.") He also reiterated his belief that countries that punish drug-selling with death don't have problems with drugs.
Would executing drug dealers end addiction in America? Pacific Standard could not immediately pull up studies examining the death sentence's effect on societies' rates of addiction, but we did find a 2012 review of three decades of research on whether the death penalty deters people from committing homicides. That review's disappointing conclusion was that the research "is not informative about whether capital punishment decreases, increases, or has no effect on homicide rates." There were separate studies that found evidence for all three effects, so the question is still up in the air.
Meanwhile, depending on how it's carried out, a crackdown on drug crimes might disproportionately affect low-income and minority Americans. Even though the evidence suggests that white and black Americans sell drugs at about the same rates, black Americans are three to four times more likely than whites to be arrested for drug-related reasons, according to a 2014 review from the National Academies of Sciences.
Trump said the Department of Justice will go for "big pushers," although he didn't specify what that meant during his speech. Politico reports the department will rely on existing law. What's already on the books allows for the federal death penalty in certain limited drug crimes, including "drug kingpin" activity, the department told the Associated Press. It does not allow for executing smaller-scale drug dealers.
2. Scary Ad Campaigns
Another idea the president seems to favor: "unsavory" ads aimed at youth, showing the ill consequences of addiction. The administration plans to spend "a lot of money on great commercials" that will be shown on TV, "or wherever, the Internet," Trump said. "That's the least expensive thing we can do, where we scare them from being like the people in the commercials."
Scare-'em-straight ads have not been shown in research to be particularly effective. Several public-health researchers told Pacific Standard last year that successful anti-drug media campaigns need to make people feel empowered to make changes in their lives, not tell them to just say no.
3. Making Medication-Assisted Treatment and Overdose-Reversing Drugs More Available
Trump did endorse two major solutions that are well supported by public-health research: making medication-assisted treatment for addiction, and naloxone, the opioid overdose-reversing drug, both more available. Trump seemed impressed by naloxone's effects on overdose victims. "I've seen people that are just about dead wake up," he said. Initial research suggests naloxone availability reduces death and serious disability rates among populations.
Meanwhile, Trump brought his secretary for health and human services, Alex Azar, on stage to talk about medication-assisted treatment, during which people with opioid addictions undergo a regimen of therapy and opioid medication that's designed to reduce cravings. Azar endorsed medication-assisted treatment strongly, calling it "evidence-based, science-based, compassionate treatment that can help people recover and stay away from relapse."
Among many addiction doctors, such a statement would be unremarkable, but the Trump administration has struggled with its opinions on medication-assisted treatment before. The previous secretary of health and human services, Tom Price, once called it "substituting one opioid for another"—a view that experts say is inaccurate and stigmatizing.
The administration has not yet offered concrete ideas for how it will work to increase the availability of these two medicines.