Drug overdose deaths in 2016 most likely exceeded 63,000. Most of these deaths (about 42,200) are due to the family of painkillers known as opioids, which includes legally prescribed medications used to treat pain such as oxycodone and hydrocodone. To put into perspective how alarming this number is: approximately 41,000 Americans die annually from breast cancer, more than 43,000 died due to HIV/AIDS during the peak of the epidemic in 1995, and approximately 40,000 Americans died from gun-related injuries during the peak of this issue in 1993.
In October 2017, President Trump declared the opioid crisis a public health emergency. The President’s Commission on Combating Drug Addiction issued its final report a week later with more than 50 recommendations to solve America’s opioid crisis. But public experts say that the Trump administration is failing to act on these recommendations. “You don’t call it an emergency and sit around do nothing about it,” said Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing. “The doing something should be a plan from the agencies … and it should be seeking money from Congress.”
Social scientists and their expertise will be required to solve many of America’s public health issues, including the opioid crisis. To more fully understanding the linkages between our DNA and a person’s predisposition to addiction, to investigating the social externalities that may result in one seeking out opioids, social scientists are needed to research these issues. Social science also is needed to help solve other important public health issues in the US such as the country’s high number of mass shootings and other gun-related deaths, especially those associated with racism. While the Trump administration’s war on science has been well-documented on issues such as climate change, there are now some signals that this administration may ramp up attacks on social science.
Evidence-based treatments targeted
“The therapies that you use have to be evidence-based, otherwise you don’t know if they actually work and you want to do what is best for you clients to help them” Dr. Danya Goodman, a Boston-based psychologist who has worked with veterans with histories of trauma and substance abuse at the Boston VA, told me on the phone when I asked her about the importance of science in her practice. “Psychologists rely on science—to help us determine the difference between practices supported by anecdotes versus data.”
Dr. Goodman also noted that when every minute of your time is being focused on clients, like at a community mental health center, you may not have the time or resources to fully review the peer-reviewed literature to assess what therapies or programs are most effective for treating your clients. This is one of the reasons why the federal government made accessible a database to help these busy practitioners find effective, proven, evidence-based programs that work to both prevent and treat substance abuse and other behavioral health problems. The database is known as the National Registry of Evidence-Based Programs and Practices (NREPP) and is housed by the Substance Abuse and Mental Health Services Administration (SAMHSA) within the department of Health and Human Services. NREPP was established to screen different therapy practices and programs to determine which are effective and which are not effective.
During December, 2017 the Trump administration ended the NREPP contract, which means that the database will no longer be updated, at least for now. SAMHSA has said that future work on NREPP would be moved “in-house,” but many are questioning if the work will truly continue, and the agency has yet to announce a plan on how it will continue updating NREPP. Maybe this is part of the Administration’s push to ban words such as “evidence-based” across federal agencies?
Key social science research on gun violence restricted
Even after the occurrence of another mass shooting at Stoneman Douglas High School in Broward County, Florida, government research on gun violence is still not allowed. Scientists at the Centers for Disease Control and Prevention (CDC) have been banned from studying gun violence since 1996 due to an amendment on a spending bill that prevents the CDC from using money to “advocate or promote gun control.”
Social scientists have suggested that gun violence would decline in the US if we understood more about it. Some social science research priorities were pointed out by a National Academies of Sciences, Engineering, and Medicine report, including: what motivates people to acquire guns? What groups and sub-groups are more at risk of being victimized? Which prevention strategies and interventions work to curb gun violence, and for whom do they work?
There are so many important research questions that demand exploration; yet, our government scientists are barred from studying them even though they have pleaded to do so.
Experts on substance abuse sidelined
White House counselor Kellyanne Conway was chosen to lead the President’s opioids agenda. With President Trump choosing one of his senior advisors to lead the charge on the opioid crisis, some viewed this as the President taking this issue seriously. But Conway seems to be keeping out the government’s own experts from any of the White House’s discussions on the matter. More specifically, the administration is excluding career staffers from the Office of National Drug Control Policy (ONDCP)—the office that has guided drug policy since President Reagan was in office. “It’s fair to say the ONDCP has pretty much been systematically excluded from key decisions about opioids and the strategy moving forward,” said a former Trump administration staffer.
The exclusion of experts at the table may not be a surprise given that the Trump administration has consistently sidelined experts from advisory committees, or that they are expected to target ONDCP for massive budget cuts, or that the senior most official in the administration leading US drug policy for a while was a 24-year-old Trump campaign staffer who had no professional experience in developing or implementing drug policy, let alone leading a federal government agency.
All talk, no action
The Trump administration has been all talk and no action on important public health and social science issues. It is rumored that the Trump administration planned to air a Super Bowl ad to bring attention to the opioid crisis, but this didn’t happen. The administration also has produced a report with many recommendations aimed at ending the opioid crisis, yet has failed to act on them. Many congressional members have offered their thoughts and prayers to victims of mass shootings, but haven’t acted to solve this public health crisis.
I asked Dr. Goodman if the halting of NREPP, the Trump administration’s inaction on the opioid crisis, and preventing social science experts from providing input or doing research may send a message to the social science community that their work is not valued. “I think this administration is attacking all science, and generally has a distaste for truth.” She let out an exasperated sigh before continuing, “These attacks on social science are just another example of that and, unfortunately, they will undermine those people who are less fortunate in the US.”
Posted in: Science and Democracy
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