What Trump’s Presidency Means for Addiction, Recovery and Drug Policy

By Kelly Burch 11/18/16

“How does heroin work with these beautiful lakes and trees?’” Trump asked last year, completely out of touch with the drug epidemic. Has he become more in tune with drug policy since then?

Donald Trump
Since winning the election, his stances have changed—what about drugs?

When Donald Trump came to my hometown in New Hampshire for a campaign rally last year, I couldn’t resist my curiosity, so I went to see him speak. Overall I found Trump uninspiring, but one thing stood out to me: He seemed completely out of touch with the drug epidemic facing so many people in this country. As a journalist who covers addiction and recovery issues, I’ll admit that I’m more tuned into these topics than the average person, but Trump, it seemed, was completely tuned out.

“How does heroin work with these beautiful lakes and trees?” he asked. “More than any place, this state, I’ve never seen anything like it with what’s happening with the drugs, more so than in other places and other places are a disaster.”

Trump’s gold-plated penthouse life has not escaped the effects of addiction. Like many American families, the Trumps have lost someone they love to the disease: Trump’s brother Freddy struggled with alcoholism and died in 1981 at the age of 43. Trump himself does not drink, reportedly because of his brother’s experience.

With the president-elect set to take office on January 20th, I wondered if he had become more informed on addiction and recovery issues, as well as drug policy. Here’s what I found:

The Opiate Epidemic

On the campaign trail, Trump continued to be dumbfounded by how much the heroin epidemic was weighing on voters. His solution? Build a wall.

“We're not gonna let this crap come into our country and poison our youth and poison our people, and it comes in mostly from the southern border,” Trump said in Ohio during an August rally. “I will cut off the source. The source is the southern border.”

The federal government agrees that Mexico is the largest supplier of heroin to the United States market. However, it is unclear how much a border wall might impede the drug cartels' sophisticated drug trafficking networks.

In his plan to address the heroin epidemic, released on October 28, Trump said that he will “fix the misguided rules and regulations that have made this problem worse.” In addition to increasing security on the southern border, he will close loopholes in Postal Service regulations that allow Chinese and other traffickers to ship synthetic heroin directly into the United States, and “aggressively prosecute drug traffickers.” Trump also wants to reduce the number of Schedule II opioids (including oxycodone) that can be manufactured and sold in the United States.

Rehab and Recovery

Although his plan is somewhat vague, it seems that Trump recognizes the importance of encouraging recovery and having access to treatment. Trump says that he will speed approval and increase access to “abuse-deterring drugs,” and encourage more doctors to use medication-assisted treatment, a tool that some people in the recovery community believe has been widely underutilized. Trump also plans to distribute naloxone widely.

The president-elect is in support of the Comprehensive Addiction and Recovery Act (CARA), which was passed in July but has yet to be funded. However, his opiate plan made no mention of funding CARA.

The plan also said that Trump will “expand access to treatment slots and end Medicaid policies that obstruct inpatient treatment.” However, this is potentially at odds with one of Trump’s most prominent campaign promises: to repeal and replace the Affordable Care Act.

“The addict population is absolutely screwed if Obamacare disappears,” said the wife of a man who has just re-entered detox after a relapse. She was concerned that changes to the law would lead to even more delays in getting help at the critical moment when an addict is willing to accept it.

“It’s hard enough to find services. They don’t need to make it worse for these people,” she said. “When they’re ready to go they need it now, not in a week, not in a couple days. Now.”

According to Trump’s website, he will ask for a full repeal of Obamacare on his first day in office. However, that hard-line approach now seems less concrete.

“Either Obamacare will be amended, or repealed and replaced,” Trump told the Wall Street Journal last week. He mentioned that he is in favor of popular sections of the law, like those allowing young adults to stay on their parents’ health insurance through the age of 26, and the prohibition on denying care based on pre-existing conditions.

Overall, it seems that the nation will have to wait to see how Trump will affect insurance laws, and how those changes will affect people seeking treatment for addiction. The Association for Addiction Professionals declined to comment for this article, citing a lack of concrete plans and specific information.


On the same day that Trump won at the polls, marijuana did too. With more than 20 percent of Americans now living in states that have legalized recreational use of the drug, there has been a lot of talk about how Trump will enforce, or perhaps change, the federal ban on pot.

In 1990, Trump told the Sarasota Herald-Tribune that the War on Drugs was a “joke,” and that the only way to win it was to legalize drugs. “You have to take the profit away from these drug czars,” he said. However, his opinions since then seem to have changed drastically.

"In terms of marijuana and legalization, I think that should be a state issue, state-by-state," Trump said during an October 29, 2015 rally in Reno, Nevada.

People on both sides of the issue seem to agree that Trump’s advisors will likely affect his stance on marijuana legalization.

“While Donald Trump himself has been rather noncommittal in regards to challenging state laws, what is more concerning is who is emerging as candidates for cabinet positions,” Erik Altieri, executive director of the National Organization for the Reform of Marijuana Laws (NORML), told The Fix. “An Attorney General Chris Christie or Rudy Giuliani has the potential to be devastating to the marijuana legalization movement, if they are allowed to have their personal predilections drive policy.”

Kevin Sabet, PhD, co-founder of anti-legalization group Smart Approaches to Marijuana, agreed.

"When we see Guiliani and Christie and Sessions around him, I think things could change pretty quickly," he told NBC News. ”Everything is up in the air right now.”

Currently, the federal government does not enforce the federal ban on marijuana in states that have legalized medical or recreational use. Two government mandates govern this: the Hinchey-Rohrabacher medical marijuana amendment and the Department of Justice's Cole Memo, which was drafted by former U.S. Attorney General Eric Holder, who served under President Obama.

Because both items are policies rather than law, it is possible that a Trump administration could overturn them.

"Every state [that has legalized recreational or medical marijuana] has used those guidelines as the North Star on how to write your new state law," Lynne Lyman, the state director of California's Drug Policy Alliance, told NBC News. "So we have no idea ... whether a Trump administration will send in the DEA or FBI to shut down California's marijuana industry.”

Altieri said that people in favor of legalization need to make their voices heard during the Trump administration.

“To ensure we don’t lose ground, the American people will need to continue to be engaged with their state and federal elected officials to make it clear that intervening in these state policies would be unacceptable and politically damaging to anyone who tries,” he said.

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.