Analysis Law and Policy

As De Facto Drug Czar, Jeff Sessions Could Do the Opioid Crisis More Harm Than Good, Critics Say

Sofia Resnick

Advocates say that criminalization of women is not the way to address the increasing rate of opioid dependence in adults—as well as exposure in newborns.

The enemies in Attorney General Jeff Sessions’ renewed War on Drugs all appear to be cut from more or less the same criminal cloth.

“We know drugs and crime go hand-in-hand,” Sessions said last week during a speech at the Drug Enforcement Administration 360 Heroin & Opioid Response Summit, held in Charleston, West Virginia. “Drug trafficking is an inherently violent business. If you want to collect a drug debt, you can’t, and don’t, file a lawsuit in court. You collect it by the barrel of a gun.”

Rarely, though, does Sessions give details about whom he thinks the victims of these apparent enemies are, unless those victims happen to be babies—specifically, babies born exposed to opioids.

“These totally innocent infants scream inconsolably and suffer from tremors, vomiting, and seizures,” Sessions said at the summit. It was standard War on Drugs rhetoric that first argued a generation of “crack babies” would be irreparably harmed by parental drug use; though such an epidemic didn’t happen, Sessions is one of many politicians who have refashioned this narrative for the opioid crisis.

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Sessions dropped this point about the screaming babies in the middle of a speech centered on fighting the U.S. opioid epidemic from a primarily criminal-justice angle, one day before announcing he would be resurrecting controversial mandatory-minimum sentencing for all drug offenders.

“Many people say, ‘We can’t arrest our way out of this problem,'” Sessions said. “But no one denies we need good prevention and treatment programs. What we must recognize is that strong law enforcement efforts are also essential. Criminal enforcement is crucial to stopping the violent transnational cartels that smuggle drugs across our borders, and the thugs and gangs who bring this poison into our communities.”

Sessions’ drug-war-mongering rhetoric concerns health experts and drug-policy advocates, particularly at a time when the White House has signaled plans to gut the Office of National Drug Control Policy (ONDCP). The George H.W. Bush administration created the office in 1988 as part of the Anti-Drug Abuse Act, to set the tone for how to deal with national drug-related crime, trafficking, and health issues. These issues include the increasing rate of opioid dependence in adults—as well as exposure in newborns. Advocates say that criminalization of women is not the way to prevent such cases.

The New York Times reported in February that ONDCP was likely headed for the chopping block in the next year’s White House budget proposal. Earlier this month, a leaked memo from the Office of Management and Budget (OMB) surfaced, indicating the White House intends to gut ONDCP by about 94 percent, reducing its 2018 budget from approximately $388 million to $24 million. The leaked document stated that some of ONDCP’s grant programs are “duplicative” of other federal efforts. To date, the office is awaiting a new director; acting director Richard Baum is running the office in the interim.

Without a fully operational office steering the national conversation on how to treat and prevent opioid dependence generally, drug policy experts worry Jeff Sessions will be the de facto “drug czar,” the term generally used to describe the head of ONDCP.

“If you don’t have a real drug czar, then the default drug czar is Jeff Sessions, and that’s not a great scenario,” said Daniel Raymond, the policy director of the Harm Reduction Coalition, a New York-based nonprofit that advocates for policy and public health reform around drug abuse. “He’s a real throwback to the tough-on-crime, war-on-drugs approach that really hasn’t gotten us where we need to be.”

OMB did not respond to Rewire‘s questions about the future of the drug office. But OMB spokesperson John Czwartacki told the New York Times earlier this month that the federal 2018 budget proposal is still under review. Both Republican and Democratic senators have pushed back on the administration’s proposal to basically defund ONDCP.

The drug office has faced pushback over the years, especially for the two programs the White House has proposed cutting: the High Intensity Drug Trafficking Areas and the Drug-Free Communities Support Program. Critics say these programs relied on over-incarceration and failed abstinence campaigns, particularly during the George W. Bush administration, but also under President Barack Obama.

But advocates like Raymond say ONDCP serves a unique role. Although the Trump administration has launched an opioid commission—which critics say is redundant—once that commission has wrapped, there will be no other federal entity looking strategically at drug policy, including and beyond opioid overdose, Raymond said.

Regina LaBelle, who was the chief of staff at ONDCP until January, told Rewire she’s particularly worried that if ONDCP is nearly defunded or scrapped entirely, the effort to address an increasingly prevalent health issue among babies, known as neonatal abstinence syndrome (NAS), is going to fall through the cracks.

NAS describes the cluster of symptoms experienced by some babies who are exposed to opiates in utero. The symptoms, according to the Centers for Disease Control and Prevention, can range from discomfort and diarrhea to seizures and slow weight gain. According to the U.S. National Library of Medicine, typically, babies who are treated often lose these symptoms within weeks or months of birth.

There is very limited data on the long-term effects of NAS, though that is something that scientists working with ONDCP are trying to study, LaBelle said.

Despite this lack of research, during his speech last week, Sessions said, “Even when the heroic efforts of doctors and nurses successfully shepherd these babies through withdrawal, they remain at risk for developmental and health problems throughout the rest of their lives.”

In some cases, exposed babies’ mothers have taken illicit drugs like heroin or prescription opioids during their pregnancies. In others, they have taken doctor-prescribed-and-monitored methadone to wean off addictive narcotics. In others still, they have taken opioids prescribed and monitored throughout the pregnancy by a doctor.

LaBelle said her office began looking into NAS a few years ago when a staff member doing research in the field started noticing this growing trend throughout the country, but especially in rural areas seeing increased opioid use. LaBelle believes ONDCP helped raise the visibility of NAS.

“We brought experts together on this issue so they could start talking about how to address [neonatal abstinence syndrome] from a science-based way,” LaBelle said. “Without ONDCP, that really would not have happened. Because I know that, in a larger organization, like  [U.S. Department of Health and Human Services] that have so many issues before them, it’s easier for things to kind of fall through the cracks.”

Dr. Stephen W. Patrick, a neonatologist at Vanderbilt University in Nashville, Tennessee,  has been working with ONDCP for several years now, assisting its policy efforts with NAS. His research has found that between 2000 and 2009, the incidence of NAS among newborns increased from 1.2 per 1000 hospital births per year to 3.4 per 1000 hospital births per year nationwide. But rural areas are seeing disproportionately higher rates, such as in West Virginia, which in 2013 saw a rate of 33 infants with NAS per 1,000 hospital births, according to some of Patrick’s research.

“I worry what effect such a large budget cut—essentially taking away a lot of what ONDCP does—means for pregnant women and infants that are impacted by the opioid epidemic,” Patrick said, noting that the rates of NAS and of opioid-related deaths in general only seem to be increasing.

Patrick told Rewire that he has been working with ONDCP, helping to share new data with various federal agencies to coordinate on a treatment-focused approach to dealing with NAS, in a way that tries to prioritize the health and welfare of both pregnant women and babies and does not promote criminalization.

In recent years, however, states have already begun applying the criminal-justice approach to NAS, in some cases using existing chemical-endangerment laws to make it a felony to use certain drugs during pregnancy, even if those drugs were prescribed by a doctor. In 2014, for example, the state of Tennessee passed a controversial, temporary law allowing the state to charge women with assault if their babies were born “addicted to or harmed by” drugs.

When asked about the law at the time, former ONDCP head Michael Botticelli said in a public statement, according to the Tennessean, “Under the Obama administration, we’ve really tried to reframe drug policy not as a crime but as a public health-related issue, and that our response on the national level is that we not criminalize addiction. We want to make sure our response and our national strategy is based on the fact that addiction is a disease.” After public outcry and criticism from the medical community, the law expired in 2016.

In response to some of these state criminalization efforts, the American Academy of Pediatrics published a policy statement last year, co-authored by Patrick, asserting that incarcerating pregnant women who are using drugs “has no proven benefits for maternal or infant health and may lead to avoidance of prenatal care and a decreased willingness to engage in substance use disorder treatment programs. A public health response, rather than a punitive approach to the opioid epidemic and substance use during pregnancy, is critical.” Other states are following this recommendation: After an investigation by ProPublica and AL.com, Alabama passed a new law last year preventing the state from charging women and new mothers with chemical endangerment for taking legally prescribed medications while pregnant.

With the anticipated budget cuts to her old office, LaBelle worries about the future of this issue and others. She said she is concerned that without a fully operational ONDCP, the federal government will “go back to siloed efforts, without health policy informing our criminal justice efforts.”

“We need to recognize that someone who is a low-level non-violent offender probably won’t be served well by ending up in the criminal-justice system,” LaBelle said.

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