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'Tough-guy' approach to opioid abuse unhelpful, regional experts say

President Donald Trump's proposal to impose the death penalty on certain drug dealers as part of a strategy to fight the opioid crisis drew no support from local and state experts contacted on Monday. "I think it is a typical inflammatory tough-g...

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OxyContin, in 80 mg pills, in a 2013 file image. (Liz O. Baylen/Los Angeles Times/TNS)

President Donald Trump's proposal to impose the death penalty on certain drug dealers as part of a strategy to fight the opioid crisis drew no support from local and state experts contacted on Monday.

"I think it is a typical inflammatory tough-guy remark, and really is an overreach," said Carol Falkowski, director of the St. Paul-based Drug Abuse Dialogues. "It's always a tricky business if you look at a harsh criminal justice response to what is really a public health crisis."

Executing drug dealers wouldn't get to the heart of the problem, agreed Gary Olson, CEO of the Center for Drug and Alcohol Treatment in Duluth.

"I don't think that has any meaningful effect," Olson said. "It's just something that is kind of satisfying as a revenge thing, I suppose."

But the experts contacted for this story also found things to like in the ideas Trump unveiled during a speech on Monday in New Hampshire.

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Falkowski said she's encouraged by the administration's support of medication-assisted treatment - drugs such as methadone and suboxone to treat substance abuse disorders.

"The thing about the opioid crisis is there is a gold standard of treatment for opioid addiction, and that is medication-assisted treatment, but it still is not widely used," she said. "And we need to change that situation so that more people can have treatment success."

Trump's proposal includes ideas about spending the $6 billion recently appropriated by Congress to fight the opioid epidemic. Maggie Kazel, director of the Rural AIDS Action Network in Duluth, said that amount of funding is "a great, amazing start."

But it needs to be targeted to those who are most at risk and least responsive to current treatments, such as people of color, women with children and "anybody who is not 42, white and male," she said.

"If they provide the right support for those folks, which means help providing housing, help dealing with child care, then we'll see something happen," Kazel said.

Olson said Trump's proposal to reduce the number of prescriptions written for opioids might not address the underlying problems.

"I think we're already doing a much better job of changing the prescribing practices," he said. "But that doesn't do anything to deal with the millions and millions and millions of people who are currently on long-term opioids for chronic pain. And what we're seeing is doctors, based on the perception that they are drug dealers, cutting people off without appropriate planning or understanding of how to manage withdrawal."

He said he'd like to see a federal requirement that doctors who prescribe opioids also become certified to prescribe medication for treatment.

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Stateline reported in 2016 that although more than 900,000 U.S. physicians could write prescriptions for painkillers, fewer than 32,000 were licensed to prescribe drugs such as suboxone to patients who had developed a dependence on opioids.

"I think doctors who have been prescribing opioids for a long time to any patient have a moral, ethical responsibility to get help for that patient, not just get rid of them," Olson said. "If you're going to prescribe opioids, you also ought to be able to prescribe medication that would help people get off opioids."

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