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The opioid crisis is a tussle between David and Goliath of Trump’s White House


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In Malcolm Gladwell’s nonfiction book, “David and Goliath,” he guides us to think beyond David’s courage. While of course that was working, he had something else working for him: veterans have poor eyesight; They can be almost blind.

“Justice is blind.” This expression is meant to state that fair justice is imparted fairly and fairly. It is a value we hold dearly in the United States. But it doesn’t literally mean the kind of blindness that characterizes Goliath. Blind justice turns a blind eye to what is real, fair and useful. What does this tell us about succeeding in ending the opioid epidemic?

The bigger the government, the more likely it is to go blind. Government extends from cities to towns, to counties, to states (and districts and territories), and then to the federal level. As the dimensions of government increase, it may have more trouble seeing the light, or it becomes powerfully refracted and distorted by political and ideological forces.

As citizens, we have recently seen many, overlapping incidents and claims that we should now foresee more about blind veterans living in Washington, D.C., the lives, families and communities exposed to opioids (and others). The consequences are far less optimistic to protect against ) drug dependence.

cartoon on president donald trump

The most bizarre, blind swing on the opioid epidemic came from the president himself. On March 1, 2018, Trump announced at the White House Summit on Opioids that “some countries have a very, very hard penalty — the ultimate punishment. … and, by the way, we have a very low drug problem.” The “ultimate punishment” is of course the death penalty. According to The Economist, 32 countries have the death penalty for drugs (including trafficking) in laws, but only six enforce it: Malaysia, China, Iran, Saudi Arabia, Vietnam and Singapore. Criminals are hanged in these countries. Are these countries the model for the “law and order” we want for our country? And who will get caught in the affair of this capital, should it ever happen? They are mainly people with addictions who are selling their habits to support them, mainly people of color and people living in poverty. But now that trap will reach white, Central-Americans — our family, friends and neighbors — as the opioid epidemic grips the Midwest, South and Northeast states. This is not just or fair justice, as is already evident from the demographics of the prisoners in our prisons, where, by the way, we have the largest (and most expensive) reform system in the world.

Joining the blind and heavy mayhem is our Chief Justice Officer, Attorney General Jeff Sessions. Goliath’s punitive and short-sighted ideas about drunkenness and how to mitigate its destruction are as vast as his judicial wealth. Sessions ordered his attorney general to prosecute the extent of the law and its penalties, federal violations (including street level, and nonviolent crimes) related to drug use and distribution. He wants to “build a wall” (even though the deadliest drugs like fentanyl are coming from China and Russia), and grab headlines with a drug bust.

Sessions also wants to follow drug manufacturers and distributors at the president’s insistence. The precedent for this exists in the lawsuits won against Big Tobacco. States and cities are also pursuing this strategy, building their cases on the consequences (financial and social) of deceptive marketing and the promotion of addictive substances, especially OxyContin. This approach, legal without executing anyone, can actually succeed. But what can we expect if the current administration recaptures settlements instead of smaller governments?

Sessions will likely use the litigation awards to further enhance his enforcement capabilities, a practice he has already demonstrated. More agents, more raids, more federal imprisonment. The attorney general remarked on 27 February that “we will use whatever laws and tools we have to hold people accountable if they break our laws.” When you have a hammer, everything is a nail, so he wants to trouble people with a substance abuse problem. Not to use resources to prevent the development of this medical condition or to provide effective treatment to these people.

A clear view of history shows us that efforts to arrest ourselves from the current opioid (and other drug) epidemic or battles with traffickers would be as futile as prohibition was. Remember the legacy of that misguided, police-promoted “restraint” movement? This gave rise to organized crime of a scale that this country had never had before.

Who are the other White House Goliaths?

Trump has proposed Richard Baum to fill the long-vacant position of director of the Office of National Drug Control Policy. The ONDCP director, known as the country’s “drug czar”, holds a White House position. The final director, Michael Botticelli, was recovering himself from a substance-use disorder and was dealt with as an illness to reduce drug-seeking. But Baum is a law school professor and criminal policy expert who was chosen by the president, we must imagine, to adopt control strategies for drug use, the other side of the demand/control coin.

Then we have the newly appointed Secretary of Health and Human Services. Another (other) attorney and former chief executive of the giant Eli Lilly pharmaceutical company, Alex Azar, brings a perspective and experience with addiction as a chronic, recurring disorder to the condition above HHS. In his decade at Lille, Azar tripled the price of insulin, the drug of abuse and life saver for so many people with diabetes. During his tenure, Lilly was fined for collusion to keep insulin prices high in Mexico. Where is the human vision in this new administration Goliath?

Finally, let’s not overlook Kellyanne Conway, the presidential pardoner who was nominated by Trump months ago to lead a national campaign to reduce opioid use and its deadly consequences. Has he done anything in this direction? Don’t think so – because she knows nothing about public health, and is busy on the airwaves trying to protect the president from his tweets and other incoherent speeches. He too, while looking less, is a big, blind giant.

I was told once that the horizon of change from city-based initiatives is one year, state-based initiatives two to three years, and federal five to 10 years. We have reason to be hopeful that (some) states, cities and counties, the ‘Davids’ of government, approach the opioid crisis using lessons from public health. Think about how public-health methods have beaten epidemics of cholera, polio, and smallpox, reduced tobacco use, and popularized seatbelts to reduce car deaths. Despite the Washington Goliath, municipalities and states may get some land in the next year or two.

But the current federal Goliaths in the White House and other executive offices are not mobilizing the nation’s public health capabilities. Instead, they blindly seek to use their immense legal and police power in ways that will do far more harm than good, while more than 170 people (that we know of) die every day from drug overdoses.



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