To stop the heroin and painkiller crisis killing thousands of Americans, President-elect Donald Trump has promised to build a wall on the Mexican border and provide more treatment to those who need it.
After Trump's shocking electoral upset, people who work in addiction recovery say they want to believe the new president will take the crisis seriously and hope Republicans in Congress who understand the problem will help guide the new administration.
But those advocates nonetheless remain wary of Trump. And for many, his emphasis on the wall as a solution is worrying.
"The leading causes of [overdose] death are from alcohol and prescription drugs," said Greg Williams, cofounder of the nonprofit group Facing Addiction. "A wall is not going to have anything to do with deaths related to those two issues."
Trump's campaign released more details about his plan to tackle the opioid epidemic late in the race. He promised to increase access to naloxone, the overdose medication; to encourage state and local governments to provide more treatment; and to speed up the Food and Drug Administration's approval of abuse-deterrent painkillers.
The president-elect said repeatedly on the campaign trail that he had talked to families ravaged by addiction and pledged to help. Areas in poor health, linked to drug abuse and other health problems, were more likely to support Trump.
"The incoming administration has acknowledged the issue," Dave Zook, who lobbies on behalf of the Collaborative for Effective Prescription Opioid Policies, said in an interview. "Obviously a lot of the impact is in the red areas of the map."
People working in recovery out in those areas are watching the new administration closely.
"I am wanting to see some serious strategies come out quickly," Dr. William Cooke, a primary care doctor in an Indiana town grappling with an HIV epidemic linked to drug abuse, said in an email. "For now, I think we are all waiting to see what happens."
Lobbyists who track addiction policy said they saw clues about Trump's addiction agenda in his promises to prosecute drug traffickers and close shipping loopholes to stop fentanyl and other drugs from being shipped to the United States from China and elsewhere.
They also believe the new president could expand access to drug courts and raise the cap on the number of patients for whom each doctor is permitted to prescribe medication-assisted treatment.
The first priority, though, is getting the Comprehensive Addiction and Recovery Act fully funded in the lame-duck session, advocates say. The law was the most significant federal legislation on addiction treatment in years, but it did not include money for the programs it authorized.
"The epidemic obviously isn't delayed by the transition," Zook said, adding he was focused on "getting that done here in the lame duck so the programs can go into place."
Once CARA is fully enacted and funded, Zook said the group he represents also wants to turn toward preventing addiction in the first place. That would mean changing health plan designs and hospital practices to put more of an emphasis on alternative pain management, without denying treatment to people in need.
There are still worries, however, about some of Trump's other campaign promises. Repealing the Affordable Care Act could eliminate coverage for many Americans in recovery who had previously been uninsured, depending on what Trump and the GOP come up with to replace it.
Williams hoped that federal agencies like the Substance Abuse and Mental Health Services Administration would not see their funding cut, as Republicans sweep into power after pledging to slash federal spending.
Advocates will also be watching to see who Trump appoints to lead the government agencies most connected to the epidemic — the Justice Department, Health and Human Services, the Food and Drug Administration, among them — for clues on how he plans to address it. Williams is concerned about a purge of career staffers who work at those agencies.
"Things like that are unforeseen and could do some damage to our current limited response to this issue," he said.
On the other hand, a unified federal government also opens up the possibility that legislation could move more quickly and frequently than it did during the last six years, when the Obama administration contended with a resistant Congress.
Williams noted that a Republican Congress and President George W. Bush created the Access to Recovery grant program, "one of the largest funding packages that's been done" for addiction recovery.
"I do think the imagination starts to run a little bit about what could be possible," he said.
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