The backstory of Trump's foundering opioid fight

Trump on opioids

In his State of the Union address on Tuesday, President Trump ticked off the startling, oft-repeated statistics about the opioid epidemic, which is now the largest public health crisis in modern American history.

"In 2016, we lost 64,000 Americans to drug overdoses. 174 deaths per day. Seven per hour," Mr. Trump said soberly, reading from his teleprompter during his second address to Congress.

The answers, according to the president's speech: tightened immigration laws that will slow drug trafficking and getting "much tougher on drug dealers and pushers if we are going to succeed in stopping this scourge."

But the rhetoric omitted any mention of the actual solutions proposed by experts on the front lines of the crisis. The president has repeatedly called the opioid epidemic a top priority for his administration. But as members of Congress donned purple ribbons meant to call attention to the crisis, Mr. Trump avoided calling for more federal money to fight back against the prescription drug scourge.

Since October, the White House has dithered on asking Congress for funding to combat the epidemic.

In the 97 days since the president declared the crisis a public health emergency, White House Press Secretary Sarah Sanders has been unable to specify how much money the White House would request for funding. She has also not said when they would be submitting a funding request to Congress.

FDA takes aim at Imodium abuse

After Mr. Trump declared the crisis a public health emergency in October -- a declaration that came with a laundry list of action items that have yet to be executed -- he has done little to bolster the paltry $57,000 available in the public health emergency fund. The president dedicated his third quarter salary of roughly $100,000 to the Department of Health and Human Services (HHS) to combat the crisis. But that's pocket change compared to the what the Council of Economic Advisers projected as the cost of the epidemic in 2015 alone: $504 billion dollars.

The decision to formally declare a public health emergency fund was a fraught one within the White House, according to sources familiar with the decision making process.

Two days before Mr. Trump announced in August that he would be issuing the emergency declaration, then-HHS Secretary Tom Price told reporters that the president wouldn't declare the crisis as an emergency, arguing that the resources needed to fight the epidemic would be available without a declaration.

Price and HHS continued to privately maintain that position. Along with Mr. Trump's Domestic Policy Council, they argued that the administration should quietly withdraw the president's public, off the cuff promise. Price, along with domestic policy aide Katy Talento, believed that the declaration provided the administration with no new powers and would ultimately embarrass the president, two sources told CBS News.

HHS Spokesperson Matt Lloyd denied that Price had misgivings and told CBS News that Price always supported the declaration. A White House spokesperson declined to comment.

But the White House's Opioid and Drug Abuse Commission chair Chris Christie, who publicly advocated for a declaration after the commission released their final report recommending one, vehemently argued in favor of the measure.

David Marella, who served as an adviser to Christie on the opioid commission, sat in the Office of National Drug Control Policy for six months as the opioid commission crafted their report on the federal response to the crisis. Marella, who has since returned to his previous job as an associate at a law firm in New Jersey, also advocated on Christie's behalf for an emergency declaration. A source familiar with the process said that Christie was eager for a public win on the topic in the form of an emergency declaration, which is now floundering.

"The emergency declaration has accomplished little because there's no funding behind it," Opioid Commission member and former congressman Patrick Kennedy told CNN last week. "You can't expect to stem the tide of a public health crisis that is claiming over 64,000 lives per year without putting your money where your mouth is."

Prior to Mr. Trump's address to Congress, one administration source was hopeful that the president would use the State of the Union to make a request for funding. But the president did not call for new funding with his speech, while still claiming that the administration is dedicated to "helping get treatment for those in need."

"While I appreciate that the president spoke about the importance of stepping up efforts to combat the crisis, he once again failed to lead in calling for more federal resources to strengthen treatment, prevention, recovery, and law enforcement efforts," Sen. Maggie Hassan, D-New Hampshire, said in a statement responding to Mr. Trump's State of the Union on Wednesday. "Struggling families and communities don't need words, they need real help."

The administration has acted on some recommendations from the Opioid Commission's final report. The Department of Justice and the Drug Enforcement Agency has continued to crack down on pharmacies and prescribers of opioids to reduce the number of prescription drugs available to Americans.

Most recently, Mr. Trump signed the INTERDICT Act, which provides border and customs agents with new screening technology to detect fentanyl being trafficked into the U.S. Republicans and Democrats gathered in the Oval Office for Mr. Trump's signing, where he engaged senators on the topic.

"This is an important bill," Sen. Sherrod Brown, D-Ohio, told the president. "The next step is that we actually provide dollars to communities so we can scale up treatment. We woefully under fund education, prevention, and treatment programs. The waiting lists are too long."

Drug companies turn to lobbying amid state opioid lawsuits

Administration sources have been complimentary of Trump adviser Kellyanne Conway, who is leading the White House's "opioid cabinet" and acting as the liaison between the Opioid Commission and the Office of National Drug Control Policy.

"She's the president's most trusted advisor with walk-in rights to the Oval who can convene and bring in the experts from the outside and inside on a moment's notice, which she has been doing," a source who has worked with Conway on the issue told CBS News.

But the Office of National Drug Control Policy (ONDCP) has been under siege in the Trump administration. The Office of Management and Budget has proposed to strip ONDCP of their grant-making authority and gut the office's funding. There still is no nominee for the so-called Drug Czar. And a 24-year-old with no previous experience in the field, Taylor Weyeneth, was recently the second in command as the office's Deputy Chief of Staff.

Experts have urged the administration to alleviate the crisis with fast-acting fixes, like negotiating lower prices for Naloxone, the drug that reverses opioid overdoses, and to make it more widely available. It's also a measure that Senate Democrats have called for.

"Internationally, Naloxone is available for less than a dollar and that is the kind of price that we should be demanding, because the product is generic, cheap to make, and we need it to really make a difference," said Leo Beletsky, a law and health sciences professor at Northeastern University.

"Obviously in the U.S. you're paying $70 dollars for a two-dose pack," he said. "You could be saving three times as many people at the very least. You could be saving 10 people for the price of one. These are real numbers and real lives."

A representative from kaléo, the company that makes the Naxolone product EVZIO, said that "representatives from kaléo have met with multiple government agencies, at the federal and state levels, including HHS, to discuss strategies to help combat the national opioid overdose crisis." The price of EVZIO skyrocketed in 2015 from $690 to $4,500.

Westward Pharmaceutical also told CBS News that they are "committed to working with" the Trump administration but did not elaborate on whether they've had conversations with HHS since the emergency declaration.

An HHS spokesperson did not respond to CBS News' inquiries on the matter.

But three other manufacturers of Nalaxone say that they have yet to hear from HHS: Amphastar, Adapt Pharma and Hospira. Some of these manufacturers already offer discount programs for their product, but said they are open to working with the government on the crisis.

"We anticipated we would hear something, especially after the president's commission put out their interim report but we haven't heard anything on any of the recommendations, interim and final," said Thom Duddy, the communications director for Adapt Pharma, the maker of NARCAN. "We are in the middle of an epidemic. We have to have conversations."

Mr. Trump has sought to highlight his public commitment to the fight while his administration struggles to solve it in private. To call attention to the epidemic on Tuesday, Mr. Trump invited the family of 27-year-old Ryan Holet, an Albuquerque police officer who adopted a baby from a homeless, heroin addicted woman, to sit in First Lady Melania Trump's box as their guests.

"Last year, Ryan was on duty when he saw a pregnant, homeless woman preparing to inject heroin," Mr. Trump said. "When Ryan told her she was going to harm her unborn child, she began to weep. She told him she did not know where to turn, but badly wanted a safe home for her baby."

The audience applauded as Mr. Trump recounted the tale. But missing from his story was an obvious detail: The fate of the drug-addicted mother.