Quick hits: Trump's weird midterm ploy

On Tuesday, exactly one week before midterm elections, I got an email from the HHS press office, giving the Trump administration full credit for the recent decline in overdose deaths—even though it first began in 2023, while Biden was still in office.

The release uses a kind of logic that's become very familiar to me since I began covering the Trump administration's health claims. There are a few real data points, but they're presented in a context that at first glance appears misleading, and at second glance becomes nonsensical.

Much of the release is focused on opioid prescribing policies from Trump's first administration, which is odd because the overdose crisis has primarily been driven by illicit fentanyl ever since Trump first took office in 2017. The release states:

During his first term, President Trump signed the 2018 SUPPORT for Patients and Communities Act, strengthening the federal response through prevention, treatment, and recovery programs. His Administration also pursued a plan to reduce nationwide opioid prescription fills by one-third within three years. In 2018, the Justice Department and DEA proposed lowering 2019 manufacturing quotas for six frequently misused opioids by an average of 10%. Together, these policies led to the first reduction in drug-related deaths in nearly three decades.

The linked report for "three decades" refers to a modest overdose decline in 2018. That year, there were 47,096 opioid-involved overdose deaths, down about 1.6 percent from 47,885 in 2017. But to state that lowering manufacturing quotas in 2019 contributed to the decline in overdoses in 2018 makes no logical sense; perhaps this is why they omit the year the declines actually happened in their statement. The small 2018 decline in opioid-involved deaths was driven primarily by prescription opioids, but fentanyl deaths had already eclipsed prescription opioid deaths by then, and would continue to sore even more with each new opioid prescription quota or restriction. The release tries to claim that 2019 prescribing quotas led to a reduction in 2018 deaths, likely because opioid deaths actually went back up by over six percent in 2019.

In 2020, 69,000 US residents died of opioid overdoses, over 20,000 more than in 2018. Limiting access to prescription opioids, especially without sufficient guardrails, can lead patients to turn to the much more dangerous street supply. In 2020, people lost access to prescription opioids around the same time everyone was losing access to routine medical care due to the pandemic.

The rest of the release repeats familiar talking points, suggesting Trump and his immigration policies are primarily responsible for the continued downward trend in overdoses—that began over a year before he retook the Oval Office. Biden's name does not come up at all in the release, which is typical—presidents don't tend to share credit with their predecessors of different parties. Any sitting president might try to take credit for this continued trajectory of overdose declines. That much is normal. But RFK Jr.'s HHS seems unable to present a claim without somehow twisting the evidence—it feels very 2 + 2 = 5. Nobody made them credit a 2019 policy change for a 2018 overdose decline, but they did it anyway.