US President Donald Trump laid out his plan to end the opioid epidemic in a speech that focused heavily on punitive measures - including executing some drug dealers.
Trump also pledged to hold pharmaceutical companies accountable for their role in fostering addiction.
In a wide-ranging speech, Trump touched on the need for greater access to treatment, praised companies that are making "lifesaving overdose-reversing drugs" and promised a public-awareness campaign to deter youths from taking drugs.
He also reiterated his call to build a wall on the US-Mexico border, saying it would help keep limit the flow of illicit narcotics, a claim many experts dispute.
But the President was most animated in his advocacy to "get tough" on drug crime, saying it was central to his goal of ending "the scourge of drug addiction in America once and for all."
"If we don't get tough on drug dealers, we are wasting our time, and that toughness includes the death penalty," Trump said. "We have got to get tough. This isn't about nice anymore."
The President's focus on punitive measures alarmed some in the public health community, who fear it will overshadow proposals from the White House and in Congress for prevention and treatment.
The White House is also calling for Congress to reduce the threshold needed to impose mandatory minimum sentences on people who are convicted of dealing fentanyl, a synthetic opioid that can kill people in small quantities and caused the overdose death rate here in New Hampshire to skyrocket.
"A significant emphasis of the President's speech and President's plan was on supply reduction and law enforcement, including enhanced criminal penalties and even the death penalty," said Michael Botticelli, Executive director of the Grayken Centre for Addiction at Boston Medical Centre and the drug tsar under President Barack Obama.
"I think that we have known throughout the recent history of the United States that has not solved our drug problem here in the United States."
Botticelli said a focus should be on strategies that immediately expand access to treatment.
In his remarks at a community college here, Trump said the Administration is "looking very seriously at bringing litigation" against some drug companies. The Justice Department did not comment on what its plans might be on this front.
This month Attorney-General Jeff Sessions, who accompanied Trump to New Hampshire, announced that a new task force would target drug manufacturers for their roles in the opioid epidemic, raising the possibility of filing charges against them.
The department also said it would file a statement of interest in hundreds of lawsuits brought against drug companies by municipalities around the country, with the federal Government seeking repayment for damages.
Trump chose to make his announcement in New Hampshire, which has America's second highest overdose death rate. He was flanked by members of law enforcement and at one point allowed the parents of a man who died of an overdose to speak on stage about their son, who became addicted to opioids after taking a prescription opioid and later died of an overdose.
The Administration is also making a marketing and education campaign part of its strategy to fight opioids; Trump spoke in front of a banner that reads "OPIOIDS: THE CRISIS NEXT DOOR." The President said the administration will be "spending a lot of money on great commercials" to show the dangers of drugs.
"That's the least expensive thing we can do, where you scare them from ending up like the people in the commercials," Trump said. "And we'll make them very bad commercials, we'll make them very unsavoury situations."
But there is concern about how the Administration will pay for its broader plan. Funding for opioid programmes was boosted by US$6 billion in a budget deal passed last month, but many believe that is not enough to make a dent in the crisis, and that any money should be directly allocated to the places that are hardest hit.
"We need resources, not rhetoric," Baltimore Health Commissioner Leana Wen said in a statement. "The President discussed funding today, but where are the resources for local jurisdictions hardest hit? Cities and counties have been fighting the opioid epidemic for years. We know what works, and any delay will cost further lives."
Speaking to reporters on Air Force One, White House counsellor Kellyanne Conway acknowledged the opioid epidemic might get worse before it gets better and that fighting it will require "a lot more money." She said the Administration wants a larger package of US$13 billion.
Conway also said that Trump wants to use existing laws on the death penalty for "very specific high-level cases" involving drug traffickers.
The Trump Administration's policies largely reflect those started under the Obama Administration. Trump's plan includes expanded access to medication assisted treatment, where people are slowly weaned off opioids under a doctor's supervision or given an injection of a medication that blocks opioids from working on the brain.
The Trump Administration is calling for a national prescription drug monitoring database, where prescriptions can be tracked across the country. Each state has its own system and some share data. The Administration also wants to cut opioid prescriptions by one-third nationwide.
"The plan contains some important steps that will increase access to effective, evidence-based treatment, particularly Medication-Assisted Treatment for opioid addiction," said Chuck Ingoglia, senior vice-president, for public policy and practice improvement at the National Council for Behavioural Health, said in a statement.
Before his speech, Trump and his wife, Melania, stopped by the Manchester Central Fire Station, which is part of a "Safe Station" initiative to offer the city's fire houses as safe havens for drug addicts who don't know where else to turn.
Joined by New Hampshire Governor Christopher Sununu and Manchester Mayor Joyce Craig, (D), Trump greeted firefighters and hailed the "safe station" as a national model.
"You save a lot of lives," Trump told the assembled firefighters and officials before accepting a fire helmet from the chief, which Trump termed "the real deal."
Q&A: A LOOK AT TRUMP'S PROPOSAL
WHAT IS THE PLAN?
The push for greater use of the death penalty is just part of a sweeping plan that includes stiffer penalties for drug peddlers as well as expanding access to treatment and recovery efforts. It's in keeping with the Trump Administration's tough-on-crime approach to the opioid abuse epidemic that claimed a record 42,000 people in the US in 2016. Trump, who mused openly that countries like Singapore have fewer issues with addiction because they harshly punish drug dealers, said he wants the Justice Department to seek the "ultimate penalty" when possible.
CAN HE DO THAT?
Maybe. Trump isn't proposing a new law, but is encouraging the Justice Department to enforce existing laws more vigorously. The US drug kingpin law allows federal prosecutors to seek the death penalty in cases when someone is intentionally killed during a drug deal or in furtherance of a drug enterprise. There are other federal laws that could potentially allow death penalty prosecutions of "kingpins" when large amounts of money and drugs are involved, even if there has not been a killing. But no administration, Democratic or Republican, has ever pursued and secured a death sentence under those laws. It's not clear that death sentences for drug dealers, even for those whose product causes multiple deaths, would be constitutional, said Doug Berman, a law professor at Ohio State University. He predicted the issue would be litigated extensively and ultimately settled by the US Supreme Court. "The death penalty is uncertain as a constitutionally permissible punishment without that connection to an intentional killing," Berman said.
HAVE ANY DRUG TRAFFICKERS EVER BEEN SENTENCED TO DEATH?
The Death Penalty Information Centre lists 14 federal death row prisoners awaiting execution for drug-related crimes. They include Azibo Aquart, who was sentenced to death in 2012 for planning and participating in the deaths of a rival and two people living with her. There is also Orlando Hall, who was sentenced in 2007 for a drug-related kidnapping that ended in death. Dustin Honken was sentenced to die in 2004 for the killings of two children in a drug-related conspiracy in which three other people were also killed.
WILL MORE FEDERAL DEATH SENTENCES EASE THE DRUG EPIDEMIC?
Trump believes so, but others are sceptical. Cornell Law School Professor John Blume said enforcement of the kingpin law tends to net poor minorities considered low- to mid-level drug dealers rather than kingpins whose products are fuelling the drug crisis. Opponents said the approach resembles the drug war of the 1970s and '80s, when there was bipartisan agreement in Washington that the best way to fight crime was with long, mandatory prison sentences. That approach is now questioned by some conservatives as well as liberals. "I don't think there's any reason to believe that attempting to revive this policy and use it more effectively will be any more successful," Blume said, adding that death sentences are hard to win. Too few drug traffickers will be sentenced to death and executed to have a real deterrent effect, he said. "I don't think people out there who sell drugs are worried about, am I going to get the death penalty?"
- Sadie Gurman, AP