Remarks in a Meeting on Opioids

The President. Thank you very much. And I think what we do—this is a meeting on opioid and the tremendous effect that's taken place over the last little period of time. And I'm very proud of it and the people working so hard on it.

But I thought what I'd do is ask Secretary Wilkie to give a statement as to what just happened with respect to choice and the VA, because I think it's a very, very big deal.

Robert.

Secretary of Veterans Affairs Robert L. Wilkie, Jr. Thank you, sir. June 6th was a doubly important day. You were celebrating the 75th anniversary of the Normandy landings. And for VA, we began to implement the Mission Act, which you signed last year.

On that day, 44,000 veterans came to us to ask for greater choice in their healthcare on day one. And we began to open up that aperture and provide them, for the first time, with urgent care across the country. So they now have what their fellow citizens have had for many years.

And we expect them to take greater advantage of it as we go along. We've contacted over 9 million veterans to tell them this is now available to them. And it is one of the great transformative steps in the history of our department.

The President. That's fantastic. It's choice.

Secretary Wilkie. And it's off to a very good—very good start.

The President. VA Choice.

Secretary Wilkie. Yes, sir.

The President. So, for 44 years, they've been trying to get it, and we got it. And they're loving it, I hear.

Secretary Wilkie. Yes. Yes, sir. With that many on the first day, that's a testament to——

The President. That's a tremendous testament.

Secretary Wilkie. Yes, sir.

The President. Congratulations.

Secretary Wilkie. Thank you, sir.

The President. Come here. I'm proud of you. That's a fantastic job.

Secretary Wilkie. Thank you, sir. Thank you very much.

The President. I'm proud of you. Thank you very much.

Kellyanne.

Counselor to the President Kellyanne Conway. Mr. President, thank you. The focus that the First Lady and you have placed on the opioid and drug demand, drug supply crisis roiling our Nation is starting to produce positive results. We are all aware of the harrowing statistics—the tens of thousands of lives lost every year, and other lives ruined. But today we wanted to present to you—through members of your Cabinet and your administration, sir—a progress report.

And I have some graphs here for you to look at as well. I will tell you that, since you declared the public health emergency and since you have introduced the three-pronged approach to focus on prevention education, treatment and recovery, and law enforcement and interdiction, all three of those areas have produced very positive results.

There's a lot of work to be done. Battleships like this turn very slowly. We didn't get here overnight and we won't get out of it overnight. But it really does show how the whole-of-government approach, focusing on treatment and recovery of the whole person, is bearing fruit.

Mr. President, in your opioid announcement in Manchester, in March of 2018, where the First Lady and you talked about your vision and what to do in the opioid crisis, you called for a one-third reduction, over the next 3 years, in first-time prescriptions. I'm happy to report that you achieved that number in the first year alone. And that is owing in large part to enhanced awareness and education by both the prescribers and the consumers.

People—there are just fewer people using these opioids now. Your take-back days that are led by Administrator Dhillon have produced 4.7 million pounds of pills in the 5 takeback days—the last Saturdays in April and October. This is 4.7 million pounds of pills. Had you said 4.7 million pills, that would be impressive—but pounds of tiny pills that are just in the supply that people aren't using. They're unused. They're unnecessary. They're expired. That's enough to fill up 20 Boeing 757s with pills. So that's out of the supply chain.

One-point-two billion lethal doses of fentanyl were interdicted by our Department of Homeland Security—that includes ICE and CBP, of course—in last fiscal year alone. I'd like to say to you, Mrs. Trump and Mr. President, that is at the points of entry—the 26 points of entry—but that's also between the points of entry. And we don't always hear that. This is just what we know about. We don't know how much we're missing. But that is literally saving lives. It was enough fentanyl to kill every American three-plus times over.

In addition, the big ad campaign that you've asked your administration to put forward, we've had 1.4 billion views of all of the advertising and marketing materials. About 58 percent of our target market—young people—the halo effect of 15-to-30-year-olds—have seen these. And I'm happy to report that the long-form ad that we had out won the Emmy this year for the long-form ad. And that's pretty exciting.

The President. I heard that.

Counselor Conway. More overdose-reversing naloxone. Your Surgeon General put out the first Surgeon General's advisory in 13 years last year, and it was about making naloxone—Narcan—more available to we, the people, and allowing us to feel comfortable to administer that either through a mist or a simple injection for those around us. This is literally saving lives.

And then, of course, Secretary Wilkie will expound upon this, but you have 117—roughly 118,000 fewer veterans being prescribed opioids. I think what the VA and you have done, Mr. President, is make clear that pain management need not mean pain medication. There are other alternatives to try first.

There's a lot of progress. I'd like to invite different members of the administration to weigh in. But before I do, I would just like to say that probably the most remarkable bipartisan piece of legislation that you signed in your time as President was H.R. 6. This is the single largest piece of legislation ever signed, in the history of our country, on a drug crisis at one time. It ended up being a compilation of 50 different pieces of legislation. Usually, when you add them together, you lose support. And we actually gained support. Every single Democrat voted for H.R. 6, including all the ones running for President.

The President. That's great.

Counselor Conway. And I think they see the need in their own communities. It's an overwhelming bipartisan piece of legislation.

[At this point, Counselor Conway continued her remarks, concluding as follows.]

There is much more to report, but I'd like to begin with our Director, Jim Carroll, of ONDCP, to give you a report. We were just briefed on our success in China with fentanyl.

The President. Good, Jim.

Counselor Conway. And he's been traveling around the world. Jim?

The President. Great job. Thank you, Kellyanne.

Office of National Drug Control Policy Director James W. Carroll, Jr. Good afternoon, both of you. As you'll recall, you did—the work at the G--20 last year led to China scheduling fentanyl for the first time ever. The early reports are they've taken this seriously and they're beginning to implement the enforcement actions that we need to see. I've now rescheduled the trip to China, and I will be going at the end of the summer.

The—what's important to note is that we really do have a whole-of-government approach on this. For the first time ever, we have a government that is united against this. We have 200 Americans dying a day. I've implemented your vision, as Kellyanne spoke, of the three-pronged approach. And it's beginning to pay off. You're going to hear from the other members of the administration today about the successes domestically, but also it's key to note, internationally, we are setting the bar for going after this.

The President. Have you noticed a change in China since the trade negotiations broke off? A change with regard to the fentanyl?

Director Carroll. Absolutely. What we're seeing is they're now at the table. They want to talk to us. They're engaged. We are actually——

The President. You mean it got better?

Counselor Conway. It actually did, on fentanyl.

The President. I was thinking maybe it would get worse. This is why——

Director Carroll. Yes, on fentanyl it did.

Counselor Conway. Yes.

The President. This is why they're great negotiators, right? They went the opposite. Most people would say, "Oh"—right? Isn't that something? That's very nice.

Director Carroll. It went from nonexistent to them at the table.

The President. Tell them I appreciate it very much. That's very nice.

Director Carroll. I will.

Counselor Conway. You'll see them at the G-20.

Director Carroll. I will.

The President. That's very nice. Yes. Director Carroll. So we're beginning to tackle this. What we're also doing, of course, is working with the families and working with the children. They love what we're doing here. For the first time ever, you've committed more resources, more people, and a vision for this. And it's paying off. And you're going to hear from the rest of the administration now.

The President. Thank you very much, Jim. Great job. You're doing a great job.

Counselor Conway. Thank you, Jim.

Dr. Giroir, our Assistant Secretary for Health at HHS.

The President. Yes.

Counselor Conway. Dr. Giroir, you see a decrease in the number of overdose deaths in some of our hardest-hit States, like West Virginia, Ohio, Pennsylvania. Could you update us please on that?

Department of Health and Human Services Assistant Secretary for Health Brett P. Giroir. Yes, ma'am. Good afternoon, Mr. President, Mrs. Trump. As a physician, I can assure everyone that the current opioid and overdose crisis is the most daunting public health challenge of our time. But under your leadership, with the policies and programs implemented by people around the table, we are seeing real results now, saving lives. And I want to give you just a snapshot of that.

Based on data released just this morning—so this is the latest data by the CDC—I'm pleased to report that this month is the 6th consecutive month of reporting for which overdose deaths were lower compared to the previous year. That's a remarkable finding.

The President. That's great. That's fantastic.

Dr. Giroir. Nationwide, overdose deaths have now fallen 4.4 percent over the past year. And let's look at some specific States. In New Hampshire, where you first announced your initiative, drug overdose deaths are down 4.8 percent. Florida—8.1 percent. West Virginia—10.3 percent. Iowa—18.2 percent. Pennsylvania—18.5 percent. And Ohio—down 23.3 percent——

The President. Wow. That's tremendous.

Dr. Giroir. ——as a result of the policies and programs that we've implemented.

The President. And those were really the hardest-hit States that we're seeing, right?

Dr. Giroir. They are the ones that everyone would say, "Look at them—how hard were they hit." But the great cooperation between the Federal and local and the State have led to these kinds of decreases.

The President. Great. Thank you very much.

Dr. Giroir. You're welcome.

The President. It's very impressive.

Dr. Giroir. Yes, sir.

The First Lady. Thank you.

Counselor Conway. Secretary Wilkie.

Secretary Wilkie. Yes. Thank you, Mr. President and Mrs. Trump. I want to start on a point that Kellyanne has been making for many months. And particularly, for VA, we needed to change the culture. Many of those who come to us are like professional athletes who have retired. They have had a lifetime of trauma, jumping out of airplanes, wounds in combat. And they come to us anticipating a lifetime of chronic pain.

[Secretary Wilkie continued his remarks, concluding as follows.]

So as part of the culture of change, we are changing the way the country looks at opioids and treats them. And it is a sea change, and it is probably one of the more important contributions the VA has made to the nation—to turn our attention away from the use of these medicines and to try to make people healthier as a whole.

The President. So how are we doing with coming up with a cure to the opioid? Meaning, I've instructed every single agency to work on this—with Dr. Collins and all of the folks—on a painkiller that's not addictive. And you would think they could do that.

Secretary Wilkie. Right.

The President. You would see—you see common medicines sold over the counter that aren't totally ineffective, right?

Secretary Wilkie. Absolutely.

The President. So how are they doing? A painkiller that is not addictive.

Secretary Wilkie. So what we are doing is we have been successful in using combinations of over-the-counter medicines—things as simple as aspirin; things that have been around since the late 19th century. And we are finding that those have the same or greater effect when it comes to treating pain. They're not addictive. They're not influencing the brain.

The President. So you're saying the same or greater?

Secretary Wilkie. Absolutely. Yes, sir.

The President. How come nobody knows that?

Secretary Wilkie. Well, again, it goes back to what she's been preaching for a long time, and that is you have to shift the culture. You have to shift the trends. People have done things for so long that it takes a big push to get them on a different path, particularly in the military.

[Secretary Wilkie continued his remarks, concluding as follows.]

So, we're on that journey, and I think what you've started in the last year has propelled us. And I believe it's starting to have an impact on the Department of Defense where veterans' treatment should start before they even come to it.

The President. That's fantastic, Robert. Let me ask you one other question. So, probably related much more so than we want to even think it's related, and that's suicides.

Secretary Wilkie. Yes.

The President. So you have suicides, and I hear numbers of 21 and 22 a day for veterans, which is an—I thought it was a mistake when I read it the first time.

Secretary Wilkie. No, it's true.

The President. Is it 21, 22, 23?

Secretary Wilkie. Twenty.

The President. It's 20. So it's just slightly down. It was 22 originally.

Secretary Wilkie. That's right. The President. Now, I called you 2 months ago, and I said there is a—I had seen it somewhere, and I've read it, regularly, quite a bit about it. I think it's made by Johnson & Johnson. But it's a suicide—if you're depressed—

Secretary Wilkie. Yes.

The President. ——you take it. It's an inhaler. And it almost immediately cures depression, at least for a little while.

And I said, "Order—corner the market on it and give it to anybody that has the problem." Because you have people calling—and our folks do a great job on the phone, but it's a telephone. You have people calling, looking for help. And if those people had that, I'm hearing like instantaneously they're in much better shape.

How are you doing with that?

Secretary Wilkie. We are working with Johnson & Johnson to distribute it. We should have it in all of our VA hospitals——

The President. That could make a tremendous difference.

Secretary Wilkie. ——by the end of the year. But it's in the purchasing process right now.

The President. Is it very effective?

Secretary Wilkie. It's very effective.

The President. So that all of these people that are committing suicide every day—21, 20, 22 a day killing themselves—that's hard to believe.

Counselor Conway. Yes, it's horrible.

The President. Honestly, when I heard the number, I said, "It can't be possible. How could it be so many?" If this is as good as we hear it is, certainly on a fairly short term it gets them over that problem. And I assume this lasts for how long a period?

Secretary Wilkie. Well, the—it is treated in stages. I think the first dose lasts for a few days, and then it's a——

The President. Which is—it gets them over the hump.

Secretary Wilkie. And you build on that. And you build up to a certain dosage.

The President. So you're working something with the——

Secretary Wilkie. With Johnson, yes. With the company.

The President. And I think they'll be very generous to you.

Secretary Wilkie. Yes, sir. Yes, sir.

The President. And if you'd like I'll help you to negotiate it, because—seriously, I just said, "Corner the market." "Corner the market."

Secretary Wilkie. That's right. That's right.

The President. All right. So you're working on that. Very important. I think that's going to be incredible. I'll bet the first few months you're going to see numbers that have—people are going to say, "What happened?" If it's as good as I hear. Good. Thank you very much. Good.

Counselor Conway. Thank you, Mr. President. Thank you, Secretary Wilkie. It is true that Dr. Collins at NIH continues to develop the nonaddictive opioid. And it includes some of the private sector trying to do that that also, Mrs. Trump, Mr. President. [Counselor Conway continued her remarks, concluding as follows.]

So, through Secretary Acosta and the Department of Labor, they've been able to issue record numbers of dislocated worker grants and actually get the opioid addiction levels down among Federal workers.

If you can tell us more about that.

Secretary of Labor R. Alexander Acosta. That's right. So, Mr. President, Mrs. Trump, as you know, we're the largest—the Federal Government's largest employer. And the Department of Labor oversees the workers' compensation programs for Federal workers. Even before you declared it a national emergency, you directed us to make all efforts to address the opioid issue.

[Secretary Acosta continued his remarks, concluding as follows.]

And so the results since your election: a 65 percent decrease in claimants receiving a morphine equivalent dose——

The President. Wow.

Secretary Acosta. ——of 500 or more—the highest. A 65 percent decrease. A 51 percent decrease in new prescriptions lasting longer than 30 days. And a one-third decrease in overall opioid use among Federal workers.

The second part of this, and as important——

The President. Does anybody know those numbers? Those numbers are astronomical.

Counselor Conway. They should now. We'll see if they get covered.

The President. Perhaps you people can report them. I mean, seriously, those are astronomical numbers. As, really, when you're down 18 percent—those are astronomical numbers too. That's a lot in a short period of time.

Secretary Acosta. A 65-percent decline in the highest dose. A 51-percent decline in 30—30-day or longer prescriptions.

The President. That's fantastic.

Secretary Acosta. The second thing that we've done is increase the fraud investigations, because often these are fraudulent prescriptions. And we've gone from three fraud investigations in 2016, to 42 in 2017, to 64 fraudulent investigations for fraud in 2018. So a twentyfold increase in investigations for, in essence, you know, places that are prescribing them fraudulently and getting opioids in the circulation and undermining all these efforts. A twentyfold increase.

And then, finally, you know, going to Kellyanne's point, when individuals receive treatment for opioids, they will leave a center and they will have addressed their issue, but then they need a job. They need a place to live. And so we've been working with Governors to fund programs where, in opioid treatment centers, they have access to job training and skills training so that when they are ready to reengage with society, they have a future path that does not involve drugs.

The President. That's fantastic. Thank you very much. Thank you, Alex.

Counselor Conway. Secretary McAleenan, if you'd like to tell us about the efforts about DHS.

Acting Secretary of Homeland Security Kevin K. McAleenan. Yes. Thank you, Mr. President, Mrs. Trump. Well, we're making significant progress on the law enforcement and interdiction pillar of your strategy over the last 15 months.

[Acting Secretary McAleenan continued his remarks, concluding as follows.] One of the things that's been critical is your engagement with China and President Xi, and getting additional data so that that mail coming in, we can access it with advanced systems and do inspections and seizures right there in the mail facilities. Then we follow up with our partners in the investigation side with Homeland Security Investigations and U.S. Postal Inspection Service. We made over 200 controlled deliveries taking out pill presses and distribution centers from Manhattan to Oregon in the last year.

The President. So China is helping you?

Acting Secretary McAleenan. China's numbers have gone up dramatically. You know——

The President. That's fantastic. Nobody knows this. That's fantastic.

Acting Secretary McAleenan. Yes. Since you engaged the President on it.

The President. That's fantastic. That's very nice. I'll have to remember that.

Acting Secretary McAleenan. The thing I think is key to highlight is we're going to be getting better in the coming months, across all of this. We've trained 2,500 canines. We have new technology going into place in the southwest border. We're improving the advanced electronic data.

[Acting Secretary McAleenan continued his remarks, concluding as follows.]

And then, lastly, I'll just say, Mr. President, this is my sixth meeting in the West Wing with either you and/or with First Lady on this issue. I know you've had many more. But we're going to maintain our focus at DHS reflecting your focus on this key priority. And thank you, Kellyanne, for your leadership.

The President. And what about the southern border, as it relates to drugs coming through?

Acting Secretary McAleenan. Yes, so we have both the dual problem: vehicles at our ports of entry and people crossing between ports of entry.

The President. Right.

Acting Secretary McAleenan. And the investments we're making in the wall, between ports, is going to help dramatically. And we're also buying a lot of technology so we can see in trucks and all those personally-owned vehicles—a huge investment that you advocated for in the FY19 budget. We're deploying that technology now.

The President. How is the wall coming along?

Acting Secretary McAleenan. Coming along aggressively. We built two miles last week. We're up to about two miles a week right now, so extending that capability across key sectors.

The President. And you'll have, by the end of next week—next year—how much do you think you'll have built?

Acting Secretary McAleenan. By the end of next year, over 400 miles, in partnership with DOD.

The President. Over 400 miles, right?

Acting Secretary McAleenan. That's correct.

The President. And we have to kick and scream for every inch because the Democrats just will not give us what we need. In fact, I think we're going to be very close to 500 miles by the end of the year, which—it'll be great.

Acting Secretary McAleenan. It'll be great. The President. Okay? It'll have a huge impact. That's fantastic. Thank you. Good job.

Acting Secretary McAleenan. Thank you.

The President. Good job.

Counselor Conway. Mr. President, after 2 years of investigations, the DOJ and HHS have generated $3.3 billion in opioid fraud takedowns. We have acting Administrator of the DEA Uttam Dhillon here today to tell us about that and more.

Uttam.

Drug Enforcement Administration Acting Administrator Uttam Dhillon. Mr. President, Mrs. Trump, DEA has made great progress attacking the opioid crisis through its regulatory and enforcement functions. And I'll just take a moment to discuss a couple of relevant cases.

So, on the regulatory front: Since 2016, DEA has reduced manufacturers' opioid quotas—that is, the amount of opioids DEA authorizes to be produced—by 47 percent. So this has significantly decreased the amount of addictive opioids available, for diversion, for people to become addicted to, to overdose on.

[Acting Administrator Dhillon continued his remarks, concluding as follows.]

And most recently, also in April, DEA is continuing to hold accountable pharmaceutical distributors who DEA regulates. For the first time ever, in April, two executives of one of the top pharmaceutical distributors in the U.S. were criminally charged for unlawfully distributing Oxycodone and fentanyl. The company that they worked for has already admitted liability and has paid a $20 million fine.

And finally, Mr. President, DEA remains laser-focused on Mexican drug trafficking organizations—the ones who are bringing fentanyl and other drugs and poisoning our citizens. And we appreciate all of your support.

The President. Would you want to name them terrorist organization or some designation that would give you additional power?

Acting Administrator Dhillon. No, sir. I think we have all the authority we need. We just need the cooperation of our various foreign governments to attack them more effectively, and we're working to gain that. Director Carroll talked about our efforts with China, and we're working with other countries to be as effective as possible attacking these.

The President. And Mexico is going to be much different now, too. I think Mexico is going to start hitting them much harder.

Acting Administrator Dhillon. That would be very helpful, sir.

The President. Okay? Let me know, okay?

Acting Administrator Dhillon. All right.

The President. Thank you.

Acting Administrator Dhillon. Thank you.

Counselor Conway. Mr. President, Mrs. Trump, one of the cruel ironies of these drugs pouring into our communities is that they're coming through our southern border and through our U.S. mail system.

And so, as we know, the 21st century drug traffickers are using low-volume, high-potency fentanyl in our own mailing—tiny, tiny little amounts in packages. So, today, I'm very happy to have USPIS Director Barksdale to give us an update on some of the progress that we have and some of the challenges that lie ahead.

United States Postal Service Chief Postal Inspector Gary Barksdale. Thank you. First, thank you, Mr. President, First Lady, and Ms. Conway, for having us here today. As you know—they may not know—the Postal Inspection Service is the law enforcement branch of the Postal Service. We work very hard to instill confidence in the U.S. mail, and basically to protect the American public.

[Inspector Barksdale continued his remarks, concluding as follows.]

So we're still—[inaudible]—source is clearly China, even though we're starting to see a trend; it may be routed through other countries. And then later this year, in September, I plan to travel to China to address this with China with Director Carroll.

The President. Great. Good job.

Chief Inspector Barksdale. Thank you, sir.

Counselor Conway. Mr. President, that concludes our presentation. So if you have any questions or comments——

The President. Well, I would like to ask my wife, the First Lady, to say a few words because she has been so much into the whole situation with the drugs and opioids, in particular—but drugs.

And she has a son that she loves and she wants to make sure that Barron doesn't have problems. And she wants to make sure that a lot of people in this country—they see the suffering, the horrible suffering. And I just want to thank you for the great job. You see the numbers? We're down 17, 18, 20 percent—in one case, 21 percent.

And, Alex, the numbers you gave were incredible. Nobody has ever even thought of that—51 and 60 percent.

So I want to thank you all. But I really think we owe a lot to the First Lady, and maybe you could say a few words.

The First Lady. Thank you. Thank you for all of your support, first of all, Kellyanne. Through my initiative, BE BEST, working with the families and our youth to get rid of stigma and talk about if you have a problem—addiction problem. And it's very important that you open up and ask for help. So I always say: Love yourself more than you love drugs.

And I will continue to do so, to bring the awareness—how dangerous drugs are, and talking with the families and young mothers and youth of United States. Thank you.

The President. Well, you've had a great impact, and we appreciate it. We all appreciate it. Thank you, honey. Thank you.

Counselor Conway. Thank you, sir.

The President. Thank you all very much. Appreciate it. Thank you very much. Thank you.