Policy Evaluation in a time of Alternative Facts:

Drug Medi-Cal, Marijuana, and Trump

Darren Urada, Ph.D and Staff

UCLA Integrated Substance Abuse Programs

Scientific Presentation
February 3, 2016
The opinions and views expressed in this
presentation are only those of the
presenter, and do not necessarily reflect
the views of UCLA or UCLA ISAP.
 Today’s Presentation
• Science under the new administration
• Big national policy drivers for SUD right now
• Medicaid / CA Drug Medi-Cal Waiver
• Marijuana
• 21st Century CURES Act
• Trump
• Where does UCLA ISAP fit in?
• Where does science fit in?
Science under the new
administration

http://www.reuters.com/article/us-usa-trump-epa-climatechange-idUSKBN15906G
 Health Care Reform and
California’s Drug Medi-Cal
Waiver
 Drug Medi-Cal Waiver
• Currently being implemented in opt-in counties
• Adds services, assessment requirements.
• Better rates, more county control.

• Opt-in counties would get

• Additional medication assisted treatment
• Residential treatment
• Withdrawal management
• Case management
• Recovery residence (block grant funded)
• Physician consultation
 Centers for Medicare &
Medicaid Services (CMS)
on CA’s Waiver
• California represents 20% of Medicaid
• Several other states have submitted SUD waiver
applications. California is the “prototype”.
• Looking at the UCLA ISAP waiver evaluation very
closely, wants to use California “as a laboratory and
develop a solid business case for providing these
services” nationally.
• But the waiver is based in part on Affordable Care
Act assumptions, i.e. the Medicaid expansion
 Trump Plan for
Health Care Reform
“We will work with Congress to make sure we have a series of reforms ready for implementation
that follow free market principles and that will restore economic freedom and certainty to
everyone in this country. 

1. Completely repeal Obamacare. Our elected representatives must eliminate the individual
mandate.
2. Modify existing law that inhibits the sale of health insurance across state lines.
3. Allow individuals to fully deduct health insurance premium payments from their tax returns . .
. review basic options for Medicaid and work with states to ensure that those who want
healthcare coverage can have it.
4. Allow individuals to use Health Savings Accounts (HSAs). . .These plans should be
particularly attractive to young people who are healthy and can afford high-deductible
insurance plans.
5. Require price transparency from all healthcare providers, especially doctors and healthcare
organizations like clinics and hospitals.
6. Block-grant Medicaid to the states.
7. Remove barriers to entry into free markets for drug providers that offer safe, reliable and
cheaper products

Source: https://www.donaldjtrump.com/positions/healthcare-reform
 Realizations on Repeal

Repeal is “going to be called Trumpcare. Republicans will

own that lock, stock and barrel, and we’ll be judged in the
election less than two years away.”
- Rep. Tom McClintock (R-Calif.)

Of particular concern to some Republican lawmakers was a

plan to use the budget reconciliation process — which requires
only a simple majority vote — to repeal the existing law, while
still needing a filibuster-proof vote of 60 in the Senate to enact
a replacement.

https://www.washingtonpost.com/politics/behind-closed-doors-republican-lawmakers-fret-about-how-to-repeal-
obamacare/2017/01/27/deabdafa-e491-11e6-a547-5fb9411d332c_story.html?utm_term=.1010837248d8
Marijuana Legalization
 Prop 64

“Legalizes marijuana under state law, for use by adults 21 or older.

Imposes state taxes on sales and cultivation. Provides for industry
licensing and establishes standards for marijuana products. Allows
local regulation and taxation.”

“The Controller shall next disburse the sum of ten million dollars
($10,000,000) to a public university or universities in California
annually beginning with fiscal year 2018–2019 until fiscal year 2028–
2029 to research and evaluate . . .” (11 specific evaluation questions.)
Also: “I say [recreational marijuana legalization] is
bad. Medical marijuana is another thing, but I
think it’s bad, and I feel strongly about it.”
(referring to Colorado and Oregon’s experiment
with marijuana legalization.)

Brother Fred struggled with alcohol, which ended

fatally.

Source:
http://addictionblog.org/infographics/donald-trump
-quotes-on-addiction-substance-abuse-and-the-w
ar-on-drugs/
From Kilmer, B. (2017). http://www.rand.org/blog/2017/01/trumps-marijuana-options.html

Shut it down. Crack down on marijuana businesses via “cease and desist”

letters to companies, their landlords. Serious political costs.
Shape the markets. To stop stores from selling high-potency products, a
letter. Or seize some products to have a chilling effect.
Maintain status quo. May lead more states to follow CO and WA, licensing
marijuana companies incentivized to maximize profits instead of protecting
public health.
Reschedule marijuana. Make it easier to research health consequences
(benefits and harms).
Address federal-state conflicts. Maintain federal prohibition but solve
problems caused by the federal-state conflict (e.g. banking).
Legalize it. Would address the federal-state conflicts, allow national taxes,
regulations. Would also violate international drug conventions.
21st Century Cures Act
 Part of a much larger bill, includes opioid funding:
• Improve state prescription drug monitoring programs;
• Implement and evaluating prevention activities
• Training health care practitioners: best practices for
prescribing opioids, pain management, recognition of
potential cases of SUD, overdose prevention;
• Supporting access to federally certified opioid treatment
programs and others that treat substance use disorders
• Funding other public health activities the state determines
appropriate for addressing opioid abuse.

House: 392 to 26. Senate: 94 to 5. 

Funded (strategic petroleum reserve sales and redirected ACA funding).

Source: https://www.thenationalcouncil.org/capitol-connector/2016/12/congress-reaches-deal-opioid-funding-mental-health/
 Also in the 21st Century
Cures Act
The Secretary of Health and Human Services
shall delegate to the Assistant Secretary for
Mental Health and Substance Use all duties
and authorities that—
. . .were vested in the Administrator . . .
What else do we know about
Trump’s positions on SUD?
 Trump on SUD
Source: http://abcnews.go.com/Politics/wireStory/policy-prescriptions-clinton-trump-drug-addiction-43209960
• Emphasis on stopping the flow of illegal drugs by building a wall along
the southern border, ending sanctuary cities.
• “. . .called for expanding enforcement as well as treatment programs,
but he has offered no specifics on costs.”
• “. . .says the DEA should limit production of Schedule II opioid
painkillers, like oxycodone and fentanyl.”
• “. . . pledges to expand access to naloxone and make it easier for
doctors to prescribe "abuse-deterring drugs."
• “. . .says the FDA is too slow to approve medications that can stop
cravings and that doctors face too many restrictions in prescribing
them.”
• “. . . proposing more incentives for states and local governments to
establish drug courts” (no dollar figure).
• “Praised running mate Mike Pence for instituting stricter mandatory
minimum sentences for drug offenses as governor of Indiana and
suggested he'd pursue a similar policy federally.”
 Sen. Jeff Sessions: Attorney General
“Good people don’t smoke marijuana”1

Joked about the Ku Klux Klan, saying he thought they were “okay, until
he learned that they smoked marijuana.”1

Sessions “is by far the single most outspoken opponent of marijuana

legalization in the U.S. Senate,” 1

In Mobile, Ala, prosecuted more crack cases than almost every other
district in the country, but in 2001 introduced a bill narrowing the 100 to
1 crack/cocaine sentencing disparity, arguing the mandatory sentencing
disproportionately affected African Americans.2
1
https://www.washingtonpost.com/news/wonk/wp/2016/11/18/trumps-pick-for-attorney-general-good-people-dont-smoke-marijuana/?tid=a_inl&u
tm_term=.02f9bb5f6c58
2 http://www.usatoday.com/story/news/politics/2016/12/22/attorney-general-nominee-jeff-sessions-reversed-course-drug-sentences/95478038/
 Sen. Tom Price: HHS Secretary?
“Price's record includes: Going against a measure that would prevent
the Justice Department from interfering with state recreational
marijuana laws.”1

Voted twice against needle exchange programs.2

“
When Democrats attacked him for wanting to jettison the array of
benefits mandated by Obamacare -- such as . . . providing substance
abuse and mental health coverage, Price said consumers should be free
to choose whether they want those benefits.”3

1
https://www.washingtonpost.com/news/wonk/wp/2016/11/29/donald-trump-adds-another-marijuana-opponent-to-his-cabinet/?utm_term=.2eaee
75c9f8b
2 http://www.sciencemag.org/news/2016/12/drug-hiv-crises-hit-hhs-nominee-price-close-home
3 http://money.cnn.com/2017/01/18/news/economy/tom-price-health-secretary-hhs-nominee-trump-obamacare/
The administration hasn’t taken a
lot of public positions on SUD.
That might be a good thing.
There might be room for science.
How does UCLA ISAP fit in?

• Health Care Reform / Medicaid /

Drug Medi-Cal Waiver
• Marijuana
• 21st Century Cures Act
As scientists, what’s our
future?
“President Trump is picking a fight he is certain to lose . . .
When rising oceans swamp coastal communities or
unvaccinated children fall to outbreaks of measles or mumps
or whooping cough, you can’t pin that on a crooked media or a
rigged election. It's simply the way the fact-based world works.
That's a lesson the Trump Administration had best learn —
before we all pay the price.”

http://time.com/4650144/trump-science-war/
 What happened to the EPA?
“Trump administration officials recently made a verbal request to
managers to take down the climate portions of the EPA’s site. EPA
career staffers pushed back against that plan . . . saying they wanted
the request in writing before anyone removed content.

“Management was pushing back as far up the chain as we could get to

say this was not an acceptable move and to delay it,” the employee
said.

https://www.washingtonpost.com/news/energy-environment/wp/2017/01/25/trump-administration-backs-off-plan-to-scrub-climate-pages-fro
m-epa-website/?utm_term=.3bfbd01c478d
https://www.washingtonpost.com/news/energy-environment/wp/2017/01/25/trump-administration-backs-off-plan-to-scrub-climate-pages-
from-epa-website/?utm_term=.3bfbd01c478d

https://www.engadget.com/2017/01/25/agriculture-department-lifts-usda-gag-order-after-public-outcry/

https://www.theguardian.com/environment/climate-consensus-97-per-cent/2017/jan/31/trumps-copying-the-bush-censorship-playbook-scientists-arent-standing-for-it
And many more:
https://twitter.com/TrevorABranch/lists/government-science/members
 What’s next?
• Do our research. Produce good
science. Inform the new administration.
• Stay in the middle of it, whether that
means working with the administration,
or something else.
 Thank You!
CONTACT

Darren Urada, Ph.D.

UCLA Integrated Substance Abuse Programs
durada@ucla.edu