Kellyanne Conway leading an ‘opioids cabinet,’ as she assumes more active policy role

WASHINGTON — Kellyanne Conway, counselor to President Trump, has been leading weekly meetings at the White House with officials across a dozen federal departments to develop a plan to respond to the opioid crisis and to implement recommendations from a presidentially appointed commission, she and other officials told STAT.

The “opioids cabinet,” as the group is known, is intended to help streamline efforts across the government and includes staffers from the Department of Health and Human Services and the Office of National Drug Control Policy, among other executive branch offices.

In an interview with STAT, Conway said she and other administration officials have also been urging Congress to appropriate additional funding for addiction treatment and prevention programs. She pushed back on the notion that the White House is not allocating sufficient resources to combat the opioid epidemic, citing ongoing conversations with budget director Mick Mulvaney.

Conway and other administration officials have barnstormed the country since the start of the year to talk with state and local authorities about the opioid epidemic, in many cases returning to states where the candidate Trump listened to pleas for help from communities struggling with the opioid crisis. But in her role in the White House meetings, the longtime political consultant is playing a more active part in helping to shape policy.

She is doing so at a time when there are leadership vacancies at HHS and the Drug Enforcement Administration; the administration also currently does not have a “drug czar.” The White House has been criticized for delegating a significant policy role to Conway, who has no prior experience working on addiction issues or as a policymaker. But Conway said she is unbothered by the perception that she is serving as a sort of stand-in for the formal agency heads.

“I’m no substitute for that,” Conway said. “Those are incredibly important roles and I think the men currently in those jobs as acting directors are really doing excellent jobs of making sure there’s seamless activity.”

She cited a variety of factors for her interest in the cause — most notably, a cousin who overdosed multiple times but was revived by first responders before finally passing away once, as Conway put it, “the body just couldn’t take it anymore.”

Despite her unorthodox background, Conway has impressed some addiction policy experts of varying political leanings with her tone, sincerity, and policy expertise.

“Unfortunately the administration’s been living in chaos and has really been unable to get out from underneath the weight of their own self-induced crises,” said former Democratic Congressman Patrick Kennedy, who sat on the White House commission, which concluded its work in November.

“If anybody can get the administration to do that successfully, I think it’s Kellyanne,” Kennedy continued. “Bringing in someone else who the president doesn’t know as well or have confidence in isn’t the right answer, given this president. In another administration you’d get someone with a tremendous CV and unsurpassed record of commitment to public health to lead this. But the president, as we all know, operates very differently from past presidents.”

Dr. Stefan Kertesz, a professor at the University of Alabama-Birmingham’s medical school who studies the opioid crisis and addiction treatment, said Conway has been talking about addiction as an illness and the ways in which communities can provide treatment and support.

She is “trying to change the frame,” Kertesz said, citing a press conference in August at which Conway spoke, along with Tom Price, then the secretary of health and human services.

“I heard a broader perspective,” Kertesz said. “She re-categorized the problem as a community issue. She spoke specifically about listening to communities that are affected.”

Conway has not been without her slip-ups.

“It takes money and it also takes a four-letter word called will,” she told ABC’s George Stephanopoulos in June, describing what a federal effort regarding opioids should look like.

Despite the ambiguity of the remarks — and questions over whether she was referring to political will — addiction treatment experts believed Conway was suggesting that willpower could be an effective treatment for what the medical community views as a disease. Sen. Ed Markey (D-Mass.) demanded an apology.

Many critics of the administration have also been skeptical of the president’s repeated reference to his own abstinence from drugs and alcohol as a model of how to address substance abuse disorder. In the interview with STAT, Conway, too, cited Trump’s abstinence.

“I’ve always been fascinated by the fact that the president has never tried a cigarette, a drop of alcohol — a drop of coffee, for that matter,” Conway said.

While the White House’s efforts to tackle the opioid epidemic have so far resulted in few new sweeping initiatives and virtually no new funding for addiction treatment and prevention, Conway has been engaged on the issue from the start. One report late last month referred to her as the administration’s “opioids czar,” a description the White House promptly rejected.

“I’ve been working on this, in my portfolio, since February or March,” she said. “But I’m very happy to get that role now post-commission report and post-convening the opioids cabinet — that role is one of coordination, communication, and then the real public-facing messaging the president wants.”

The coordination itself is a sizable task. The opioids cabinet includes representatives from numerous other federal departments — Justice, Agriculture, State, and Housing and Urban Development — as well the vice president’s office and the Office of Management and Budget.

Separately, Conway has met with the administrator of Medicare and Medicaid to discuss changes to reimbursement policy at inpatient mental health facilities, and with the labor secretary to discuss using apprenticeship programs as a component of holistic addiction treatment. Conway is also personally following through on the marketing campaign she cited, which the president has described as “really great advertising so we get to people before they start” and has repeatedly told Conway is a personal priority.

Participants in meetings with Conway say her role has been more than just administrative.

At multiple points during the White House commission’s work, two attendees said, she served as a de facto political consultant to the panel, which was chaired by New Jersey Gov. Chris Christie.

According to attendees, she worked at one point to refocus the group after a disagreement over whether to cite a recent study showing that marijuana legalization in Colorado coincided with a lower number of opioid deaths.

Issuing policy recommendations acknowledging that study — which NIH Director Francis Collins has warned does not demonstrate a causal link — would be both politically self-defeating and likely medically unsound, Conway warned.

“The Commission acknowledges that there is an active movement to promote the use of marijuana as an alternative medication for chronic pain and as a treatment for opioid addiction,” the final report read. “Recent research out of the NIH’s National Institute on Drug Abuse found that marijuana use led to a 2½ times greater chance that the marijuana user would become an opioid user and abuser.”

Conway declined to say how much the administration would like to see Congress appropriate, but added that she is working with Office of Management and Budget Director Mick Mulvaney on finding additional funds. “The resources need to be there, but so does the education,” she said.

A leaked draft in a White House budget last year showed a proposed 95 percent cut to ONDCP. Current conversations include a request to most cabinet departments to “find room in their budget” to help fund the marketing campaign, Conway said.

Democrats in the House and Senate have introduced bills that would fund treatment and prevention to the tune of $45 billion over the course of the next decade.

Even without a sweeping bill from Congress, Conway said, there is other simple work to be done, citing a Baltimore Sun article detailing the state’s 800 fentanyl-related deaths in the first half of 2017. Baltimore’s health officials say that in part because of federal resource constraints, they still don’t have sufficient access to overdose reversal drugs.

“Given that there is no DEA head, there is no ONDCP head, and there is no HHS head, bottom line is if she represents the administration on this crisis I’d just assume it’d be someone [Trump] really likes and admires,” Kennedy said. “You can have the person with the best credentials in the world fill one of those spots. But at this stage it’s about hiring the people with the right political will.”