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Opioid emergency declaration inspires optimism, caution among advocates

President Donald Trump signs an order declaring a public health emergency over opioid addiction at the White House on Oct. 26, 2017. (CNN Newsource)

President Donald Trump declared opioid addiction a nationwide public health emergency Thursday, a move that frees up some federal resources and provides increased flexibility for states grappling with the epidemic, but one that some critics say falls short of his past promises.

“We can be the generation that ends the opioid epidemic,” Trump said at a White House event.

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He cited his own personal experience with addiction involving his older brother who died after suffering from alcoholism, and he directed federal agencies to exercise their emergency powers to address the “national shame” of opioid addiction.

“Almost every American has witnessed the horrors of addiction,” he said.

Among other things, Trump called for “really tough, really big advertising” to encourage kids to stay away from drugs.

"If we can teach young people and people generally not to start, it's really, really easy not to take them," he said.

The public health emergency declaration lasts for 90 days, but it can be extended.

“We are going to overcome addiction in America,” Trump vowed.

A bipartisan commission chaired by New Jersey Gov. Chris Christie recommended in July that Trump declare a national emergency either under the Stafford Act or the Public Health Service Act.

According to the opioid commission’s interim report, an estimated 142 Americans die every day from drug overdoses, and in 2015 nearly two-thirds of overdoses were linked to opioids. The number of opioid overdoses has quadrupled since 1999, as has the amount of prescription opioids.

“Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the Executive Branch even further to deal with this loss of life,” the report stated. “It would also awaken every American to this simple fact: if this scourge has not found you or your family yet, without bold action by everyone, it soon will.”

A final report is due next week.

The president first said in August that he would declare a national emergency, and he repeated that promise last week.

“That is a very, very big statement,” Trump said when asked about it at the White House last Monday. “It's a very important step. And to get to that step, a lot of work has to be done and it's time-consuming work. We're going to be doing in next week, okay?”

Later in the week, Press Secretary Sarah Sanders reiterated that declaring a national emergency is “a very in-depth legal process” and an announcement would be coming this week.

Thursday’s declaration of a public health emergency is a less drastic step than a national emergency, but White House officials have insisted it is a more appropriate action. They say the national emergency status is not well-suited for a long-term crisis and does not provide substantial powers the administration does not already have.

Don Flattery, who lost a son to opioids and was at the White House Thursday, said the statement by the president is vital, regardless of what kind of emergency he declares.

“I don’t care what we call it,” he said. “It is an emergency. It is an epidemic…. We need to hear from the president of the United States, we need him to recognize and embrace that we have an epidemic on our hands.”

From a policy perspective, the distinction is significant, according to Jeffrey Levi, a professor of health policy and management at the George Washington University's Milken Institute School of Public Health.

“A public health emergency leverages authorities of the U.S. Department of Health and Human Services (HHS); the Stafford Act applies to the entire federal government,” he said. “In addition, the Stafford Act permits tapping emergency resources such as those leveraged immediately after the hurricanes. A public health emergency would not release any new funds.”

It does allow HHS to tap into its public health emergency fund, but that account currently has less than $57,000 in it and the administration does not plan to seek more from Congress until the end of the year.

There are some things officials say the administration will be able to do immediately under Trump’s declaration:

  • Enable patients to get treatment and prescriptions for opioid addiction through telemedicine
  • Increase flexibility for federal and state governments in hiring of substance abuse specialists
  • Provide dislocated worker grants for people who are unemployed because of their addiction
  • Allow Medicaid recipients to receive opioid treatment at facilities with more than 16 beds

Republican lawmakers have applauded Trump’s action.

“I spoke with the president aboard Air Force One about the opioid crisis and the need for swift action, and I thank him for taking these important steps to truly address this epidemic,” said Rep. Evan Jenkins, R-W.V., before attending Thursday’s event. “Our states and communities need speed and flexibility to access federal funding and assistance.”

“Building on actions Congress has already taken, this directive will help states and local communities better fight this battle, and strengthen the tools available at the federal level,” House Speaker Paul Ryan, R-Wis., said in a statement.

However, House Minority Leader Nancy Pelosi, D-Calif., said the administration must do much more to seriously confront the opioid epidemic.

“It is deeply concerning that this declaration, which comes a full three months after the President’s Commission on the Opioid Crisis’s report, fails to authorize federal funding to help those Americans locked in a life-or-death struggle with opioid addiction,” she said.

Pelosi’s statement also demanded that the president end his “spiteful sabotage” of the Affordable Care Act and Medicaid.

“We will continue to fight to send states the resources needed to combat this crisis, and will fight to improve prevention and expand access to care, so that we can bring treatment and care to the men and women fighting for their lives,” she said.

Sen Chris Murphy, D-Conn., called the declaration “a hollow promise.”

“Let’s be clear, Congress passed a budget this week that would decimate our ability to fight this epidemic to help finance huge tax cuts for rich people,” he said in a statement. “A true commitment to confront this crisis head on will require more funding for local communities, and more resources for families and individuals coping with opioid addiction.”

Rep. Patrick McHenry, R-N.C., noted that Congress passed two pieces of legislation combatting opioid abuse last year, but he said Trump’s declaration is a welcome move.

“It’s very good that the president declared an emergency and Congress must get more done so that we can tackle this health and family and community crisis that has originated out of opioid addiction,” he told WLOS Wednesday.

Flattery, policy director for the Fed Up Coalition, acknowledged that Congress did provide hundreds of millions of dollars for treatment under the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act in 2016, but he called those sums “woefully inadequate” when compared to the billions spent on other public health crises like Zika, Ebola, and the avian flu.

He hopes the president’s heavily-publicized statement Thursday spurs lawmakers to do at least as much for opioids as they did for those diseases.

“I think it sends a message to the Congress,” he said. “What we are doing to address this issue is not working.”

Some experts and advocates are already questioning how much impact the new order can have if no new funding is included.

“With public health already under-funded and the president proposing major cuts to public health in his FY 2018 budget, there is no way that states and localities can effectively address the opioid epidemic with existing resources without decimating other critical public health programs,” Levi warned.

He suggested other steps the federal government could take to promote evidence-based programs to educate kids about the dangers of drugs, expand medication-assisted treatment, and allow federal funds to go toward syringe exchange programs.

Levi also observed that states that accepted the Medicaid expansion under the Affordable Care Act have been able to provide greater access to drug treatment. The effort Trump has endorsed to repeal the ACA and restructure its Medicaid funding could endanger that progress.

“The administration, rather than discouraging states from going this route, should be encouraging all states to take advantage of the expansion to assure that there is access to care,” he said. “Promoting treatment without providing coverage for it is meaningless.”

Grant Smith, deputy director of national affairs for the Drug Policy Alliance, signaled caution regarding what the emergency declaration will mean, given past positions taken by Trump and Attorney General Jeff Sessions in support of “strong law enforcement” as a response to drug use.

“President Trump has a long track record of using hardline rhetoric to talk about how his administration should approach drug policy,” Smith said in a statement. “There’s a danger that this president will use an emergency declaration as an excuse to ratchet up the war on drugs with more funding for locking up more people and harsher sentencing laws.”

His organization is instead urging Trump to embrace treatment and prevention over enforcement, noting that many of the opioid commission’s recommendations were health-related.

“President Trump can call the opioid crisis whatever he wants,” said Gary Mendell, founder and CEO of anti-addiction organization Shatterproof, in a statement. “The most important thing will be how this declaration is implemented and how quickly he takes action. It will require laser-like, business execution by the administration to take the necessary actions to save lives.”

Mendell also expressed some concern about the lack of funding, but he listed steps that can be taken without it including setting higher treatment standards and changing FDA labeling of opioids.

“President Trump ran a business based on results,” he said. “And so far, when it comes to the opioid epidemic, we have seen no results. This declaration is providing the government with tools to save lives – I hope they act immediately.”

Jessica Hulsey Nickel, president and chief executive officer of the Addiction Policy Forum, said in a statement that the emergency declaration is “an important step” toward preventing and treating substance abuse.

“Prioritizing this national crisis will bring much-needed resources to communities, improve access to services and facilitate better coordination among government agencies,” she said. “In particular, I am heartened by the decision to bring all federal government agencies to the table to play a unique role.”

Flattery called Trump’s announcement “an absolutely necessary and somewhat late step,” and one that underscores the seriousness of the national crisis.

“It’s not going to solve it all but it’s an important statement from the president of the United States to the public,” he said.

Now, Flattery is looking to Congress and the American people to come to a similar realization about the severity of the threat and act accordingly.

“At what point are we going to develop the national will to invest in some real solutions?” he asked.

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