Trump Declares Opioid Crisis ‘Public Health Emergency’
Abstract
While the president resolved to harness resources to address the opioid crisis, he fell short of taking action that would have resulted in allocating new funding.
President Donald Trump’s decision to declare an official national public health emergency instead of a national emergency to combat the opioid epidemic puts the ball in Congress’s court to approve additional funding for the crisis in the year-end spending package.
“This epidemic is a national health emergency—nobody has seen anything like what is going on now,” Trump said at a White House event on October 26. “As Americans, we cannot allow this to continue. It is time to liberate our communities from this scourge of drug addiction.”
If Trump had used the Stafford Disaster Relief and Emergency Assistant Act, as he previously suggested he would do, the federal government could have immediately tapped into funds from the Federal Emergency Management Agency’s Disaster Relief Fund. The Stafford Act has typically been used to provide recovery money for natural disasters, such as hurricanes and earthquakes, and the administration did not consider it to be a good fit for a long-term crisis.
Presidential Commission Releases Report
At press time, the President’s Commission on Combating Drug Abuse and the Opioid Crisis had just released its long-awaited report. APA’s Division of Policy, Programs, and Partnerships is conducting a full analysis of the report, which will be covered in the next issue of Psychiatric News.
In its initial review of the report, APA was pleased to see that it includes some of its recommendations such as enforcement of the Mental Health Parity and Addiction Equity Act, the development of a national media campaign to address the stigma of substance use, improved data surveillance systems, and improved access to drug courts and medication-assisted treatment in the criminal justice system. While the report aims to provide a comprehensive strategy for addressing the opioid crisis, APA noted that it does not include a funding request to implement many of the recommendations.
“The APA welcomes the final report because it helps bring much-needed attention to this crisis,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We are still reviewing the report’s contents for a full evaluation, but we stand ready to work with the administration, Congress, and the states to help provide education, funding, training, and support to address the opioid crisis.”
Many advocates and lawmakers have commented that declaring the opioid crisis a national public health emergency must come with significant federal funding to be effective. So far, several Senate Democrats have introduced a bill, Combating the Opioid Epidemic Act, for opioid prevention, detection, surveillance, and treatment efforts.
The number of deaths attributed to the crisis continues to grow. In September, the Centers for Disease Control and Prevention reported that there were more than 64,000 drug overdose deaths in 2016. More than 20,000 of those deaths were attributed to fentanyl and synthetic opioids.
Trump’s presidential memorandum directed Acting Health and Human Services (HHS) Secretary Eric Hargan to declare a national public health emergency and order all federal agencies to take measures to reduce the number of opioid deaths. “This marks a critical step in confronting the extraordinary challenge that we face,” Trump said. His order will be in effect for 90 days and can be renewed every 90 days.
The administration laid out initiatives that it proposed could be undertaken quickly under the public health emergency:
Allow access to medication-assisted treatment through telemedicine, particularly in rural areas, and allow people to receive prescriptions for controlled substances without an in-person visit with a physician.
Curb the HHS bureaucratic delays to speed up the hiring process to have people in place to help states in crisis.
Make grants available through the Department of Labor to people who cannot find work because of their addiction.
Instruct federal agencies to curb bureaucratic delays for dispensing grant money and shift federal funding for people with HIV/AIDS to get substance abuse treatment.
Make funds available through the Public Health Emergency Act; however, it has been reported that only $57,000 remains in the fund for the fiscal year.
The HHS and the Substance Abuse and Mental Health Services Administration (SAMHSA) will help spearhead the effort to solve this public health issue, according to a SAMHSA press release.
Newly appointed psychiatrist Elinore F. McCance-Katz, M.D., the first assistant secretary for mental health and substance use and an APA member, said in a press statement, “The announcement by President Trump reflects our commitment to this cause and inspires us to redouble our efforts on behalf of all who have suffered the effects of opioid addiction.”
“APA stands ready to work with the administration and the states to help provide education, training, and support to address the opioid crisis,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “APA trains thousands of clinicians each year in the diagnosis and treatment of people with opioid use disorders. Additionally, we are an active partner in the Providers’ Clinical Support System for Medication Assisted Treatment coalition funded by SAMHSA. This national initiative provides training and mentoring in response to the prescription opioid misuse epidemic and increases the availability of pharmacotherapies to address opioid use disorder.”
As part of this emergency response, Trump said a new policy will replace a restrictive rule known as the “IMD exclusion” (Medicaid Institutions for Mental Disease exclusion) that prevents states from using Medicaid financing to provide care at residential treatment facilities with more than 16 beds for people with mental illness, including substance use disorders. APA has long been opposed to this rule.
Other actions under way include implementing best practices for safe opioid prescribing; special training for medical professionals; the launching of a campaign called “Rx Awareness” to increase the public’s awareness and knowledge about the risks of prescription opioids and stop inappropriate use; and requiring drug companies that manufacture prescription opioids to provide more training to prescribers to help prevent abuse and addiction.
Trump also said the U.S. Postal Service and the Department of Homeland Security are strengthening the inspection of packages coming into the country to restrain the flood of cheap fentanyl from China.
Expanding law enforcement is critical to containing the epidemic, he said. Trump’s planned wall along the U.S.-Mexican border would further improve efforts to turn back illegal drugs, he claimed, although much of the opioid epidemic has been fueled by painkillers prescribed by physicians in the United States.
Trump further suggested as a preventive measure a “really tough, really big, really great advertising campaign” aimed at persuading Americans from using opioids at all. “The fact is, if we can teach young people—and people, generally—not to start, it’s really, really easy not to take them.” Trump said his older brother, Fred Jr., who died of complications due to alcoholism, warned his brother never to drink, and he listened.
Last year Congress passed the Comprehensive Addiction and Recovery Act, which authorized grants to help states curb the use of prescription painkillers and heroin. The 21st Century Cures Act gave a total of $1 billion over two years to address the epidemic. The Democrats’ recently proposed legislation would expand funding already allowed under the 21st Century Cures Act for surveillance, data collection, and reporting on the number of opioid overdose deaths, among other activities. ■
