When Donald Trump directed his administration to declare America’s opioid overdose crisis a public health emergency, Republicans swiftly praised his “bold national leadership”.
But with no new funding, many public health experts and state officials said it was “magical thinking” to imagine that the declaration would stem the tide of opioid overdoses that has already killed 183,000.
Almost 100 people are dying every day across America from opioid overdoses – more than car crashes and shootings combined. The majority of these fatalities reveal widespread addiction to powerful prescription painkillers. The crisis unfolded in the mid-90s when the US pharmaceutical industry began marketing legal narcotics, particularly OxyContin, to treat everyday pain. This slow-release opioid was vigorously promoted to doctors and, amid lax regulation and slick sales tactics, people were assured it was safe. But the drug was akin to luxury morphine, doled out like super aspirin, and highly addictive. What resulted was a commercial triumph and a public health tragedy. Belated efforts to rein in distribution fueled a resurgence of heroin and the emergence of a deadly, black market version of the synthetic opioid fentanyl. The crisis is so deep because it affects all races, regions and incomes
“We need more resources,” said Dr Jay Butler, chief medical officer for the state of Alaska, who was at the White House for Trump’s announcement. Butler said the president’s speech sounded “a call for an opioids moonshot, but in order to focus resources, you need resources”.
Announcing the measure, Trump called on Americans to come together as a national family, and laid out a sweeping call for reform, though it mostly lacked specifics.
“The federal government is aggressively fighting the opioid epidemic on all fronts,” Trump told a crowd of addiction survivors, Congress members and law enforcement officials at the White House. “We can be the generation that ends the opioid epidemic. We can do it.”
In addition to a national health emergency, Trump announced an intention to sue pharmaceutical companies; to pull an “evil” opioid from the market; to create an addiction education campaign for youth; and to build a wall on the southern border of the United States.
He also called for a public-private partnership between scientists at the National Institutes of Health and drug companies to develop non-addictive painkillers, and pledged to suspend an obscure provision of federal law that bars public funds from paying for addiction treatment in facilities with more than 16 beds.
The president’s proposals heartened some. “We went into it hopeful that it would be a comprehensive strategy, and it was just that.” said Jessica Nickel, president of the Addiction Policy Forum. “Using the public health emergency route makes a lot of sense. This is a health condition, an illness.”
But it was what the president left out of his announcement that most frustrated many addiction treatment advocates.
Trump failed to call for more funding; stopped short of declaring a more sweeping national emergency as he had promised and his own White House commission recommended; and declared the emergency as his administration attacks public health insurance for the poor.
Jeff Levi, professor of health policy at George Washington University, said it was simply “not true” that the federal government was using all the tools at its disposal.
“Declaring a public health emergency brings no new resources to the table, and there is a broad consensus in the public health community that we need additional resources for prevention, harm reduction and treatment,” said Levi.
The public health emergency Trump announced is technically declared by the US health and human services secretary, Eric Hargan. It will allow people to receive addiction treatment through telemedicine. It will also make federal grants for HIV and for displaced workers available to combat the opioid epidemic. It also gives the health secretary access to the health emergency fund.
However, the public health emergency fund has a balance of only $57,000, and some experts were concerned using funds dedicated to HIV could mean robbing Peter to pay Paul.
Further, because public health emergency declarations are typically used to cut red tape after natural disasters or during disease outbreaks, they expire after 90 days. The declaration will then have to be renewed.
“It’s not a proposal, it’s not a plan,” said Dr Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing and co-director of opioid policy research at Brandeis University. “If Trump is serious, this afternoon we’ll hear an appropriations request, I believe, in the billions.”
“You want – in every county – to be able to walk into a treatment center and on that same day access treatment,” Kolodny said, “regardless of their ability to pay for it.” He estimated a request to “build out” an addiction treatment network in the US would cost $6bn.
James Hodge, an Arizona State University public health law professor, said declaring a public health emergency, not a national emergency, was “a real missed opportunity”.
“Failing to do that against the backdrop of his own White House commission, it’s hard to understand,” Hodge said. “That’s not, in my view, the president taking the opioid crisis seriously enough.
“States and localities will be struggling to figure out why the federal government is not taking this more seriously,” said Hodge.
Butler, who will be looking at the declaration’s details in his own state, said: “To think we can do a lot more without any new resources is really magical thinking.”
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