Trump Declares Public Health Emergency Over Opioids, Adds No New Funding

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Here’s what the declaration misses.

President Donald Trump has finally declared the opioid crisis a public health emergency, two months after he first said he would. The belated declaration is short of what is immediately needed to combat this epidemic. It offers no new funding that experts on the frontlines of the crisis say is needed — one expert says hundreds of billions in investment is necessary   and does not seem to yet prioritize increased access to the critical overdose reversal drug naloxone.

Thursday’s public health emergency declaration frees up very limited resources to combat the opioid epidemic that killed more than 33,000 people in 2015 alone. The declaration lasts 90 days but can be renewed. The new order allows for the following:

  • Access to the Public Health Emergency Fund: The declaration opens up access to a limited pot of money. The public health emergency fund currently stands at $57,000, an HHS official told ThinkProgress. Congress will likely need to appropriate more money, and fast.
  • Telemedicine: The administration will allow the prescription of medicine commonly used for substance use disorder or mental health treatment via telemedicine. Some health experts ThinkProgress spoke with say this could help individuals with substance use disorder living in undeserved areas access care.
  • Deploy personnel: HHS could, per the request of state governors, make temporary appointments of specialists to respond to the crisis.
  • Labor Grants: A Department of Labor grant — National Dislocated Worker Grants —  will be available to those displaced from the workforce due to opioid crisis.
  • States can shift federal funds from HIV/AIDS: Resources available to programs aimed at HIV/AIDS care will also be accessible to opioid misuse.
  • Improve access to inpatient treatment: Trump said during his speech that the HHS secretary will temporarily eliminate barriers to treatment by allowing the Medicaid program to reimburse services provided in inpatient treatment facilities that have more than 16 beds.

“We can be the generation that ends the opioid epidemic,” said Trump during his announcement. “We can do it. We can do it.” (This crisis will likely get worse before it gets any better.) 

By declaring this a public health emergency, President Donald Trump has additionally set the national tone for the way this administration talks about addiction to opioids. Melania Trump said, like diabetes, cancer, and heart disease, addiction is a disease. Right now, it’s a disease killing tens of thousands at an alarming rate. When Trump spoke, he said drugs are undesirable and “bad,” missing a crucial point of how potent and addictive opioids are.

Trump says more measures are expected in coming weeks — once his commission publishes its final draft of recommendations expected next week — but so far, Trump’s use of the public health declaration fails to address the magnitude of the epidemic. This opioid crisis is multifaceted and requires more than just expanded federal powers under the Public Health Service Act — or even through the Stafford Act, another way the Trump administration could have issued the emergency (and which it has previously done for hurricane-affected areas). Rather than adding new sources of funding to address the crisis, this declaration is essentially moving around a small amount of money that can be used for one health issue to another.

Trump’s own commission asked him to declare a public health emergency. He does not accomplish all of his commission’s suggestions from their draft report. There’s a general consensus among health experts about what a public health emergency ought to do. It’s narrow in scope, as it should only be among the first, expedited measures taken. Some of these recommendations were in the declaration, but many crucial measures were missing.

Presumably the Department of Health and Human Services (HHS) Acting Secretary Eric D. Hargan could take some of these steps, as the declaration emboldens his authority.

The immediate care health experts say is actually needed

One of the things that is most needed right now and could be pursued under the declaration is increasing people’s access to the overdose reversal drug access naloxone. Under extended authority, the acting HHS secretary could negotiate reduced pricing for all governmental units of naloxone. Health officials battling this crisis on the front lines have long called for the government to do this. In Baltimore City, the health commissioner has been rationing her dwindling supply because the drug is expensive and the demand for it is high. Trump said the federal government will promote naloxone supply and ensure Emergency Medical Technician (EMT) carry it. (It’s unclear how they do this as it’s expensive.)

Trump did not commit to this Thursday during his speech.

Additionally, like naloxone, the HHS secretary could negotiate prices for costly medication-assisted treatment (MAT), an effective way to address addiction. (Medication-assisted treatment is using drugs like methadone and buprenorphine in conjunction with patient counseling.)

But instead of insurance access to addiction treatment services, the Trump administration and Congress have been looking to cut Medicaid funding. Medicaid, which provides insurance to people with modest incomes, currently covers 3 in 10 nonelderly adults with opioid addiction.

There’s agreement among medical professionals that the Trump administration and Congress can do plenty more to address this crisis than just declaring an emergency. Further relief and assistance is not necessarily tethered to an emergency declaration.

One thing that’s cost effective is eliminating barriers to treatment. For example, despite the proven effectiveness of MAT, few physicians are prescribing it. The federal government can look into removing the red tape around physicians prescribing buprenorphine. Or at least reimburse physicians for taking the course and getting certified to prescribe the effective treatment, per two health experts recommendations.

“Access to care is necessary but nowhere near enough,” Chief Medical Officer at Catasys Omar Manejwala told ThinkProgress. It’s exceedingly naive to think medication alone can holistically address this epidemic, he said.

Helping solve the opioid crisis is a heavy lift. The government, and society as a whole, needs to think about chronic health differently and pay close attention to racial disparities and social determinants of health such as unemployment and poverty. The declaration Thursday is just playing catch-up.

 

Reprinted with permission from Think Progress