President Trump on Thursday said the U.S. opioid misuse epidemic "is a national emergency," signaling that he will begin the necessary paperwork to officially put such a declaration into effect.
The announcement came nearly two weeks after the White House Commission on Combating Drug Addiction and the Opioid Crisis released an interim report that urged the president to declare a national emergency, and two days after Trump was briefed on the epidemic by HHS Secretary Tom Price and other officials. Price at the time said the administration believed the opioid misuse epidemic could be "addressed without the declaration of an emergency."
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However, by Thursday Trump appeared to change tracks, Politico reports, telling reporters, "I'm saying officially right now, it is an emergency. It is a national emergency." He added, "We're going to spend a lot of time, a lot of effort, and a lot of money on the opioid crisis."
The White House in an official statement Thursday said, "Building upon the recommendations in the interim report from the President's Commission on Combating Drug Addiction and the Opioid Crisis, President Donald J. Trump has instructed his Administration to use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic."
How could the declaration be implemented?
However, it remains to be seen how exactly Trump will declare the national emergency, and whether he will act on any of the opioid commission's other recommendation, Vox reports.
Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness, said, "There's no doubt that this shines a brighter light on the epidemic." He added, "It remains to be seen how much this will fundamentally change its course."
The White House's opioid commission report highlighted two main paths through which the Trump administration could declare a national emergency:
- The Stafford Act, which would involve a declaration from the president to unlock federal and state resources typically used for natural disasters; or
- The Public Health Service Act, which would involve a declaration from the HHS secretary and would allow HHS to deploy federal medical providers to underserved areas and ease certain policy hurdles to opioid misuse treatment.
Experts, including Price, have noted that national emergencies typically are declared in specific areas or states, and often are in response to natural disasters or infectious disease outbreaks, such as the Zika virus. Therefore, as Lainie Rutkow of Johns Hopkins Bloomberg School of Public Health, said, "No one can point you to the exact model for how this would work for an emergency that's been declared for a noncommunicable health condition. This is a new thing."
What this could mean for states, cities, and providers
According to the Times, declaring an emergency could open up federal relief funds to states and cities hit the hardest by the opioid epidemic. The declaration also could allow the HHS secretary to waive federal rules that limit Medicaid funds or lift restrictions on experimental treatments, giving states and cities more flexibility. For instance, the White House commission report suggested eliminating a Medicaid rule that restricts inpatient care coverage for mental health and substance use disorders.
Tom Coderre, a senior adviser with the Altarum Institute and a former Substance Abuse and Mental Health Services Administration official under the Obama administration, said, "Waiving that requirement would allow many, many more facilities to be able to accept patients, and maybe reduce waiting lists and get people the kind of help that they need when they need it."
David Rosenbloom, professor of health policy and management at Boston University's School of Public Health, said the declaration also might allow HHS to require hospital emergency departments to treat patients with substance misuse disorders instead of stabilizing the patients and then referring them to an addiction specialist. "Making hospital emergency rooms places where methadone and buprenorphine could be started immediately would obviate a lot of the need for the inpatient detoxification," Rosenbloom said.
Further, the White House opioid commission and other experts have said the declaration could expand access to medication-assisted treatment, such as buprenorphine and methadone, as well as the overdose reversal drug naloxone.
Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University, said the Drug Enforcement Agency might be able to use the declaration to require opioid prescribers to be trained on the drugs and best prescribing practices.
Reaction
While Trump's statement was met with praise by several advocates and state officials, some public health experts said the move was largely symbolic.
Jessica Nickel, president of the Addiction Policy Forum, said, "This declaration can help communities with flexibility and resources to help implement a comprehensive response to the opioid epidemic."
Attorney General Jeff Sessions, who last week announced a new fraud unit targeting opioid prescribers, said, "I applaud President Trump for his leadership in taking this drastic and necessary measure to confront an opioid crisis that is devastating communities around the country and ripping families apart."
However, Richard Frank, a professor of health economics at Harvard Medical School, said the declaration is "symbolic mostly and it actually involves a lot of reporting and paperwork."
Tom Frieden, the former CDC director, also said the Stafford Act, which is primarily used for short-term response efforts, "doesn't seem appropriate or useful" for an ongoing, national epidemic. He added, "(I)t could help, in the right context, as part of a comprehensive response, and if it encourages both funding and better collaboration between public health and law enforcement" (Ehley, Politico, 8/10; Shear/Goodnough, New York Times, 8/10; Lopez, Vox, 8/10; Radnofsky/Campo-Flores, Wall Street Journal, 8/10; Ross Johnson, Modern Healthcare, 8/10; Siddons, CQ HealtBeat, 8/10 [subscription required]; White House statement, 8/10; Achenbach et al., Washington Post, 8/10).
Reduce opioid misuse and abuse with our new report
Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties.
This report outlines three imperatives to guide hospitals and health systems in their efforts to reduce the impact of inappropriate opioid prescribing and misuse.