Trump Opioid Declaration Falls Short, Say State Officials

By Brianna Ehley, Politico

26 October 17

The move doesn't come with new funds to fight the epidemic ravaging the country.

resident Donald Trump on Thursday will declare the opioid crisis a public health emergency — a move that is narrower than what his own opioid commission had recommended and that will not pump additional money into an epidemic that has ravaged communities and claimed thousands of lives.

State officials and public health experts expressed disappointment, saying the epidemic is growing faster than efforts to contain it. Trump had promised in August that his administration will spend "a lot of money" on the opioid crisis — a vow that he did not deliver upon.

“People are dying," said Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing. "We have people dying of overdoses on waiting lists for an effective treatment.”

Senior administration officials told reporters that acting HHS Secretary Eric Hargan will sign the declaration on Thursday. That will allow public health agencies to swiftly redirect existing health resources to the crisis, but won't add fresh funds. It will also cut "bureaucratic delays" in hiring personnel and expand access to telemedicine, including remote prescribing of medication commonly used for substance abuse or other mental health treatment.

The declaration will not include the extra money that state officials and some in Congress say is critical for a comprehensive response to the drug epidemic that the White House estimates is claiming about 175 lives a day. The HHS public health fund currently has only about $57,000 left in it, although Congress could replenish it and the department has some other emergency resources to draw on. An administration official said there are "ongoing discussions" with lawmakers about how much money is needed to address the emergency.

Public health and addiction experts say a multi-pronged approach is needed immediately — a national prevention strategy, greater access to substance abuse treatment and enough money for communities to stock up on naloxone, a drug that can reverse life-threatening overdoses. Some experts had urged Trump to trigger another kind of national emergency under the Stafford Act, which can unlock more federal resources and emergency powers but is usually used for more clearly delineated crises like hurricanes or fires.

The spreading opioid crisis reaches from abuse of prescription painkillers to street drugs like heroin and the even more lethal fentanyl. Drug overdoses now kill more people than traffic crashes or gun-related deaths, and there's growing fear that IV drug use will set off waves of new HIV/AIDS infections in the heartland.

Some lawmakers from hard-hit states immediately said they would be open to allocating more resources — but it's not clear how much of an appetite there is on Capitol Hill to significantly increase spending. As of now, the House and Senate appropriations bills for next year keep opioid funding levels flat. States are already getting $1 billion between 2017 and 2018 under the 21st Century Cures legislation to respond to the drug crisis.

"We're underwater," said Rep. David McKinley (R-W.Va.) during a congressional hearing earlier this week where he criticized the federal response. "I don't understand why more resources aren’t flowing to help out a rural state like West Virginia." His state has the highest overdose death rate in the country.

New Jersey Gov. Chris Christie in a statement praised Trump for taking "bold action." But the president's order will fall far short of the recommendations his Commission on Combating Drug Addiction and the Opioid Crisis made in its preliminary report in July.

For example, the commission recommended mandatory education for doctors and waiving a longstanding federal prohibition on using Medicaid funds to pay for inpatient substance abuse treatment — which the panel said was the single fastest way to increase treatment.

Michael Fraser, executive director of the Association of State and Territorial Health Officials, urged Congress to act. "The lack of resources is concerning to us since the opioid epidemic is presenting lots of challenges for states' budgets," he said.

Advocates worry about redirecting other health funds, particularly from programs such as HIV prevention.

“There are some measures in the package that suggest states could shift money away from HIV to the opioid crisis, but the fact is patients who are suffering from the opioid crisis, they have other health concerns too," said Tiffany Kaszuba, deputy director of the Coalition for Health Funding. "It's not even robbing Peter to pay Paul anymore. It's robbing Peter to pay Peter."

The declaration doesn’t include other priorities identified by state and local officials. For example, it won't immediately address access to the emergency overdose treatment naloxone. The price of the drug has soared in the past couple of years, making it hard for cash-strapped emergency departments to stock the drug.

Ohio was able to negotiate a lower price of naloxone for emergency medicine agencies and police officers, but at a cost of $40 a vial it’s still too high for many EMS agencies, particularly as some of the stronger opioids now require multiple doses per patient, said Carol Cunningham, Ohio’s state medical director for the department of public safety’s EMS division and the chairperson of the National Association of State EMS Officals.

Policy experts said the administration's decision to use a public health emergency fund instead of a national emergency declaration under the separate Stafford Act is not enough.

"You show me in the past a national public health emergency declaration with no accompanying funds or even requests for funds, I’d be pretty surprised," said Andrew Kessler, who runs Slingshot Solutions, a consulting firm specializing in behavioral health and drug abuse.

Some states had hoped to see more help to build out programs that show promise. Rhode Island, for instance, wants to establish a pre-arrest diversion program so that law enforcement sends people using opioids to treatment instead of jail. "We know that prevents deaths, and criminalization does not,” said Rhode Island’s Health Director Nicole Alexander-Scott.

Trump said in August and then again last week that he would declare the crisis a national emergency, which would give the administration more tools to fight the crisis but also raise a host of legal and economic issues.

At the time, officials were considering using the Stafford Act, which is typically reserved for natural disasters and administered by FEMA. Former HHS Secretary Tom Price, White House budget director Mick Mulvaney and the White House Domestic Policy Council had objected to such a declaration because of its potential multi-billion-dollar price tag, legal issues and questions about how it could be implemented.

The more measured response speaks to the complexity of a drug epidemic that is pervasive yet not isolated in a particular time or place like a hurricane or a fire.

Another official added the administration has already spent $1 billion on the opioid crisis since the president took office. Roughly $500 million for drug addiction response efforts was provided under the 21st Century Cures Act signed into law by former President Barack Obama last year.

The declaration of public health emergency lasts 90 days but can be renewed.