On Thursday, October 26, 2017, President Trump officially declared the opioid crisis a “National Public Health Emergency”. This executive action directs the Department of Health and Human Services to make the declaration and sets into motion several parts of the federal government who now have to act to write legislation, alter policies or allocate money for addressing the issues around the opioid crisis.
Scope of the Challenge
The statistics on the opioid crisis are daunting to say the least. Below is a brief point by point breakdown of what we are up against as a country:
- According to the federal government, drug overdose is now the leading cause of accidental death in the United States. There were 54,404 reported fatal drug overdoses in 2015, and opioids accounted for 33,091 of those fatalities. Of those, 20,101 were the result of prescription pain relievers, and 12,990 were due to heroin. These are alarming numbers.
- Annual opioid overdose deaths quadrupled from 1999 to 2008.
- Four out of five new heroin users started out on prescription pain medication. Caution should be noted that these users did not all start out with a prescription for the medication from a physician.
- Substance abuse treatment admissions in 2009 were 6 times the rate of 1999.
These statistics paint a picture of a growing epidemic in US society. It is with this in mind that President Trump and his administration came to publicly address this expanding crisis.
The final report from his commission on the opioid crisis, led by New Jersey Governor, Chris Christie, was still not released to the public when the president made his address as it was due to be released one week later.
This was a topic on the campaign trail with every single candidate during the primaries in both parties mentioning it at least once. Very few subjects cross party lines these days, but this one was and is simply too big to ignore.
What Does This Declaration Do Exactly?
This is the big question. Some felt that it did not go far enough, while others applauded the moves as steps in the right direction. Here is what we know right now:
- This declaration will be in force for 90 days, and it will have to be renewed every 90 days after that.
- The three federal administrations tasked with carrying out this declaration are: White House Office of National Drug Control Policy (ONDCP), the Department of Health and Human Services (HHS) and the Drug Enforcement Administration (DEA). It should be noted that none of these administrations have Senate confirmed department heads and are instead run by interim leaders.
- “As part of this emergency response, we will announce a new policy to overcome a restrictive 1970s-era rule that prevents states from providing care at certain treatment facilities with more than 16 beds for those suffering from drug addiction,” Trump said in his speech Thursday.
- The rule, known as the Institutions for Mental Diseases exclusion rule, prohibits Medicaid from paying for patients to stay in residential programs with more than 16 beds. This was part of the move away from large institutional settings that gained even more prominence in the 1980’s and 1990’s which saw many of the largest institutions shuttered.
- States can request waivers from this rule, but some believe that approval for the waivers is a slow process.
- President Trump said, “A number of states have reached out to us asking for relief, and you should expect to see approvals that will unlock treatment for people in need. And those approvals will come very, very fast. Not like in the past — very, very quickly.”
- President Trump was using his executive position to encourage the Centers for Medicare and Medicaid to approve these waivers faster.
- It remains to be seen if this will happen, and some believe that the best way is to simply eliminate the rule altogether. Some believe that the waivers are themselves too restrictive, often only allowing for payment of residential programs for as little as 15-30 days, thus keeping people from gaining access to long-term recovery programs.
- Investing in a national advertising campaign similar in style to Nancy Reagan’s “Just Say No” campaign in the 1980’s. The idea is to encourage young people to never start using opioids in the first place. This idea has had some success with tobacco after a large infusion of money from a class action lawsuit was used to launch a nationwide education program on the dangers of tobacco use, but it has not proven to be even marginally successful with preventing illicit drug use. This will hopefully at least raise the discussion around the issue to a new level.
- No funding was directly allocated for this declaration. The Public Health Emergency Fund currently sits at a mere $57,000. Some had hoped that President Trump would have declared the opioid crisis a national emergency, largely because this would have involved FEMA and their budget and resources. Unfortunately, as many people pointed out, FEMA is quite busy with clean-up efforts from a busy hurricane season and is stretched quite thin already.
- The declaration expands the approved use of telemedicine to include the prescribing of mental health and addiction medicines remotely. This will allow patients in rural areas greater access to doctors who hold special licenses to prescribe drugs like Buprenorphine, commonly known by the brand names of Suboxone, Subutex and Zubsolv. Research has consistently shown that these drugs have as much as 10x the effectiveness in opioid addiction recovery when combined with formal substance abuse counseling than traditional acute detox followed by abstinence programs alone.
- “Allowing physicians to prescribe controlled substances by telemedicine to treat patients with addictions, using medication assisted treatments, is a very positive move and one that will certainly help more patients to access high quality treatment,” American Telemedicine Association President Peter Yellowlees, M.D., said in a statement.
- President Trump also outlined an initiative that is already underway with a public-private partnership between the National Institutes of Health and the pharmaceutical companies to develop safe and non-addictive alternatives to opioid medications. Trump said that he will be “pushing the concept of non-addictive painkillers very, very hard.”
- Also mentioned was a championing of Medication Assisted Treatment and greater access to the opioid reversal drug Naloxone as harm reduction approaches.
- On the other hand, the president also used some of the classic language from the decades long War on Drugs when he stated that “Illegal drug use is not a victimless crime…There is nothing admirable, positive or socially desirable about it. There is nothing desirable about drugs. They’re bad.”
Time is going to have to tell if Congress makes budgetary allocations for any of the broader initiatives outlined by President Trump, and because this declaration needs to be reauthorized every 90 days, there is a chance that it will not be reauthorized in the future, possibly even before the crisis has passed. This is a first step, and it will hopefully be followed by many more.
Certainly, however, the expanded use of Medication Assisted Treatment, telemedicine for addiction medicine in rural areas and elevating the national conversation around the opioid crisis will help.
As it currently stands, the majority of treatment is still paid for by the Centers for Medicare and Medicaid, so any cuts to these programs will certainly scale back any expansions that are currently proposed.
While not perfect, the president did outline some steps in the direction of addressing an issue that is touching the lives of more and more Americans.
WhiteHouse.Gov – Remarks by President Trump on Combatting Opioid Crisis
American Society Of Addiction Medicine – Opioid Addiction
CNN – Opioid Crisis Fast Facts
The New York Times – Trump Declares Opioid Crisis ‘Health Emergency’ but Requests No Funds
The Hill – White House: Trump To Declare Opioid Crisis A Public Health Emergency
The Atlantic – What’s Still Missing From Trump’s Plan to Tackle the Opioid Crisis
Business Insider – The Most Important Part Of Trump’s Opioid Crisis Plan May Be Overturning An Obscure Decades-Old Rule
Fierce Healthcare – Trump’s Public Health Emergency Declaration Expands Access To TeleHealth Addiction Treatment