The opioid crisis affects millions of Americans, including many who became addicted after taking pain-relieving pills exactly as prescribed by their doctor.
With no sign that the crisis is slowing, a specially appointed opioid commission last week called for President Trump to officially declare the epidemic a “national emergency.”
Health and Human Services (HHS) Secretary Tom Price, though, stopped short of that. He said in a briefing that the “opioid crisis can be addressed without the declaration of an emergency.”
But later in the week, Trump signaled during an impromptu press briefing that he would accept the commission’s recommendation.
“The opioid crisis is an emergency and I’m saying officially right now: It is an emergency,” he said.
The White House has yet to release specific details on its plan. But if the administration moves forward it could have a significant impact on the opioid epidemic in the United States.
“Designating the opioid crisis a national emergency is much more than symbolic. It gives the Trump administration the ability to tackle this problem in ways that it couldn’t without that designation,” Dr. Andrew Kolodny, co-director of Brandeis University’s Opioid Policy Research Collaborative, told Healthline.
Emergency money to address the crisis
One of the major benefits of an emergency declaration is enabling the federal government to dip into its coffers.
“The designation allows the administration to access emergency funding much more easily,” said Kolodny. “And it could get that funding out to states and communities that have been hit hard by the epidemic.”
As of July, the Federal Emergency Management Agency (FEMA) had about $1.5 billion in its disaster relief fund. This fund is usually reserved for natural disasters such as floods, hurricanes, and tornadoes.
But even this money might not be enough to make a dent in the opioid crisis.
In June, as the Senate was debating one version of its healthcare bill, Richard Frank, PhD, a professor of health economics at Harvard Medical School, estimated it would take $180 billion over 10 years to address the opioid epidemic.
Kolodny said an emergency declaration would also help federal agencies that “have a piece of this problem” — like the Centers for Disease Control and Prevention (CDC), the Drug Enforcement Agency (DEA), and the Food and Drug Administration (FDA) — “to immediately get more staff to help them work on the problem.”
Trump’s 2018 budget, though, called for a 17 percent cut to the CDC’s funding and a 31 percent cut to the FDA’s budget.
So even with an emergency declaration, the agencies might still end up with fewer employees.
Expanded addiction treatment options
Almost 2.6 million Americans have an opioid use disorder, according to the National Institute on Drug Abuse.
This includes both prescription opioids and heroin.
This has increased dramatically since the late 1990s, with opioid overdose deaths rising in parallel. The CDC estimates that on average 91 Americans die every day from an opioid overdose.
Medicaid is an important part of addressing this problem, especially for Americans in need.
According to the Kaiser Family Foundation, 3 in 10 people with opioid addiction were covered by Medicaid in 2015.
In the 32 states that chose to expand Medicaid as part of the Affordable Care Act, more low-income adults were eligible for addiction treatment and other health services.
The federal government could also grant waivers to states to increase treatment options for people on Medicaid.
Even with these efforts, some areas of the country simply do not have enough addiction specialists or treatment programs. Rural areas are particularly hard hit.
If Price declared an emergency under the Public Health Service Act, public health workers could be redeployed from existing projects to ones focused on substance abuse.
“Physicians that are members of the National Health Service Corps could be sent to hard-hit communities where there isn’t adequate access to addiction treatment,” said Kolodny.
Federal emergency funds could also be used to expand the use of medication-assisted treatment in recovery programs or require that they be offered at every licensed treatment facility.
Drugs like methadone and Suboxone can reduce withdrawal symptoms and help people stop using illegal opioids. But these are not available at every treatment program.
In addition, an emergency designation could enable the HHS secretary to negotiate lower prices for naloxone, a drug that is used to reverse overdoses. This could make the drug more widely available to state and local authorities.
With the rise in opioid overdoses, more first responders now carry naloxone in their bag alongside other things such as oxygen, aspirin, and glucose.
Communities hard hit by the opioid crisis are already spending more of their budgets on naloxone. Federal efforts could take some of the pressure off these communities.
Address overprescribing of opioids
Many public health experts now recognize that overprescribing of opioids by doctors has fueled the opioid epidemic.
This began in the late 1990s with a big push for doctors to treat pain more aggressively.
Along with this, pharmaceutical companies that developed opioid pain medications sometimes downplayed their risks while emphasizing their benefits. Several cities have recently sued drug companies for this kind of marketing.
“What’s fueling the problem is that every medicine chest has opioids in it,” said Kolodny. “Doctors have been writing way too many prescriptions. In 2015, 92 million Americans received a prescription for an opioid in that year. So that’s why we have an epidemic.”
This comes out to more than 1 in 3 Americans taking opioid pain medications prescribed by their doctor, according to a recent National Institute on Drug Abuse survey.
Changing physicians’ prescribing habits will require educating them about the true risks of prescription opioids.
An emergency declaration could make this easier.
“The DEA would be able to mandate that [physicians] receive education before they can prescribe opioids,” said Kolodny. “Without the designation, this would require legislation — which would be a very long, slow process.”
Emergency funds could also be used to enhance states’ prescription drug monitoring programs that flag people obtaining opioid prescriptions from multiple doctors.
Studies show that these programs — when actually used by physicians and pharmacists — can reduce opioid abuse. It also can reduce the number of patients selling or giving away their pills, what’s known as diversion.
Kolodny also hopes that an emergency declaration would help federal agencies work together better.
“We really haven’t seen a coordinated response from the federal government to this problem,” said Kolodny. “In fact, we saw agencies at odds with each other.”
As an example, he points to the CDC “calling for much more cautious prescribing of opioids” while the FDA “kept approving new opioids and allowing the manufacturers to encourage aggressive prescribing of opioids.”
States can declare an emergency
As health experts debate whether a national state of emergency will help, several states have already used disaster or emergency declarations to ramp up their fight against the opioid epidemic.
This includes Maryland, Massachusetts, Alaska, Arizona, Virginia, and Florida.
Massachusetts’ governor declared an emergency in 2014 — the first of its kind in the country for the opioid epidemic.
This banned the sale of a new pain medication, although this was later overturned in court. It also required doctors and physicians to use the state’s prescription drug monitoring program and allowed first responders to carry and administer naloxone.
In Arizona, which saw 790 opioid overdose deaths in 2016, an emergency declaration by the governor increased funding and personnel to address the epidemic.
This included improving real-time tracking of overdose deaths by county, which may help officials respond more quickly and effectively.
Law enforcement officers in Arizona are also trained on how to use naloxone to reverse an opioid overdose.
The greater focus on law and order in dealing with the opioid crisis — including from Trump — has some worried.
During the crack cocaine epidemic of the 1980s — which “disproportionately hit inner city communities,” said Kolodny — a law-and-order approach to the epidemic led to mass incarcerations of people who were addicted.
This time around, though, there are signs that more policymakers see the opioid crisis as a public health problem rather than a criminal justice issue.
Kolodny said that for a few years now, we’ve been hearing — even from conservative politicians — a different approach, with many of them saying: “We can’t arrest our way out of this problem. We have to see that people who are addicted receive access to treatment.”
“We didn’t hear that during the crack cocaine epidemic of the ’80s or the heroin epidemic of the ’70s,” noted Kolodny.