WASHINGTON -- In a long-awaited move, President Trump on Thursday declared the nation's opioid addiction epidemic to be a "public health emergency," freeing up government agencies to put more resources toward fighting the epidemic.
"This epidemic is a national health emergency, unlike what we've seen in our lifetimes," Trump said, speaking from the East Room of the White House. "As Americans, we cannot allow this to continue. It's time to liberate our communities from the scourge of drug addiction. We can be the generation that ends the opioid epidemic."
"That is why, effective today, my administration is officially declaring the opioid crisis a national public health emergency under federal law, and why I am directing all executive agencies to use every appropriate emergency authority to fight the opioid crisis," he said.
Trump said his administration would soon announce a new policy to , which bars federal Medicaid reimbursement for mental health and substance abuse treatment in hospitals with more than 16 beds. "A number of states have reached out to us asking for relief, and you can expect to see approvals to unlock treatment for people in need -- those approvals will come very, very fast, not like in the past," he said.
No New Federal Funds
Because Trump declared the crisis to be a public health emergency rather than a national emergency, no additional funds can be allocated -- only existing funds can be used. However, "the administration is working closely with the Congress right now on an end-of-year budget deal. We expect that [funding for] this will be part of that conversation," a senior administration official said during a phone call with reporters Thursday morning.
An example of what declaring a public health emergency can do was provided by Hurricane Harvey in August. That declaration allowed Medicare officials to waive the usual documentation required for reimbursement, so that beneficiaries who had been evacuated from hospitals and nursing homes could receive care at other facilities that didn't have the beneficiaries' health records.
The president is already on board with spending more money on the crisis, the official said, noting Trump's support of "both the House healthcare reform bill that provided at least $15 billion for opioid relief, and especially with the Senate healthcare reform bill, which provided $45 billion." Neither of those bills has passed, however.
Reviving “Just Say Noâ€
The opioid crisis has not abated, with 64,000 people dying in 2016 from opioid overdoses, Trump noted. He said more attention should be focused on getting people not to start taking drugs in the first place. “The fact is, if we can teach young people — and people, generally — not to start, it’s really, really easy not to take them. And I think that’s going to end up being our most important thing.â€
But Tracy Jackson, MD, of Vanderbilt University, disagreed. “The idea that the ‘Just Say No,’ prevent all exposure to drugs is a reasonable thing — there have been decades and decades of scientific literature that do not bear that out to be the case,†she said in a video interview with ľֱ.
“What we really need to do instead of criminalizing or stigmatizing this is recognize that addiction is a chronic brain disease … and treat it as such.â€
Patrice Harris, MD, chair of the Opioid Task Force at the American Medical Association, issued a statement applauding Trump's action "as a move that will offer needed flexibility and help direct attention to opioid-ravaged communities.
"This alone won't solve a complicated problem," she added: physicians, insurers, and drug manufacturers must do their part as well.
"As physicians, we must be leaders in continuing to make judicious prescribing decisions, and by considering the full range of effective therapies for pain, including non-opioid and non-pharmacologic options, co-prescribing naloxone, helping patients access medication-assisted treatment for opioid use disorder and removing stigma."
Additional federal funding is needed to adequately train additional opioid addiction treatment providers, said Dessa Bergen-Cico, PhD, coordinator of addiction studies programs at Syracuse University in an email. However, in the absence of funding, there are other steps the administration could take; for example, "[instituting] government policies to reduce the numbers of days and amounts that doctors can prescribe for opioids."
In addition, "requirements for adequate education and training for substance abuse prevention professionals, addiction treatment counselors, physicians, nurses and healthcare providers who are on the front line interfacing with people at risk or struggling with substance abuse are needed," she said in an email. "There is currently no federal certification or licensure for addictions counselors; it is ad-hoc state by state. There is no required addiction education in medical school for physicians or nurses."
More Treatment Access Needed
Lack of additional funding is unfortunate, said Michael Fiori, MD, director of addictions at the Mount Sinai Health System, in New York City. "President Trump's declaration is a positive step in addressing this crisis, but it's critical to actualize it with real money and resources immediately to fund outpatient and rehabilitation services, and to educate patients, families, and caregivers about this chronic illness, versus only talking about it," said Fiori in an email.
"Patients need access to more inpatient and outpatient rehabilitation services and outpatient treatment. The most acute need is for more outpatient detoxification services and more programs offering the option of medication assisted therapies, such as suboxone, methadone, and naltrexone. We also need to train more doctors and healthcare professionals in addiction medicine."
In addition to the White House announcement, the FDA also has taken action to address the crisis, Trump noted. "The FDA is now requiring companies that make prescription opioids to on abuse and addiction, and requesting that one specific high-risk opioid be taken off the market immediately." Trump may have been referring to Endo Pharmaceuticals' Opana ER, which the company it was pulling from the market.
“Overall, I thought the president’s speech was very promising and offers hope,†Joseph Boscarino, PhD, MPH, of Geisinger Health System, said in an email. “I have been working in the drug addiction field for decades and do not recall such a broad-scoped public health agenda.â€