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President Donald Trump characterized the U.S. opioid epidemic as a national public health emergency and directed the executive government to "use every appropriate emergency authority" to fight the crisis.
"Ending the epidemic will require mobilization of government, local communities, and private organizations. It will require the resolve of our entire country," Trump said in a speech from the White House on Oct. 26.
More than 64,000 people died in 2016 from drug overdoses, the majority of which were linked to opioids, such as oxycodone, synthetic opioids such as fentanyl, and the illicit drug heroin. CDC found that the number of opioid overdose deaths soared 200 percent between 2000 and 2014. At least 91 Americans die daily from opioid overdose.
The Trump administration’s declaration of the opioid crisis as a national public health emergency allows the quick hiring of personnel to deal with the issue, expanded access to telemedicine services, such as remote prescribing of medicine, and flexibility in use of grant money to combat the epidemic.
But the declaration fell short of the expected designation of national emergency under the Stafford Act, which would have allowed the use of money from the federal Disaster Relief Fund to tackle the crisis.
About half of opioid overdose deaths involved a prescription opioid, legally obtained.
Opioid analgesic pain relievers are the most prescribed class of medication in the United States, with more than 289 million prescriptions written each year, according to a 2016 report by the U.S. Surgeon General.
The over-prescribing of opioids began in the mid 1990s amid a marketing campaign telling doctors that they should prescribe more opioids to help ease patients’ pain, said Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University's Heller School for Social Policy and Management.
The message came from pain specialists, professional societies, hospitals and state medical boards and was underwritten by drug companies. The message, in a nutshell: "If you are a caring, enlightened physician, you will be different from those stingy puritanical doctors of the past who will let people suffer needlessly," Kolodny said.
CDC said that though there have been recent declines, opioid prescribing remains high and inconsistent across the United States. "Providers in the highest prescribing counties prescribed six times more opioids per person than the lowest prescribing counties in 2015," CDC reported.
By declaring the opioid crisis a national public health emergency, the federal government can now do the following:
• accelerate temporary appointments of specialized personnel to address the emergency (pending any funding needed);
• work with the Drug Enforcement Administration to expand access for certain groups of patients to telemedicine for treating addiction;
• provide new flexibilities within HIV/AIDS programs.
Trump also said his administration would announce a new policy to allow treatment at more facilities.
"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.
The Medicaid Institutions for Mental Diseases exclusion, part of the Medicaid program since its enactment in 1965, prohibits the use of federal Medicaid funds at facilities that treat mental health or substance use disorder, if they have more than 16 beds. Some exceptions apply. The exclusion was designed to leave mental health services funding to state governments.
Trump was expected to declare the opioid epidemic a national emergency — a step up from a public health emergency — based on Trump’s own previous remarks. This had been the recommendation of the Commission on Combating Drug Addiction and the Opioid Crisis, established by Trump via executive order. The commission recommended making the declaration under the Stafford Act or Public Health Service Act.
A declaration of a national emergency under the Stafford Act would have granted access to funds from the Federal Emergency Management Agency.
After Trump’s announcement, Sen. Edward J. Markey, D-Mass., criticized him for not committing emergency funds to fight the epidemic, saying Trump "offered the country a Band-Aid when we need a tourniquet."
Trump administration officials argued that the national emergency label would have been too broad, an undue burden on the Disaster Relief Fund, and not the right call for a lengthy crisis. The national emergency designation is usually used after major national disasters.
Republican U.S. Rep. Matt Gaetz’ Mostly False claim that Medicaid expansion is fueling the opioid crisis
Former Health and Human Services Secretary Tom Price’s controversial remarks on opioid treatment, suggestion there’s a cure for addiction
Former Health and Human Services Secretary Tom Price’s Half True claim that the federal government has increased funds by "hundreds of millions" to fight the opioid epidemic
Sen. Elizabeth Warren’s Mostly True claim that "One in three people who’s receiving treatment for drug problems gets some help from Medicaid to pay for that."
Sen. Claire McCaskill’s False claim that "We have 5 percent of world population. 80 percent of opioids."
White House, Remarks by President Trump on Combatting Drug Demand and the Opioid Crisis, Oct. 26, 2017
White House, Presidential Memorandum for the Heads of Executive Departments and Agencies, Oct. 26, 2017
U.S. Department of Health and Human Services, Declaration of opioid crisis as a national public health emergency
Sen. Edward J. Markey, Senator Markey on Trump Opioid Announcement: A Vision Without Funding Is An Hallucination, Oct. 26, 2017
Sen. Edward J. Markey, Senators Unveil Legislation to Invest $45 Billion to Address Opioid Crisis, Oct. 25, 2017
New York Times, Trump Declares Opioid Crisis a ‘Health Emergency’ but Requests No Funds, Oct. 26, 2017
Legal Action Center, The Medicaid IMD Exclusion: An Overview and Opportunities for Reform
Federal Emergency Management Agency, The Stafford Act, as amended and Emergency Management-related Provisions of the Homeland Security Act, as amended, August 2016
House of Representatives, Office of the Legislative Counsel, Public Health Service Act
Centers for Disease Control and Prevention, Provisional counts of drug overdose deaths, as of 8/6/2017
National Institute on Drug Abuse, Opioid Crisis, Revised June 2017
U.S. Department of Health and Human Services, HHS Acting Secretary Declares Public Health Emergency to Address National Opioid Crisis, Oct. 26, 2017
Congressional Research Service, Medicaid’s Institutions for Mental Disease (IMD) Exclusion, May 8, 2015
ABC News, Trump says he's going to declare the opioid crisis a national emergency. Here's what that means, Oct. 23, 2017
American Action Forum, The Problems With The IMD Exclusion, Oct. 15, 2015
LBJ Presidential Library, The 1965 Medicare Amendment to the Social Security Act, Aug. 27, 2012
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U.S. Surgeon General, Facing addiction in America, 2016
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Health and Human Services Secretary Tom Price, SAMHSA/CDC/CMS State Opioid Workshop Remarks, Aug. 8, 2017
U.S. Sen. Rob Portman press release, Portman Welcomes New Opioid Funding as President Signs 21st Century CURES Dec. 13, 2016
Hartford Courant editorial, "Overdose Epidemic Demands More Than Federal Baby Steps," April 13, 2016
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New York Times, "Call for Action, Not More Study, On Opioid Crisis," June 17, 2017
New York Times, "Panel Wants Opioid Crisis Declared Emergency," Aug. 1, 2017
Washington Post, FDA is targeting international mailings of opioids, Aug. 6, 2017
Washington Post Wonkblog, "White House opioid commission to Trump: ‘Declare a national emergency’ on drug overdoses," July 31, 2017
PBS, "What It Would Mean To Declare the Opioid Crisis a National Emergency," Aug. 1, 2017
The Hill, "Amid federal uncertainty, states confront opioid crisis," March 8, 2017
Huffington Post, "Bush, Oz, Advocates To Trump: Declare Emergency On Opioid Crisis Now," Aug. 7, 2017
Miami Herald, "Gov. Scott declares public health emergency over opioid crisis," May 3, 2017
PolitiFact, "Claire McCaskill cites disproven figure on opioid use" May 10, 2017
PolitiFact, "HHS Secretary Tom Price says 'hundreds of millions' more already spent to fight opioid addiction," May 26, 2017
PunditFact, "Newt Gingrich misleads with point that House health care bill grows Medicaid spending," June 28, 2017
Interview, Dr. Mehmet Oz, host Dr. Oz show, Aug. 8, 2017
Interview, Robert I.L. Morrison, Executive Director/Director of Legislative Affairs National Association of State Alcohol and Drug Abuse Directors, Aug. 8, 2017
Interview, Andrew Kolodny, co-director of opioid policy research at Brandeis University's Heller School for Social Policy and Management, Aug. 8, 2017
Washington Post, Trump declares the opioid crisis a public health emergency, Oct. 26, 2017
CNN, What Trump's opioid announcement means -- and doesn't mean, Oct. 26, 2017
Federal Emergency Management Agency, Disaster Relief Fund
Centers for Disease Control and Prevention, Opioid Prescribing, Page last updated Sept. 26, 2017