W

ASHINGTON — The White House’s commission on combating the opioid epidemic has recommended that President Trump declare a federal state of emergency to address the crisis, a potentially significant step for an administration that has repeatedly pledged to take steps to ease the epidemic.

“The first and most urgent recommendation of this Commission is direct and completely within your control. Declare a national emergency under either the Public Health Service Act or the Stafford Act,” the committee wrote in an interim report released Monday.

The declaration would effectively nationalize a move that has already taken place in numerous states. Governors in Florida, Arizona, and Maryland have previously declared states of emergency, granting those governments access to millions of dollars and, in some cases, regulatory leeway in administering their responses.

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It was not immediately clear whether or when the president would make such a declaration, and what it would mean for the federal government’s response to the opioid crisis. Half of the roughly $1 billion Congress approved last year to address the opioid crisis as part of the 21st Century Cures Act was awarded in April, with a similar amount expected to be awarded next year.

Most discussions of additional spending on the issue have focused on the Senate’s now-defeated health reform effort.

In a statement, the White House said it would “immediately begin reviewing” the commission’s interim recommendations.

The five-member commission is chaired by Gov. Christie Christie of New Jersey and includes Gov. Charlie Baker of Massachusetts, Gov. Roy Cooper of North Carolina, former Congressman Patrick Kennedy, and Bertha Madras, a psychobiology professor at Harvard University. It was established by an executive order in March, but missed its first two deadlines in issuing the interim report, which was originally due June 27. The final report is due in October.

The commission’s other interim recommendations included:

  • Reimbursing state Medicaid programs to cover addiction treatment at facilities with more than 16 beds. (The limitation on federal reimbursements for facilities with more than 16 beds was established decades ago so federal tax dollars would not be going to state mental hospitals.)
  • Requiring doctors who prescribe opioids to take a class in treating pain.
  • Expanding access to medication-assisted treatment, or MAT. Only 10 percent of drug treatment facilities offer MAT, the commission says, despite the fact that it’s a proven treatment for opioid use disorders
  • Equipping all law enforcement officials with naloxone, the overdose antidote. In addition, the commission said, states should make naloxone available to all residents with “standing orders” and doctors should prescribe naloxone when prescribing high-risk opioids so patients can have it on hand.
  • Changing some patient privacy laws to “ensure that information about [substance abuse disorders] be made available to medical professionals treating and prescribing medication to a patient.”

Administration figures involved in health and drug policy issues, like FDA Commissioner Scott Gottlieb and NIH Director Francis Collins, have also played a visible role in conversations about the opioid crisis. But in recent weeks, perceived White House inaction in dealing with the opioid crisis had led some lawmakers on Capitol Hill to air their frustrations publicly.

Rep. Trey Gowdy (R-S.C.), the chair of the House Committee on Oversight and Government Reform, railed against the Office of National Drug Control Policy at a hearing last week for failing to produce a top-down federal strategy to reduce overdose deaths.

“ONDCP has failed to produce a formal national drug control strategy and a national drug control budget, which is supposed to be released no later than Feb. 1 each year,” Gowdy said at a hearing last week.

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Despite the pending report and increased attention to the issue, the White House reportedly considered a 95 percent budget cut to ONDCP in May, but restored the funding after widespread and bipartisan outcry.

Other legislators with eyes on the crisis have also expressed doubt that strategies outlined by the commission could impact the crisis response significantly, or at least quickly.

“We don’t really have time to wait on a commission from the White House that hopefully will produce something at some point,” Sen. Joe Donnelly (D-Ind.) said in a recent interview with STAT, referring to himself and senators from other hard-hit states, including Ohio and West Virginia. “We’re losing people every day. … We don’t have time for them to put their report together. We’re trying to get some of our neighbors through next week.”

The report was assembled by the commission independently of ONDCP, though ONDCP did submit a list of policy recommendations for the commission’s consideration.

Andrew Joseph contributed reporting.

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  • Why Not Make Marijuana Legal…It has been proven that using Marijuana has dropped the use of opioids so much and if the BIG wigs in America don`t see this I feel sorry for them…… DO YOUR HOMEWORK…
    I Blame you for not seeing that using Marijuana does help………

  • Since I found this site STAT, I have been reading the stories of fellow chronic pain patients. There has to be a way to have our voices heard by those who make policy.
    I hear many saying that medical marijuana will be their option if opioids are taken away. I know it helps many, but not everyone is able to benefit from it. I am also concerned because I believe it and not opioids is the major gateway drug to addiction of illegal drugs. I am aware of this because I have watched it happen. I have seen people who used marijuana end up addicted to heroine, crystal meth.
    It is sad to think that people will be forced to live with unbearable constant pain or try to supress it with alcohol or marijuana, just because of the illegal opioids and the regulations that were put in place by the Obama administration.
    I have been without any help to manage my pain since November of 2014, with the exception of Nsaids. I am now battling ulcetative colitis and my spine has significantly degenerated due to the inability to stay active. Prior to my opioids being stopped, I was able to practice yoga and ride my bike, not to mention, taking care of everyday tasks. Now, everything takes a monumental effort to accomplish. This is because chronic pain untreated also leads to “depression,” or an acceptance of defeat. I battle it everyday. I have feelings of despair because my home isn’t kept, so I can’t enjoy company or decorate for holidays. I also avoid socializing, because I can’t get past the pain to enjoy normal conversations.
    What is the process of grief when you loose someone? Well, when you live with chronic pain…you loose yourself and go through the same thing.

  • Date: Aug 1, 2017 3:52 AM
    Subject: Reader feedback for ‘White House opioid commission to Trump: “Declare a national emergency” on drug overdoses’

    I’m sick to death of hearing that prescription medication is the problem. I am a chronic pain patient. I have been without any relief since November 2014. My doctor said he wasn’t prescribing it anymore and sent me to pain management. I have had to take Nsaids since then. I am now diagnosed with ulcerative colitis. I was on opioid medication for 7 years and could enjoy daily activities and physical activities. I practiced yoga and rode my bike. Now, I stay in rather than go out with people and be miserable. I have no quality of life. I am in pain all the time, nauseous and can’t sleep. I can almost understand the man who shot the doctor for not helping his wife. It is a terrible existence. If I don’t get relief soon I don’t know how I’ll go on. I can’t even take Nsaids anymore. But, people are still dying…why? Because it is illegal drugs that are killing people. If they want to fix things they need to focus on illegal drugs, stop the methadone and let doctors assess their patients pain and treat accordingly.
    Not everyone that needs prescription opioids is an addict, their are many like myself in chronic pain. #PATIENTSNOTADDICTS
    It is terrible that so many should suffer because of this so called “War on Opioids.” It was started by Obama and like many if his flawed programs and policies, it is the good citizens who suffer for it.
    Are you aware that the report from the CDC that initiated this was skewed. It lumped heroine, morphine and prescribed opioid deaths under one catagorie. Did you further know that 2 years prior to this report, doctors were told they weren’t prescribing enough pain medication. So, to me it looks like a setup. Inflating the number of prescribed opioids prior to collecting the data, skewing the overdose cause. Inciting fear in the public to justify all of this.
    Do you realize that the majority of the population is retired or soon to retire and either by disease or age related conditions this group requires help managing their pain?
    This would also inflate the numbers. So, what happens next? Legalizing doctor assisted suicides for people who can’t live in pain anymore?
    Yes, I’m angry, I’m hurting all the time. I don’t know whether to cry or scream. I just know that life is not worth living this way. I’m tired of feeling like a victim of Obama policy and it seems the rest of the politicians are buying it too.
    What is it going to take for them to see how wrong this is?

    • Thanks for your reply. I am in a pain clinic as my pcp also stopped writing opioid scripts. I have some how managed the outrageous requirements of the clinic so far.. But a new one is going to have me dismissed any day….We are drug tested each month. Now we are allowed only 2 minutes to produce a urine sample……And it generally takes me that long to get ready to produce….And you may say gee who can’t pee in 2 minutes….Well the process is you sit in the waiting room until you are called, the you have 2 minutes once called to produce the sample….And mind you I have sit 3 hours waiting to be called,in agony trying not to pee on myself…..

    • @InPain – Sorry to hear about the hoops you have to jump through. I don’t know where you live or how close pain clinics are to you. I wonder if you can drink water before hand, then ask them if you can pee in the urine sample when you are ready versus when they call you and give you two minutes. That really seems uncomfortable having to hold it not knowing when you need to perform. I have a bladder like a grandma’s purse, so I understand you fearing peeing in your pants. It has happened to me unfortunately a few times in my life in public. So embarrassing!

    • I suffer from Lupus and RA, I am on opiods for pain. I cannot function without the decreased pain level. My body actually crunches when I move. My shoulder locks up when I brush my hair, my entire collar bone into both my shoulders moves, clicks, snaps and pops. I have 3 vertebrae in my neck and 4 I my lower back. Sometimes I have to have help getting out of bed in the morning. My knees have tears in them and my feet and toes can barely tolerate weight and wearing inclosed shoes is very painful. I don’t consider myself an “addict”. I am a patient with real legitimate pain. NSAIDS are a joke and cause serious internal issues which are not welcome and cruel to deal with on top of everything. I pay a large out of pocket for co-pays for all the medications I take in addition to the opiods. Due to the shoulders and caller bone it pulls on my neck and is causing my frame to curve inward. If you don’t think this is painful I invite you to spend an hour in my world and I guarantee you will be begging to get out, but I can’t get out. I could not have any quality of life without pain medication. If they force doctors to stop prescribing opiods then it’s cannabis for me, there is no other alternative, I have to live and I have to manage this pain and I have doctors who are caring and monitor me closely. Stop the talk about prescription drugs, those aren’t the issue, ignorance is!

    • @Denise – I don’t know what state you’re in, but I hope medical/legal marijuana is an option for you. I’ve not used it personally for pain, but I did read a news article where a woman taking 30mg oxycodone 4x a day felt like a zombie and debilitated. She switched to smoking joints and she said she got her life back. Fewer side effects and pain relief was good enough to help her function.

      https://www.theatlantic.com/health/archive/2017/02/marijuana-cannabinoids-opioids/515358/

  • Money saver. Give each addict $365.00. That way they can go to one NA meeting a day, put a dollar in the basket, admit their powerlessness, get a Higher Power, get the obsession removed, and since most of these folks don’t work they will have ample time to make amends to all of the people whose lives they’ve ruined. Treatment facilities are just revolving door. Get an intervention, get a sponsor, somebody who will take a real interest in you. The rehabs depend 75% on repeat customers; if every junkie only needed one rehab these mills would go under faster than poo through a goose.

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