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n Arizona, it allowed state officials to get daily reports on overdoses. In Alaska, it allowed officials to expand naloxone use. In Massachusetts, it led to new prescription monitoring guidelines and even a controversial ban on a specific painkiller.

But at the national level, Health and Human Services Secretary Tom Price said Tuesday the Trump administration did not yet think it was necessary to declare a state of emergency regarding the opioid crisis. And it is still unclear what invoking such powers would mean for an epidemic that is touching every corner of the country and will likely endure for the foreseeable future.

Most national emergency declarations, which grant the government temporary new powers with little in the way of oversight, have come in response to natural disasters or the spread of infectious diseases like the H1N1 virus. They allow the federal government to redirect military personnel or to relax certain rules so, for example, hospitals can treat diseases off site.

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Those powers might not meaningfully help advocates fighting the opioid crisis, who instead acknowledge the accompanying media spotlight may be the most tangible effect of the declaration.

“I think the question really becomes, not that you just say it, but what are the actions behind it? What are the series of actions that you’re going to take as a result of that declaration?” asked Michael Botticelli, who ran the Office of National Drug Control Policy under President Obama. “There is some merit to it, but only if that brings along with it real meaningful action.”

Others went further.

“It’s a PR stunt if it doesn’t come with money, and doesn’t come with a total government commitment to give people the best access to health care to resolve this issue,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “Unless you do that, all you’ve done is made a statement.”

But some states have successfully used the same idea — of a disaster or emergency declaration — to take more purposeful aim at the battles they’re waging on a local level. Six states — Maryland, Massachusetts, Alaska, Arizona, Virginia, and Florida — have declared some form of public health emergency in recent years to implement new guidelines for prescribing, tap into funding reserves, and expand access to naloxone, the overdose reversal medication.

Each state has taken a different approach, based on their local laws and varying levels of coordination with state legislatures, governors, and local providers. Because they are so recent, experts say, it’s difficult to assess whether they’ve measurably improved access to treatment.

In Arizona, a June emergency declaration allowed officials to tap a public health emergency fund for additional resources. The state has since trained 1,000 law enforcement officers how to use naloxone and improved their tracking so they get daily reports of overdoses and cases of babies born dependent on opioids, instead of relying on numbers that are six to 18 months old.

“This is data we haven’t been able to have in a real-time capacity,” said Dr. Cara Christ, Arizona’s health director.

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In Alaska, the state issued a disaster declaration in February because the crisis mirrored what happens during a disaster — a loss of life, a threat to property (in this case from an increase in crime), and limited capacity from local agencies. The announcement came after health officials realized they did not have the legal authority to issue a standing order for naloxone, essentially a blanket prescription to make it available to the public.

“This seemed like the best approach,” said Dr. Jay Butler, Alaska’s public health director.

The disaster declaration expired after 30 days — and after the standing order was implemented. But the declaration also inspired state agencies to team up on a more coordinated response, Butler said, and that work has continued.

Former Massachusetts Gov. Deval Patrick, whose March 2014 declaration was the first of its kind in the country, used his emergency powers most broadly — and instituted a ban on the sale of a new painkiller, although it was ultimately overturned in court.

The order also made mandatory a previously voluntary prescription monitoring program for physicians and pharmacies, and let first responders carry and administer naloxone. Some of those policies were later codified by the state legislature.

The Massachusetts Medical Society said the drug monitoring program had a “dramatic effect,” pointing to a 24 percent drop in the number of people being prescribed opioids in the state between 2015 and 2017.

Fewer prescriptions “may mean that we are helping to prevent new cases of substance abuse disorder among patients,” the group said in a statement. “However, with roughly 2,000 lives lost to overdose in Massachusetts last year, we know that this crisis is still far from over.”

In each jurisdiction, the declarations trained even more public attention on the growing crisis. In Virginia, for example, authorities declared opioid addiction there a public health emergency right before Thanksgiving, hoping it would prompt families to discuss the problem over the holiday.

A federal declaration is an entirely different animal — and one that may not readily achieve the goals opioid advocates have pressed for.

In interviews this week, advocates identified few new policy solutions that would only be possible if an official, nationwide emergency is declared. Major hospital groups couldn’t easily point to specific rules they might need relaxed to help them address the problems in their communities, the way they did during the H1N1 epidemic.

Instead, advocates pinned their hopes on funding that might accompany an order.

The White House’s commission on combatting the opioid epidemic seemed to acknowledge as much when it made its recommendation to declare an emergency last week. Many of the steps outlined in its interim report would require congressional action or are steps that governmental agencies can already take, from changing Medicaid rules for addiction treatment to tweaking patient privacy laws to encourage information sharing among providers.

But the report intimates that such a declaration would rouse a sweeping response, even if it just meant stirring officials to act with authorities they already have.

“Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the Executive Branch even further to deal with this loss of life,” the commission wrote to the president. “It would also awaken every American to this simple fact: if this scourge has not found you or your family yet, without bold action by everyone, it soon will.”

“It’s a PR stunt if it doesn’t come with money, and doesn’t come with a total government commitment to give people the best access to health care to resolve this issue.”

Dr. Georges Benjamin, American Public Health Association executive director

New Jersey Gov. Chris Christie, who is leading the commission, reinforced that point on CNN on Sunday, arguing that given how pervasive and damaging the problem is — with 142 people dying each day — then how could it not be an emergency?

“If that’s not a national health emergency, I don’t know what is,” Christie said.

Though an emergency declaration might open up some limited federal resources through the Disaster Relief Fund, any major spending injection would have to come from Congress.

And money isn’t easy to come by in Washington. Lawmakers traditionally spend months or longer bickering about such spending decisions, and in recent years, their willingness to authorize big sums has declined. Though they allocated $7.7 billion for H1N1 in 2009, they offered up $5.4 billion to address Ebola in 2014, and then just $1.1 billion for a response to Zika last fall.

Outside of the spotlight a declaration could train on the crisis, it’s difficult to predict other tangible effects.

In its report, for example, the commission said that a state of emergency would enable federal health officials to negotiate a lower price for naloxone, the overdose reversal medication. But a spokesman for Christie declined to offer further details about how that negotiation would proceed or why it could only be done under an emergency declaration.

A federal declaration might also enable the Trump administration to send public health officials or other federal personnel to local and state agencies overwhelmed by whatever crisis has struck — something that providers in particular say is badly needed.

“To get psychiatrists, counselors, to get primary care providers who are trained in medication assisted treatment is really challenging,” said Louise Reese, the head of the West Virginia Primary Care Association. “If there was one thing that could help West Virginia get out of this situation, it would be some sort of program that would … get more providers into West Virginia. Whether that’s some sort of bonus or expanded loan repayment program, we just really have a significant shortage.”

But not every advocate agrees that a federal disaster declaration would be a positive step.

“Would this administration use a declaration of a national emergency to further an agenda that places at its center health-based solutions, or would it then turn around and say, we have an emergency, we need draconian legislation like sentencing laws, or crackdowns on people who use or misuse opioids?” asked Grant Smith, deputy director at the Drug Policy Alliance. “The latter would be more in line with how the administration has handled its drug policy to date, more than the former.”

One challenge with this crisis is that, no matter the response, it will remain a problem for years to come, experts said. That complicates the process of declaring some sort of emergency because they are often defined by law as short-term bursts of action that require measurable outcomes to determine success. Emergencies are typically single events — a tornado or earthquake — or even a disease outbreak that might take months to control, but not something that researchers can’t envision the end of.

“Frequently when a declaration is being considered, one of the first questions is, how will we know when it’s over?” said Dr. Marissa Levine, Virginia’s health commissioner. The opioid crisis “is a very different type of emergency.”

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  • “pointing to a 24 percent drop in the number of people being prescribed opioids in the state between 2015 and 2017.” ….

    Are they seriously bragging on this? Ever since these tighter restrictions have been passed, they’ve seen an incredible increase in both their suicide rate and their heroin/illicitly-produced fentanyl overdose rate. (This is true for every state that has passed these excessive restrictions). Years ago, addicts abandoned prescription medications because they were no longer willing to jump through all of the hoops and therefore, moved on to heroin. Heroin was (and still is) much easier and cheaper to obtain.

    Now what we’re seeing is humans who are in severe pain either taking their own lives or seeking relief from street substances that have pain-relieving properties. More and more restrictions have only hurt those who are vulnerable and chronically ill, forcing so many of them to suffer pure hell on earth.

    I said this 3 years ago when I learned they were rescheduling hydrocodone to a CSII – heroin overdose rates and suicide rates will literally skyrocket … and look at what’s happening. I suspect we will see even higher rates of this happening. Pretty pathetic and sickening they’re punishing one group for another much smaller group’s actions. These idiot bureaucrats literally have no clue as to what they’re doing, along with making the situation even worse.

    The mere exposure to a substance is not what causes addiction. Just as the mere act of sex is not the “cause” of sex addiction, the mere act of eating is not the “cause” of food addiction, the mere act of shopping is not the “cause” of shopping addiction, the mere act of gambling is not the “cause” of gambling addiction, the mere exposure to a substance is not the “cause” of substance addiction.

    The substance (or activity) of abuse and addiction is merely the main symptom (often a very deadly symptom) of a very complex issue known as addiction. In most, if not all, cases of addiction, it began in a person’s early teen years. While we hear and read the “80% of heroin addicts began with prescription opioids,” the media is leaving the most important aspect of this study out – they began MISUSING and ABUSING prescription opioids in which most were NOT obtained for legitimate medicinal purposes and most usually obtained illegally.

    Most addicts are self-medicating emotional pain, sometimes numbing themselves to traumatic events early in their life, sometimes having an underlying mental illness like clinical depression. There’s no doubt these people are humans, have loved ones who are watching them destroy themselves, and need compassion and treatment options that they can afford and access.

    That being said, that same compassion and tailor-made treatment options should also be applied to those with incurable diseases and inoperable injuries which cause them severe pain that never stops. Punishing one group for another group’s actions is not the answer. Passing excessive restrictions that is making it near impossible for those in severe pain to get adequate pain relief is not the answer.

    People need to wake up and realize that our government and their excessive restrictions on medication which helps relieve pain and suffering is making this much more worse than it already is. Providing adequate treatment options (including medication) for those who wish to recover that are affordable and accessible while providing adequate pain relief options (including medication) for those who are in legitimate severe pain is what needs to be happening.

    • I am sure that addiction historian, William L. (Bill) White would agree with me that the current fuss over opioid deaths reflects that the US public health system is more a political beast than a promoter of citizen health when it comes to addictions. In past decades we just put addicts in prison and they had to create AA and other self-help programs to try to stay out of jail. That did not work. In recent decades, we have seen Reagan’s “Just Say No” cure for addiction, the White House Office of Drug Control Policy encouraging “Lock ’em up” then shifting to “Treat them” to the current policy of “shame the doctors, pharma, anybody but the government” Now they they pretend to throw money at the problem.” Dr. Price was right in opposing this national emergency circus, because it is not part of a well-coordinated program of enhancement, and thus political follow through will evaporate once POTUS starts a war with somebody or creates some other distraction.

  • When the oxy RX ‘s dry out look for fentanyl and other drugs by mail from China to sky rocket. Removing one drug will just move them to another. The problem is addiction not the specific drug. Again not finding the root cause doesn’t solve the problem. I am not trying to be an ass, just wanting us to put our money on actually solving the problem for why so many people are becoming addicted.
    Because it probably is a societal problem it will be very difficult to solve. Our society likes to think of these people as bad people or people who have made a bad choice and should be punished. Addiction is a medical problem not a problem of weak willed people.

    • Molly-
      I agree with you that addiction is a medical problem. Hopefully someone will find the cure for whatever causes that to happen in so many.

    • For Molly and others. The National Institute on Drug Abuse has been searching for a “cure” for addiction for decades. The problem is partly that of unintended consequences. For example, if you stop the neurological effect of opioids, you also risk creating resistance to the pain relief of these drugs when medically necessary, as in surgery, auto accidents, and war wounds.

      It is non-sequitur logic to conclude that addiction stems from physical pain medication per se. Addiction is not a one-size-fits-all event. It is entirely idiosyncratic and is nearly always due to experiencing relief from emotional pain. For example, after the wound in your leg heals, you may still be unemployed and worried about how to support your family. On opioids, emotional pain also can abate.

      Finally, when somebody becomes addicted, it changes how their brain functions. Access to more drug/alcohol becomes an over-riding focus in their lives – work and family responsibilities become irrelevant, and they will continue to engage in self-defeating behaviors just to find toxic substances to appease their craving. Thus, even if you have a syringe with a Clockwork Orange cure for addiction in it, you still have to get the addict to bend over and receive the inoculation. That is not as likely as you might assume.

  • The root cause is not the over prescribing, because people are prescribed opiates every day and just use them as needed PRN and do not become addicted. Something is missing or wrong in people’s lives that makes them continue to take opioids when they have no pain and can get high and to seek more. If you have pain that requires opioids you don’t get high, you get pain relief and often sleepy. Why do they need that high? Many heroin users will say they don’t feel normal without the heroin and they function normally with heroin on board.
    I still suspect our society and culture where money and possessions are key signs of success and the total out of whack difference in the wealth of the rich to the barely surviving poor has grown astronomically.

    • The evidence is very strong that as prescriptions for opioids have gone up in the US so have opioid overdoses and the less focused on but serious problem of opioid abuse disorder.

      The US writes 250 million opioid prescriptions each year. In total and on a per capita basis that makes us an extreme outlier among all countries.

      Please read the study completed at John Hopkins in 2015 called The Opioid Prescription Epidemic an evidenced based analysis.

      While it is true that most people who take opioids can and do stop. But the evidence shows 15-25% of those getting a script will struggle stopping. And even if most who struggle get away from opioids it takes only a small percentage to create an epidemic where over 2 million Americans have long term problems. And that is where we are today.

      The evidence is strong and compelling that one solution to this crisis is to write far fewer opioid prescriptions.

    • Francis, I’m afraid you have a very naïve and simplistic view on addiction. The mere exposure to substances is not the cause of addiction. The act of sex does not cause sex addiction. The act of gambling does not cause gambling addiction. The act of shopping does not cause shopping addiction. The act of taking a sip of alcohol does not cause alcohol addiction.

      Most addicts are self-medicating emotional pain, sometimes numbing themselves from traumatic events that happened to them early in their life, sometimes having an underlying mental illness like clinical depression. Excessively restricting pain relieving medication from those who are in legitimate severe pain does NOTHING to save an addict’s life and instead agitates the situation.

      There are a lot of people who are suffering legitimate physical pain that never stops. These are the same ones who’ve already tried the alternatives, including kratom and mmj (though I am in favor of removing any federal and state bans on these two substances, as I do believe they help some people).

      Forcing one group of humans to suffer for the actions of another much small group is not the answer. Addiction most usually begins early in a person’s teen years, many years prior to obtaining a prescription opioid for legitimate physical pain. The gateway theory is just that – a theory. However, if you want to get technical, alcohol is almost always the very first substance a human abuses. In fact, it still remains the number one intoxicating substance of abuse in this country.

      We’ve watched state after state pass excessive restrictions on the prescribing of opioids. This has done NOTHING but cause harm to vulnerable, chronically-ill humans who merely want to obtain legal, safe (yes, safe when taken as directed) government-approved medication that is properly dosed. These people did NOTHING to cause this, yet they’re the ones being punished.

      I had my 4th dose of medication I’ve been taking as directed with no problems for over 11 years cut just a few months ago. I’ve already tried the alternatives (and in fact, spent a ton of money we didn’t have). The medication is what allows me to work, stay active, get adeqaute sleep, exercise daily (including physical therapy exercises), spend quality time with my family, take care of my house, my family, my yard, and my fur-babies and, most importantly, gave me some quality to my life.

      Now that my 4th dose has been cut, I do nothing on the weekends so that I can save up my medication to take at night when I wake up in pain (which is every night). Whose life did we save by cutting my 4th dose? Not one life. In fact, it’s made my life pure hell. This affects my husband, my son, my widowed mother-in-law and widowed mom, both of which I would run around with on the weekends. How is this fair to me or my family? (BTW this is medication that I keep locked up).

      Punishing one group of people (chronically-ill and in severe pain) for another much smaller group’s actions is not the answer. If you’re complaining about too many doctors prescribing legal, safe (yes, safe when taken as directed) government-approved medication, go visit China, Armenia, and all of those other countries that force their chronically-ill citizens in severe pain to suffer needlessly, including their cancer patients.

      Again, excessive restrictions and outright bans do nothing but create a booming black market. A black market that is utilized by those who have addiction issues. The sad part is now with all of the restrictions, some people in severe pain are faced with two options – suicide or self-medicating their severe pain with substances that possess pain-relieving properties. In other words, these excessive restrictions are forcing many of those in severe pain to desperately seek relief from physical pain using illegal, potentially-harmful substances.

  • I believe this epidemic has its roots in the over prescribing of opioids by often we’ll intended healthcare professionals. This has been fueled by some companies in the pharmaceutical industry who have and continue to make billions.

    Dramatically reducing scripts for opioids is a crucial step even though we know it is not a cure.

    I don’t think we have all of the answers we will need to this very complicated problem. But I do know that denial of the significance of the problem is a mistake.

    In the meantime putting our fingers in the dyke can make a difference. Particularly if it’s 10,000 or 100,000 hands

  • It’s like the tale of Peter and the Dike, putting his fingers in more and more holes, but never finding and fixing the root cause. Is the opioid problem stemming from communities where there is a sense of no hope, no decent jobs, no chance to improve one’s life, feeling the rest of the country is passing them by and no one cares? All of the proposed answers will fail if the root cause of the despair that fuels this need to escape reality are not solved.

  • Alas, there is little empirical evidence that these emergency measures do more than make the public feel like they did “something,” by throwing money at a social problem without thoughtful investment. Secretary Price is right about not joining in the hysteria of white middle-class substance abuse and opioid death. Whether HHS will effectively act to improve matters is another concern.

    Where was there public outrage these past decades when society viewed drug abuse as playful recreation and addiction as a disease limited to minorities and lower-class slackers? Where is the discussion of how recent economic factors may have triggered the increase in reckless drug use – even opioid suicide – among middle class whose futures have been erased by automation and global competition? Perhaps the fix for opioid addiction lies not at HHS but but other agencies such as DOL, Treasury, or SSA to shore up deteriorating social safety nets for those people who feel obsolete and hopeless.

    It is time to have a thoughtful re-examination of US addictions and interventions. Pharmacological overdose interventions far too often just kick the addiction can down the road. Methadone and buprenorphine are effective treatments, but funds for clinic staffing, counseling, and even pharmacological interventions are woefully inadequate.

    It is curios that the media seem to ignore government experts at the National Institute on Drug Abuse and the National institute on Alcohol Abuse and Alcoholism. Have they been muzzled, or is the media more interesting in fanning political flames by seeking out people with extreme opinions (and too often trivial awareness of the research literature)?

    Congress needs to understand that NIH-funded research shows self-sustainable recovery takes 3-5 years (more often 5 than 3) depending on the substances used and genome of the addict. Graduation from treatment is the start of recovery, not the fact of it, as research has shown for decades – repeated relapse is the norm in addictions – including alcoholism. Unfortunately, in addition to inadequate funding for addiction treatments, there has been even less public money available for recovery monitoring, support, and relapse intervention.

  • Of course this is a national health care epidemic which has created an emergency situation. The CDC report at least 91 Americans die each and every day as a result of opioids. In addition the numbers who suffer with opioid abuse disorder is reported to be 2 million or more.

    There are no simple or easy solutions to be had, and this is a long term fight. Step 1 is to recognize the pervasive problems the over prescribing of opioids have created for our nation. An emergency declaration would insure it stay in the headlines and likely prompt more people and more ideas to join the effort at combating one of our largest problems.

    • 91 people per day is not an epidemic…

      This article describes more bad ideas from the people who got us here in the first place

    • Won’t this problem eventually run out of victims? Similar to the end of the Black Death during the Middle Ages. If it’s your family member, it’s a cold attitude, but in terms of cost to society at large, I believe the problem will eventually die out.

    • Comment on Juan’s remark: Juan, I suggest you read William L. White’s book “Slaying the Dragon” which is a very readable scholarly review of addictions over the history of mankind. Addictions DO NOT die out like the Black Death. In fact, plagues do not die out either – we just develop immunities and change our behaviors to safer ones.

      Addictions have always been part of the human scene probably because there has always been pain and catastrophes in people’s lives that attract them to alcohol and drugs as an escape. Once people start regularly drinking or drugging to excess, their bodies’ homeostatic set points change the way their brains function in order to accommodate to the toxic effects of alcohol and drugs. Over time, people become chemically dependent alcoholics and addicts.

      Once that set-point changes to accommodate regular consumption of toxins (alcohol and/or drugs), it takes 3-5 years of abstaining for the brain to help the body to re-adjust. That is one of the reasons why pharmacological interventions like methadone and buprenorphine offer a helpful method for eliminating brain symptoms that result in poverty and homelessness, and thereby enable people to restore their pre-addiction lives. Of course, withdrawal from those medications will initiate homeostatic changes that often create some physical withdrawal symptoms, and recovering addicts will undergo a period of craving drugs while their nervous systems gradually re-adjust over the next 3-5 years. It is not uncommon for recovering addicts to remain on methadone or other opioid or opiate agonists for decades while they rebuild their lives to a point where they are willing to pursue an abstinent life once again.

    • Francis, what do you suggest doing about the 100,000 plus deaths that alcohol contributes to each year in this country while still remaining the number one intoxicating substance of abuse and addiction? How about the 480,000 plus deaths that cigarettes contribute annually in the US?

      Two legal substances with no medicinal value that our government profits from and which contribute to over half a million deaths each year in this country … That’s over 1,589 deaths each DAY in this country … *crickets* … Amazing how our government picks its epidemics, isn’t it?

      (For the record, I do not agree with further restrictions, bans or higher taxes on tobacco and alcohol. There’s no doubt that those with addiction issues need affordable, accessible treatment options and should be dealt with in a compassionate manner, including support for their loved ones. That being said, I’m merely pointing out the pure hypocrisy and double standard of our government, media and society in general.)

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