WASHINGTON — The Trump administration is poised to declare the opioid epidemic a national emergency on Thursday, following through on a recommendation made nearly three months ago by a special White House commission tasked with addressing the crisis.
President Trump pledged on Oct. 16 to make such a declaration this week, and at a hearing on Wednesday, members of Congress outlined their expectation for Trump to declare the opioid crisis a national emergency the following day. An email from the Office of National Drug Control Policy obtained by STAT also invited a number of drug policy stakeholders to a Thursday afternoon “event on the nationwide opioid crisis” on the president’s behalf.
Public health experts expect the declaration to free federal resources to help stock adequate quantities of overdose reversal drugs, expand capacity for treating substance use disorder, and create financial incentives for health providers to better conform to industry standards of care like prescribing medication-assisted treatment.
Addiction treatment advocates, however, cautioned that the declaration could prove toothless if the White House or Congress do not provide sufficient resources to implement the plan.
“It will be as meaningful as the resources being redirected,” said Dr. Joe Parks, the medical director for the National Council for Behavioral Health. “There’s not a lot of discretionary money that isn’t already committed.”
A group of Senate Democrats responded preemptively to that challenge on Wednesday, unveiling legislation that would provide $45 billion over the next decade for addiction treatment and prevention initiatives, including an annual fund of nearly $4.5 billion for state programs and a $50 million annual appropriation for the National Institutes of Health.
Parks said he hopes the emergency declaration will bring about changes to laws preventing prescription of medication-assisted treatment via telemedicine; incentivize the use of MAT combined with counseling at facilities that receive Medicaid reimbursements; and increase access to the overdose reversal drug naloxone. He and other experts also said they hoped to see tweaks to the IMD exclusion, which prevents addiction treatment facilities with more than 16 beds from receiving reimbursements from Medicaid.
“The emergency declaration should include guidance to ensure medication-assisted treatment is available for all Americans overcoming an opioid use disorder,” said Gary Mendell, the CEO of the addiction treatment advocacy group Shatterproof. “We also must provide naloxone everywhere there is a fire extinguisher.”
Both Parks and Mendell have testified before the president’s commission on the opioid crisis, before the release of the interim report recommending a public health emergency declaration.
Pressure had built for the White House to declare an emergency declaration since a back-and-forth between Trump and his former health secretary, Tom Price. In recent weeks, members of Congress from both parties have urged Trump in writing to follow through on delivering the declaration.
Prior to his resignation in September, Price had said he believed the Department of Health and Human Services was capable of addressing the public health crisis without issuing an emergency declaration. But in the days following those comments, Trump indicated he would issue one, a pledge he re-upped last week.
Price’s resignation and the absence of a permanent director at the Office of National Drug Control Policy mean the declaration comes despite current vacancies atop two administration agencies central to shaping drug and addiction treatment policy.
Trump has not yet nominated a new health secretary, though Eric Hargan, a recent appointee, is running the department until a new secretary is confirmed. Under Price, HHS has declared public health emergencies following hurricanes in Texas, Florida, and Puerto Rico and the U.S. Virgin Islands, and played a key role handling logistics and delivering emergency care.
Trump has also not selected a new nominee to lead the Office of National Drug Control Policy following the withdrawal of Rep. Tom Marino (R-Pa.), though the acting ONDCP director, Richard Baum, controls the administrative aspects of the president’s opioids commission.
That commission is also set to unveil its final report on Nov. 1. Bertha Madras, a member of that panel and a possible candidate for the national “drug czar” job, has been tasked with drafting that document. An interim report in July that first recommended the emergency for the “drug czar” came largely from Gov. Chris Christie and his staff.
Six states — Maryland, Massachusetts, Alaska, Arizona, Virginia, and Florida — have used various emergency or disaster declarations in recent years to free up new funding sources, implement new guidelines for prescribing, and expand access to naloxone.