W

ASHINGTON — 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.

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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.”

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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.

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  • The Phony War on Drugs
    George Meredith MD

    Ah, more on the phony war on drugs! American electronic media continues to publish in support of the central government’s phony war on drugs. Interestingly, contrary to the electronic media’s propaganda presentations, are the little people’s responses to to this hog wash, . Who gave government a license to practice medicine, anyway?

    If only all the little people could be made to believe this drivel. Consider: fifty nine percent of the 2.4 million US prisoners are incarcerated because of drug related “crimes”

    Ninety five percent of the readers comments to the Virginian Pilot re: a recent piece on the (phony) war on drugs went like this:

    Failing attempts to regulate behavior drive up street prices, fund violence world-wide, and incarcerate tens of thousands of non-violent offenders while working to create and equip violent distributors. Check who funds the politicians who vote for longer sentences…a good bit of their money comes from the prison industries, the companies who build and operate prisons.

    The promotion of prison building as a job creator and the use of inmate labor are key elements of the prison industrial complex. The term often implies a network of actors who are motivated by making profits, rather than solely by punishing or rehabilitating criminals or reducing crime rates.

    Millions of dollars spent just locally, in paying police, dogs, lawyers, judges, and prisons, to put people in prison perhaps for life (!!), for buying and selling and smoking a plant that grows naturally in the earth

    Every time I read these kinds of stories in the Pilot, it just enrages me that our government spends millions of dollars of our tax money on basically violating the very citizens they are sworn to protect. The politicians and police who engage in this kind of activity are the ones who deserve life in prison.

    High prices create crime. Before 1923 you could go into any corner drug store and get heroin and cocaine over the counter without a prescription, manufactured by big phama. This article’s comments run 95% to end the war on drugs

    Over twenty years ago, the old Virginian Pilot brought down one wannabe president, cocaine addict Chuck Robb. And his goodtime, coke snorting, drug wholesaling pals. But that was then…

    Anyway, drugs will continue to be illegal, and the dog will continue chasing his tail, as long as it is profitable for lawyers and banks, and it keeps the court system and law enforcement entities employed. These stories of once in a while success by police departments are laughable.

    Of time, money and resources. The Government is full of total idiots
    Drug enforcement is nothing more than a treasure hunt in the guise of police protection. The thrill of an every bust now hinges on the seizure of personal property and assets

    The fact of the matter is that it’s very enforcement increases crime and supports an industry of jobs centered on incarceration of US citizens
    The ones that should spend the rest of their lives in prison are the ones who have thrust this phony war on drugs upon the American People.

    The horribly corrupt politicians (past and present): Richard Nixon, Hillary Clinton, Oliver North, GHW Bush and Kathleen Sebelius.

    And the corrupt Judges who looked the other way: including Raymond Jackson, J Harvie Wilkinson, Paul Niemeyer, Monte Belot, GE Tidwell, Barry Bennington and a host of others.

    And all those corrupt, complaisant government lawyers, including Alan Bersin, Paul McNulty, Eric Holder, Janet Reno, and hundreds of others..

    And the American drug kingpins: George Sorus, Don Tyson, Jackson Stevens, Steven Bresky and many others.

    George Meredith MD
    Virginia Beach

  • What about the National emergency of the chronic pain disease patients? Where is the compassion, respect, caring and empathy for millions of Americans who have chronic incurable pain?
    The emergency should be for the manufacturing, importation and distribution of illegal opioids, heroin and illegal fentanyl coming into this country. Instead the target is easy, physicians and patients with chronic diseases that cause debilitating, excruciating pain. Making us live a life not worth living. Making our families and friends suffer along with us.
    There is compassion for the addict, who makes it a choice to use. We are patients who have no other options left but to rely on opioid medications to relieve our pain, for even a short amount of time. Instead we are being punished because of the addicts.

    These Government agencies are fighting chronic pain disease patients. We use legitimate prescription medications for diseases that cause us debilitating excruciating pain. The crisis is that they are targeting CHRONIC PAIN PATIENTS and the physicians that have enough compassion and empathy too treat us. Chronic pain is now the epidemic. We are being caterogized and descriminated against for a medication we require to reduce our pain. No other chronic disease patient is targeted for their use of prescription medication.
    What about the good of opioid medications. They are lifesaving medications for millions of Americans who live in constant, debilitating, chronic pain.
    Though the number of prescribed opioids are down, the overdose deaths are “reportedly, at an all time high”. So this system is not working.
    When a death does occur, there is no specific testing as to what opioid drugs attibuted to the death. Whether there were other drugs or alcohol in the system or whether the specific “medication” was for that individual. Was it illegally manufactured and distributed heroin, fentynal or carfentynal.
    The misuse of medication by legitimate chronic pain disease patients is .02-.6 %. It is use of illegal opioids and misuse of legal opioid medications that lead to addiction and/or death.
    The FDA, DEA, CDC and all other Government agencies need to go after the illegal fentynal and heroin producers and manufacturers, also, methamphetamine, cocaine and all other illegal drugs.
    Why is it that our physicians are no longer able to Doctor and treat us? Why is it that these agencies can now Doctor us and practice medicine without a medical license? What has happened to Doctor/patient confidentiality. It no longer excists. Pharmacists, insurance companies and these Government agencies are now able to decide what us patients actually need when it comes to our medications. They are policing our physicians. It is up to our physicians to treat us adequately and humanely with medication so many of us desperately need for our disease.
    This targeting is wrong! It is discrimination against legitimate chronic pain disease patients who use our MEDICATION responsibly.
    We pain disease patients are not addicts, we are PATIENTS, with incurable diseases. Medications are readily available to us for our conditions that happen to fall into the same category as the illegal drugs. Not treating us chronic pain disease patients is inhumane and discriminatory.
    The words used in news papers or on the news stations is “opioids”, why not specify? What should be used is heroin or illegal fentynal. These illegal drugs are being smuggled into this country by the boatload. It’s too difficult for the DEA to actually catch and prosecute these individuals. Us patients and our physicians are easy targets for prosecution. This is a war on us in need. We patients who are in pain. We deserve relief. Our physicians deserve to treat us as they see fit without threat of prosecution for doing their jobs and treating us with care, empathy, respect and caring.

  • It has been 78 days from the first time Trump said he would declared opioid crisis a national emergency. Federal effort against the opioid epidemic that is claiming 91 lives a day in the nation. What is he waiting for!!!!!!!!!!!!!!

  • Tom Marion should be in prison. He has the blood of tens of thousands of opioid overdose victims on his hands. What needs to happen now is repeal “Marino’s Law.
    This is what trump tweet about him, Tom is a fine man and a great Congressman! The industry worked behind the scenes with lobbyists and key members of Congress, pouring more than a million dollars into their election spent years trying to move the law through Congress. It passed after Sen. Orrin G. Hatch (R-Utah) negotiated a final version.
    Political action committees representing the industry contributed at least $1.5 million to the 23 lawmakers who sponsored or co-sponsored four versions of the bill, including nearly $100,000 to Marino and $177,000 to Hatch. Overall, the drug industry spent $102 million lobbying Congress on the bill and other legislation between 2014 and 2016, according to lobbying reports. So the first business for Trump should be to sign an executive order to repeal Marino H.R.4709 and let the DEA do their job. I would like to thank Joseph T. Rannazzisi, He should be the next drug czar.

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