Opioid abuse is a crisis, but is it an emergency?
That's the question gripping Washington after President Trump's Commission on Combating Drug Addiction and the Opioid Crisis recommended that the president declare the epidemic a national emergency.
"We're going to get it taken care of," he said.
Later that day, Health and Human Services Secretary Tom Price backed off from the need for an emergency declaration.
"We believe that, at this point, that the resources that we need, or the focus that we need to bring to bear to the opioid crisis can be addressed without the declaration of an emergency," he said, adding that the option was still on the table.
On Thursday, the president availed himself of that option.
"The opioid crisis is an emergency, and I'm saying officially right now: It is an emergency," Trump said at an impromptu press briefing at his golf club in Bedminster, N.J.
The White House followed up with a press release saying the president "has instructed his Administration to use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic."
So while the president has announced an emergency, he and his administration haven't formally declared one – a process that comes with specific legal authority and brings specific sets of powers and access to money.
You can see a series of formal public health emergency declarations here.
If the president does move ahead and declare the opioid crisis an emergency, here's what could happen.
1. FEMA money could be available to states.
The president could use authority under the Stafford Act to declare an emergency. That would open up resources that are usually reserved for natural disasters like hurricanes or floods, including FEMA's disaster relief fund, which had about $1.5 billion available as of July.
2. Public health workers could be redeployed.
The president could ask HHS Secretary Price to declare an emergency under the Public Health Service Act. Unlike FEMA, HHS doesn't have a standing emergency fund (although during last year's Zika virus scare, many people urged that one be established), but money could be freed up. Right now, public health workers and researchers are working on projects defined by grants from HHS. If Price were to declare an emergency, those workers could be redeployed temporarily, from working on AIDS outreach for example, to work on substance abuse issues.
3. Access to medication-assisted treatment could get a boost.
In a public health emergency, the HHS secretary could make it easier to get medications to counter addiction. For example, Price could allow "standing orders" for the drug naloxone, used to reverse overdoses, which would allow certain populations to get the medication without a prescription. He could also waive the restrictions on doctors who want to administer methadone or buprenorphine to patients with opioid addictions. Those medications currently require a prescribing doctor to have special certification, and there are limits to the number of people doctors can treat.
4. Medicaid could pay for more treatment.
A public health emergency would also allow HHS to waive certain regulations. One major target could be a rule that restricts where Medicaid patients can get inpatient drug treatment. If HHS waived that rule, then Medicaid beneficiaries might find it easier to get treatment.
5. Congress could appropriate money.
Congress doesn't need an emergency declaration to appropriate money for more drug treatment and intervention. But if the Trump administration were to issue such an order, it would put a lot of pressure on Congress to back it up with money. Last year, lawmakers passed a law to address addiction issues but refused to include $1.1 billion that President Barack Obama requested to expand treatment programs.
6. States could request aid.
Six states have already declared opioid emergencies. A federal emergency could open up paths for those states to request federal grants for specific purposes. Maryland, for example, has a tool that tracks overdoses in real time so emergency responders can identify where particularly potent synthetic opioids may be on the streets. Federal money could potentially allow other states to follow suit.
AILSA CHANG, HOST:
Yesterday before his security briefing in Bedminster, N.J., President Trump made an unexpected announcement.
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PRESIDENT DONALD TRUMP: The opioid crisis is an emergency. And I'm saying officially right now it is an emergency.
CHANG: The president said paperwork still needs to be done to make it officially a national emergency. This was a change, of course, from earlier this week when Health Secretary Tom Price held off on making that declaration. We have NPR health policy correspondent Alison Kodjak in the studio now to talk us through all of this. Hi, Alison.
ALISON KODJAK, BYLINE: Hi, Ailsa.
CHANG: OK. So this was a recommendation from a presidential commission studying this issue. And it looked like the White House was not going to accept that recommendation. Now it looks like the president wants opioids declared a national emergency. What is going on?
KODJAK: Well - so what the president's done now is he's said it out loud. He's setting a tone for his administration - the states to follow - that they're going to put this front and center. What would be the next step is to formally declare an emergency, which comes with legal authority and gives the government some emergency powers and money for a limited time. We'll see if that's what he actually - this next step he takes.
CHANG: That's the substantive difference in declaring something - this epidemic - a national emergency, money. Is that the main substantive difference?
KODJAK: Well, there's both. It can unlock money. And it can allow the government to waive regulations and give them additional powers. So for example, they could get money from FEMA if they took that route to give to the states to respond to the crisis. Or, you know, there are state public health workers who right now are working under federal grants on AIDS or diabetes. They can't work on anything else. But if they declared this emergency, the states could redeploy them to respond to substance abuse problems or overdoses.
CHANG: Oh. So there might be more resources for treatment. But President Trump has also talked a lot about law enforcement getting more resources. What bigger role can law enforcement play in all of this?
KODJAK: Well - so here's the issue with this addiction crisis. It often starts with prescription drugs - doctors prescribing opioids for pain or something. But what happens when - people progress to more potent street drugs. So that can be heroin. So there's obviously a role for law enforcement to deal with heroin, you know, dealers, street issues. There's also these new, really potent opioid pills, Fentanyl and...
CHANG: Synthetic opioids.
KODJAK: Synthetic opioids. And one is called carfentanil that law enforcement has been seeing across the country. This is actually an animal - large animal tranquilizer used on things like elephants.
KODJAK: And these are where the real overdoses are happening - people taking these drugs. And so there's a role of law enforcement in trying to keep these out of the country and finding them on the street and who's dealing them.
CHANG: I understand several states have already gone ahead and declared the opioid problem an emergency. What has that meant for them so far?
KODJAK: So states have some powers when they do this. So in Maryland, for example, they make it easier for people to be able to use and prescribe and get a hold of naloxone, which is the drug that can reverse an overdose. If somebody stopped breathing, this will actually start them breathing again. And they also are able to monitor overdoses in real time. They can see where the problems are day to day and respond to those areas and really can get on the case. What they don't have right now is additional money from the federal government. And so that's what the federal response could be - giving them money for treatment beds, for substance abuse, education, things like that.
CHANG: So the communities that are hit hardest by opioid abuse - are they likely to get all they need even with a declared national emergency?
KODJAK: Well, we're getting some mixed messages on that because right now, what they say they need is more treatment beds, more money to answer - to respond to substance abuse issues. But the president's budget actually cuts the Department of Health and Human Services by quite a lot. So unless this brings additional appropriations for substance abuse treatment and response in those communities, it may not actually give them what they need.
CHANG: OK. NPR health policy correspondent Alison Kodjak. Thank you so much for coming in this morning.
KODJAK: Thank you, Ailsa.
(SOUNDBITE OF ILLA J SONG, "R U LISTENIN'?") Transcript provided by NPR, Copyright NPR.