Understanding Trump's Opioid Plan

National emergency declared: What are the new tools for fighting the epidemic, and how will they be used?

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On October 26th, President Trump made good on a campaign promise and took action on the opioid epidemic. The added attention given to the issue has been cheered across the board, but the plan which was actually enacted is getting mixed reviews.

Opioids killed 59,000 people in 2016, making them responsible for nearly as many deaths as car crashes. It has been part of the public consciousness for years and played a large part in the 2016 election cycle.

Let’s take a look at how the President is choosing to address the epidemic.

The Facts

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In March of this year, President Trump called for the creation of an “opioid commission” led by Governor Chris Christie of New Jersey. The commission’s goal was to gather information, deliberate on how to best solve the crisis, and make a recommendation to the President.

In July, the commission decided a national emergency should be declared, in one of two ways. The first way was via the Stafford Act, which makes FEMA funds -- money usually used for tornado or hurricane disaster relief -- available for any opioid-battling measures. The other choice was declaring the emergency under the Public Health Service Act, a less drastic plan which does not make FEMA money accessible for opioid programs.

The Trump administration has been vocally cautious of making an open-ended commitment of major federal funds to such a long-term project, so the President chose the latter option, instructing acting Health Secretary Eric D. Hargen to announce a “public health crisis”. The declaration has opened the door for more federal involvement in battling the opioid epidemic, but some believe it doesn’t go nearly far enough.

The Good

While Trump’s decision to declare the emergency under the Public Health Service Act instead of the Stafford Act takes FEMA funds out of the picture, it does pave the way for a serious federal plan to unfold.

According to a solid NYT article covering the announcement, the current course of action:

  • Allows the Department of Labor to award federal grant money to families most economically impacted by the epidemic

  • Permits the hiring of specialists to tackle the crisis (think: “Opioid Czar”)

  • Expands telemedicine to treat people in rural areas, where addiction is most prevalent and doctors are most scarce

  • Requires that federally employed opioid prescribers be trained in safe prescription practices

  • Kicks off a new federal initiative to develop non-addictive painkillers

  • Intensifies efforts to block shipments of fentanyl (a synthetic drug 50x stronger than traditional opioids) coming from China.

Finally, he’s promised to allow Medicaid to fund more drug rehabilitation facilities, suspending an obscure rule still on the books.

Patrice Harris, Chairwoman of the American Medical Association’s opioid task force, called the declaration “a move that will offer needed flexibility and help direct attention to opioid-ravaged communities.”

The Not So Good

While some are happy to see any progress being made in the opioid battle on the federal level, others are criticizing the President’s actions, arguing that they are merely lip service and fall short of creating lasting change.

Funding

The most glaring issue with declaring a national emergency under the Public Health Service Act is the aforementioned lack of access to FEMA dollars. Various Democratic politicians, including Democratic Senator Edward J. Markey (D-MA), have denounced the declaration as a “half-measure” and “a Band-Aid when we need a tourniquet.”

Andrew Kolodny of the Heller School for Social Policy and Management at Brandeis University believes that only a “substantial commitment of federal money and a clear strategy for overhauling the way the country treats addiction” will make a dent in the crisis.

Opportunity for inaction

In response to accusations of inaction, the administration often deflects by insisting they’re working with Congress to obtain money to battle the crisis. However, Congress’ best attempt at true federal commitment was a $45 billion stipend for opioid abuse programs. The inclusion of the opioid amendment was an excitement to many in the opioid fight, but it was attached to an unpassable Obamacare repeal bill, which fell flat on its face months ago. Since then, Congress has allocated $1 billion for opioid programs over the next two years, but most everyone acknowledges that’s not enough.

Another gray area in the Trump plan is the Department of Health and Human Services’ intention to negotiate lower prices for naloxone, the drug which saves people mid-overdose. Naloxone currently runs at $70-$90 dollars for a two-pack, putting a major strain on the budgets of emergency responders in opioid hotbeds.

The new plan gives the HHS the ability to renegotiate naloxone prices for government use, but no such actions have been taken to date. Any bold action will be especially difficult considering the administration’s slow start on the staffing of government agencies across the board (a problem which Trump promised to remedy in his announcement, but an “opioid czar” has yet to be selected).

Messaging

During the Oval Office announcement of the new national emergency, President Trump told reporters about his personal experience with addiction. Trump’s brother, Fred, died due to alcohol-related complications. President Trump said “I learned because of Fred; I learned.”

He went on to state, “This was an idea that I had, where if we can teach young people not to take drugs, it’s really, really easy not to take them.”

This messaging surely doesn’t resonate with the 20.5 million Americans with a substance use disorder, including 2 million people with prescription pain relief addictions or 591,000 people addicted to heroine. These are the people in need of the most help, and the President’s words downplay their battle against addiction and devalue their daily struggles.

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The emergency declaration is a good step toward a real federal commitment to defeating the opioid epidemic. Industry leaders are happy to see the added attention that comes with a presidential press conference. Unfortunately, the measures themselves are difficult to quantify and leave space for the administration to drag their feet. As stated before, this measure paves the way to relief, but the government appears to be providing a cobblestone side street where a freeway is desperately needed.

Hopefully this declaration is just the first step, because we have a long way to go in the battle against addiction.

James Crater