The president’s Commission on Combating Drug Addiction and the Opioid Crisis called on President Trump Monday to declare a public health emergency over the epidemic of overdose deaths nationwide. This urgency came in an interim report by the commission that was itself more than a month late.
Per Trump’s executive order establishing the commission, interim recommendations were due June 27, with a final report October 1. The bipartisan commission, led by Republican New Jersey Gov. Chris Christie, delayed the report twice before finally issuing it July 31. On a conference call, Christie cited 8,000 public comments as the “driver behind us delaying the report … so we could take [them] into account.”
A declaration of emergency would allow the secretary of health and human services to place affected populations on Medicare insurance and reduce the price of necessary prescription drugs, and would allow waivers of several regulatory measures around patient privacy and reporting requirements.
Declaring an emergency would also trigger access to the Public Health Emergency Fund to make grants, sign contracts, and support investigations into prevention and treatment. Unfortunately, as of last year that fund held just $57,000. Congress would need to appropriate more money; the commission report states that a declaration of emergency “would force Congress to focus on funding.”
Joshua Sharfstein, associate dean for public health practice and training at the Johns Hopkins Bloomberg School of Public Health, believes such a declaration would be useful. “There are some mechanisms by which an emergency declaration could lead to a more rapid expansion of access to effective treatment,” he told The Intercept. “That could certainly save lives.”
It’s unclear whether the Trump administration will accept the recommendations, however, or continue to stall on fighting opioid abuse.
On July 18, Senate Democrats condemned the delay in federal action amid a crisis that claimed over 33,000 lives last year. Drug overdoses now serve as the leading cause of death for Americans under 50. On the Monday conference call, Commission Chair Christie described the death toll as the size of “a September 11 every three weeks.”
Senate Democrats asked the Office of National Drug Control Policy (ONDCP) to revisit a surgeon general’s report released last November. That report endorsed enhanced access to Medication-Assisted Treatment (MAT), ready availability of the overdose-reversing medication naloxone (with legal protections for emergency prescribers), community-based treatment programs, continuing education training for providers, and better sharing of substance abuse information.
All of those are key recommendations in the opioid commission’s interim report, including everything from equipping all law enforcement personnel with naloxone to MAT research partnerships between drug companies and the National Institutes of Health. The surgeon general’s report has mostly sat on a shelf for eight months.
In other words, potential solutions to at least slow down the crisis are available and known, but political will has been lacking.
The interim report’s focus on MAT contrasts with the administration’s top health official, HHS Secretary Tom Price, who offered skepticism of the practice on a listening tour in May. Joining the public health consensus, the commission leaned heavily into MAT, asking for funding for more access to treatment (only one in 10 opioid addicts are in some kind of drug-assisted program) and supplying all types of MAT at licensed facilities. “MAT has proven to reduce overdose deaths, retain persons in treatment, decrease use of heroin, reduce relapse, and prevent spread of infectious disease,” the report argues.
Spurred on by commission member and former Congressman Patrick Kennedy, D-R.I., the report also asks the secretary of labor to strongly enforce mental health parity laws, so insurers support substance abuse treatments as favorably as other ailments. The commission endorsed data sharing between state-based prescription drug monitoring programs. And it waded into a long-running controversy over Medicaid funding at specialized psychiatric or substance abuse treatment facilities with more than 16 beds. The commission wants immediate waivers to open these facilities to Medicaid patients.
Other recommendations hew closer to the traditional Republican focus on interdiction. The commission supported development of detection sensors for fentanyl, the deadly opioid that has grown in prominence recently, and a crackdown on entry of the drug from China. But they did not take the kind of punitive approach to addicts that characterizes the Justice Department’s current rhetoric. “Law enforcement knows we cannot arrest our way out of this problem,” said North Carolina Gov.Roy Cooper, a Democrat and commission member.
Meanwhile, the Trump administration’s high-profile efforts to roll back public health programs, while at the same time highlighting opioid sufferers in need, creates a troubling juxtaposition.
“The opioid crisis has become a shiny ornament,” said Harold Pollack, a professor in public health at the University of Chicago. “Everything else the administration is doing is making it harder to address the crisis.”
For example, the administration has proposed a whopping 95 percent reduction to the ONDCP’s budget. They’ve called for huge cuts to the NIH and the Centers for Disease Control, major partners in the fight against opioid abuse, as well as $400 million in reductions to the Substance Abuse and Mental Health Services Administration.
Furthermore, Republicans spent several months trying to slash Medicaid, which pays for one in four prescriptions for addiction treatments like buprenorphine, and as many as one in two in states like Ohio. “It clearly is not the right time to roll back the Medicaid expansion and cut hundreds of millions of dollars from the program,” said Sharfstein.
Despite the high profile of the commission, overall the Trump administration has done nothing of substance on the opioid crisis, failing to fill key appointments and delivering mostly talk. Meanwhile, Sen. Claire McCaskill, D-Mo., has undertaken an expansive investigation into the companies profiting from the opioid epidemic, including issuing subpoenas to leading drug companies and distributors and looking into company marketing. The commission had little to say about disrupting the supply of opioids and punishing companies who sell them, although Christie did point out that “in 2015 we prescribed enough opioids to have everyone in America fully medicated for three weeks.”
“The recommendations are good, but it’s so depressing that we can’t approach this in a stable environment where we’re methodically pursuing evidence-based policies all the time,” said Pollack. “The commission is being used as a substitute for what we need to do across a range of public health policy.”
You can follow the progress of President Trump’s opioid commission and all his other demands on federal agencies at our executive order deadline tracker: