WASHINGTON — Despite President Trump’s announcement that the opioid crisis is “a national emergency” two weeks ago, there has been no formal declaration from the administration.
At the time, Trump said, “we’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis. It is a serious problem the likes of which we have never had.”
His statements came just days after a White House commission on opioids, headed by New Jersey Gov. Chris Christie, said in a draft report, “The first and most urgent recommendation of this Commission is direct and completely within your control. Declare a national emergency under either the Public Health Service Act or the Stafford Act.”
No formal declaration
The Public Health Services Act gives the Department of Health and Human Services broader authority in tackling a public health emergency, such as last year when Zika was declared a public health emergency in Puerto Rico.
Yet two weeks later, no formal declaration about opioids has been made. “The President is considering not just the emergency authorities outlined in the report, but other potential options as well, to ensure we’re doing all that we can to tackle this crisis head on,” a White House spokesman said. “The President recently instructed his administration to take all appropriate and emergency measures to confront the opioid crisis. Right now these actions are undergoing a legal review.”
The White House also confirmed that the administration will declare a formal state of emergency but would not elaborate on when. “We are declaring one but we are considering which option to use to declare one,” the spokesman said.
It’s unusual to have a lapse between an announcement like the President’s and a formal declaration.
“I’m no historian who’s studied all of these instances, but typically, the paperwork and the specifics are drawn up before public announcements are made,” said Dr. Jay Butler, president of the Association of State and Territorial Health Officials, a consortium of senior public health officials from all 50 states, US territories and the District of Columbia that provides guidance and support to state health departments.
Six states have declared a state of emergency over the opioid crisis: Alaska, Arizona, Florida, Virginia, Maryland and Massachusetts.
28 ongoing national emergencies
The National Emergencies Act of 1974 outlines how a president can activate special statutory power during a crisis. Under the statute, an national emergency automatically expires every year unless it is renewed. Currently, there are 28 active national emergencies, none of them related to public health. The last health-related national emergency was declared by former President Barack Obama in regards to swine flu in 2009.
But declaring the opioid crisis a national emergency doesn’t automatically grant access to emergency funds. Public health-related emergencies are typically declared using the Public Health Services Act, Butler said. Though this act gives both the president and the secretary of health and human services some broad latitude, such as reassigning federal staff members and providing waivers on how federal funds can be used, it doesn’t open up emergency funds.
“There is no pot of money waiting to be tapped the way there is for a Stafford Act declaration,” Butler said.
But Butler says that just because there isn’t a pot of money attached to the Public Health Services Act, it doesn’t mean a national emergency declaration can’t authorize funds to be used to fight the opioid epidemic. In addition, he says, the act can be key in implementing some of the recommendations in the commission’s interim report, such as changes to Medicaid reimbursement for treatment that is currently available only to facilities with 16 beds or fewer and expanding access to medically assisted treatment, considered the gold standard of opioid addiction treatment.
142 Americans die every day from drug overdose
The opioid crisis’ mounting toll is staggering. More people die of drug overdoses — including both prescription painkillers like oxycodone and hydrocodone and illicit drugs like heroin and fentanyl — than from guns or car accidents. According to the US Centers for Disease Control and Prevention, drug overdoses are the leading cause of unintentional death in the United States.
The President’s opioid commission says that about 142 Americans die every day from a drug overdose, equal to the death toll from the September 11 attacks every three weeks. Most of those overdoses are from opioids.
Though there were over 30,000 fatal overdoses from opioids in 2015, public health experts believe that for every fatal overdose, there are 30 non-fatal overdoses. That would mean over 900,000 overdoses in 2015 alone.
Butler says that the opioid crisis is a priority for every state. “Things are happening in all of the states right now, and those activities are going to continue. They’re oftentimes being done at the expense of other things,” he said.
But he added that the federal government has been a partner in this effort. “I want to be very clear, regardless what the future is or what this emergency declaration means, the feds have been very supportive.”