(WASHINGTON) — When President Trump told reporters that the opioid crisis is a “national emergency” and he would be officially declaring it as such, he raised a point experts have echoed for months.
The opioid epidemic is a critical emergency on a national scale, the experts agree, but does a proper solution involve a declaration from the White House similar to ones surrounding major hurricanes or virus outbreaks? That’s the question gripping academics and policy makers alike.
To explore what declaring the country’s first national emergency for a drug crisis means and what it could accomplish, ABC News reached out to academics, drug policy experts and former officials with intimate knowledge of public health and national emergency policy.
Experts agree that prescription opioids like oxycodone and hydrocodone serve a critical role in modern medicine, but often point towards statistics from the Centers for Disease Control suggesting a possible over prescription of the drugs, leading to widespread use of synthetic and illegal variations like heroin and fentanyl.
The amount of prescription opioids legally sold nearly quadrupled from 1999 to 2010, despite no change in the amount of pain that Americans reported. Today, drug overdose is the leading cause of accidental death in the United States — the majority of those lethal episodes involve an opioid.
President Trump made the crisis a primary talking point during his campaign for the White House and two months have his inauguration, he signed an Executive Order launching a commission led by New Jersey Gov. Chris Christie to explore ways to curb opioid abuse and overdoses.
The first report from the commission gave the president a frank recommendation: “declare a national emergency.”
Several experts said such a decision would be “unprecedented.” These declarations have typically been reserved for natural disasters, infectious diseases and terrorist events.
To find any kind of precedent, Dr. Rebecca Haffajee an assistant professor at the University of Michigan’s Department of Health Management and Policy, says you have to look at the six states that individually declared states of emergency for the opioid epidemic. According to Haffajee however, the circumstances under which they can be declared and how they define an emergency vary.
As the states have different methods of declaring an emergency, so, too, does the federal government.
Experts say there are two ways the White House can declare a national emergency on a drug crisis: under the Stafford Act or the the Public Health Service Act.
The Stafford Act opens up federal resources such as FEMA’s Disaster Relief Fund — usually employed for natural disaster such as Hurricane Maria and Harvey. This gives federal agencies the authority to cut red tape hindering recovery missions. Requests for funding from the Disaster Relief Fund come from a governor who claims the circumstances has overwhelmed his or her state’s resources.
According to a FEMA spokesperson, the fund currently has $4.28 billion. The House passed legislation last week to add $18.7 billion. The Senate could take an initial vote on the measure on Monday.
Rafael Lemaitre, former communications director for the White House Drug Policy Office during the Obama administration and former FEMA director of public affairs, told ABC News “declaring a national emergency is not a silver bullet solution to the opioid crisis.”
Lemaitre said the traditional form of declaring an emergency is usually reserved for natural disasters and terrorist attacks — events that have a finite period of time in which they occur.
There is generally a point after these events when a community has recovered and the resources provided from the Disaster Relief Fund can gradually decline.
“How do you declare an end of this emergency? When you have half as many overdoses every year? Is it when you reduce it by 25? This is not going to end any time in the near future.”
Lemaitre said the the option of tapping into FEMA’s multi-billion dollar pot of money sounds enticing, but the White House needs to work with Congress to pass “its own set of comprehensive tools and funding sources to address this crisis.”
Tapping into the Disaster Relief Fund for an indefinite period of time could drain the dedicated savings and leave the nation unprepared for the next catastrophic natural disaster like Hurricanes Harvey or Maria, Lemairte said.
If President Trump fulfills his repeated promise to declare a national emergency (he made a similar pledge in August), Lemaitre believes he will most likely do so through the Public Health Service Act.
The president can ask the acting-Secretary of Health and Human Services (Tom Price resigned on Sept. 29) to declare a public health emergency, allowing the agency to waive restrictions and deploy medical personnel to rural areas where medical options are limited.
This option could be effective, Haffajee, the University of Michigan assistant professor said, but limited in terms of dollars available.
The Public Health Emergency Fund at HHS currently stands at $57,000, according to an agency spokesperson.
Congress created the fund in 1983 and designed it to be replenished up to $30 million on an annual basis. The last time congress reauthorized the fund was in 1990 when the balance was raised to $45 million, but refunding has since ceased.
President Trump’s latest budget proposal includes such an emergency fund, but does not provide a dollar amount. If the budget passes in its current form, HHS would lose more than $4 billion in funding.
Those inside and outside of HHS understand that any federal emergency declaration through the Public Health Service Act would require additional capital from congress for HHS’s emergency fund. Such a declaration however could provide HHS the freedom to tear down red tape and facilitate quick and effective action, according to experts.
For example, the HHS chief could allow pharmacies to distribute naloxone, the opioid overdose antidote, to those without a prescription, called a “standing order.”
“Family, friends can get that naloxone if they know they’re going to be around somebody who is using, and have a higher likelihood of being able to administer that,” Haffajee said.
One thing some states have done, that the federal government could facilitate, according to Haffajee, is to equip first responders and even librarians or other personnel in public places with the antidote where overdoses occur with some frequency.
“The whole idea is getting more naloxone into more people’s hands and getting them to feel comfortable using it,” Haffajee told ABC News.
Under Medicaid, the federal government will not reimburse opioid abuse treatments at larger medical facilities dedicated to such mental diseases, another restriction HHS could lift under the Public Health Service Act.
“This is the single fastest way to increase treatment availability across the nation,” the White House commission wrote in their report.
The commission also recommended by declaring a national emergency, “you can empower the HHS Secretary to negotiate reduced pricing” for naloxone, something currently restricted by federal law.
The experts agree that these steps could be, and in some cases already have been, effective, but the apparent lack of funds through a Public Health Service Act emergency declaration could become problematic.
“States have done a lot,” Haffajee said. “But because we need so much more for the population, states are starting to run out of funds.”
Richard Frank, a Harvard University health economics professor told McClatchy News that the price of necessary services to combat the growing opioid problem is roughly $190 billion over 10 years.
Officials ABC News spoke to on many sides of the debate agree that federal government involvement is critical to tackling the epidemic and an emergency declaration would bring an important amount of attention to what is likely the most severe drug crisis in the country’s history. The question, they say, remains: what course of federal action provides the best resources.
Grant Smith, deputy director of National Affairs at the Drug Policy Alliance, says some positive results could come out of an emergency declaration, but added that he thinks the Trump administration’s stance on drug policy is worrisome to an extent and handing the opioid fight to the current White House could be an extension of the “war on drugs.”
In a speech Attorney General Jeff Sessions delivered to the National Alliance For Drug Endangered Children in August he said “robust enforcement of our laws helps keep drugs out of our country, decreases their availability, drives up their price, and reduces their purity.”
President Trump later echoed the sentiment from Bedminster, N.J.
“Strong law enforcement is absolutely vital to having a drug-free society,” Trump said. “I’m confident that by working with our health care and law enforcement experts we will fight this deadly epidemic and the United States will win.”
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