Trump speaks on opi­oid epi­demic

Pres­i­dent: Cri­sis of­fi­cial emer­gency

Northwest Arkansas Democrat-Gazette - - FRONT PAGE -

Pres­i­dent Don­ald Trump on Thurs­day de­clared the coun­try’s opi­oid cri­sis a na­tional emer­gency, say­ing the epi­demic ex­ceeded any­thing he had seen with other drugs in his life­time.

The pres­i­dent’s dec­la­ra­tion came in re­sponse to a ques­tion as he spoke to re­porters out­side a na­tional se­cu­rity brief­ing at his golf club in Bed­min­ster, N.J., where he is on a work­ing va­ca­tion.

“The opi­oid cri­sis is an emer­gency, and I’m say­ing of­fi­cially right now it is an emer­gency. It’s a na­tional emer­gency. We’re go­ing to spend a lot of time, a lot of ef­fort and a lot of money on the opi­oid cri­sis,” he said.

“It is a se­ri­ous prob­lem, the likes of which we’ve never had. You know, when I was grow­ing up, they had the LSD, and they had cer­tain gen­er­a­tions of drugs. There’s never been any­thing like what’s hap­pened to this coun­try over the last four or five years.”

He in­di­cated that the White House was still work­ing on the of­fi­cial pa­per­work.

“This is a world­wide prob­lem, not just a United States prob­lem. This is hap­pen­ing world­wide. But this is a na­tional emer­gency, and we are draw­ing doc­u­ments now to so at­test,” he said.

The scale of the cri­sis, which has been build­ing for well over a decade, is such that a pres­i­den­tial dec­la­ra­tion may not have much im­me­di­ate im­pact, but it should al­low the ad­min­is­tra­tion to re­move some bu­reau­cratic bar­ri­ers and waive some fed­eral rules gov­ern­ing how states and lo­cal­i­ties re­spond to the drug epi­demic. One such rule re­stricts where Med­i­caid re­cip­i­ents can re­ceive ad­dic­tion treat­ment.

“It’s sym­bolic, mostly, and it ac­tu­ally in­volves a lot of re­port­ing and pa­per­work,” Richard Frank, a pro­fes­sor of health eco­nom­ics at Har­vard Med­i­cal School, told The Wash­ing­ton Post ear­lier this week when asked about the im­por­tance of a pres­i­den­tial dec­la­ra­tion.

Gov­er­nors in Arizona, Florida, Mary­land and Vir­ginia have al­ready de­clared emer­gen­cies. And in re­cent months the Cen­ters for Dis­ease Con­trol and Preven­tion, the Food and Drug Ad­min­is­tra­tion, Congress, physi­cian groups and the in­surance in­dus­try have all taken in­sti­tu­tional steps to ad­dress the cri­sis. At the street level, po­lice, fire­fight­ers and paramedics now rou­tinely carry nalox­one — brand name Nar­can — the anti-over­dose drug that can yank a pa­tient from the brink of death.

The prob­lem is that drug ad­dic­tion is wide­spread, with an es­ti­mated 2.6 mil­lion opi­oid

ad­dicts in the U.S., a num­ber that’s grow­ing.

In March, Trump es­tab­lished the Pres­i­dent’s Com­mis­sion on Com­bat­ing Drug Ad­dic­tion and the Opi­oid Cri­sis, which is led by New Jersey Gov. Chris Christie. Last week, the com­mis­sion is­sued a pre­lim­i­nary re­port that de­scribed the over­dose death toll as “Septem­ber 11th ev­ery three weeks” and urged the pres­i­dent to de­clare a na­tional emer­gency.

“The opi­oid epi­demic we are fac­ing is un­par­al­leled. The av­er­age Amer­i­can would likely be shocked to know that drug over­doses now kill more peo­ple than gun homi­cides and car crashes com­bined,” the re­port states.

The re­port ac­tu­ally un­der­stated the lethal­ity of the epi­demic. The com­mis­sion based its es­ti­mate of the num­ber of fa­tal drug over­doses on 2015 sta­tis­tics. But new fed­eral data cov­er­ing the first nine months of 2016 showed that the death toll jumped sig­nif­i­cantly since 2015.

Trump’s dec­la­ra­tion Thurs­day came days af­ter he re­ceived an ex­tended brief­ing on the sub­ject in Bed­min­ster. Af­ter that event, Health and Hu­man Ser­vices Sec­re­tary Tom Price told re­porters that declar­ing a na­tional emer­gency is a step usu­ally re­served for “a time-lim­ited prob­lem,” such as the Zika out­break or prob­lems caused by Hur­ri­cane Sandy in 2012.

Price seemed to sug­gest at the time that the pres­i­dent was lean­ing against the rec­om­men­da­tion, ar­gu­ing that the ad­min­is­tra­tion could de­ploy the nec­es­sary re­sources and at­ten­tion to deal with the cri­sis with­out declar­ing a na­tional emer­gency. Still, Price stressed that “all things” were “on the ta­ble for

the pres­i­dent.”

Christie ap­plauded Trump’s de­ci­sion in a state­ment, say­ing the pres­i­dent “de­serves great credit.”

“As I have said be­fore, I am com­pletely con­fi­dent that the Pres­i­dent will ad­dress this prob­lem ag­gres­sively and do all he can to alle­vi­ate the suf­fer­ing and loss of scores of fam­i­lies in ev­ery cor­ner of our coun­try,” he said.

Opi­oids are a broad cat­e­gory of le­gal and il­le­gal drugs, rang­ing from pre­scrip­tion painkillers to heroin. In the past cou­ple of years, ac­cord­ing to the Drug En­force­ment Ad­min­is­tra­tion, much of the street-level heroin in the U.S. has been laced with il­licit fen­tanyl, a pow­er­ful syn­thetic opi­oid that is much cheaper to pro­duce than heroin.

Ad­dicts of­ten say they want the most pow­er­ful drug they can find and seek batches of drugs that have been linked to rashes of over­doses.

Al­though heroin has been around for a long time, the cur­rent opi­oid cri­sis has its ori­gin in the 1990s, when the phar­ma­ceu­ti­cal in­dus­try mar­keted new for­mu­la­tions of pre­scrip­tion opi­oids. They soon flooded the mar­ket, mak­ing Amer­ica by far the world’s lead­ing con­sumer of these painkillers.

At the be­gin­ning of this decade, gov­ern­ment of­fi­cials shut down many “pill mills” in which doc­tors dis­pensed huge numbers of pre­scrip­tion opi­oids, and many ad­dicts switched to street heroin.


In the face of the cri­sis, states have en­acted or are seek­ing to im­ple­ment strict lim­its on the num­ber of pre­scrip­tion painkillers doc­tors can pre­scribe, a move that many be­lieve will help

fight the cri­sis but has raised alarms among some physi­cians.

At least 17 states have en­acted rules to curb the num­ber of painkillers doc­tors can pre­scribe. Some, in­clud­ing Arizona, Connecticut, Delaware, Mas­sachusetts, New Jersey and Ohio, have passed laws lim­it­ing the du­ra­tion of ini­tial opi­oid pre­scrip­tions to five or seven days. Oth­ers are pass­ing dosage lim­its.

In Kentucky, a law went into ef­fect last month cap­ping opi­oid pre­scrip­tions for se­vere acute pain to three days.

“We know that most peo­ple who even­tu­ally be­come ad­dicted to heroin have started with a pre­scrip­tion opi­ate,” said Kentucky state Rep. Kim­berly Moser, a Repub­li­can who spon­sored the bill and is also a nurse.

Kentucky has ex­emp­tions for cancer and hos­pice pa­tients, ma­jor surg­eries, and pa­tients deal­ing with se­vere or chronic pain.

“We felt it was im­por­tant to just set that pause but­ton and have pre­scribers just stop and think about the ap­pro­pri­ate­ness of what they’re pre­scrib­ing. Is it med­i­cally nec­es­sary?” she said.

Last year, 1,404 peo­ple died of drug over­doses in Kentucky, ac­cord­ing to the Kentucky Of­fice of Drug Con­trol Pol­icy. About half of the deaths in­volved fen­tanyl, which is of­ten used in hos­pi­tals but also has been man­u­fac­tured il­lic­itly over­seas and has cut into the heroin sup­ply.

In the spring, Arkansas man­dated that physi­cians and other pre­scribers of pow­er­ful painkillers check the state’s pre­scrip­tion drug mon­i­tor­ing data­base to de­ter­mine whether a first-time pa­tient has filled sim­i­lar pre­scrip­tions be­fore. Be­fore the new

law was signed by the gover­nor, prac­ti­tion­ers were only en­cour­aged to con­sult the data­base, which was cre­ated in 2012.

The Cen­ters for Dis­ease Con­trol and Preven­tion last year is­sued guid­ance for providers, rec­om­mend­ing shorter du­ra­tions for opi­oid pre­scrip­tions, stat­ing that three days should be suf­fi­cient and a course of more than seven days “will rarely be needed.”

Ac­cord­ing to a CDC study, pa­tients who use such painkillers for longer pe­ri­ods of time are more likely to end up ad­dicted to them.

Sens. John McCain, R-Ariz., and Kirsten Gil­li­brand, D-N.Y., in­tro­duced fed­eral leg­is­la­tion in April to limit an ini­tial opi­oid pre­scrip­tion to seven days. It would not ap­ply to the treat­ment of chronic pain, cancer, hos­pice or pal­lia­tive care.

More than 52,000 peo­ple died of drug over­doses in 2015, ac­cord­ing to the CDC. Drug over­doses sharply in­creased dur­ing the first nine months of 2016, ac­cord­ing to the Na­tional Cen­ters for Health Sta­tis­tics. They were driven by in­creases in opi­oid deaths, es­pe­cially from heroin and fen­tanyl. But for many peo­ple, their first ex­po­sure to opi­oids is through pre­scrip­tion painkillers.

“Given that this cur­rent opi­oid epi­demic is in very real part caused by the pre­scribers, we should be OK with some guid­ance,” said R. Corey Waller, chair­man of the leg­isla­tive ad­vo­cacy com­mit­tee for the Amer­i­can So­ci­ety of Ad­dic­tion Medicine. “If we had been able to con­trol this and follow the ev­i­dence, we wouldn’t nec­es­sar­ily need these rules.”

But Waller and other physi­cians also have con­cerns with the new state laws. In Connecticut, doc­tors wor­ried that a law lim­it­ing ini­tial opi­oid pre­scrip­tions to seven days would be overly pro­hib­i­tive, said David Em­mel, chair­man of the Connecticut State Med­i­cal So­ci­ety’s leg­isla­tive com­mit­tee. But now that the reg­u­la­tions have been in place for about a year, doc­tors have adapted to the rules, which Em­mel said are “not hor­rif­i­cally re­stric­tive.”

Pa­trick Pad­gett, ex­ec­u­tive vice pres­i­dent of the Kentucky Med­i­cal As­so­ci­a­tion, said some doc­tors are glad that there is a limit on the num­ber of days a painkiller can be pre­scribed, be­cause it gives them a guide­line they can show to pa­tients who are seek­ing longer cour­ses of the drug.

But Mishael Azam, chief oper­at­ing of­fi­cer of the Med­i­cal So­ci­ety of New Jersey, said the state’s five-day limit, which went into ef­fect ear­lier this year, is still a “work in progress” for the state’s physi­cians. Doc­tors, she said, are still be­ing ed­u­cated about the law and some are now leery of treat­ing pain pa­tients be­cause of it.

“That’s the gen­eral tone — doc­tors are to blame,” she said, and treat­ing a pa­tient in­di­vid­u­ally is dis­cour­aged. “Medicine, in all other realms, we’re sup­posed to be per­son­al­iz­ing and in­di­vid­u­al­iz­ing. But when you do a hard man­date, it doesn’t al­low for any sort of per­son­al­iza­tion.”

In­for­ma­tion for this ar­ti­cle was con­trib­uted by John Wag­ner, Lenny Bern­stein, Joel Achenbach and Jenna John­son of The

Wash­ing­ton Post; by Jill Colvin and Jonathan Lemire of The As­so­ci­ated Press; and by staff mem­bers of the Arkansas Demo­crat-Gazette.


Pres­i­dent Don­ald Trump speaks to re­porters Thurs­day at Trump Na­tional Golf Club in Bed­min­ster, N.J.

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