Trump raises opi­oid stakes

The Denver Post - - FRONT PAGE - By John Wag­ner, Lenny Bern­stein and Joel Achenbach

WASH­ING­TON» 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 state­ment by the pres­i­dent 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.

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

On Tues­day in Bed­min­ster, Trump re­ceived an ex­tended brief­ing. White House aides said Trump was re­view­ing the re­port and was not ready to an­nounce which of its rec­om­men­da­tions he would em­brace.

A White House state­ment is­sued Thurs­day evening said Trump “has in­structed his ad­min­is­tra­tion to use all ap­pro­pri­ate emer­gency and other au­thor­i­ties to re­spond to the cri­sis

caused by the opi­oid epi­demic.”

The scale of the cri­sis, which has been build­ing for more than a decade, is such that a pres­i­den­tial dec­la­ra­tion may not have much im­me­di­ate im­pact. 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.

“There’s no doubt that this shines a brighter light on the epi­demic. It re­mains to be seen how much this will fun­da­men­tally change its course,” said Caleb Alexan­der, co-di­rec­tor of the Johns Hop­kins Cen­ter for Drug Safety and Ef­fec­tive­ness. “No one thinks the re­cov­ery from this is go­ing to be fast, emer­gency or not.”

The emer­gency dec­la­ra­tion may al­low the gov­ern­ment to de­ploy the equiv­a­lent of its med­i­cal cav­alry, the U.S. Pub­lic Health Ser­vice, a uni­formed ser­vice of physi­cians and other staffers that can tar­get places with lit­tle med­i­cal care or drug treat­ment, said An­drew Kolodny, codi­rec­tor of opi­oid pol­icy re­search at the Heller School for So­cial Pol­icy and Man­age­ment at Bran­deis Univer­sity. He said the DEA might be able to use the emer­gency to re­quire pre­scriber ed­u­ca­tion for doc­tors and oth­ers who dis­pense opi­oids.

“There’s a lot that could be done. It could be very help­ful, much more than just sym­bolic,” he said.

Gov­er­nors in Arizona, Florida, Mary­land and Vir­ginia al­ready have 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 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 an ad­dict back from the brink of death.

Drug ad­dic­tion is a wide­spread and grow­ing prob­lem, with an es­ti­mated 2.6 mil­lion opi­oid ad­dicts in the United States.

The re­port is­sued last week states: “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 ac­tu­ally un­der­stated the lethal­ity of the epi­demic. The com­mis­sion based its es­ti­mate of the num­ber of fa­tal drug over­doses on 2015 sta­tis­tics, when 52,404 peo­ple died of over­doses of all drugs, in­clud­ing opi­oids, for an av­er­age of 142 a day. But new fed­eral data cov­er­ing the first nine months of 2016 showed that the death toll jumped sig­nif­i­cantly since 2015 and could reach 60,000 once the numbers are all in for that year.

In Thurs­day’s brief­ing, Trump 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.”

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 United States 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 of­ten 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. Soon they flooded the mar­ket, mak­ing the United States by far the world’s lead­ing con­sumer of such 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.

An anal­y­sis pub­lished in June by The Wash­ing­ton Post showed that death rates for Amer­i­cans ages 25 to 44 have risen since the be­gin­ning of the decade, a trend seen across al­most all racial and eth­nic groups and sig­nif­i­cantly driven by the opi­oid epi­demic. Once stereo­typed as a prob­lem in largely white, ru­ral and eco­nom­i­cally de­pressed Rust Belt com­mu­ni­ties, the opi­oid epi­demic has been killing large numbers of peo­ple of all races in big cities in re­cent years — many of them un­wit­tingly hav­ing bought pack­ets of pow­der in which heroin or co­caine has been mixed with fen­tanyl.

Alexan­der, of Johns Hop­kins, said that while the pres­i­dent’s dec­la­ra­tion of an emer­gency could be used to free up money for treat­ment and other ser­vices, he is con­cerned that ex­tra funds might also be used for law en­force­ment, to “clamp down harder” on peo­ple with opi­oid-use dis­or­ders.

“We’re not go­ing to ar­rest our way out of this epi­demic,” Alexan­der said.

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