Trump remains cautious before opioid declaration

Labeling epidemic a national emergency increases authority

WASHINGTON President Trump first promised to declare a national emergency to confront the epidemic 68 days ago. Since then, statistics show more than 6,000 Americans have died of opioid overdoses waiting for federal action.

Trump now says he’ll formally declare that emergency next week, a two-month delay that he said underscores the “time-consuming work” behind his administration’s response to the crisis.

“We are going to be doing that next week,” Trump said at a news conference Monday, 67 days after he first promised to sign the emergency declaration. “That is a very, very big statement. It’s a very important step. And to get to that step, a lot of work has to be done and it’s time-consuming work.”

An emergency declaration would be a powerful rhetorical tool in focusing national attention on an epidemic that, according to the Centers for Disease Control and Prevention, claims 91 lives every day.

But the impact of an emergency wouldn’t just be symbolic. It would give the Trump administration novel and untested powers: broad authority to waive patient privacy laws, divert funds and give immunity to medical professionals and first responders.

Without a formal proclamation, it’s impossible to know which of these powers — some of which could be controversial — Trump intends to use.

Neither Trump nor the White House would explain what’s holding up the proclamation, though Trump suggested that he’s wading through uncharted waters. “And I want to get that absolutely right,” he said Monday.

He’s doing it without two key advisers: Health and Human Services Secretary Tom Price was fired last month for taking private jets at taxpayer expense — often traveling to opioid-related events. And Trump on Tuesday withdrew his nomination for “drug czar” after The Washington Post and 60 Minutes reported Rep. Tom Marino’s role in pushing through legislation to make it difficult for the Drug Enforcement Administration to crack down on shipments of opioids from drug companies to black market dealers.

“If you want to be cynical, it’s one thing to declare we are now in a state of emergency. Well, everyone seems to already know that and understand it. So the question is, what specific logjams are removed?” said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. “As this epidemic goes on and claims more lives, that question takes on even greater weight.”

Under federal law, the administration has special powers to combat disease when there’s a public health emergency declared by the secretary of Health and Human Services.

Those emergencies are routine. Just since August, the secretary of Health and Human Services has declared 17 different public health emergencies to deal with the effects of Hurricanes Harvey, Irma, Maria and Nate, and for the California wildfires. But none for opioids.

Presidents can put even more muscle behind those public health emergencies by declaring a state of national emergency, giving the president additional powers to waive Medicaid and Medicare regulations and patient privacy regulations.

That’s what the President’s Commission on Combating Drug Addiction and the Opioid Crisis recommended in July.

The chairman of that commission, New Jersey Gov. Chris Christie, a Republican, said last week that it’s “not good” Trump hasn’t declared an emergency yet. “I think the problem is too big to say that if he had declared an emergency two months ago that it would make a significant difference in two months,” he said at a Trenton press conference. “But I would also say you can’t get those two months back.”

The pharmaceutical industry has been publicly supportive of the commission. During the most recent meeting, drug company CEOs promoted their products and sought Food and Drug Administration and Medicaid reimbursement rates that would benefit their proposed opioid treatments and alternatives.

The commission will hold its final scheduled meeting Friday.

The White House says the administration is still working out the details of the emergency.

“It’s a very important step. And to get to that step, a lot of work has to be done and it’s time-consuming work.” President Trump

NICHOLAS KAMM, AFP/GETTY IMAGES President Trump said more than two months ago he would officially call the opioid crisis a national emergency.