NOW WHAT ON OPIOID EMERGENCY?
Presidential declaration is meaningful only if Trump’s words become actions
In many communities, more people are losing their lives from opioid overdoses than from homicides, suicides and traffic fatalities — combined. In my own city of Baltimore, where violence dominates front page news, more than twice as many people died from overdoses last year than from shootings.
President Trump said this month: “The opioid crisis is an emergency, and I’m saying officially, right now, it is an emergency.” A presidential declaration sends a strong signal of urgency and resolve, but then what?
I’ve spent years working on the front lines in public health, including serving as health secretary in Maryland and as city health commissioner in Baltimore, where we took action that reduced overdose rates. I know firsthand that emergency declarations are meaningless if they’re not backed up by action. The administration must quickly move on a series of steps:
Mobilize emergency resources for a monitoring program that provides data weekly on addiction and overdose in communities across the country. The Centers for Disease Control and Prevention relies on months- or years-old data from death certificates. A far better approach would be to work directly with medical examiners and coroners to apply standard protocols and report information immediately.
According to the U.S. surgeon general, only one in 10 Americans with a substance use disorder receive treatment, though opioid use disorder is one of the most treatable addictions. Health and Human Services Secretary Tom Price should deploy physicians, physician assistants and nurse practitioners in the Commissioned Corps of the U.S. Public Health Service to hard-hit communities to set up treatment programs. As recommended by the presidential commission led by New Jersey Gov. Chris Christie, the Health Services and Resources Administration should require health professionals in federally funded clinics to receive training and provide medicationassisted treatment.
The White House should direct emergency resources to innovative local efforts that are based on evidence. Local and state budgets have borne a huge burden from opioid overdose. There are enormous costs in emergency medical services, law enforcement, child welfare and multiple other systems. Strategic investments can help local police divert people who use drugs into needed services, help local jails establish and refer to effective treatment programs, and help local medical systems adopt standards for prescribing for pain and treating addiction.
These emergency funds should support local programs that directly tackle the unique threat posed by the highly potent opioid fentanyl, which is now responsible for a majority of overdose deaths in many states. For example, the federal government should make resources and legal flexibility available to communities that wish to set up promising alternative models of treatment, such as mobile treatment with methadone or buprenorphine.
There should also be space for more aggressive efforts. Communities that are ready to establish supervised consumption spaces, associated with reductions in overdoses in Canada, should receive both needed resources and the assurance that the Justice Department will not prosecute those who participate.
The federal government can and should require such programs to be evaluated as a condition of funding and law enforcement discretion.
Finally, the emergency declaration should alter the White House approach to health policy. It is not the right time, in the middle of a national emergency such as this, to drastically cut the Medicaid program that supports access to lifesaving treatment. Many of the presidential commission’s recommendations, including those for emergency action, depend on the Medicaid expansion for single adults. Similarly, the emergency should stimulate White House action on drug prices and open for consideration a national program to make the reversal drug naloxone more widely available.
If the president’s declaration leads to these and other strong public health actions, the Trump administration could help the nation turn the corner on this lethal epidemic. On the other hand, if the administration pursues ineffective and draconian law enforcement strategies, or just enjoys a transient public relations benefit of talking tough, the declaration could make matters worse.
Many lives depend on the answer to the question: “Now what?”
Joshua Sharfstein is director of the Bloomberg American Health Initiative. He was principal deputy commissioner of the Food and Drug Administration during the Obama administration.