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October 27, 2017

Trump admin declares opioid crisis a public health emergency: What it means (and doesn't mean)

Daily Briefing

    President Trump on Thursday signed a presidential memorandum directing HHS to declare the U.S. opioid misuse epidemic a public health emergency—but stopped short of declaring the national emergency that he had said in August he would invoke.

    Background: Public health emergency vs. national emergency

    There are several key differences between a public health emergency and a national emergency.

    Your top resources for combatting the opioid epidemic in one place

    A public health emergency is declared by the HHS secretary under the Public Health Services Act and allow HHS to deploy federal medical providers to underserved areas and ease certain policy hurdles to opioid misuse treatment. These declarations, which last for 90 days and can be renewed, typically are declared in response to disasters and disease outbreaks. According to USA Today, the public health emergency declaration for the opioid misuse epidemic marks the first time such a declaration has been made nationwide since 2009-2010, when officials were preparing for the H1N1 influenza virus.

    A national emergency is broader in scope and is declared by the president under the Stafford Act or the National Emergencies Act. Declaring a national emergency would have given the Trump administration more authority to waive privacy laws and Medicaid regulations, and, according to the New York Times, "would have prompted the rapid allocation of federal funding to address the issue."

    According to CNN, both Trump and former President Barack Obama administration officials said a public health emergency declaration was the appropriate response to the opioid epidemic.

    Rafael Lemaitre, the former communications director for the White House Drug Policy Office under Obama, said, "I do think the Public Health Service Act is more appropriate route to take than the Stafford Act designation." He added, "I worked at FEMA for two years and dealt with multiple disasters. The Stafford Act is not structured to deal with a long-term, complicated public health crisis like the opioid crisis."

    Public health emergency declaration details

    The presidential memorandum ordered acting HHS Secretary Eric Hargan to waive certain regulations and give states more flexibility in how they spend federal funds to address the epidemic.

    Senior administration officials said the memorandum does not provide or request any new funding to combat the crisis, but they said that the White House hopes that new funds to combat opioid misuse are included in a year-end spending bill.

    Hargan issued the declaration Thursday, giving the administration additional authority to allocate federal, state, and private resources, USA Today reports. For instance, the declaration:

    • Allows the Department of Labor to issue dislocated worker grants to help those who are unemployed because of the opioid misuse epidemic;
    • Allows HHS and states to shift resources for HIV/AIDS programs to help individuals eligible for those programs access substance misuse treatment;
    • Allows HHS to quickly hire temporary specialists to address the crisis; and
    • Allows HHS to draw from the Public Health Emergency Fund to help address the crisis—though, USA Today reports that Bill Hall, a deputy assistant secretary of Health, said the fund currently has just $57,000; and
    • Expands access to telemedicine services for opioid misuse and mental health treatment.

    According to USA Today, HHS already has approved waivers to other regulations in four states that provide greater flexibility in how they spend federal funding. HHS also is soon expected to issue guidance that would waive certain HIPAA privacy laws to allow health care providers to communicate with the families of overdose victims.

    Trump's comments

    Trump in a speech announcing the memorandum suggested he would pursue a new requirement that federally employed prescribers receive training on safe opioid prescribing practices, advance a federal initiative to bolster development of nonaddictive painkillers, and crack down on the synthetic opioid fentanyl, which is developed in China. Further, Trump said his administration was considering taking legal action against unspecified "bad actor" companies that he said have fueled the epidemic.

    Trump also said he plans to suspend a rule that prevents Medicaid from funding many drug rehabilitation facilities, and suggested the government would launch a new advertising campaign to discourage U.S. residents, particularly young people, from starting to use opioids.

    Trump said, "We can be the generation that ends the opioid epidemic," adding, "No part of our society—not young or old, rich or poor, urban or rural—has been spared this plague of drug addiction and this horrible, horrible situation that's taken place with opioids."


    Republican lawmakers and provider groups praised Trump's announcement as a step in raising awareness about the opioid misuse epidemic—but some industry observers said the directive does not go far enough to have a true effect.

    Patrice Harris, chair of the American Medical Association's opioid task force, in a statement called the declaration "a move that will offer needed flexibility and help direct attention to opioid-ravaged communities." She added, "There is plenty of work ahead ... and the emergency declaration adds further urgency to this epidemic."

    American Hospital Association President and CEO Rick Pollack in a statement said, "This declaration appropriately highlights the urgent need to act so that fewer of our fellow citizens are suffering." Pollack also urged both the administration and Congress to approve additional funding to combat the epidemic, and to "take further action such as eliminating the barriers to treatment created by the Medicaid Institutions for Mental Disease exclusion, knocking down impediments to the appropriate sharing of patient substance use records, and ensuring that patients have comprehensive coverage that facilitates access to the services they need."

    A spokesperson for Ohio Gov. John Kasich (R) said the state would "welcome any additional resources provided by the federal government to better arm those on the front lines combating addiction."

    However, Democratic lawmakers and some industry experts suggested the declaration did not go far enough to address the epidemic.

    Sen. Edward Markey (D-Mass.) said, "Instead of a commitment to emergency funding for our states and communities, President Trump offered empty words and half-measures."

    Atul Gawande, a surgeon at Brigham and Women's Hospital, in a series of tweets also said the directive would be unlikely "to make a significant dent in the crisis"

    While Lemaitre, the former Obama administration official, agreed that the public health emergency declaration was the appropriate response, he said, "A smarter play here would be for the administration to move beyond this declaration and pass the billions in funding needed to address this crisis. That is how you move the needle on this" (Hirschfeld Davis, New York Times, 10/26; Korte, USA Today, 10/26; Radnofsky/Kamp, Wall Street Journal, 10/26; Merica, CNN, 10/27; AHA Now, 10/26; AAFP release, 10/26).

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