Emergency declaration is key to curbing opioid epidemic, experts say

President Donald Trump’s declaration of the opioid epidemic as a public health emergency Thursday is a key step in curbing the problem, as it helps redirect funds and ease state laws for those fighting on the front lines, according to public health experts and medical professionals.

Trump’s announcement stopped short of calling the crisis a national emergency, which would’ve opened additional funding to fight the issue even faster. However, experts said the public health emergency declaration is a vital, long-overdue part of the battle against America’s opioid problem. It allows agencies to set priorities in tackling the epidemic and directs US Department of Health and Human Services funds to help carry out that mission.

“In practical terms, I believe this declaration of public health emergency will unify the country and our leadership in a nonpartisan way around finding solutions to this growing problem in the US,” said Dr. Halena Gazelka, an anesthesiologist who chairs the Mayo Clinic’s Opioid Stewardship Program. “As state, federal and private funds are directed at curbing the primary issues (of) supply and demand, hopefully we’ll see a rapid decrease in the overdose deaths and related health issues.”

Although the emergency declaration doesn’t change guidelines for doctors, Gazelka said she hopes the declaration will empower providers to write “only the right amount of opioid for the right patient.”

“No longer should patients be able to request and receive opioids ‘easily,’ and they should receive them only when truly warranted by medical diagnosis,” Gazelka said. “No longer should providers freely write prescriptions without care and consideration to who is truly going to use those medications and for what purpose.”

Since 2000, more than half a million people have died of drug overdoses, with opioids accounting for the majority of the deaths, according to government figures. Last year alone, more than 64,000 Americans died of a drug overdose, primarily due to opioids.

“In the last several years, US life expectancy has actually declined, not because of cardiac disease or cancer or an incurable new virus but because of opioid overdose,” Gazelka said. “This is incredibly tragic and wasteful and must be halted with that trend in life expectancy reversed.”

Lainie Rutkow, an associate professor at Johns Hopkins Bloomberg School of Public Health who has studied public health emergencies, said Thursday’s measure could lead to increased grant funding for states to address opioid use disorders.

“The availability of additional funds, particularly for the states, to address opioid use disorders will be critical,” Rutkow said.

Baltimore City Health Commissioner Dr. Leana Wen said she was glad the president was focusing on the issue, but she expressed disappointment he didn’t declare it a national state of emergency. “Right now, the announcement today calls for repurposing of existing funding, instead of new funding — and that’s what we desperately need.”

Michael Fraser, executive director of the Association of State and Territorial Health Officials, a consortium of senior public health officials from all 50 states, US territories and the District of Columbia, applauded the measure because it puts pressure on Congress and federal agencies to make the opioid crisis a priority.

“It means a lot for the President to make a statement,” Fraser said. “Words matter. He’s the President, and this means this is a national priority.”

He said he hopes that the politics of Washington don’t get in the way and that appropriate funds for states get approved. “It would be awful if the opioid emergency funding got caught up in the year-end budget,” he said.

Jessica Hulsey Nickel, the president and chief executive of the Addiction Policy Forum, a nonprofit organization that works to raise awareness of the opioid epidemic, called President Trump’s announcement “an important step toward preventing and treating substance use disorders.”

“Prioritizing this national crisis will bring much-needed resources to communities, improve access to services and facilitate better coordination among government agencies,” she said. “In particular, I am heartened by the decision to bring all federal government agencies to the table to play a unique role.”

Impact of a health emergency declaration

It is not often that a public health emergency is declared. The US Department of Health and Human Services declared one in Puerto Rico last year after more than 10,000 Zika cases were reported there. Before that, the last emergency declaration unrelated to a natural disaster was during the 2009-10 flu season, when there was widespread concern over a potential pandemic.

Dr. Arthur Reingold, a professor of epidemiology at the University of California-Berkeley, worked with the World Health Organization on providing advice during the H1N1 pandemic in 2009. The crucial thing an emergency declaration does, he said, is mobilize resources and bring much-needed attention to the problem, especially in getting politicians, leaders and the public on the same page.

“Typically, humans don’t get motivated until there’s actually a problem,” Reingold said. “In this case, this is a problem that has been festering for some time — and now we’re finally paying attention to it.”

Dr. Alberto de la Vega at the University of Puerto Rico who evaluated over 1,000 pregnant patients with Zika said the public health emergency declaration last year “definitely helped.”

It brought attention and forced resources from federal agencies to work toward bringing an end to the epidemic, he said. Puerto Rico’s health department poured a lot of money into the effort, along with the Centers for Disease Control and Prevention.

“We definitely received a benefit from the classification and receiving more funds. There’s no question about it,” de la Vega said. “But the bureaucracy, in making those allocation of funds reach us, always comes later than we wish.”

‘The fight must go on’

In an interim report in late July, the president’s commission examining the opioid epidemic recommended that President Trump declare a public health emergency. The commission, led by New Jersey Gov. Chris Christie, recommended rapidly increasing treatment capacity for those who need substance abuse help; establishing and funding better access to medication-assisted treatment programs; and making sure that health care providers are aware of the potential for misuse and abuse of prescription opioids by enhancing prevention efforts at medical and dental schools.

Reports in recent days had suggested dysfunction and chaos within the commission. On Wednesday, commission member Patrick Kennedy said he wanted to see action.

“We don’t want any more visits to rehab centers and photo ops, saying how courageous we are. Enough already. We want to save lives,” said Kennedy, a former House representative from Rhode Island who has spoken about his own recovery from drug and alcohol addiction.

On Thursday, surrounded by members of families affected by the opioid crisis, first responders and members of Congress, President Trump hailed the emergency declaration as means of stopping the epidemic.

“As Americans, we cannot allow this to continue. It is time to liberate our communities from this scourge of drug addiction,” he said. “We can be the generation that ends the opioid epidemic. We can do it.”

Experts on the front lines are now waiting to see the measure turned into action.

“After the razzle dazzle and public interest dies down — and after politicians have ceased to make a name for themselves and moved on to other pressing concerns — the fight must go on,” Gazelka said.