Last week the President’s Commission on Combating Drug Addiction and the Opioid Crisis released a preliminary report proposing recommendations for addressing the nation’s opioid crisis. One of their top recommendations was for the president to declare the opioid crisis a national public health emergency.

At a news conference this week the president declined to declare such an emergency.

The Washington Post reports that following an update from his health officials on the report, the president held a press conference and made statements focused on the importance of preventing people, particularly the youth, from ever starting to use drugs. Additionally, Health and Human Services Secretary Tom Price provided background to the decision not to declare a national emergency but assured those in attendance that the crisis would still be treated as an emergency:

Health and Human Services Secretary Tom Price later told reporters that declaring a national emergency is a step usually reserved for “a time-limited problem,” like the Zika outbreak or problems caused by Hurricane Sandy in 2012. Declaring a state of emergency allows the government to quickly lift restrictions or waive rules so that states and local governments don’t have to wait to take action. Price said that the administration can do the same sorts of things without declaring an emergency, although he said Trump is keeping the option on the table.

“The president certainly believes that it is, that we will treat it as an emergency — and it is an emergency,” Price said during a news briefing held about eight miles from Trump’s golf club, where he is on a 17-day working vacation. “When you have the capacity of Yankee stadium or Dodger stadium dying every single year in this nation, that’s a crisis that has to be given incredible attention, and the president is giving it that attention.”

What does it mean to declare a public health emergency? Route Fifty reports on what a declaration of state of emergency on the opioid crisis would have meant. Generally a declaration would open the option for states to apply for additional funds from the Federal Emergency Management Agency, that could be used for treatment and prevention efforts. It would also provide flexibility to federal programs to allow for waivers of certain rules and regulations:

First, an emergency declaration would allow states that are declared disaster zones—areas that have been particularly hard-hit by the crisis—to receive funds from the federal Disaster Relief Fund, which as of June 30, 2017, had a balance of nearly $4.4 billion.

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And, if the Trump administration declares an emergency under both the Stafford Act and Section 319 of the Public Health Service Act, it would allow temporary waivers on specific rules regarding federal programs like Medicare, Medicaid and CHIP. For example, Medicaid does not currently reimburse the costs of receiving drug treatment in facilities that have more than 16 beds. Many states have already applied for waivers on this rule, but an emergency declaration could give a blanket waiver to all 50 states.

An article in The Intercept decried the President’s focus on “just say no” and harsher sentences as a return to the 80’s war on drugs (that was ultimately found to be ineffective), but offers support for the Commission’s recommendation regarding Medication Assisted Treatment (MAT):

Even without the emergency declaration, at least one of the commission’s recommendations would transform the U.S. approach to the crisis and give those in its grip a real chance at recovery. It’s an approach that was embraced by the surgeon general in a report in November and consistently by the Office of National Drug Control Policy under Obama.

The recommendation is a direct shot at a drug-treatment industry that still relies on strict abstinence as the only form of true recovery, rejecting any intervention by medication. The stigma associated with what’s known as medication-assisted treatment is leading to unnecessary death and suffering across the country.

While much of the focus has been on the recommendation to declare a public health emergency, the report included a number of additional recommendations:

– Rapidly increase treatment capacity. Grant waiver approvals for all 50 states to quickly eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases (IMD) exclusion within the Medicaid program. This will immediately open treatment to thousands of Americans in existing facilities in all 50 states.

– Mandate prescriber education initiatives with the assistance of medical and dental schools across the country to enhance prevention efforts. Mandate medical education training in opioid prescribing and risks of developing an SUD by amending the Controlled Substance Act to require all Drug Enforcement Administration (DEA) registrants to take a course in proper treatment of pain. HHS should work with partners to ensure additional training opportunities, including continuing education courses for professionals.

– Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions; we must equip all law enforcement in the United States with naloxone to save lives.

– Prioritize funding and manpower to the Department of Homeland Security’s (DHS)Customs and Border Protection, the DOJ Federal Bureau of Investigation (FBI), and the DEA to quickly develop fentanyl detection sensors and disseminate them to federal, state,local, and tribal law enforcement agencies. Support federal legislation to staunch the flow of deadly synthetic opioids through the U.S. Postal Service (USPS).

– Provide federal funding and technical support to states to enhance interstate data sharing among state-based prescription drug monitoring programs (PDMPs) to better track patient-specific prescription data and support regional law enforcement in cases of controlled substance diversion. Ensure federal health care systems, including Veteran’s Hospitals, participate in state-based data sharing.

– Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law.

– Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses.

For more information:

President’s Commission on Combating Drug Addiction and the Opioid Crisis Preliminary Report

Trump Holds off on Declaring Opioid Crisis a National Emergency (The Washington Post)

Trump Didn’t Declare the Opioid Crisis a National Emergency. What If He Had? (Route Fifty)

Trump’s Opioid Commission Had Some Stunningly Good Recommendations. He Ignored Them for 80s Drug War Nostalgia (The Intercept)