Politico

'Nothing is actually being done': Trump's opioid emergency order disappoints

President Donald Trump in October promised to “liberate” Americans from the “scourge of addiction,” officially declaring a 90-day public health emergency that would urgently mobilize the federal government to tackle the opioid epidemic.

That declaration runs out on Jan. 23, and beyond drawing more attention to the crisis, virtually nothing of consequence has been done.

Trump has not formally proposed any new resources or spending, typically the starting point for any emergency response. He promised to roll out a “really tough, really big, really great” advertising campaign to spread awareness about addiction, but that has yet to take shape. And key public health and drug posts in the administration remain vacant, so it’s not clear who has the authority to get new programs moving.

A senior White House official disputed the assessment of inaction, saying the emergency declaration has allowed the president to use “his bully pulpit to draw further attention to this emergency that he inherited.” The official added that the declaration has enabled federal agencies to “really change their focus and prioritize the crisis,” and that getting an effective media campaign underway “takes time.”

The president’s emergency declaration can be extended, though the White House official said that’s up to the HHS secretary, or currently the acting secretary. Regardless of whether the declaration is renewed, “the president will continue to draw attention to this crisis as a national emergency,” the official said.

But given the record so far, some public health officials question whether it would make much difference.

In West Virginia, which has the highest drug overdose death rate in the country, Public Health Commissioner Rahul Gupta hasn’t seen any significant change under Trump’s emergency order. “His thoughts and prayers have helped,” Gupta said. “But additional funding and resources would be more helpful.”

“I have not seen an explosion of activity linked to this declaration,” said Rob Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors. “None of our members have knocked on my door to say they have been provided money or actual people on the ground.”

The emergency designation gave federal health agencies the power to move quickly against the epidemic in several ways, including hiring more treatment specialists and reallocating money to amp up the response. An HHS spokesperson declined to provide details on whether and where those powers were used, or on what scale.

The senior White House official said the administration has made significant steps to combat the crisis within the last year. He pointed to legislation signed into law by Trump on Wednesday that will help Customs and Border Protection agents crack down on the trafficking of synthetic opioids like fentanyl, which are responsible for a surge of opioid deaths. That measure was introduced last March, well before the emergency declaration, but the administration official said the recent attention helped Congress prioritize it.

The Trump administration has taken steps to address opioid addiction, mostly outside of the emergency declaration, including issuing new guidance for states trying to expand access to inpatient treatment and to advance research into non-opioid pain management. The FDA also approved a new 30-day injectable treatment for addiction, and the NIH is working with the pharmaceutical industry to come up with new pain treatments. The CDC recently launched an awareness campaign warning about the risks of addiction.

The federal government doled out roughly $1 billion to states last year to combat opioid abuse, and about half of that was authorized by Congress under former President Barack Obama.

State health officials and policy experts say billions of dollars in new funding are needed to make a dent in the crisis. The Public Health Emergency Fund, which HHS could tap under the Trump declaration, has a balance of just $57,000 and the administration hasn’t proposed replenishing it. Rather than asking for new money, the administration can move funds around in existing agency budgets — but that just means taking money away from other health programs.

“The unfortunate part is that the declaration conveyed to the public that something was being done, when nothing is actually being done,” said former Rep. Patrick Kennedy, a longtime advocate for addiction treatment who served on Trump’s opioid advisory commission.

The White House official said the administration is “actively in discussion with Congress” about funding for the crisis.

The emergency declaration also allowed the Labor Department to issue grants to help dislocated workers related to the opioid epidemic, but none have been issued so far, according to a department spokesperson.

Unlike a national emergency declared under the Stafford Act, which is open-ended and overseen by the Homeland Security Department, a public health emergency is finite and comes under HHS. More than a dozen were declared last year alone for California wildfires, the Zika virus, and hurricanes in multiple states.

Trump campaigned on combating the opioid epidemic and carried hard-hit rural areas by large margins. He put his ally, outgoing New Jersey Gov. Chris Christie, in charge of an opioids advisory commission, which strongly recommended declaring an emergency. He also tapped his senior counselor, Kellyanne Conway, to coordinate White House efforts, which she continues to do.

He has yet to nominate a director for the Office of National Drug Control Policy, a White House agency that typically coordinates federal strategy on addiction. HHS has been without a permanent secretary since Tom Price resigned over his taxpayer-funded charter flights. Trump’s pick to replace him, Alex Azar, is likely to be confirmed soon, maybe later this month.

One of the most significant recent initiatives — allowing states to lift a Medicaid restriction on payments for inpatient substance abuse treatment at certain facilities — has been touted as a major initiative by the Trump administration, but it actually began under the Obama administration. Other measures the Trump administration has discussed, such allowing doctors to prescribe anti-addiction medicine via telemedicine, haven’t yet developed.

“I do not pay attention to the emergency declarations; my focus is on what has followed,” said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. “The president said we’re going to have a massive media campaign. … Where is it?”

Congress approved bipartisan legislation in 2016 that authorized $1 billion over two years for opioid crisis response grants to states, which was signed into law by Obama. The first $500 million was doled out last year. The rest is being held up in a larger fight over a bill to fund the government, but it is eventually expected to be appropriated and distributed to states. And other money that Trump has touted comes from CDC and SAMHSA — agencies whose budgets were kept mostly flat under the 2017 spending bill and would have been cut in Trump’s budget proposal for 2018.

Still, a HARVARD/POLITICO poll found more Americans approve of Trump’s handling of the crisis than disapproved. But it and other recent surveys also found that the public regarded opioids as a problem, but not a full-fledged national emergency.

The administration has emphasized a law-and-order approach, cracking down on drug offenses and trying to cut the flow of illegal drugs into the country. Attorney General Jeff Sessions recently challenged states that have voted to legalize marijuana.

Trump’s health department has routinely touted its “five-point” strategy to combat the opioid crisis: prevention, treatment and recovery; expanding access to the overdose reversal drug naloxone; improving data about the scope of the crisis; and supporting research on pain and how it is managed.

Nevertheless, Eric Hargan, the acting HHS secretary, said in November that the president was leaving it to Congress to decide whether more money should be appropriated. Democrats argued hypocrisy.

The administration has also proposed loosening privacy restrictions so it’s easier to notify a family about a loved one’s overdose, and CDC launched a new media campaign on the risks of addiction. Many of these initiatives, too, began before the emergency declaration.

“We have yet to see the president take the serious actions this emergency demands and that he promised on the campaign trail,” Sen. Patty Murray (D-Wash.) said during a HELP Committee hearing Tuesday on the opioid crisis. “Our communities are crying out for serious solutions, not stunts.”

Although congressional appropriators have not committed to new funding, two health committees have held hearings and are in the early stages of considering major legislation this year. HELP Chairman Lamar Alexander (R-Tenn.) has said that he expects Congress to appropriate new money but would not predict when or how much.

“It’s surprising, given all the talk and the splash, that neither Congress nor the administration has really given this the energy it needs,” said Michael Fraser, executive director of the Association of State and Territorial Health Officials. “It’s disappointing.”

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