President Donald Trump overrode his own advisers when he promised to deliver an emergency declaration next week to combat the nation’s worsening opioid crisis.
“That is a very, very big statement,” he said Monday. “It’s a very important step. … We’re going to be doing it in the next week.”
Blindsided officials are now scrambling to develop such a plan, but it is unclear when it will be announced, how or if it will be done, and whether the administration has the permanent leadership to execute it, said two administration officials.
“They are not ready for this,” a public health advocate said of an emergency declaration after talking to Health and Human Services officials enlisted in the effort.
Trump’s off-script statement stunned top agency officials, who said there is no consensus on how to implement an emergency declaration for the drug epidemic, according to interviews with officials from the White House, a half dozen federal agencies, state health directors and lobbyists.
Trump had previously promised an emergency declaration in August, after his handpicked opioid commission headed by New Jersey Gov. Chris Christie made it an urgent recommendation. But the commitment quickly got bogged down in White House infighting and concerns about the order’s scope and cost.
Members of Trump’s Domestic Policy Council, budget director Mick Mulvaney and former HHS Secretary Tom Price opposed the plan for months because of the multibillion-dollar price tag, legal issues and questions about how it would be implemented, according to White House officials. Price argued that the government could respond efficiently without taking such a step.
“Everyone wants opioids to be a priority, but there’s a lot of resistance to calling it an emergency” because of the legal and budgetary implications, said one senior administration official.
In the meantime, White House senior counselor Kellyanne Conway convened meetings and events on the problem, drawing episodic interest from the president, aides said.
Emergency declarations are typically used to respond to isolated events such as hurricanes and floods, or disease outbreaks. Using one to combat a nationwide epidemic with no obvious end point might require unprecedented resources and raises numerous legal and other questions, said one senior White House official.
By mid-October, with no commitment from the White House, Christie publicly needled Trump for not declaring the drug crisis an emergency, saying it was “not good.”
A few days later, Trump resurrected his promise.
“The reaction was universal,” said a senior health official specializing in drug policy. “Believe it when [we] see it.”
Multiple sources in and out of relevant federal agencies said key leaders on the opioid issue had not been asked to draw up strategies and tactics.
A senior FDA official said she did not know who was in charge of the emergency declaration efforts and described the effort as “such a mess.”
“I would hope that the agency heads had been asked to formulate a plan, and if they haven’t by now it’s hard to believe there will be substance to any announcement made next week,” said Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, which advocates for state and federal policies to combat opioid misuse.
An HHS spokesman said Thursday night the agency is working with the White House on short-term and long-term strategies to combat the crisis and is providing advice on the declaration. A White House spokesman declined comment ahead of the announcement.
Complicating the administration’s announcement are the vacancies at the top of four key health and law enforcement agencies that would execute the plan:
— Trump’s health department is without a secretary since Price resigned under pressure in September after spending more than $1 million in taxpayer money on private and government planes for travel.
— His Drug Enforcement Administration, pivotal to cracking down on drug distributors, is without a head after the acting director resigned last month in protest of Trump’s statements.
— His choice to lead the Office of National Drug Control Policy, Rep. Tom Marino(R-Pa.), withdrew his nomination Tuesday amid accusations he helped drug distributors pass an industry-friendly law that hobbled the DEA’s efforts to halt the spread of the opioid crisis.
— And his nominee to lead the Department of Homeland Security, which the president says will play a critical role in stopping the flow of illegal drugs into the country, hasn’t been confirmed.
“It is very difficult to make a big change in direction when the heads of almost every relevant agency are either not appointed or been forced to quit,” said Peter Lurie, most recently the associate commissioner for public health strategy and analysis at the Food and Drug Administration.
Trump has installed several key health officials — Centers for Disease Control and Prevention Director Brenda Fitzgerald, FDA
Commissioner Scott Gottlieb and Surgeon General Jerome Adams, who played a crucial role in responding to Indiana’s drug epidemic when he was the state’s health commissioner under then-Gov. Mike Pence. But it was unclear what role those officials or their agencies might have.
Policy experts say Trump could go several ways to declare a formal emergency — or he could opt for an entirely different approach with a symbolic statement that simply directs agencies to work on solutions.
The Stafford Act is typically employed after natural disasters, giving the federal government authority to waive regulations and dispense federal dollars to affected communities — usually through the Federal Emergency Management Agency. But White House officials are dubious about whether they can use that authority for a drug epidemic.
The Stafford Act stipulates that requests must come from a governor who asserts an event has overwhelmed his state’s resources. The only exception is if a president determines the primary responsibility for an emergency rests with the federal government.
Trump could also declare a public health emergency — an approach that is narrower in scope and would rely on the health department’s resources. Public health experts say that option is more likely. But the pot of new money available is minuscule — $57,000, according to an HHS spokesperson.
The agency might also pull money from existing block grant programs related to substance abuse and preventive health. But advocates oppose that, saying it would undermine other vital health programs.
The White House could also appeal to Congress to ask for support for the initiative — an approach that advisers are pushing.
State health officials say they are not waiting around for Trump to act. A half dozen have declared their own emergencies, enabling officials to divert resources to response efforts and expand access to naloxone, a medication designed to rapidly reverse opioid overdose.
“There are no silver bullets,” said Jay Butler, Alaska’s chief medical officer and president of the Association of State and Territorial Health Officials, a group of public health officials. “We can’t get distracted on unicorn hunts thinking there’s one solution to solving the complex issue of the opioid crisis. It’s not a problem that will be quickly or easily resolved.”
This article originally appeared here on Politico.