Following months of uncertainty, President Trump late last month made good on his promise to declare the opioid epidemic a national emergency. After much talk about fighting the devastating and deadly impact of these highly addictive drugs, the administration is now taking action.
It remains unclear exactly what President Trump’s emergency declaration will entail. A declaration of a public health emergency against a class of drugs is unprecedented and uncertain in both its scope and duration. There are reasons to be concerned with the outcome.
Here’s what we know: The president is asking the Department of Health and Human Services for a declaration of a public health emergency under the Public Health Service Act. This action allows medical personnel to be deployed to the hardest hit areas, and empowers HHS to ease any regulations that could get in the way.
But such declarations were designed to deal with infectious diseases, not addiction and substance abuse disorders. There is also no clear way for paying for it. At present, the Public Health Emergency Fund at HHS amounts to a grand total of $57,000.
Also lacking is a clear scope and duration of this declaration. It is increasingly clear that opioid addiction can be a lifelong challenge, not a temporary emergency. No matter how extensive a support network or how effective a rehabilitation program, for many people who are affected by a substance use problem, addiction and the threat of a relapse can forever haunt them.
That realization begs the question of how this emergency declaration will address the years of treatment and recovery support that many with opioid addiction will need. One thing remains certain — this epidemic will not follow the dictates of government declarations.
Opioid overdoses kill about 90 Americans every day. These deaths, above 30,000 a year, exceed or come close to the annual death toll from HIV/AIDS when that disease was rampant. In Georgia, prescription opioid overdose deaths increased tenfold between 1999 and 2014, almost equaling deaths from motor vehicle crashes. In a recent year, Georgia saw more than half-a-million opioid-related hospitalizations. Similar impacts are being felt from Kentucky to California.
Combating this scourge requires a national policy. With recent attempts at crafting a new national health care policy having failed, one can be forgiven for doubting the strategy of tying opioid treatment to health care reform. We cannot afford to let a response to the opioid crisis wait until Washington gets its act together on broader health care policy.
At the top of the agenda should be further expansion of access to naloxone, commonly known by its commercial name Narcan, which first responders, parents, spouses, roommates and friends can use to save a loved one from an overdose. The declaration does allow some increased access, but more must be done to get this lifesaving drug to the frontlines of the fight against opioid overdose deaths. Proven-effective treatment and recovery care and services must also be extended in a way that the poorest and most vulnerable Americans can access over the long term.
Congress should continue to give states room to improve digital tools that help physicians identify patients who “doctor shop” for a fix. These prescription drug monitoring systems seem to be contributing to marked decreases in opioid-related deaths and hospitalizations.
There are other rules that can be relaxed. Georgia has wisely changed its regulations to allow harried doctors and pharmacists to task licensed staff to check the registry. At the same time, we need to make sure these databases do not unduly restrict physicians’ ability to prescribe opioid-based painkillers for the patients who truly need them.
Better tracking systems and education programs for patients can also avoid the dangers of contraindications between opioids and other prescribed pharmaceuticals. This digital surveillance approach is especially needed to monitor for the dangers of mixing opioids with psychiatric drugs for anxiety and depression, a potentially lethal combination.
We should also look to the potential of strange bedfellow alliances between liberals and conservatives, who typically oppose big government, but whose communities are being ravaged by the opioid epidemic. Consensus is growing that expansion of Medicaid would provide the access to addiction treatment so many Americans desperately need and deserve.
Lastly, as a retired physician, I must encourage greater focus on prevention — keeping people from abusing, misusing, and becoming addicted to opioids in the first place.
This country cannot afford to let Congress’s failure to pass health care reform derail the fight against opioid addiction. Nor can it afford to pat itself on the back by making dramatic, but ultimately toothless, declarations that opioid addiction is a serious problem and one that needs more resources but they are not forthcoming.
A crisis often brings out the best in our government. When lives are on the line we have always been able to put our differences aside and work towards a common goal. In this era of partisanship and gridlock, this is a chance for Congress to prove that the spirit of unity is not dead. For the sake of millions of Americans and their loved ones, we must hope that they do.
Philip Gingrey, M.D. is a former U.S. Congressman who served Georgia’s 11th congressional district from 2003 to 2015. He is currently a senior adviser with the District Policy Group at Drinker Biddle & Reath LLP.
This op-ed piece was originally published in The Hill, here.