Breaking News: Trump will declare a public health emergency to combat the opioid crisis. Here’s what that will do. - News Paper

It’s a limited move, but it will help jump-start some action in the opioid crisis.

More than two months after he suggested he would, President Donald Trump on Thursday will start the process of declaring a public health emergency over the opioid epidemic — a drug overdose crisis that now kills tens of thousands of Americans each year.

Senior administration officials said Trump will direct the acting health and human services secretary, Eric Hargan, to declare a 90-day public health emergency through the Public Health Service Act, and tell other heads of federal agencies to prioritize the opioid crisis.

The move comes nearly three months after Trump’s opioid epidemic commission in July said that the president should “[d]eclare a national emergency under either the Public Health Service Act or the Stafford Act.” Senior administration officials said that they chose the Public Health Service Act because the Stafford Act is typically focused on natural disasters and specific geographic areas.

The declaration is limited, falling far short of the steps experts say is necessary to combat the crisis. But Lainie Rutkow of Johns Hopkins Bloomberg School of Public Health previously told me that it “could make a difference, or it could at least jump-start things that would then be helpful in the longer term.”

The main practical effect of the declaration is to waive regulations to speed up resources going to the opioid epidemic. Senior administration officials said Trump’s order will enable several specific moves:

• It will allow states to shift federal funds dedicated for HIV to also deal with opioid addiction. HIV and opioid use are linked, because HIV can spread through shared needles; Indiana, for example, suffered a big HIV epidemic as a result of opioid misuse.
• It will open up the Public Health Emergency Fund to help address the opioid crisis. But senior administration officials said Congress has not added money to the fund over the past few years, and USA Today reported that there’s only $57,000 remaining in it.
• It will let the Department of Health and Human Services staff up to deal with the crisis.
• It will let patients use telemedicine to get medication-assisted treatment, the gold standard of opioid addiction care, in which medications like buprenorphine and methadone are prescribed to treat addiction. This could help overcome a major hurdle in rural states hit by the crisis, such as West Virginia, which has the highest drug overdose death rate in the US. It can be difficult to get to a doctor capable of prescribing these treatments in these states.
• It will make National Dislocated Worker Grants available to people with opioid addiction. These grants are normally only available to victims of natural disasters.

None of these steps are significant enough to solve the crisis or even make a big dent in it. Experts estimate that the crisis will take tens of billions of dollars to solve. (For reference, a 2016 study estimated the total economic burden of prescription opioid overdose, misuse, and addiction at $78.5 billion in 2013.) This will likely require action by Congress.

Senate Democrats on Wednesday unveiled a bill that would spend $45 billion over 10 years on the opioid epidemic. The extra funds would go to funding prescription drug monitoring, improving doctors’ prescribing practices, expanding access to addiction treatment, and support other public health initiatives related to drug misuse, among other moves. But the bill so far has no Republican cosponsors on board.

The opioid epidemic began in the 1990s, when doctors became increasingly aware of the burdens of chronic pain. Pharmaceutical companies saw an opportunity, and pushed doctors — with misleading marketing about the safety and efficacy of the drugs — to prescribe opioids to treat all sorts of pain. Doctors, many exhausted by dealing with difficult-to-treat pain patients, complied — in some states, writing enough prescriptions to fill a bottle of pills for each resident. The drugs proliferated, landing in the hands of not just patients but also teens rummaging through their parents’ medicine cabinets, other family members, friends of patients, and the black market.

Eventually, many opioid users progressed to heroin and the synthetic opioid fentanyl. Not all painkiller users went this way, and not all opioid users started with painkillers. But statistics suggest many did: A 2014 study in JAMA Psychiatry found 75 percent of heroin users in treatment started with painkillers, and a 2015 analysis by the CDC found people who are addicted to painkillers are 40 times more likely to be addicted to heroin.

As the crisis has gone on, an increasing share of people with opioid addiction have started with heroin. A 2017 study in Addictive Behaviors found that 51.9 percent of people entering treatment for opioid use disorder in 2015 started with prescription drugs, down from 84.7 percent in 2005. And 33.3 percent initiated with heroin in 2015, up from 8.7 percent in 2005.

As a result, a lot of people are dying: In 2016, more than 64,000 people died of drug overdoses in the US, according to preliminary data from the CDC. This is the highest death toll from overdoses recorded in any single year in US history — surpassing the highest-ever single-year death tolls from guns, car crashes, or HIV/AIDS.

This is a result of essentially two simultaneous crises — which Keith Humphreys, a Stanford University drug policy expert, explained as the dual problems of “stock” and “flow.” On one hand, you have the current stock of opioid users who are addicted; the people in this population need treatment or they will simply find other, potentially deadlier opioids to use if they lose access to prescribed painkillers. On the other hand, you have to stop new generations of potential drug users from accessing and misusing opioids.

As I previously explained, we have a pretty good idea of what these resources would go to: They could be used to boost access to treatment, pull back lax access to opioid painkillers while keeping them accessible to patients who truly need them, and adopt harm reduction policies that mitigate the damage caused by opioids and other drugs.

All of this will take a significant amount of resources. Trump’s emergency declaration will free up some of those — but not anywhere near enough.

For more on the solutions on the opioid epidemic, read Vox’s explainer.

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Breaking News: Trump will declare a public health emergency to combat the opioid crisis. Here’s what that will do. - News Paper