President Donald Trump has correctly identified the opioid crisis as a national emergency. An overburdened drug court prosecutor wife of one of the authors of this article agrees, as do, no doubt, countless medical examiners, emergency responders, corrections officers, substance abuse counselors and judges throughout the country.
Also presumably in agreement are governors in several states, including Maryland, who have declared some form of a public health emergency related to the crisis. These executives understand what is going on in their communities; they are well situated to implement approaches that meet specific needs. Here, the ability to amend sentencing laws, expand access to various treatment regimens or tap into reserve funds are examples of prudent state actions responsive to this growing epidemic.
Nationally, the question becomes what this all means; such declarations of “national emergency” typically target national disasters or contagious diseases and end at a certain time. But there is no sign the epidemic is slowing down. And so the country asks: What is the administration going to do? How does the president intend to define “victory”?
Here’s hoping the president will, early in the process, identify specific goals to avoid the mission creep often associated with government programs. The alternative is the government attempting — and failing — to solve every facet of a complex challenge. A poorly executed emergency declaration creates false expectations in the public sphere, increases pressure for funding and allows political grandstanders to assume a leadership role.
On the spending and accountability front, Health and Human Services Secretary Tom Price knows the drill. A few months ago, his agency awarded grants (pursuant to the “21st Century Cures Act”) that provide $1 billion in opioid treatment to the states. Enacted during President Barack Obama’s last year, the government has distributed the first round of funding and is developing a system to measure outcomes for the second. Herein at least is a refreshing attempt to strike a balance between an urgent spending priority and a process for tracking results.
On a separate track, New Jersey Gov. Chris Christie’s White House Opioid Task Force invoked 9/11 to highlight the country’s staggering number of overdose fatalities. The governor’s report urged the president to issue an emergency declaration and thereby “force Congress to focus on funding.”
But finding dollars is something Congress does quite well. The Senate’s tortured efforts to pass a health care “Repeal and Replace” bill are illustrative. So-called GOP moderates used the crisis as leverage during negotiations with the leadership. In the end, one version of that bill included $45 billion in add-on substance abuse treatment dollars to be distributed to the states.
Another funding source is the lawsuit route. A growing number of state and local jurisdictions are gearing up for what the Financial Times calls a “tidal wave” of litigation. The legal theory is familiar: The exploding cost of addiction presently borne by state and local governments are damages that should be paid by the opioid manufacturers due to their deceptive marketing practices. At last count, 30 states, cities and counties were in various stages of preparing such legal challenges. Can you say “payday”?
You may be interested to learn that a leading organizer of the pharmaceutical litigation is former Mississippi Attorney General Mike Moore, the mastermind behind the $246 billion ($144 billion paid out to date) states’ tobacco settlement of 1998. The stated purpose of those dollars was to reduce smoking. But many are asking where the money has gone. (The Campaign for Tobacco-Free Kids says that only $500 million has been spent on smoking prevention.) The answer: state government general fund budgets and trial lawyers. Expect a similar result should this litigation against pharmaceutical companies prove successful.
The bottom line: A productive fight against the opioid scourge should be less about federal funding and lawsuit-induced money grabs and more about governing during a crisis. Admittedly, this notion is counterintuitive: A natural reaction from elected officials is to identify a major problem and want to throw as many resources at it as possible, or worse, assign blame and hope to collect accordingly. But this tried and true approach is too easy. There is no endgame. Taxpayers never get to see what actually works. Witness the never ending war on drugs and the never ending dollars that never seem to produce the desired results.
The people who pay the bills deserve better. Identifying and reporting on existing efforts is a good first step in the right direction. Even marginal improvement translates into lives saved — a promising development for one wife who would welcome a little less business these days.
Robert L. Ehrlich, Jr. is the former governor of Maryland, and Jim Pettit (firstname.lastname@example.org) is a public policy consultant.