What difference will calling the opioid epidemic an 'emergency' make?

Last year more than 2,000 Marylanders died of drug overdoses, nearly 700 of them in Baltimore City alone. Public health officials say that fatal overdoses involving heroin and its synthetic substitute, fentanyl — a cheaper, more powerful narcotic that is often mixed with heroin — kill more than twice as many state residents as homicides every year, and the toll keeps rising.

That’s why we’re cautiously optimistic following reports that President Donald Trump plans to declare opioid overdose deaths a national public health emergency, a move that potentially could save thousands of lives if it cuts through bureaucratic red tape and frees up additional federal resources to confront the crisis. Maryland and other states desperately need such help, but the impact of the president’s plan depends more on what his administration does after the paperwork is signed than on what he chooses to call the epidemic.

This is not the kind of thing presidents usually declare an emergency — the model is typically an acute outbreak, like swine flu, or the result of a natural disaster, so there’s not much precedent for what his action could accomplish. But there are at least two different sources of legal authority he could use in this case, and either could make a difference. Depending on the legal framework Mr. Trump employs, a declaration could allow states to waive Medicaid rules that prohibit federal funds from being spent on large, inpatient drug treatment centers of the kind Baltimore City health advocates say are effective in weaning people off opioid addiction when combined with counseling and anti-addiction medications. It could also allow the federal government to negotiate lower prices for overdose medications like naloxone and allow doctors to treat more than 275 recovering addicts with the anti-addiction medication buprenorphine. The Obama administration increased the cap on the number of patients each doctor could treat with the drug at that level last year, but federal officials could and should remove the restriction entirely. Part of the reason we got into this mess was the overprescription of opiod painkillers; it makes little sense to now restrict use of a medication that can help people escape the addiction that came as a result.

Responding effectively to this public health emergency will require concerted and sustained efforts to reach the people most at risk of drug overdose. But it isn’t rocket science. We already know a lot about what works and what doesn’t, and also how to help addicts get back on their feet again with social services designed to meet their individual needs. The problem has never been what can be done in the face of this awful scourge, but how: How to identify those at greatest risk of overdose, how to reach them with counseling and treatment interventions to help them turn their lives around, and how to pay for it all without busting already overstretched state and local budgets.

In Baltimore City, for example, Health Commissioner Dr. Leana Wen has long recognized that reducing overdose deaths requires a multi-pronged strategy that includes aggressive public health information and outreach campaigns; increased access to the anti-overdose drug Narcan, also known as naloxone, for addicts, their friends, families and first responders such as fire fighters and police; and the financial resources to provide immediate, on-demand treatment to addicts who want to kick the habit.

Maryland Gov. Larry Hogan took a welcome step this year in declaring his own state of emergency and pledging to spend an additional $10 million in state funds to reduce overdose deaths, but no one thinks that will be enough to halt the epidemic the state is currently experiencing. Recovery from an opioid addiction involves a long and painful process often characterized by frequent relapses that actually can increase the likelihood a person will suffer a fatal overdose before he or she breaks the dependency. Despite all the recent advances in the science of addiction and its effects on the brain, people will continue to succumb to this terrible illness.

That’s why so much depends on what Mr. Trump has in mind when he says the federal government must play a larger role in response to the overdose crisis. Clearly a state like Maryland could use millions more in federal funds on top of the state funds Governor Hogan already has set aside to fight the epidemic. Just calling it an emergency won’t save any lives unless federal officials follow through with significant increases in funding for anti-overdose policies, programs and treatment strategies, clinical trials and basic research, because all of them will be needed to halt and eventually reverse the course of this epidemic. This is a battle that is well worth fighting, but it won’t be won by words alone.

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