President Donald J. Trump declared the opioid crisis a public health emergency on Thursday, a move that could expand access to treatment in some parts of Maryland but that falls short of the significant increase in federal funding that public health advocates had sought.
The 90-day declaration means the Department of Health and Human Services can waive regulations that some say have hampered the response. Trump also vowed to pursue a “massive advertising campaign” and to expand access to telemedicine — potentially allowing the prescription of powerful addiction medication without an office visit.
“No part of our society — not young or old, rich or poor, urban or rural — has been spared this plague of drug addiction,” Trump said during a sometimesemotional event inthe East Room of the White House. “This epidemic is a national health emergency. Nobody has seen anything like what’s going on now. As Americans, we cannot allow this to continue.”
But the move was far less sweeping than what many public health advocates had hoped for. It also fell short of what had been proposed bya commissionthe president created to study the problem. That group, led by Republican Gov. Chris Christie of New Jersey, called for a designation of a national emergency as a way to free up federal money to expand treatment.
A national state of emergencydesignation— rather than the public health emergency Trump announced — would have given the White House and the administration more power to free up treatment funding.
“It’s not nothing, but it’s not nearly adequate to the challenge,” said Rep. John Sarbanes, a Baltimore County Democrat who has been a leading voice on the issue, of Thursday’s announcement. “It’s a big missed opportunity on the part of the president to show that our response as a nation is going to be one that is up to and meets the challenge.”
The number of people who died in Maryland from drug- and alcohol-related overdoses is up nearly 20 percent through June of this year to 1,172, according to state health department data released Tuesday. That’s after such deaths surged 66 percent last year to 2,089, according to the state health department.
Baltimore reported 694 overdose deaths last year, more than twice its 318 homicides. Another 393 died in the city in the first half of 2017, up 29 percent compared to the same period last year.
The rising death toll has been driven by fentanyl, a cheap and powerful synthetic opioid that dealers are blending into heroin.
Trump said he would raise the issue of fentanyl with Chinese leaders during his trip next month to Asia. China is the world’s largest producer of fentanyl.
In one of the more tangible policy changes announced Thursday, the president said his administration would waive a rule that prohibits residential treatment facilities with more than 16 beds from receiving Medicaid reimbursement. Maryland officials said the state already had received a waiver from those rules.
Trump also promised to support efforts at the Bethesda-based National Institutes of Health to pursue research into non-addictive painkillers.
Sarbanes and public health experts said those ideas sounded fine, but they questioned the administration’s commitment given other changes the White House has proposed. The Trump administration has sought major cuts to both traditional Medicaid and the expanded Medicaid program approved in 2010 as part of the Affordable Care Act. Earlier this year the administration called for a $5.8 billion cut to NIH funding.
“We are hearing that funding can be reallocated and repurposed, but that would just take away from other key health priorities,” said Baltimore Health Commissioner Dr. Leana S. Wen.
“I'm glad that the president is calling attention to this issue by declaring a public health emergency,” she said, “but I wonder why a broader declaration of a national state of emergency did not happen.”
Trump described his personal experiences with addiction, noting the struggles his brother, Fred, faced with alcoholism. Departing from his prepared remarks, Trump described his brother — who died at 43 — as having a “very, very tough life because of alcohol."
“He was a strong guy, but it was a tough, tough thing that he was going through,” Trump said. “But I learned because of Fred. I learned.”
Presidents have declared national emergencies in response to a surprising variety of issues, often as a tool to freeze the assets of foreign nationals. President Bill Clinton declared an emergency in 1995 targeting Colombian narcotics dealers. Citing a “breakdown of law and order in Zimbabwe,” President George W. Bush declared an emergency in 2003 that froze the assets of Zimbabwean President Robert Mugabe.
But such declarations are rarely targeted at public health crises. One notable exception: a 2009 order by President Barack Obama on the swine flu epidemic. That declaration allowed hospitals across the country to set up off-site facilities to treat patients with the flu.
Public health crises generally are handled through emergency designations of the kind Trump announced Thursday. Public health emergencies, which gives the federal Department of Health and Human Services additional power to divert money to new uses, were declared in Puerto Rico last year during the Zika virus outbreak and for hurricanes that hit the Gulf Coast and the Caribbean this year.
Clay Stamp, executive director of the state’s Opioid Operational Command Center, said in a statement that “it will take a nationwide effort by the federal government in support of the states' efforts” to address the opioid crisis, adding that Maryland would “leverage all available federal resources to support our balanced approach.”