Public health experts in Maryland are applauding President Donald Trump's plan to declare an emergency to confront the nation's opioid crisis, but warn the impact of the move will depend heavily on the steps his administration takes after the paperwork is signed.
Trump, who vowed to address the overdose epidemic during the presidential campaign last year, said he would formalize the emergency declaration this week — two months after he floated the idea.
An emergency declaration has the potential to be more than a symbolic gesture. It can free up untapped funding and allow officials to bypass federal regulations that some say have hampered the response to a public health crisis that kills 91 Americans every day.
The number of people who died in Maryland from drug- and alcohol-related overdoses surged 66 percent last year to 2,089. Baltimore saw 694 overdose deaths last year, more than twice its 318 homicides.
"A state of emergency is long overdue," said Baltimore Health Commissioner Dr. Leana Wen, a national voice on the issue. "Imagine if this was ebola and there were over 100 people dying a day. There'd be no question."
Wen said she will be watching closely for the details of the declaration, and what steps the administration plans to take. By far the most important potential impact, she said, is the possibility of additional federal funding flowing to places such as Baltimore.
"We have implemented interventions that are working to save lives, but we are limited in our ability to scale them up because of limited resources," Wen said. "We know what works."
More than a public relations stunt, a federal emergency declaration gives a president the power to bypass regulations. Public health analysts have said an emergency declaration could allow states to waive Medicaid rules that prohibit federal funds from being spent on large inpatient drug treatment centers, for instance.
A declaration could also allow the federal government to negotiate lower prices for the overdose drug naloxone.
Wen and others have pushed for years to lift the cap on the number of patients a doctor may treat with the heroin addiction medication buprenorphine. The Obama administration raised the limit to 275 patients last year, but some would like to see it removed entirely.
Former Baltimore Health Commissioner and Maryland Health Secretary Dr. Joshua M. Sharfstein said Washington should quickly stand up a monitoring program to provide better data on addiction and overdose deaths. The Centers for Disease Control and Prevention currently relies on data from death certificates, which can be slow to process.
Sharfstein, now an associate dean for public health practice and training at the Johns Hopkins Bloomberg School of Public Health, has also said that the federal government could use emergency funding to deploy doctors, physician assistants and nurse practitioners in the Commissioned Corps of the U.S. Public Health Service to set up treatment programs in hard-hit communities.
"Declaring a national emergency officially essentially has no on-the-ground impact," Sharfstein said. "It's all about what the government does through its emergency."
It's not yet clear what the White House has in mind.
Maryland Gov. Larry Hogan, a Republican, declared a state of emergency in March and pledged to spend an extra $10 million a year fighting the epidemic.
State officials declined to answer specific questions about how a federal emergency declaration might augment that effort. But a spokeswoman for the state's Opioid Operational Command Center said it would "take a nationwide effort by the federal government" to turn the problem around.
"Maryland will continue to advocate for additional resources from the federal government, and the state will leverage all federal resources to support a balanced approach that includes prevention, enforcement, and treatment," spokeswoman Katie Kuehn said in a statement.
Presidents have declared 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.
Both of those orders, and dozens of others, remain in effect today.
But 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 public health emergencies, which are declared by the secretary of Health and Human Services. Public health emergencies, which give the department 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.
Trump's secretary of the Department of Health and Human Services, Tom Price, resigned last month amid an imbroglio over his use of private jets for routine travel. It's not clear whether the vacancy at the top of the health department will have an impact on the administration's effort to address opioids.
Trump told reporters in August that his administration would make the emergency declaration, setting off a flurry of coverage suggesting an order was imminent.
"I'm saying officially right now it is an emergency," Trump said at the time.
"We are going to be doing that next week," the president said. "It's a very important step. And to get to that step, a lot of work has to be done and it's time-consuming work."
The question came amid a discussion about Rep. Tom Marino, who was then Trump's nominee to serve as the nation's drug czar. The Pennsylvania lawmaker was the subject of a Washington Post and CBS News report that detailed his role in crafting a 2016 law that weakened the Drug Enforcement Administration's authority to regulate opioids.
Marino subsequently withdrew his name from consideration.