Will President Trump Declare the Opioid Crisis a National Emergency?

Editor's note: On Oct. 26, 2017, President Trump officially declared the opioid crisis a nationwide public health emergency. The public health emergency designation was formally made by acting HHS Secretary Eric D. Hargan. This approach is different, as explained below, from what Trump suggested he was pursuing in August. For more on this issue, visit www.aaos.org/Advocacy/FDA.

Despite Trump's statement, an official announcement has not been made
According to the Centers for Disease Control and Prevention, 91 Americans die every day from an opioid overdose. As a result—and following the recommendation from the Commission on Combating Drug Addiction and the Opioid Crisis—President Donald J. Trump stated on Aug. 10, 2017, that it was time to proclaim the U.S. opioid crisis a "national emergency."

However, as of early October, the White House has not yet made that official declaration. According to White House spokespersons, the delay is due to various administrative and legal matters. Administration officials have also pointed to hurricane relief efforts as potentially limiting availability of resources. In the meantime, legislators are urging President Trump to take immediate action on his declaration and other steps to end the opioid use and overdose crisis.

"Regardless of whether you choose to declare a state of emergency, continued inaction on this issue is deeply concerning," wrote Sen. Sherrod Brown (D-Ohio), Sen. Ed Markey (D-Mass.), and nine other members of Congress in a letter to the president. "In order to effectively treat this crisis with the urgency it demands, we believe you must take action immediately to expand treatment capacity, increase prevention efforts (including prescriber education initiatives), improve data sharing, and support detection and interdiction efforts to address the supply side of this epidemic—all recommendations for action proposed by the commission you created."


An official national emergency declaration for the opioid crisis would result in expanded executive branch powers and more resources, including additional funding for cities and states for drug treatment, overdose-reversal medication like naloxone, and training.
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What's involved in making an emergency declaration
Although congressional and regulatory efforts continue at the state and federal levels, an official national emergency declaration results in expanded executive branch powers and more resources to address the crisis. Specifically, additional funding would be made available to cities and states for drug treatment, overdose-reversal medication like naloxone, and training. The declaration would also allow temporary relaxation of federal rules, such as the one that limits Medicaid reimbursement for inpatient addiction treatment.

Currently, the United States has about 30 active national emergencies, including erosion of human rights in Venezuela, nuclear proliferation on the Korean Peninsula, and Syria's support of terrorism. Many national emergencies do not involve health care and are needed to justify certain policy decisions, like freezing assets or imposing sanctions. The swine flu epidemic in 2009 is an example of a national emergency focused on a health crisis. Declaring it a national emergency provided hospitals the flexibility, among other things, to open alternative care sites to protect uninfected patients and to absorb potential patient surges.

A declaration of a public health emergency is a different matter. Such a declaration can be made by the secretary of the U.S. Department of Health and Human Services (HHS) and would provide limited, but still expanded, powers under the health department. There are currently no active public health emergencies in this country.

"Once the HHS secretary determines that a public health emergency exists, the secretary is authorized, consistent with the secretary's other authorities, to respond to the public health emergency" explains an Association of State and Territorial Health Officials document. "These authorities include making grants, contracting, and investigating the cause, treatment, and/or prevention of the disease or disorder underlying the public health emergency. The secretary may use funds from the Public Health Emergency Fund when funds are appropriated for it."

In fact, it was former HHS Secretary Tom Price, MD, who stated a few days before President Trump's announcement, that the opioid epidemic could be addressed without the declaration of an emergency. At the time, Dr. Price stated that the HHS had the resources and focus needed to address the opioid crisis, although he acknowledged that all options were on the table.

Legislators also seek to address the crisis by considering varying measures that would, for example, require e-prescribing of prescription drugs that are controlled substances for coverage under Medicare Part D; limit the initial supply of opioid prescription for acute pain; or increase funding for treatment and other efforts.

Ultimately, the president alone can decide to declare a national emergency, and the latest official communication from the White House is that President Trump plans "to use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic."

Elizabeth Fassbender is the communications manager in the AAOS office of government relations. She can be reached at fassbender@aaos.org.

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