President Donald Trump plans to officially declare the opioid epidemic a national emergency by next week, two months after first announcing a pledge to do so.
"We are going to have a major announcement, probably next week, on the drug crisis and on the opioid massive problem and I want to get that absolutely right," Trump said during a news conference Monday.
Some have criticized the delay in declaring the opioid crisis a national emergency, saying a declaration would immediately release resources to help municipalities and states in their efforts.
More than 500,000 people have died from drug overdoses from 2000 to 2015. The deaths are occurring at an average of 91 deaths a day, according to the Centers for Disease Control and Prevention.
"I want to hear in the declaration exactly how much funding the president is going to be putting forth to treat this epidemic," said Dr. Leana Wen, Baltimore city health commissioner. In 2015, Baltimore became one of the first cities in the country to issue a citywide standing order for the overdose-reversal medication naloxone.
But the city is currently running low on its supply. Wen said less than 10,000 doses of the medication remain and that there is no money left to purchase new supplies. The city has had to ration the supply to the most-heavily hit areas.
"In the last several months people have died because we have rationed this medication," Wen said.
Wen said the federal funding that is likely to come from the president's emergency declaration is what counties and municipalities need to fund treatment and prevention efforts in their communities.
But hospitals and health systems aren't waiting for funding. Many providers would welcome federal funding, but say they're moving forward on strategies they have developed to respond to the crisis.
"We have multiple prongs to our strategy that don't rely on external funding," said Aaron Weiner, director of addiction services at Linden Oaks Behavioral Health, a mental health and substance abuse treatment provider affiliated with Edward-Elmhurst Health system in the Chicago suburbs. In 2016, overdose deaths in DuPage County, where it's based, rose 53% compared with the previous year.
Linden Oaks has deployed continuing education for clinicians to improve their prescribing habits. It has also altered its electronic medical record system to automatically prescribe naloxone when patients are over a certain high-dose threshold on their opioid prescriptions. Clinicians can also look up information from the state's prescription drug-monitoring program within the EHR rather than having to go to an outside system.
"Any healthcare system can reform prescribing practices, workflows and in-system issues in a relatively budget-neutral way," Weiner said.
Under an emergency declaration, HHS would have the authority to allow providers to purchase naloxone as well as medication-assisted treatment drugs like buprenorphine at a discounted price. The HHS also could waive Medicaid rules that limit the number of days patients can receive mental health or substance abuse treatment within a residential facility with more than 16 beds.
Some experts believe a declaration could require hospitals to treat patients for substance abuse when they visit an emergency department. Currently the common practice has been for EDs to hold patients long enough to stabilize them for transfer to a treatment facility, or to discharge them if one is not available or they refuse to be treated.
Ultimately, Weiner said he didn't think his facility would have changed its approach if Trump's declaration had been formalized sooner.
"There are additional things that we could do, but we weren't planning on it from the beginning because it wasn't on the table," Weiner said.
An edited version of thist story can also be found in Modern Healthcare's Oct. 23 print edition.
