Experts: Trump declaration needs to be more than funding hike for states

As President Donald Trump gears up to formally declare the opioid crisis a national emergency, addiction medicine experts hope the hotly anticipated announcement will go beyond financing states' efforts to combat the epidemic.

Months after Trump first announced plans to formally declare the opioid crisis a national emergency, the president is expected to make his first meaningful response to the issue on Thursday, which will likely include releasing millions in federal resources to respond to the epidemic.

Many addiction medicine experts have praised the administration's move. They say an emergency declaration will undoubtedly help to shine an even brighter light on the severity of a problem that has garnered many headlines over the past two years as the number of Americans who have died from drug overdose has continued to increase.

But the declaration's impact will ultimately hinge on the provisions in the order and how thoughtfully those details are implemented.

"An emergency declaration, just like many other government policies, could be a force for good or force for harm," said Dr. Caleb Alexander, an associate professor of epidemiology and medicine at the Johns Hopkins Bloomberg School of Public Health and founding co-director of its Center for Drug Safety and Effectiveness. "The devil is in the details."

Trump's emergency declaration could take one of many paths. If he uses the Public Health Service Act, the HHS could negotiate drug prices for medication-assisted treatments to increase access for healthcare providers. It would also give HHS the authority to waive Medicaid rules that limit reimbursement to 15 days for patients receiving mental health or substance use disorder treatment in residential facilities that have more than 16 beds.

Widening access to medication-assisted treatment would have significant, long-lasting effects toward curbing the opioid epidemic, according to Dr. Andrew Kolodny, co-director of policy research at Brandeis University. Currently an estimated one in 10 of the more than 20 million people in the U.S. with a substance use disorder have access to buprenorphine treatment, according to a 2016 U.S. Surgeon General's report.

Making medication-assisted treatment more available than the opioids themselves will take significant cash.

"I think we need about $6 billion at least this year, if not annually over the next 10 years," Kolodny said. "I think we need an appropriation of that amount so that in every county in the country, someone who is opioid-addicted is able to access buprenorphine treatment regardless of their ability to pay for it and access it on the same day that they need it."

The declaration should also allow all federal agencies working on the crisis--which includes HHS and the CMS, as well as the Office of Homeland Security, the Substance Abuse and Mental Health Services Administration, the Drug Enforcement Administration and the Food and Drug Administration--to have the ability to hire additional staff to address the crisis, Kolodny said.

Trump's declaration could also order members of the National Health Services Corps., which provides primary, dental and behavioral health care to the most medically vulnerable communities in the country, to be deployed to areas hardest hit by the opioid crisis and where there are shortages of healthcare professionals to provide addiction treatment, Kolodny said.

Alexander said a national response to the opioid crisis couldn't be solely a funding boost to support state efforts. Between January and September of this year, HHS has funneled more than $340 million in grants to state-run programs.

Six states have declared emergencies on their own to expedite resources to address the opioid epidemic. Most states used the opportunity to bypass legislative action that would otherwise have been needed in order to provide statewide access to the overdose-reversal medication naloxone to first responders, pharmacies and others.

That's not enough; a nationwide response is necessary to effectively combat the crisis, according to Alexander.

"The responsibility to address this cannot be fully ceded to the states," Alexander said. "There is no Ohio Food and Drug Administration, there is no Kansas DEA—the federal agencies have to be part of this."

But treatment is only one component of the federal response an emergency declaration could expedite.

Trump's order could also help prevent more Americans from becoming addicted to opioids by tackling clinician education. The declaration could require clinicians receive prescribing education on opioids as part of their licensing or mandate prescribers review state prescription drug monitoring programs.

An estimated 16 states currently have laws that require prescribers to search patients' prescription drug histories on PDMPs. But those databases are ineffective if a patient travels outside of their state to fill an opioid prescription, since most state PDMPs don't access prescribing information from other states.

That could be solved with a national database and a more uniformed set of standards for clinicians.

"Ultimately there has to be a database established for monitoring this on a larger scale than has been done," said Bradley Sayles, a healthcare attorney at the Nashville-based firm Nelson Mullins Riley & Scarborough.

No matter the scope of Trump's declaration this week, Alexander said he hoped it would be the beginning of the nation's response to the epidemic rather than an attempt to declare "mission accomplished."

"This epidemic continues to change and evolve," Alexander said. "There's no such thing as a be-all and end-all to this."