Politics: Trump declares the opioid crisis a 'national emergency' — here's what that means

President Donald Trump declared a national emergency on the opioid crisis, a decision in line with what White House Opioid Commission recommended on July 31.

The decision is in line with what the White House Opioid Commission recommended on July 31, though on Tuesday, Health and Human Services secretary Tom Price said Trump didn't plan to declare the emergency.

"The opioid crisis is an emergency and I'm saying officially right now it is an emergency," Trump told reporters on Thursday.

The White House hasn't released a formal document confirming the declaration yet, though it did say in a statement Thursday afternoon that Trump "has instructed his Administration to use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic."

Trump went on to say that he plans to spend a lot of time and money on addressing the opioid epidemic.

"We're going to draw it up and we're going to make it a national emergency. It is a serious problem the likes of which we have never had," he said. "You know when I was growing up they had the LSD, and they had certain generations of drugs. There's never been anything like what's happened to this country over the last four or five years."

Trump can declare the opioid crisis a national emergency under the Public Health Service Act or the Stafford Act, a decision that's usually reserved for natural disasters.

More than 183,000 people died from overdoses related to prescription opioid painkillers like oxycodone, hydrocodone, fentanyl, and morphine over the last 15 years.

What it means to declare a 'national emergency'

Simply, the declaration elevates the severity of the opioid epidemic.

National emergency declarations are generally declared for natural disasters, like Hurricane Sandy, or disease outbreaks like the Zika virus in 2016 or H1N1 in 2009 — crises that have clearly defined scopes.

Emergency declarations under the Public Health Service Act or Stafford Act have never been made for an issue like the opioid crisis, "so there's not a lot of precedent," Lainie Rutkow, an associate professor at the Johns Hopkins Bloomberg School of Public Health, told health news site STAT earlier this week.

Many public health experts have said that the effect of the declaration will be primarily to raise the profile of the issue, both with the public and within the federal, state, and local governments.

"It means every state health department, local government and the federal government would treat this as the top priority," Dr. Guohua Li, a professor of epidemiology at Columbia University told CNN.

While it is yet to be seen under what law Trump will make the declaration, STAT reported that doing so under the Stafford Act could "let states in some of the hardest-hit areas apply for millions of dollars in federal aid through the Disaster Relief Fund."

Major funding increases or changes to federal policy to open up treatment and access to medications like naloxone or buprenorphine would still require action from Congress or new initiatives from agencies like the Department of Health and Human Services.

Michael Botticelli, one of the so-called drug czars under President Barack Obama, told STAT earlier this week that Trump's declaration will mean little without "real meaningful action" enacted alongside it.

Ending a 'federal disincentive' to fund treatment

The White House Opioid Commission said at the end of July that one of the most impactful measures that could be taken by declaring a national emergency would be for the federal government to alter or eliminate an obscure Medicaid rule that has been around since the 1960s.

The Institutions for Mental Diseases exclusion rule prohibits the use of federal funds for Medicaid patients in residential mental health or substance-use disorder treatment centers with more than 16 beds.

The rule is a major roadblock to expanding overloaded treatment centers in hard-hit states, said Deb Beck, the president of the Drug and Alcohol Service Providers Organization of Pennsylvania, a coalition of drug- and alcohol-abuse prevention, addiction treatment, and education programs and providers.

Changing the rule, which Beck called a "federal disincentive to fund treatment," would allow treatment centers to gain critical funding from Medicaid as well as expand their facilities to become more cost-efficient.

"It's very exciting," Beck told Business Insider. "Anything would be an improvement" from the current situation.

Several Republican and Democratic senators introduced legislation in May to eliminate the rule. And Beck said that no declaration of a "national emergency" is needed for Trump or Price to alter the rule.

Price said during a press conference Tuesday that most measures recommended by the Opioid Commission, including altering the IMD Exclusion rule, could be done without an emergency declaration.

“We’re talking about what should be done and working through the department and through the other agencies to come forward with that coherent strategy, that comprehensive strategy and recommendation for the president, and will do so in short order,” Price said.

Eliminating the exclusion would effectively expand the use of Medicaid to treat those suffering from opioid-use disorder, drawing more funds and resulting in more access to sorely needed inpatient treatment.

"It opens up the existing infrastructure and gives patients access to a far broader range of treatment" by allowing Medicaid to pay for treatment in more settings, said Bradley Stein, a senior natural scientist at the Rand Corporation who studies substance-use disorders.

'It's ironic'

Expanding Medicaid is a striking contrast to the administration's efforts to repeal the Affordable Care Act, the law better known as Obamacare.

A key tenet of both Senate and House Republicans' plans to repeal Obamacare was a rollback of Medicaid and the expansion established under the law, which established that any adult living under 138% of the federal poverty level was eligible for states choosing to participate.

Overall, 1.29 million people are receiving treatment for substance-use disorders or mental illnesses as part of the Medicaid expansion, according to research conducted by Harvard Medical School Health Economics professor Richard Frank and New York University Dean Sherry Glied. About 220,000 of those people are receiving treatment for opioid abuse.

"It's ironic," Grant Smith, deputy director of national affairs at the Drug Policy Alliance, a nonprofit that advocates drug-law reform, told Business Insider. "It underscores how much the administration has been going in the wrong direction on healthcare ... and mitigating the crisis."

The 'potential for harm'

Some drug policy advocates, like Smith, have questioned whether an emergency declaration could be used as justification to pursue, in his view, "counterproductive" and severe crackdowns on vulnerable communities, as has happened during past drug crises such as the crack epidemic in the 1980s and the methamphetamine crisis in the mid-2000s

Smith questions the political implications of Trump's national emergency declaration: "What kind of drug policy would we see?" he said.

Given the proclivities of Attorney General Jeff Sessions, who called repeatedly for an escalation of "War on Drugs" policies, Smith said he's not sure the benefits of Trump declaring an emergency outweigh the "potential for harm."

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