Thursday, 10 August 2017

Politics: Trump to declare the opioid crisis a national emergency

donald trump

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.

President Donald Trump declared a national emergency on the opioid crisis on Thursday.

The decision's in line with what the White House Opioid Commission recommended on July 31, though on Tuesday, Health and Human Services secretary Tom Price said that 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 said at a news conference. The White House hasn't released a formal document confirming the declaration yet. He 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," Trump 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.

"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.

One potential benefit of declaring an emergency, according to Bradley Stein, a senior natural scientist at the Rand Corporation who studies substance-use disorders, is that Trump would be able to direct Health and Human Services Secretary Tom Price to alter or eliminate an obscure Medicaid rule that has been around since the 1960s. The Opioid Commission recommended eliminating the exclusion as part of the national emergency.

The Institutions for Mental Diseases (IMD) 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.

But doing so 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, Stein said.

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," Smith said. "It underscores how much the administration has been going in the wrong direction on healthcare ... and mitigating the crisis."

A possible change to drug policy

The "national emergency" status also brings up some political questions.

"What would it mean politically if Trump declares a state of emergency? What kind of drug policy would we see?" asked Grant Smith, deputy director of national affairs at the Drug Policy Alliance, a nonprofit that advocates drug-law reform, pointing to past drug crises such as the crack epidemic in the 1980s and the methamphetamine crisis in the mid-2000s as examples of how crises fueled severe, and in his view, "counterproductive" crackdowns on vulnerable communities.

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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