Trump Stops Short of Calling Opioid Crisis a National Emergency

Alicia Ault

Disclosures

October 26, 2017

President Donald J. Trump has declared the opioid crisis a public health emergency, not a national emergency, as his own special commission had urged in July.

Trump signed the memorandum at a White House briefing. "Effective today, my Administration is officially declaring the opioid crisis a national public health emergency under federal law," said the president. He said he was "directing all executive agencies to use every appropriate emergency authority to fight the opioid crisis." Trump called the declaration "a critical step in confronting the extraordinary challenge that we face."

Acting Department of Health and Human Services (HHS) Secretary Eric Hargan was expected to quickly sign the declaration.

Although the president said that the administration's "efforts will be based on sound metrics and guided by evidence and guided by results," he also said his agencies will devote a lot of effort to convincing people not to take drugs. "If we can teach young people, and people in general, not to start, it's really, really easy not to take them," he said, adding that the federal government would initiate an advertising campaign aimed at preventing people from using drugs.

A public health emergency, overseen by the HHS Assistant Secretary for Public Health Preparedness and Response (ASPR), will reduce some bureaucratic obstacles to hiring needed specialists and could possibly allow for discounted prices for Medicare beneficiaries receiving naloxone and therapies for medication-assisted treatment, such as buprenorphine. But the declaration applies for a period of 90 days and does not come with specific funding.

The declaration allows for shifting of resources within HIV/AIDS programs to help people eligible for those programs to receive substance abuse treatment, "which is important given the connection between HIV transmission and substance abuse," according to a fact sheet issued by the White House before the briefing.

According to the statute, a public health emergency declaration gives the ASPR increased grant-making functions and the ability to access "no-year" funds appropriated to the Public Health Emergency Fund ― when such funds are appropriated. The ASPR's entire fiscal 2018 budget request was for $1.5 billion, a $110 million increase over what was appropriated in fiscal 2017. The budget funds a wide range of activities that include preparedness and response to the health and medical consequences of bioterrorism and other public health emergencies, a counterintelligence program, cybersecurity efforts, and pandemic influenza preparedness and response.

Congress can appropriate additional funds for any public health emergency. Legislators already approved funds that have been directed to combating the opioid epidemic through the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act.

As part of that, the Trump fact sheet noted that since April, more than $800 million has been distributed for prevention, treatment, first responders, prescription drug monitoring programs, recovery, and additional healthcare in communities, inpatient settings, and correctional systems. An additional $254 million has been issued by the administration for funding for high-risk communities, law enforcement, and first-responder coordination.

Increased Access to Treatment?

In July, the president's Commission on Combating Drug Addiction and the Opioid Crisis urged Trump in its interim report to declare a national emergency, which according to Chairman Chris Christie was "the single most important recommendation."

A national emergency, which could be declared under the Department of Homeland Security's Stafford Act, covers national disasters such as hurricanes and earthquakes. It would give the government more wide-ranging powers than a public health emergency declaration, said the commission.

However, some of the commission's other recommendations may be covered by a public health emergency, insofar as the declaration allows the HHS secretary to "waive or modify certain Medicare, Medicaid, Children's Health Insurance Program and Health Insurance Portability and Accountability Act Privacy Rule requirements."

The commission said that states should be able to immediately seek waivers from a regulation that prohibits Medicaid reimbursement for services provided in inpatient facilities that have more than 16 beds, and President Trump said that that would be one of the first actions taken under the emergency declaration.

"You should expect to see approvals to unlock treatment for people in need, and those approvals will come very, very fast," he said.

The public health emergency also allows Medicare to adjust reimbursement for certain Part B drugs. "In the case of a public health emergency in which there is a documented inability to access drugs and biologicals and a concomitant increase in the price of a drug or biological that is not reflected in the manufacturer's ASP [average sales price] for one or more quarters, the Secretary may use the wholesale acquisition cost or other reasonable measure of drug or biological price instead of the manufacturer's ASP," according to the statute. This price change does not require a federal rule in order to be implemented.

That could result in lower prices for the overdose antidote naloxone ― as recommended by the commission. The panel also urged the administration to find ways to reduce reimbursement hurdles for medication-assisted treatment.

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