No action on opioid emergency three weeks after Trump declaration

President Trump on Aug. 10 said the nation’s opioid epidemic was officially a national emergency.

More than three weeks later, Trump is dealing with a natural disaster.

Hurricane Harvey has displaced tens of thousands, leading Trump to declare federal emergencies in Texas and Louisiana. The decisions have freed up funding to help people who have lost their homes to rising waters.

{mosads}In contrast, nothing has happened yet since Trump’s declaration on opioids. No paperwork has been issued formally declaring an emergency, and no new policies have been announced.

One reason is that there’s no established procedure for an emergency related to opioid abuse, which is new territory for the federal government.

The opioid epidemic is a chronic problem, and national emergencies are usually only intended to provide short-term relief.

Former agency officials and public health experts said it appears the administration was caught off guard by the president’s remarks announcing the emergency — which came during an appearance outside his Bedminster Golf Club in New Jersey while he was on a 17-day vacation, and after Health and Human Services Secretary Tom Price made a detailed argument about why declaring a national emergency isn’t necessary.

“The opioid crisis is an emergency, and I’m saying officially right now it is an emergency,” Trump said. “We’re going to draw it up, and we’re going to make it a national emergency.”

A White House spokesman told The Hill that Trump is considering all options available to him.

“The President is considering not just the emergency authorities … but other potential options as well, to ensure we’re doing all that we can to tackle this crisis head on,” the spokesman said in an email.

“The President instructed his administration to take all appropriate and emergency measures to confront the opioid crisis. Right now these actions are undergoing a legal review.”

According to one former HHS official, a declaration of emergency usually only comes after a plan of action has already been agreed upon, so there’s no delay between pronouncement and formal declaration.

“These things are usually done in pretty coordinated fashion, and there was no coordination here,” the former official said. “It seems the president is driving the train, and left a whole bunch of people scrambling.”

Trump has broad authority, and since the government has never declared a national emergency for drug abuse, experts said nailing down exactly what he could do is difficult.

He could potentially use existing resources to address the problem, which is what Price was advocating before Trump’s comments.

Trump could also potentially use executive orders, but it’s not known what the impact would be.  

“In theory, the president could state something is an emergency without using the legal mechanisms, but this would only serve to communicate with the public rather than allow access to the temporary powers and resources that come with a legal declaration,” Lainie Rutkow, an associate professor at Johns Hopkins Bloomberg School of Public Health, wrote in an email.

The actual declaration of emergency would make it easier for the administration to use emergency funding — so long as Congress appropriates it. Advocates said a declaration without funding is essentially a symbolic gesture.

“We don’t know how far we’d get without the power of the purse,” said Andrew Kessler, founder of the consulting group Slingshot Solutions. “It’s not that simple, you can’t just say ‘emergency!’ ” and fix the problem.

If the president wanted to declare a national emergency, there are a couple routes the administration could take.

Trump can declare national emergency under the Stafford Act, which is typically reserved for a terror attack or natural disaster. There’s a “highly synchronized process” for an emergency under the Stafford Act, said Rafael Lemaitre, a former FEMA director of public affairs, who said plans are normally put into action “immediately.”

Tom Price could also declare a public health emergency. He is the only administration official with the authority to declare such an emergency, which is typically used for infectious diseases such as Zika.

Doing so would loosen certain regulations and allow the secretary to issue grants and spend money that he otherwise would not be able to.

Congress doesn’t need an emergency declaration to appropriate money for more drug treatment and intervention. But if a public health emergency were declared, lawmakers would be under an enormous amount of pressure to fund it.

Public health emergencies are also usually local in scope, making them similar to the declarations made after Hurricane Harvey.

If money is appropriated for a Stafford Act declaration, advocates worry Trump could direct it toward law enforcement and building a border wall, rather than treatment.
 
“We’re very concerned. Taking into account the rhetoric, I think that concern is justified,” Kessler said.

Trump has repeatedly made comments about securing the southern border to stop the flow of illegal drugs, and has vowed to work with law enforcement against “drug dealers that poison our communities” both inside and outside the country.

Advocates want the funding that could come from a public health emergency, and some are frustrated with the delay.

“We were really excited and anticipating the potential of what this could have opened up on multiple levels,” said Jesse Heffernan, national outreach and empowerment coordinator at Faces and Voices of Recovery. “And here we are, [over three] weeks later. Disappointed is kind of a good term.”

Since 1999, deaths from opioids have quadrupled as the country grapples with a nationwide epidemic of prescription painkillers and heroin, according to the Centers for Disease Control and Prevention.

Other advocacy groups are divided on whether the administration needs to push forward a plan right away.

“One would think you don’t make that kind of declaration without doing your homework,” one advocate said of Trump’s announcement. “This is a crisis that has an immense amount of timeliness to it, and families are reeling right now.”

Kessler said the apparent lack of a plan from the White House is worrisome.

“I would rather they take the time to get it right, and make sure they know what their priorities are,” Kessler said. “You only get one bite at this. You can’t declare an emergency, and then if protocols don’t work, declare it again and a get a do-over.”