President Trump’s ‘state of emergency’ — a health commissioner’s perspective

On Thursday, President Trump announced that he was declaring the opioid epidemic to be a public health emergency, rather than a national state of emergency. As a public health official on the frontlines of this epidemic, I am surprised and disappointed by the limited scale of this declaration. 

Most importantly, the declaration comes with no specific funding. National state of emergency declarations come with commitments for new funding, not a request to repurpose existing funds. When natural disasters strike, funds aren’t removed from the community that is already hit hard in order to rebuild infrastructure. It does not make sense to take resources away from other health priorities to fight this epidemic.

{mosads}Those of us in local jurisdictions around the country would have put the funding to immediate use. In Baltimore, our programs to get the opioid antidote, naloxone, into the hands of every resident have saved over 1,200 lives in just two years. Yet, we are out of funding to purchase more naloxone, and are forced to ration it.

We desperately need funding for this and for addiction treatment. According to the Surgeon General’s report, only 1 in 10 people with addiction are able to get the treatment that they need. This is particularly tragic because we know what treatments work. We know what can end the epidemic, but we must have the resources to get there. President Trump states that he looks to Congress to provide funding. A declaration of a national state of emergency could have released these funds immediately that are urgently needed to save lives.

Instead of providing funding, the president’s announcement was focused on changing regulations that may increase access to treatment. These are steps that can help, but many are under the purview of Health and Human Services (HHS) and could have also been done without a declaration.

Other aspects of this week’s announcement puzzled me. For example, the president spoke about the need for expanding National Institute of Health (NIH) research into non-addictive pain therapies. This is important work, but hard to do when the NIH budget is in peril. The very agency that focuses on substance use (NIDA) is being slashed by $210 million dollars.

President Trump also spoke about building a wall to stop the trafficking of drugs. While law enforcement is important, I wonder about the price of building the wall, and how many thousands upon thousands of people’s lives can be saved if that money were invested instead in increasing treatment beds and rebuilding communities.

The president focused much of his message on prevention. The core message of public health is that prevention is the best medicine, but we must also address the millions of people who already have the disease of addiction and who need treatment.

If they cannot access treatment, they will continue to fuel the demand for drugs and contribute to the rising toll of overdose deaths. To that end, we must do everything possible to protect and expand Medicaid, which supports one in three patients with addiction. I also look to the president to ensure that private insurance plans continue to be mandated to reimburse for addiction treatment.

Some have commended the president’s announcement for raising awareness of the opioid epidemic. This is important, but it is long past time to go beyond rhetoric. Communities like ours in Baltimore city have lost thousands of lives from addiction for decades. We cannot afford to wait any longer. The science is clear.

We know that addiction is a disease, treatment exists, and recovery is possible. We know that the efforts that are effective on the frontlines can be scaled up to save many more lives. I urge the president to consider expanding his declaration so that it can have the full power of the federal government to truly turn the tide on the opioid epidemic.

Dr. Leana S. Wen is the health commissioner of Baltimore City. You can find her on Twitter: @DrLeanaWen