If Donald Trump declares America’s opioid addiction crisis a national emergency, as a White House commission urged him to do earlier this week, it could mark a dramatic escalation in the administration’s response.
“Think what we would do in this country if Zika and Ebola were taking 100 lives every single day,” said Gary Mendell, the CEO of Shatterproof, a nonprofit working to end addiction.
“We would call it a national emergency and we would marshal all the resources of federal agencies to attack the issue,” Mendell told the Guardian. “And that’s what needs to happen here.”
Formal emergency declarations are rarely used on a national scale, and are typically reserved for natural disasters and infectious diseases such as H1N1 virus.
But Monday’s draft report by a bipartisan commission led by New Jersey governor Chris Christie suggests the situation was serious enough to warrant such a dramatic step, as 91 Americans die each day from an opioid overdose.
An emergency declaration would empower the government to quickly expand access to in-patient treatment services and negotiate lower prices for the overdose reversal drug naloxone, according to the report. It could also cut out some bureaucracy to expedite data-sharing, funds distribution and laws that improve access to treatment.
Six states have used mechanisms similar to a federal emergency declaration to respond to the opioid crisis at a local level. The declarations helped Florida, Maryland, Arizona, Virginia, Alaska and Massachusetts expand access to the overdose reversal drug naloxone, improve reporting of overdose deaths, institute prescription drug monitoring programs and allocate funds for addiction services.
Jay Butler, the chief medical officer of Alaska’s health department, coordinated the implementation of the state’s emergency declaration, which was in effect for 30 days. Butler said it improved coordination between agencies and expanded access to naloxone – something the commission has recommended be done on a nationwide scale.
Butler, who is also president of the Association of State and Territorial HealthOfficials (ASTHO), told the Guardian that a federal state of emergency “nicely puts into context the magnitude of the issue”, but he was not clear how such a declaration would be managed at the federal level.
“If there are no additional resources – funding, personnel – it will be at the price of compromising the response to other priorities, such as Zika virus,” Butler said. “The public health infrastructure cannot bear additional load without upkeep.”
Others are concerned about how a national emergency would be used by the Trump administration, which has so far favored policies that could undermine efforts to curb addiction – such as limiting access to healthcare, harshly penalizing drug users and cutting funds for agencies tasked with addressing the crisis.
“The report issued this week demonstrates how far out of touch the Trump administration has been with respect to its drug policy and its policy towards addressing the opioid crisis,” Grant Smith, deputy director of national affairs at the Drug Policy Alliance, told the Guardian.
The contradictions between the administration’s policies and evidence-based solutions, such as medication-assisted treatment and expanded access to addiction treatment, have plagued the commission since it was organized in March.
At the commission’s first meeting in June, nearly every speaker explained to an audience that included senior Trump advisors Kellyanne Conway and Jared Kushner that the repeal of the Affordable Care Act – something Republicans have so far tried but failed to achieve – would be a “disaster” for the opioid crisis response.
“If we make it harder and more expensive for people to get healthcare coverage, it’s going to make this crisis worse,” said North Carolina governor and commission member, Roy Cooper.
In May, the US health secretary, Tom Price, said that using medication assisted treatment was “substituting one opioid for another”, prompting nearly 700 researchers and practitioners to demand a clarification of his statement, which he eventually walked back from. The health department also clarified that it supports medication assisted treatment.
Other key agencies tasked with responding to the crisis have been hampered by threats to cut funding and leadership vacancies.
The White House proposed cutting 95% of funding to the Office of National Drug Control Policy in its original budget proposal, but restored most of the funding in a revised budget plan after facing widespread backlash from Republicans and Democrats.
Trump also fired US surgeon general Vivek Murthy in April, months after his office published a nonpartisan report on addiction, and his position has not been filled. The Centers for Disease Control and Prevention only just appointed a new director after Thomas Frieden resigned from the post on inauguration day.
Outside of the administration’s health infrastructure, drug policy experts are concerned about the policies of attorney general Jeff Sessions. He has long supported punitive drug policies that harken back to the war on drugs, which has been discredited as a failure.
In May, Sessions directed federal prosecutors to pursue the harshest possible sentences for drug crimes, a move seen as a return to drug-war policies.
And two days after the report was released, Sessions advocated for a southern border wall to stem the flow of drugs, an effort promoted heavily by the president, though it was not mentioned in the commission report and is not expected to significantly reduce drug abuse in the US.
Smith, of the Drug Policy Alliance, said: “A national emergency declaration – will it be used in the way that the commission intends it to be used or will it be used to further the agenda that attorney general Sessions pursued?”