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Trump Declares Opioid Crisis a “Public Health Emergency”
Former White House ‘Drug Czar’ says more is needed to “make a significant impact on the trajectory of the worst health crisis of our time.”
After saying for months he would declare the opioid crisis a national emergency, which his own special commission has urged since July, President Donald J. Trump this week has announced a “public health emergency” – a big step down from “national emergency” as far as the commitment of federal resources are concerned.
“Trump may have underscored the gravity of the opioid epidemic by declaring a public health emergency,” said former White House Drug Czar Michael Botticelli, “but he failed to put forth any new resources or actions that would make a significant and immediate impact on the trajectory of the worst health crisis of our time.”
In a special StatNews article, Botticelli said that President Trump has ignored the strongest recommendations of his own White House Commission on Combating Drug Addiction and the Opioid Crisis. By doing so, he has “failed to put forth any new resources or actions that would make a significant and immediate impact on the trajectory of the worst health crisis of our time,” Botticelli added.
Only 10% get treatment
A recent National Survey on Drug Use and Health has found that only 10 percent of the nearly 21 million people with substance use disorder are receiving any type of addiction treatment. And one of the main reasons is lack of insurance coverage, or inadequate insurance.
Yet President Trump, in his zeal to do away with the Affordable Care Act, has been working hard to cripple Medicaid and Medicaid expansion, which has been the main and often the only source of funding available to millions of Americans needing treatment.
“Medicaid expansion under the Affordable Care Act – adopted by 31 states – has played a crucial role in increasing treatment access in states that have been hit hard by this epidemic,” Botticelli said. “If the President really does believe that this is a public health emergency, he should drop his effort to repeal the ACA and eviscerate the Medicaid program.”
It’s been fairly estimated that the President’s intentions to reduce Medicaid will put treatment even further away for millions more Americans.
Administration upbeat about its plans
At the White House briefing, President Trump was upbeat about his plans.
“Effective today, my Administration is officially declaring the opioid crisis a national public health emergency under federal law,” the President said. He called the declaration “a critical step in confronting the extraordinary challenge that we face.”
Officials added that the administration’s response is “more than just a declaration.” Several new rules and actions are expected to be issued in the coming weeks, such as:
- A regulatory change will allow prescriptions “commonly used for substance abuse or mental health treatment” to be filled via telemedicine – instant electronic connection via the internet to a telehealth hub with board-certified specialists. This will be a big boost in access to care for people in rural areas.
- Health and Human Services (HHS) and states with governors who request it will be allowed to “make temporary appointments of specialists with the tools and talent needed to respond effectively” to the crisis.
- The administration’s emergency declaration doesn’t provide for any new money. It relies on a public health emergency fund that, according to HHS is worth only $57,000. However, senior officials said the opioid crisis will “figure heavily” into ongoing budget negotiations and the December spending bill.
- The White House will instruct the Department of Labor to issue “dislocated worker grants to those displaced from the workforce” due to the opioid crisis. This idea will depend on available funding.
- A shift in resources within existing HIV/AIDS care programs will improve care for those with both HIV/AIDS and substance use disorders.
Lifting the Medicaid 16-bed limit
The President also announced as part of the plans a workaround for the very limiting Medical 16-bed limit, whereby facilities with more than 16 beds that treat mental illness or substance use disorders are not eligible for federal Medicaid. This policy is a hangover from the time when Washington wanted to cut reimbursements to state psychiatric hospitals.
Recently, however, the opioid crisis has led to many calls for an end to the 16-bed limitations. By 2015, the Obama administration started offering such waivers, and four states have reportedly received reimbursements that are improving access to treatment. President Trump said his administration will “introduce new policy” to overcome the rule, probably continuing the Obama waivers, and “those approvals will come very, very fast,” he said.
In his article, Botticelli called for a few points not covered by the White House declaration:
- “Better support those who are in recovery, so they will stay in recovery”- e.g., longer insurance coverage.
- Improved access to medication-assisted therapy which can “reduce overdose deaths, retain persons in treatment, decrease use of heroin, reduce relapse, and prevent spread of infectious disease.” The president’s commission called for federal funding to enhance access but none is included in the emergency declaration.
- More funding for first responders to purchase naloxone, the most effective antidote to overdose deaths.
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