On October 26, 2017, President Donald Trump declared the opioid crisis a public health emergency. To help us understand what this means exactly, we interviewed Health Policy and Management Professor Jeffrey Levi.
What does a public health emergency allow the government to do?
A public health emergency gives agencies in the U.S. Department of Health and Human Services flexibility in how current funds and personnel are allocated. A public health emergency lasts for only 90 days—so these are very temporary shifts in resources. This authority was designed for a short-term crisis (e.g., the aftermath of a natural disaster or in response to a pandemic flu), not for a sustained problem like substance use disorder. An emergency declaration would also free up money in the Public Health Emergency Fund, but that only has $57,000 in it since Congress hasn’t replenished it.
What is the difference between a public health emergency and a national emergency?
A national emergency is declared under the Stafford Act. This applies to the entire federal government. This can mobilize multiple agencies. More importantly, it also permits the government to tap emergency response funds in the same way that was done after the hurricanes—and that fund is replenished regularly. However, most of what is done under the Stafford Act is also meant to be short term.
In terms of the opioid crisis, what will be able to happen under a public health emergency declaration?
Very little that wouldn’t be possible without a declaration. The principal issues with the opioid response are associated with funding—for prevention, for treatment, for social support, for harm reduction (syringe exchange, naloxone to reverse overdose).
What else needs to happen to address this issue?
There is no magic bullet for addressing this problem. We need to scale up proven programs that make kids more resilient and thus less likely to try drugs; we need to make sure prescribing practices by physicians assure access to opioids for those who need them but prevent over-prescribing for those who don’t need them; we need to make sure that there are treatment slots available for those who become addicted, with treatment encompassing medication-assisted treatment (MAT) along with the social supports that encourage adherence to MAT; and we need to be sure that we are saving the lives of those still actively using drugs by making sure that naloxone is available in the community to reverse overdoses and making sure that clean syringes are available for those who inject drugs so we don’t create a secondary hepatitis C and HIV epidemic.
Why do you believe President Trump classified the opioid crisis as a public health emergency?
This is a symbolic move. It communicates to the nation the importance of the crisis. This would be of value if it were also associated with funding for the services and programs needed to address the crisis. Most importantly, the Medicaid expansion created under the ACA is a critical means for people misusing opioids to get care. Those states that expanded Medicaid have much better access to treatment. The president’s efforts to repeal the ACA (and the Medicaid expansion) would, if successful, exacerbate the crisis. He should rather be encouraging all states to do a Medicaid expansion.
Levi also noted that there is no precedent for presidents declaring emergencies on drug problems. Time will tell whether the recent declaration will be able to address the multifaceted nature of this crisis.
This Q&A comes on the heels of the forum, “Opioid Use: An Epidemic of Addiction, Not Abuse,” which featured panelists, including Milken Institute SPH Dean Lynn Goldman and best-selling author J.D. Vance, discussing the underlying issues that complicate America's ability to mitigate addiction. The event was hosted by the George Washington University and ICF, a strategic consulting and communications firm.