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Trump declares opioid public health emergency but no extra money

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4998 (Published 27 October 2017) Cite this as: BMJ 2017;359:j4998
  1. Bob Roehr
  1. Washington, DC

Opioids are the “worst drug crisis in American history,” claiming 175 lives every day, said President Donald Trump in declaring a public health emergency on Thursday 26 October.1

“No part of our society—not young or old, rich or poor, urban or rural—has been spared this plague” of addiction and death, he said.

Trump announced a broad series of actions that the federal government has and will be taking to rein in the supply of illegal drugs, to shift from a legal to a medical approach to the problems of addiction, and to expand treatment for substance misuse.

But he stopped short of declaring a national state of emergency, as was done recently for states affected by hurricanes and floods, which would trigger access to the federal Disaster Relief Fund. The last public health emergency was in 2009 over the H1N1 flu outbreak.

Trump spoke movingly of how his older brother, Fred Trump Jr, struggled with alcoholism and died of the condition at the age of 43. Trump recalled how Fred would continually tell his younger brother not to drink or smoke, and he never has. The president emphasized the need for “really tough, really big, really great advertising to get to people before they start” taking addictive substances.

Patrice Harris, chair of the American Medical Association’s opioid task force welcomed the attention that the president has given to the issue but warned, “This alone won’t solve a complicated problem. Ending the epidemic will require physicians, insurers, drug manufacturers, and the government to follow through with resources, evidence based treatment plans, and smart public policies at the national and state levels.”

Democrats were quick to criticize Trump’s unwillingness to significantly increasing spending. “When will the administration send up a serious request for funding to fight this crisis?” asked House of Representatives minority leader Nancy Pelosi.

The acting secretary of health and human services, Eric Hargan, countered that his agency had funded nearly $900m (£680m; €770m) in opioid specific activities by states and localities. It has granted waivers to some states to enable them to use Medicaid funding for addiction treatment. A spokesman for the White House said that it would work with Congress to increase spending where needed but that it is awaiting an advisory committee report, due next week.

Perhaps the bigger issue is how to spend money wisely. Last week at a National Academies panel on the opioid crisis Massachusetts’ governor, Charles Baker, said, “We do not have a body of evidence and the kind of muscularity in addiction treatment that we have in so many other areas of medicine . . . What works and what doesn’t depends a lot on who you are, what stage of life you are in, how you became addicted in the first place, what you are addicted to, and what kinds of family and other supports you have around you.”

Nor are there personnel trained to take what evidence there is and rapidly expand treatment capacity with effective programs. Few physicians have received any training in prescribing opioids, and even fewer are trained in the more complex field of treatment and recovery from substance misuse.

“Working together we will free our nation from the terrible affliction of drug abuse,” Trump said. But he also acknowledged, “It will take many years and even decades to address this scourge in our society.”

Footnotes

  • bmj.com Editorials Overprescribing is major contributor to opioid crisis doi:10.1136/bmj.j4792, Epidemic of deaths from fentanyl overdose doi:10.1136/bmj.j4355; Feature How inappropriate prescribing prompted the opioid addiction ravaging small town America doi:10.1136/bmj.j4730

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