Opioid Epidemic Declared Public Health Emergency: Empty Words or New Impetus?
With the number of opioid-induced overdose deaths rising each year, it is fair to say that “America has an insatiable appetite for prescription opioids." The number of heroin related overdose deaths in the United States increased significantly between 2007 and 2013, rising 244 percent in just 6 years. Many law enforcement agencies now report that the substance now posing the greatest threat to American communities is heroin, closely followed by methamphetamine, and then controlled prescription drugs (CPDs) by a wider margin. According to the Centers for Disease Control and Prevention drug overdose death has become the leading cause of injury death in the United States. In 2015 alone there were as many as 33,091 overdose deaths related to prescription opioids or heroin. One may reasonably assume that illicit opioids, such as heroin, pose the greater threat to society. However, CPDs (opioid analgesics), due in part to their broad distribution and licit status, are the cause of a far greater number of overdose deaths than one might expect. For example, in 2013 opioid analgesics were related to 16,235 overdose deaths in the United States, whereas heroin and cocaine related overdoses combined amounted to only 13,201.
The resurgence of opioid related overdose deaths in recent years (including heroin, CPD’s, and fentanyl) is the result of many factors. The increased cultivation of the opium poppy in Mexico, increased purity and availability of heroin in US markets, as well as the illicit production of fentanyl, a cheap synthetic alternative to heroin, have all proven to be catalysts in the increasing rate of overdose deaths.
In spite of the tens of billions of dollars being spent annually on treatment, law enforcement, and interdiction by the Federal Government, the number of drug overdose deaths from opioids has continued to rise.
On March 29th of this year, President Donald J. Trump established by Executive Order the President’s Commission on Combating Drug Addiction and the Opioid Crisis. On October 26th, following the advice of the Commission, the President announced a Public Health Emergency in regard to the opioid epidemic.
The President’s Commission echoed much of what was already provided by the Comprehensive Addiction Recovery Act (2016), as well as The Surgeon General’s Report on Alcohol, Drugs, and Health (2016), and is by no means the first instance of Executive action to be taken on this issue. However, aside from the rather superfluous nature of officially declaring a recognized epidemic a public health emergency, the announcement does have legal significance. President Trump’s announcement simultaneously directed the Department of Health and Human Services to declare a Public Health Emergency under Federal law. Under the law, the declaration may give way to emergency funding for specific efforts aimed at tackling the crisis. However, as yet no funds have been appropriated to support the measures proposed in the Commission’s report, nor have they been requested.
That being said, the Commission’s report does call for an expansion and bolstering of the Substance Abuse and Mental Health Services Administration (SAMSHA) by increasing ‘block funding’ and folding existing grant programs into SAMSHA, in order to support state-level programs. This would effectively make SAMSHA the sole source of Federal funding. The Commission notes concerns from State Governors that current Federal funding is fragmented, poorly coordinated, and administratively burdensome to obtain. Currently the states have to rely on fragmented funding and absent leadership from among the broader spectrum of Federal agencies. The Commission advises that the Office of National Drug Control Policy (ONDCP) coordinate all State level efforts in a manner that monitors and tracks the efficacy and efficiency of policy and implementation.
In the absence of any additional funds being appropriated, some commentators maintain that the President’s recent announcement is all talk. In contrast, the White House maintains that it is currently in “conversation with congress” to obtain more funding, and that the Administration has spent $1bn to deal with the crisis since Trump took office. It is worth noting that all of this funding was secured and allocated under the Comprehensive Addiction Recovery Act, which was enacted while Barack Obama was still in office.
Without any substantive legislation on the table at this time it is difficult to tell what impact, if any, the President’s October announcement will have on the opioid epidemic. However, if the Opioid Commission’s November report is indicative of the direction the Administration intends to take, then structural changes in the way that the Federal Government directs and implements anti-drug policy may be on the horizon. Specifically, the Commission envisions a better equipped, better staffed, and better funded Drug Czar (ONDCP), to take responsibility for the distribution of Federal funding to State level programs. Given the arguments laid out in the Commission’s report, as well as the guidance offered by the Surgeon General’s 2016 report, it is fair to say that the Trump Administration’s position on the opioid epidemic is largely in line with his predecessor in office. Trump has at least another three years in office to take on the opioid epidemic. Only time will tell if he is able to build on the Obama era policies and successfully reduce the overdose death toll, or whether Trump will be forced to keep his own declaration in place and maintain the current state of emergency.