Tag Archives: opioid epidemic

Opioid State of Emergency Muddies the Waters

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

On July 31st, 2017, President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis put forth its recommendations for combating the opioid epidemic in the United States. It’s “first and most urgent recommendation:” “…declare a national emergency under either the Public Health Service Act or the Stafford Act” (Ingraham, 2017). The President was quick to react, promising he would do so. It only took nearly three months, but he followed through with as much forethought and careful planning as every other venture in this administration. That is to say, it did not go very well.

One of the biggest frustrations with the Trump Administration has been its members’ tendency to act with seemingly no real concern or knowledge of existing programs and systems already in place, or of any complications or repercussions their decrees and executive orders may create. Moreover, getting him to follow through on any of his promises always seems to require a Herculean effort that inevitably involves constant hounding, public comments, and eventual media shaming. Even then, after being raked over the coals, when he does act, it always seems to fall short of actually meaning or doing anything. Thus is the case with last week’s announcement of a quite limited “Public Health Emergency.”

Using the Public Health Service Act, the President declared on October 26th, 2017, a not-so-sweeping “Public Health Emergency” in an effort to combat the opioid epidemic (Johnson & Wagner, 2017). This declaration orders acting Acting-Secretary of Health and Human Services Eric Hargan to waive regulations and give states more flexibility in how they use Federal funds (Korte, 2017). It also allows the U.S. Department of Health and Human Services (DHHS) to work around what the administration calls “…bureaucratic delays and inefficiencies in the hiring process” to temporarily appoint specialists to deal with the crisis. In addition, it allows for expanded access to telemedicine services, including services involving remote prescribing of medicine commonly used for substance abuse or mental health treatment.

President Donald Trump shakes hands with New Jersey Gov. Chris Christie after signing a presidential memorandum to declare the opioid crisis a national public health emergency in the East Room of the White House, Thursday, Oct. 26, 2017, in Washington. (AP Photo/Pablo Martinez Monsivais)

Photo Source: AP Photo/Pablo Martinez Monsivais

Most troubling, the action specifically:

“…allows for shifting of resources within HIV/AIDS programs to help people eligible for those programs receive substance abuse treatment, which is important given the connection between HIV transmission and substance abuse.”

This is particularly alarming, given the fact that the programs that provide coverage for the treatment of HIV in lower-income patients – namely the Ryan White program – already allow funds to be used for outpatients substance abuse treatment and rehabilitation services under both Title I and Title II. That being the case, the inclusion of this language in last week’s declaration sparked a panic within the HIV services and advocacy communities as they attempted to parse exactly what the declaration meant, as well as which programs were at risk of having their funding reallocated for another purpose. Other HIV/AIDS programs beyond treatment coverage include prevention efforts, research, data mining, and efforts at the CDC. Are those on the chopping block, now?

Perhaps the most oft-repeated refrain of 2017 has been, “We just don’t know.” Virtually every action by the Trump administration has left every department responding to almost every question about intents, implications, or repercussions by saying, “We just don’t know.” This holds true for the public health emergency declaration:

From where is the funding for these programs going to come? “We just don’t know.” Senator Richard Blumenthal (D-CT) said the measure won’t be sufficient for most states. In Connecticut, the President’s move would free up only $57,000 in additional public health funds (Firger, 2017).

What temporary appointments can or will be made within the DHHS? “We just don’t know.” Many of the experts in these fields are either already working within the government or are working for other governments in nations where Harm Reduction is actively funded and healthcare is universally provided.

How does this declaration plan to increase access to telemedicine, and how will that access work without being connected to other recovery services? “We just don’t know.” Many of the most affected regions in the country are in areas where rehabilitation and recovery services are already sparse, and medication-assisted treatment for substance abuse is intended to be used in conjunction with those services. And, again, how will we pay for all of this? “We just don’t know.”

The President’s partial measure in announcing a public health emergency rather than a national emergency seems arbitrary to most people, but had he done the latter under the Stafford Act, that would have opened up resources that are usually reserved for natural disasters (i.e. – FEMA’s disaster relief fund) and states could have requested Federal grants for those purpose. Instead, we got an unfunded half-measure that includes some rather terrifying implications for HIV/AIDS programs, and a “Fact Sheet” about the declaration, half of which was comprised of self-congratulatory back pats instead of a detailed and specific plan for moving forward with this declaration.

Perhaps the most telling part of the aforementioned Fact Sheet was the introductory quote at the top of the page:

“The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place.  If they don’t start, they won’t have a problem.” – President Donald J. Trump  

Well. That certainly clears things up for everybody.

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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