Five questions for President Trump’s big announcement on opioids

This week, President Trump announced that he plans to formally declare a statement of emergency on the opioid epidemic. It’s about time. Experts, including the President’s own Commission on Combating Drug Addiction and the Opioid Crisis, have repeatedly called for the President to put the full weight of the federal government to stem the tide of this disease that is claiming hundreds of lives per day.

As a physician and public health official on the frontlines of the opioid epidemic, I would like to ask five questions to determine whether the declaration is symbolic or whether it has real substance that will move the needle and save lives:

1. What is the exactly commitment to funding? Federal emergency declarations come with commitments for funding. When hurricanes devastate communities, it’s understood that billions of dollars are required to rebuild homes and repair infrastructure.

{mosads}The same understanding applies for stopping an epidemic. In Baltimore and across the country, we desperately need these resources. Studies show that only 1 in 10 people with addiction can receive the treatment that they need — a statistic we would not find acceptable for any other disease.

Funding can be used to start 24/7 addiction and mental health treatment centers and to scale up effective community-based pilots that have already proven to be effective. The President needs to announce a specific dollar amount for new — not repurposed — funding that should be commensurate with the scope of the epidemic.

2. Will funding go directly to communities of greatest need? Cities and counties have been fighting this epidemic for years. We know what works, and local officials should not have to jump through additional hoops to obtain the resources we need. Issuing grants and having local jurisdictions compete for them will cause months if not years of delay while unnecessarily pitting communities in need against each other.

Funding that passes to the states before getting to cities and counties will also add administrative burden and cost time — and lives. Any epidemic should be treated with the utmost urgency. The federal government should make a decision now about how to allocate based on which areas are hardest hit. Local jurisdiction should not have to wait to receive direct, necessary funding.

3. Will the federal government engage its powers to the full extent? Recently, Rep. Elijah Cummings (D-Md.) led a group of 51 representatives to call for the President to negotiate directly with manufacturers for a much-decreased price of the opioid antidote, naloxone. Our city of Baltimore is out of funds to purchase naloxone, forcing us to ration and make decisions everyday about who can receive a life-saving medication.

If this were an infectious disease for which an antibiotic were readily available, there would be no question that we need to obtain this and issue it to all those in need. The federal government can take other bold actions, including to require all hospitals and doctors to provide evidence-based treatments for patients with addiction, and to promote and fund harm-reduction approaches such as needle-exchange programs, mobile treatment, and safe consumption facilities.

4. Will there be equal attention to law enforcement and disease treatment? Law enforcement to stop the trafficking and distribution of drugs is important, as is prevention through more judicious prescribing of opioids by doctors.

However, reducing the supply of drugs alone is not going to work unless there is equal attention to curbing demand for them. Science is unequivocal that treatment for addiction works and recovery is possible, yet there are millions of people in need of treatment who cannot access it. Will a federal declaration allocate equivalent funding for enforcement and treatment?

Will enforcement approaches take into account lessons from the failed “war on drugs,” which has led to mass incarceration and worsened existing inequities — and will there be a shift to programs that enlist public safety officials as partners in increasing treatment access such as the Law Enforcement Assisted Diversion program?

5. Will the President reverse proposals that are detrimental to treating addiction? Gutting Medicaid would hurt the one in three patients with addiction who depend on it for addiction treatment. Other patients on private insurance could find themselves without access to treatment if addiction is no longer part of their health plan.

Furthermore, budget cuts to the Centers for Disease Control and Prevention and the National Institutes of Health will impede progress in controlling the epidemic. The state of emergency declaration should recognize the direct and immediate impacts of these policy decisions and reverse these proposals, before it is too late.

In his forthcoming declaration, President Trump has the opportunity to assert bold leadership and put the full force of the federal government toward ending the opioid crisis. He has already stated that such a declaration is a “very very big statement.” The question is, will the statement be more rhetoric, or will it actually come with the resources and the will to be truly transformative?

Dr. Leana S. Wen is the health commissioner of Baltimore City. You can find her on Twitter: @DrLeanaWen