Earlier this week, President Trump tweeted that he will be holding “a major briefing on the opioid crisis, a major problem for our country.” Many of us in the public health community held out hope that this briefing would include a declaration of a national state of emergency, as recommended by the president’s own Commission on Combating Drug Addiction and the Opioid Crisis.
No such declaration was made. At a time when 142 Americans per day die from overdose, it begs the question: How much worse does this epidemic need to get before it rises to the level of an emergency? Imagine if there were 142 people dying every day from a disease like Ebola or a natural disaster like a hurricane — there would be no question about the necessity of such a declaration.
At a subsequent press conference, Secretary of Health and Human Services Tom Price explained that emergency declarations are reserved for time-limited emergencies, implying that the opioid epidemic will continue no matter the resources invested. However, this is not the reality I experience on the ground. It will be a time-limited emergency if we commit the necessary resources.
In the last two years, Baltimore City’s blanket prescription for naloxone, accompanied by targeted outreach efforts, have resulted in more than 1,000 lives saved by everyday residents. Unfortunately, we have had to ration our limited supply of this antidote due to lack of funding.
This means that we know that we can save more lives but are priced out of the ability to do so. Similarly, throughout the U.S., only 1 in 10 people who have the disease of addiction are able to obtain the treatment that they need. This epidemic continues even though evidence-based treatment is available. With sufficient resources, we can end this crisis.
President Trump’s statement also contained a call for increased law enforcement. He cited a decrease in federal prosecutions and said that “we are going to be bringing them up and bringing them up rapidly.”
While law enforcement is important to stem the flow of illicit drugs — including the synthetic opioid, fentanyl — the president’s language and similar comments by Attorney General Jeff Sessions recall the rhetoric of the “war on drugs”. This “war” did not work, though it did contribute to the mass incarceration of predominantly poor, minority populations and the decimation of inner-city communities.
Furthermore, decreasing the supply of drugs is only one part of the solution. We must apply equal attention to reduce demand for them. The president brought up prevention, stating that “if they don’t start, they won’t have a problem.” This is true, but what about the millions of people who already have the disease of addiction and who need treatment? If they cannot access treatment, they will continue to fuel the demand for drugs and contribute to the rising toll of overdose deaths.
A comprehensive approach includes taking all necessary steps to expand health insurance to ensure treatment access. This includes protecting Medicaid, which covers 1 in 3 patients who have a substance use disorder, as well as ensuring that essential health benefits covering addiction and mental health treatment remain as part of every insurance plan. Slashing Medicaid and replacing them with block grants is no solution. No other disease is treated through grants alone.
As the president refines his approach to the opioid epidemic, I hope that he heeds the recommendations from his commission. The draft recommendations released thus far are in line with the scientific consensus. These include support for medication-assisted treatment that has been proven to be effective in treating opioid addiction and the importance of addressing the role of stigma in perpetuating this disease. The millions of people in recovery around the country are a testament to what we know from medicine and science to be true: that addiction is a disease, treatment exists, and recovery is possible.
President Trump’s acknowledgment of the scope of the opioid epidemic is an important first step, but it falls short. This is a national emergency for which there is a solution. The science is clear. We know what works to overcome this crisis. We need the resources and the will to get there.
Dr. Leana Wen is the Baltimore City Health Commissioner. You can find her on Twitter @DrLeanaWen and @BMore_Healthy.
The views expressed by contributors are their own and not the views of The Hill.