On Thursday, President Donald Trump finally made it official: He is declaring a public health emergency over the opioid epidemic. The long-awaited announcement, which was nearly three months in the making, is being heralded by public health advocates and experts as a step forward.
“As Americans, we cannot allow this to continue,” Trump said. “It is time to liberate our communities from this scourge of drug addiction.”
But as much attention as this will get in the coming days, there’s another thing that experts and advocates want to make clear: The emergency declaration is simply not enough. This crisis has been decades in the making, and a single presidential order — one not even backed by congressional action — won’t fully address the ongoing crisis.
The main problem: The declaration comes with no new significant federal funding. So it can’t add up to much.
“I’m disappointed,” Andrew Kolodny, an opioid policy expert at Brandeis University, told me. “Mentioning a few helpful items … is not a plan for tackling a public health emergency. We need a plan with details, and we need an appropriation request in the billions to build a treatment system. Until effective outpatient treatment is easier to access than pain pills, heroin, and fentanyl, overdose deaths will remain at record-high levels.”
The order does unlock some limited tools to address the crisis. Among other moves, it will let some funding dedicated to HIV also go toward opioid addiction, which can lead to the spread of HIV through shared needles. It will let doctors prescribe lifesaving medications, such as buprenorphine, to patients over telemedicine. And it will open up the Public Health Emergency Fund to help address the opioid crisis — though, crucially, Congress has not put money toward the fund for several years. (USA Today reported that there’s only $57,000 remaining in it.)
Any extra support to address the opioid crisis is welcome. This epidemic now kills tens of thousands of people each year, with preliminary data suggesting that more than 64,000 people died of drug overdoses in 2016 alone — more than have ever died in a single year from car crashes, guns, or HIV/AIDS.
But Kolodny and other experts have told me that the federal government will require tens of billions of additional dollars, on top of the tens of billions it already spends annually, to fully address the opioid crisis. For reference, a 2016 study estimated the total economic burden of prescription opioid overdose, misuse, and addiction at $78.5 billion in 2013.
Trump’s emergency declaration comes nowhere close to hitting that target.
The opioid epidemic has been decades in the making
The opioid epidemic goes back to the 1990s, with the release of OxyContin and mass marketing of prescription painkillers, as well as campaigns like “Pain as the Fifth Vital Sign” that pushed doctors to treat pain as a serious medical problem. This contributed to the spread of opioid painkiller misuse and addiction, which over time also led to greater use of illicitly produced opioids like heroin and fentanyl. Drug overdose deaths have climbed every year since the late ’90s as a result.
In fact, the crisis has really turned into two simultaneous crises — which Keith Humphreys, a Stanford University drug policy expert, has described as the dual problems of “stock” and “flow.” On one hand, you have the current stock of opioid users who are addicted; the people in this population need treatment or they will simply find other, potentially deadlier opioids to use if they lose access to prescribed painkillers. On the other hand, you have to stop new generations of potential drug users from accessing and misusing opioids.
Addressing two crises at once will, obviously, require a lot of resources. But as I previously explained, we have a pretty good idea of what these resources would go to: They could be used to boost access to treatment, pull back lax access to opioid painkillers while keeping them accessible to patients who truly need them, and adopt harm reduction policies that mitigate the damage caused by opioids and other drugs. (More on all of this in Vox’s full explainer.)
This is beyond what Trump can do alone; it will require action from Congress. Yet so far Congress has barely dedicated any new money to the crisis. The most significant bill to this point is the 21st Century Cures Act, which added $1 billion over two years for drug misuse prevention and addiction treatment — again, far from enough.
“Crises in a nation of 300 million people don’t go away for $1 billion,” Humphreys previously told me. “This is the biggest public health epidemic of a generation. Maybe it’s going to be worse than AIDS. So we need to go big.” (The federal government still spends tens of billions of dollars a year on HIV/AIDS.)
Some members of Congress are working toward a solution: On Wednesday, Senate Democrats unveiled a bill that would add $45 billion over 10 years to the fund established by the Cures Act. The extra money would go to funding prescription drug monitoring, improving doctors’ prescribing practices, expanding access to addiction treatment, and supporting other public health initiatives related to drug misuse and addiction, among other moves.
But the bill so far has no Republican co-sponsors on board, and the White House has yet to embrace it.
Maybe some of that will begin to change next week, when Trump’s opioid commission is expected to release its final report and recommendations. That may spur Trump and Congress to action.
Until then, though, all we have from the Trump administration is a good — but limited — start.