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Trump needs to do way more on the opioid epidemic than declare a national emergency

This is a massive crisis, and it needs massive solutions.

President Donald Trump. Justin Merriman/Getty Images

After his administration briefly suggested he wouldn’t, President Donald Trump on Thursday said he would declare a national emergency over the opioid epidemic.

The move has been celebrated by public health experts and advocates who are closely following the crisis. But the celebration has been tempered by one problem: No matter what Trump’s new declaration leads to, it most likely won’t be enough to stop as many as hundreds of thousands more from dying due to the epidemic — because the crisis has festered for so long that even emergency protocols just aren’t enough anymore.

To understand why, it’s important to understand the full scale of the opioid epidemic. Consider these numbers:

  • In 2015, more than 52,000 people in the US died of drug overdoses, about two-thirds of which were linked to opioids. And in 2016, 59,000 to 65,000 are believed to have died of drug overdoses, according to an early analysis by the New York Times — more Americans than died in the Vietnam War. These are the highest death tolls from overdoses recorded in any single year in US history.
  • Between 1999 and 2015, more than 300,000 people died of opioid overdoses — greater than the population of Cincinnati.
  • In the same time frame, more than 560,000 died of all drug overdoses — greater than the population of Atlanta.
  • One forecast by STAT concluded that as many as 650,000 people will die over the next 10 years from only opioid overdoses — more than the entire city of Baltimore.

We don’t know what Trump’s declaration will look like and what kind of guidance will accompany it. (White House officials didn’t offer any specifics when asked.) But generally, an emergency declaration could open up a bit of funding — maybe a few hundred million — and some regulatory waivers that will allow, say, Medicaid to take new action to cover treatment or perhaps let the administration negotiate down prices for the opioid overdose antidote naloxone.

Simply put, this isn’t enough. Experts have told me that it will likely require tens of billions in new funding a year to get a full grip over the opioid epidemic. (For reference, a 2016 study estimated the total economic burden of prescription opioid overdose, misuse, and addiction at $78.5 billion in 2013.)

“Crises in a nation of 300 million people don’t go away for $1 billion,” Stanford drug policy expert Keith Humphreys previously told me, referring to the money Congress allocated for the epidemic in the 21st Century Cures Act. “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 good news is we know what to do: As I noted in my explainer about how to stop the opioid epidemic, more resources 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 details in the full explainer.)

The catch is all of this will require a comprehensive bill, not just executive action and declarations. You can’t allocate tens of billions of dollars a year without some action by the legislative branch in particular.

But to do something like that, Trump and Congress will have to develop the political will to act. So far, they haven’t done much. The only notable bill Congress has passed is the 21st Century Cures Act, which was signed into law last year by President Barack Obama and added $1 billion over two years for drug addiction treatment. Besides that, Trump and Republicans’ efforts to repeal Obamacare threaten to make the crisis worse — by reducing access to health insurance that can be used to pay for addiction care.

An emergency declaration could spur Trump’s administration and Congress to take this issue more seriously.

But I am skeptical. As former CDC Director Tom Frieden recently told me, “There’s always the argument that declaring something an emergency increases attention to it, but in this case there’s a lot of attention — just not a lot of effective action so far.”

For more on the opioid epidemic, read Vox’s explainer.