Donald Trump has ordered the declaration of a public health emergency in response to what he called the “national shame and human tragedy” of the US’s escalating opioid epidemic.
As a first step, the president said his administration is requiring the removal of what he called a “truly evil” prescription opioid from the market. But while he said he intends to “mobilise his entire administration” to combat the crisis, there was swift criticism of the lack of major new funds to deal with an epidemic claiming 100 lives or more a day.
Trump, flanked by families bereaved by drugs, spoke powerfully about the cost of “the worst drug crisis in American history”, driven by the mass prescription of opioid painkillers.
“The United States is by far the largest consumer of these drugs, using more opioid pills per person than any other country by far,” he said. “No part of our society – not young or old, rich or poor, urban or rural – has been spared this plague of drug addiction.”
Almost 100 people are dying every day across America from opioid overdoses – more than car crashes and shootings combined. The majority of these fatalities reveal widespread addiction to powerful prescription painkillers. The crisis unfolded in the mid-90s when the US pharmaceutical industry began marketing legal narcotics, particularly OxyContin, to treat everyday pain. This slow-release opioid was vigorously promoted to doctors and, amid lax regulation and slick sales tactics, people were assured it was safe. But the drug was akin to luxury morphine, doled out like super aspirin, and highly addictive. What resulted was a commercial triumph and a public health tragedy. Belated efforts to rein in distribution fueled a resurgence of heroin and the emergence of a deadly, black market version of the synthetic opioid fentanyl. The crisis is so deep because it affects all races, regions and incomes
Earlier this week a Drug Enforcement Administration report said that prescription drugs, mostly opioid painkillers, have been the single largest cause of overdose deaths since 2001, but the rising use of heroin and the synthetic opioid fentanyl has driven the cost in lives to new heights.
Over the past six years overdose deaths have outnumbered those from guns, cars, suicide and murders.
Trump spoke about the human toll of the epidemic, including the large numbers of babies suffering withdrawal symptoms after being born to mothers addicted to opioids. “Beyond the shocking death toll, the terrible measure of the opioid crisis includes the families ripped apart and, for many communities, a generation of lost potential and opportunity,” he said.
“Nobody has seen anything like what’s going on now. As Americans we cannot allow this to continue. It is time to liberate our communities from this scourge of drug addiction.”
But the president gave little detail about how the administration intends to do that. He emphasised abstinence as he spoke movingly about his brother Fred who was an alcoholic and who warned him not to drink. “If we can teach young people, and people generally, not to start, it’s really, really easy not to take them. And I think that’s going to end up being our most important thing,” he said.
However, that view is challenged by data which shows a parallel rise in overdose deaths and the mass prescribing of opioids the president acknowledged earlier in his speech.
New Jersey’s governor, Chris Christie, the chair of Trump’s opioid commission, commended the president for his “bold action” in adopting the commission’s recommendation to declare a health emergency, saying that it showed “an unprecedented commitment to fighting this epidemic” and that placing the weight of the presidency behind it would save lives.
But the nature of the declaration has raised further questions about the seriousness of that commitment. Trump sidestepped declaring a national emergency himself, which would have immediately unlocked billions of dollars of federal money from a disaster fund as happened in response to the recent wave of hurricanes to hit the US.
State governments have been pressing for federal money to fund long-term treatment programmes to help the estimated two million Americans in need of help to shake drug dependency.
Instead the president is ordering his acting health secretary, Eric Hargan, to declare a health emergency under legislation which allows the administration to “reorient resources” but will delay new money until Congress allocates it.
While Christie pressed for urgent action, Trump’s former health secretary, Tom Price, opposed proclaiming a national emergency because of the cost.
The president caught his officials off guard in August when he said he would declare an emergency but then stalled.
Senator Patrick Leahy spoke for a number of politicians in criticising the lack of additional funding. “The president’s talk is just that – talk. There is no action or new funding behind the president’s empty words to address this crisis. This is not acceptable,” he said.
A senior White House official said on Thursday that the crisis was an “urgent priority for the president” and that the declaration under the Health Service Act would help the administration direct additional resources toward some of the worst-hit areas, such as expanded access to telemedicine in rural areas of Appalachia where medical resources are limited.
It will also allow the administration to appoint specialists and address doctor shortages as well as direct some money used to treat HIV/Aids toward people within that programme who are also addicted to opioids.
Dr Andrew Kolodny, co-founder of Physicians for Responsible Opioid Prescribing, questioned whether the president’s declaration would make any major difference.
“There’s no real plan. We’re not hearing a dollar amount. It’s very disappointing,” he said. “The problem is if you are going to declare a public health emergency you should at the same time be saying we’re going to be asking Congress to appropriate billions to tackle this public health emergency. That’s just not mentioned. I don’t see how that’s really going to have any impact at all. I think what’s clear is they don’t have a plan.”
Emily Walden, a leader of the activist group Fed Up whose son died of an opioid overdose, questioned whether the administration was serious about tackling the epidemic.
“I think it’s good he’s going to declare it but if there’s no funding, that’s what the states are really struggling with, having the available treatment. I’m not sure what good is going to come of it unless people can get the help that they need,” she said.
Walden also said the administration had failed to sufficiently address the mass prescribing of opioid painkillers underpinning the epidemic.
“We have to address the root cause of this to prevent new addiction,” she said. “It’s very frustrating and upsetting. I’m not sure when they’re going to get it and with the influence that the pharmaceutical companies have over our government, it seems almost hopeless that this is going to change.”
The White House said it was having a “conversation with Congress” about new funding. It said that the administration had spent $1bn to deal with the crisis since Trump took office – although that money was allocated while Barack Obama was in power.
It was not immediately clear which “truly evil” drug the president was talking about banning but it may be fentanyl, a powerful synthetic opioid often used to treat cancer pain. Fentanyl has been responsible for increasing numbers of overdose deaths although it is more often smuggled from China and mixed with heroin or used to make fake pills.
On Thursday, federal agents arrested the founder of Insys, a company which manufacturers a spray version of fentanyl. John Kapoor is accused of marketing the powerful drug, which is authorised for use by cancer patients but was marketed for much wider use allegedly after the company bribed doctors to prescribe it. Kapoor is accused of racketeering, conspiracy and fraud. Six other Insys executives were indicted over similar accusations in December. Brian Kelly, an attorney for Kapoor, told CBS his client “is innocent of these charges and intends to fight the charges vigorously”.
Earlier this year, the Food and Drug Administration forced another opioid, Opana, off the market because it was assessed to be dangerous to public health. Trump also suggested that his plans to build a wall along the Mexican border will slow the flow of heroin into the US. The Commission on Combatting Drug Addiction and the Opioid Crisis is scheduled to release its final report to the president on Wednesday.
