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What emergency?
Delegates, advocates waiting for opioid emergency declaration

09/21/17



 It’s been more than a month since President Donald Trump announced he would be declaring an official emergency for the opioid epidemic, a move that promises to free up federal dollars and rapidly scale up relief efforts. And as treatment and recovery advocates and elected officials wait for action, uncertainty about the details has left state planning efforts in a holding pattern.

 
What is an emergency declaration?
“The opioid crisis is an emergency, and I’m saying officially right now: It is an emergency,” Trump said Aug. 10 at an impromptu press conference. 
This came on the heels of comments made by Health and Human Services Secretary Tom Price two days prior that the issue can be addressed “without the declaration of an emergency.”
Most took the president’s comments as a promise to make the formal declaration, which comes with certain legal mechanisms that kick in to help states dealing with the crisis. 
Tym Rourke, the chairman of the Governor’s Commission on Substance Use, said the idea is appealing to many in New Hampshire who are working to combat the opioid epidemic.
“The theory behind such a declaration is that it would allow agencies of federal government a more streamlined method of releasing resources to states, similar to, as I understand it, when there’s a natural disaster like a hurricane,” Rourke said.
And those resources couldn’t come any sooner. A finalized report by the state medical examiner’s office counted a record total of 485 deaths from drug overdoses in 2016, of which 424 were confirmed to be opioid-related. As of Aug. 15, there have been 187 drug deaths, 161 from opioids, this year.
An unfulfilled promise?
Given the time that’s passed, some have begun to wonder if the president intended to promise a formal declaration or if the announcement itself and directing HHS to focus more resources on the issue was as far as he planned to go.
The uncertainty of whether an emergency declaration would even happen was evident in a joint letter by New Hampshire Sens. Jeanne Shaheen and Maggie Hassan to the Trump administration on Sept. 8, which called the initial announcement an “unfilled promise.”
“Regardless of whether you choose to declare a state of emergency, continued inaction on this issue is deeply concerning,” the senators wrote.
Rourke agreed there doesn’t seem to be much urgent action on the part of the White House.
“It’s either an emergency or an isn’t. It’s either a crisis or it isn’t,” Rourke said.
On Sept. 10, The New York Times published a story about how slowly the wheels appear to be turning. According to the story, one proposal brought to the administration by the White House Commission on Combating Drug Addiction and the Opioid Crisis led by Chris Christie would use the Stafford Act to trigger relief resources, but that was met with some criticism. The Stafford Act gives the federal government the authority to free up resources for physical disasters like the recent hurricanes in Texas and Florida or a major terror attack like the destruction of the World Trade Center on Sept. 11. According to the commission report, the average daily death toll from the opioid epidemic amounts to a Sept. 11 death toll every three weeks.
An answer to some of these questions came on Sept. 14, when Secretary Price visited New Hampshire and announced a series of grants to nine health centers plus the city of Manchester to help with expanding access to opioid treatment. NHPR reported Price addressed the issue of an emergency declaration directly during the press conference at Goodwin Community Health in Somersworth. 
He reportedly said, “The president has talked recently about raising the level of the opioid crisis to an emergency. And we’re working on that with his staff, literally as we speak, to bring greater clarity and focus to that, and to bring greater enthusiasm, if you will, on the part of elected officials in Washington.”
But it’s still not clear what such a declaration will look like.
 
Uncertainty
Rourke said nobody knows how much funding to expect, what strings might be attached, where the resources will be directed or what they will be used for.
“There’s uncertainty all over the place right now, I think,” Rourke said. “Beyond contractual expediency, what does it mean in terms of resources? … Would a declaration lead to new resources that are currently are not available or is it just we’re going to take the resources but we’re going to get them out differently?”
The state Department of Health and Human Services declined to comment for this story because officials there still don’t know enough about the president’s intentions.
Shaheen said in an emailed statement to the Hippo that recent efforts in Congress to fund treatment, recovery and prevention have helped but have fallen short of what’s needed.
“We need more bipartisan efforts to fund treatment and recovery initiatives to combat the opioid epidemic, which demands meaningful action from the President to help the communities that he promised relief and support,” Shaheen said.
If the president doesn’t use the Stafford Act, which dips into FEMA money that is needed for severe storms, he could instead direct Secretary Price to declare an emergency under the Public Health Service Act, which doesn’t have a standing fund like FEMA but can be used to redeploy public health workers to hard-hit areas. HHS could also raise restrictions on access to anti-opioid medications like suboxone or naloxone. It could also change the rules for Medicaid recipients temporarily, which would broaden where they are allowed to get addiction treatment.
If there is any additional funding coming to the state from the federal government, Rourke said the best way to spend it would be to rapidly scale up New Hampshire’s treatment and recovery centers and make sure treatment providers have the money they need to meet the demand. Another area experiencing an acute shortage, according to Rourke, is in supportive housing for people in recovery after they complete treatment.
“We are a state that lacks that greatly compared to some others that have a more robust infrastructure for safe and sober living opportunities,” Rourke said.
For him, the uncertainty of what happens with a disaster declaration is outweighed by lingering fears that efforts by Republicans in Congress could result in thousands of residents losing their Medicaid insurance and thousands more losing substance abuse coverage through their private insurance. That’s what could happen if the Affordable Care Act gets repealed. While most serious plans by Republicans to do that have failed, a last-ditch effort was proposed on Sept. 13 by South Carolina Sen. Lindsey Graham and Sen. Bill Cassidy of Louisiana.
Short of that happening, elements of Obamacare could go unfunded. 
That questions of coverage and the details of the emergency declaration have led the governor’s commission to put its work to create a new state plan (due in 2018) on hold for now.
“It’s very difficult to do that when some of the underlying tenets of what we think is needed are up for discussion again,” Rourke said. 





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