Trump says opioids are an emergency, but it's not the declaration some were looking for

WASHINGTON — Over the last 77 days, President Trump repeatedly promised to declare what he called a "national emergency" to combat the opioid epidemic.

“We’re going to draw it up and we’re going to make it a national emergency," he said at his Bedminster, N.J., golf club on Aug. 10.

"We are studying national emergency right now. Believe it or not, doing national emergency, as you understand, is a very big statement," he said at the White House two weeks ago.

"What about declaring a written national emergency for this crisis?" a reporter asked last week. Trump replied, "We are going to be doing that next week. By the way, you know that's a big step."

And then just Wednesday: “We're going to be doing a very, very important meeting sometime in the very near future on opioids, in terms of declaring a national emergency, which gives us power to do things that you can't do right now,” he said.

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The president has the power to declare a state of national emergency. That authority exists in the Stafford Act — usually applied to hurricanes, tornadoes, floods and wildfires — and the even more sweeping National Emergencies Act. 

But that's not what Trump did. Instead, he ordered the secretary of Health and Human Services to declare a public health emergency under the Public Health Service Act. Acting HHS Secretary Eric Hargan did just that later Thursday afternoon. 

Both are emergencies, but they invoke different sets of powers. A presidential emergency would have allowed blanket waivers to a wide range of Medicaid and patient privacy rules that some health professionals say can get in the way of providing treatment.

For example, it could have allowed him to issue a blanket waiver of a Medicaid rule that prohibits federal funding for substance abuse hospitals of more than 16 beds, which have traditionally been considered a state responsibility.

"The public health emergency raises awareness, which is important, but we had hoped for a national state-of-emergency declaration, because that would carry with it a commitment for funding," said Leana Wen, the Baltimore health commissioner. "We don’t need more rhetoric. We need resources."

Wen has written a city-wide prescription for naloxone, the opioid-reversing drug that can save lives in the event of an overdose. But without money to buy they drug, she's had to ration limited quantities around the city.

"That's an example of something I was looking for in the president's state of emergency declaration," she said. "What I heard was a re-purposing of existing funds."

Read more:

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The emergency declaration isn't the only tool in the administration's toolbox. To be sure, Trump also spoke of a wide range of actions the administration has taken even without a national emergency declaration.

The Justice Department has indicted major Chinese drug traffickers smuggling the powerful opioid fentanyl into the country. The FDA has pushed a drug company to take the dangerous prescription opioid Opana ER off the market. The National Institutes of Health is doing research on non-opioid painkillers. 

But a presidential emergency declaration would have been a powerful rhetorical tool that the problem goes beyond a health concern.

Opioids claim the same number of American lives as if there was a 9/11 attack every three weeks, said David Patterson Silver Wolf, director of the Community-Academic Partnership on Addiction in St. Louis. A recovering addict and social worker, he says he's been on both sides of the desk.

He wants a declaration of emergency similar to the one President George W. Bush signed after 9/11, which focused all the resources of the federal government on finding those responsible and making sure it doesn't happen again.

"To call it a public health crisis, were' not getting to the bottom of why? Why does this happen?" he said. "This is not the bird flu. This is not the black plague. I would consider it an attack on the American people. And unfortunately it was done by American businesses with the help of politicians and attorneys so Big Pharma could make a profit."