The New Opium Wars
President Trump says the opioid crisis is a national emergency, Quibbl considers the personal and political consequences
By Jonathan Silverman with Ben Purcell
The Rust Belt helped put President Trump in the White House, and now citizens of those states are watching as the President addresses the opioid epidemic that has plagued states like West Virginia and Ohio for the last decade. Leading public health experts recently quantified how bad the crisis could become: an average of ten forecasts shows nearly 500,000 possible deaths before 2027. Both the personal and political stakes are obvious. If President Trump is perceived as guiding Americans through drug addiction, if his policies are able to impact the spiraling mortality rate from overdoses expected over the next three years, then the President will almost certainly maintain support from those states hardest hit by the epidemic.
On July 31st, Trump’s Commission on Combating Drug Addiction and the Opioid Crisis presented a penultimate report of policy recommendations for how to handle the nation’s opioid epidemic. The final report is expected in October. The first recommendation of the recent report is for the President to declare a state of emergency: “The first and most urgent recommendation of this Commission is direct and completely within your control. Declare a national emergency under either the Public Health Service Act or the Stafford Act.”
On August 8th, during a press conference held by Secretary of Health and Human Services Tom Price and top White House advisor Kellyanne Conway, a debate ensued about the potential effects of enrolling more opioid-afflicted Medicaid recipients into treatment via such emergency measures. Secretary Price posited that such measures could be taken without declaring a state of emergency; declarations of emergency are usually for short-term crises, unlike longstanding, intractable problems like addiction. Two days after Price’s comments, President Trump, Vice President Pence at his side, announced that he did in fact plan to declare a national emergency.
Will he follow through?
The mixed messaging seems to indicate that disagreement exists within the Trump administration over what provisions a declaration of national emergency would actually entail and what their effect would be in solving the problem. Will the President follow through on his announcement sign the documents declaring a national state of emergency to fight the nation’s opioid epidemic? If so, when? The move could be imminent, but Trump may also elect to wait on the final report from the Commission on Combating Drug Addiction and the Opioid Crisis. Quibbl about it here.
Youth opioid addiction and HIPAA
Before announcing his intention to declare a national emergency, President Trump made several interesting and potentially revealing remarks to the press before a briefing with staffers on the opioid crisis. One of his comments specifically addressed the reality that young people are among those affected by the current situation: “If they don’t start, they won’t have a problem. If they do start, it’s awfully tough to get off. So if we can keep them from going on — and maybe by talking to youth and telling them: ‘No good, really bad for you in every way.’ But if they don’t start, it will never be a problem.”
Opioid addiction among minors is an aspect of the problem that may serve as the impetus for a White House initiative to create a new exception to the Health Information and Portability Act (HIPAA) Privacy Rule. In the same opioid crisis press briefing, Counselor to the President Kellyanne Conway spoke to this possibility by identifying that “sometimes the privacy laws don’t allow the parents of a 19 year old, in fact to be notified. So this is something we’re very aware of also.” HHS Secretary Price added, “So we’re looking through the regulatory process to determine what can be done, if anything, to make it so that those requirements are not — those privacy requirements are not as onerous in the case of an overdose.” Will HIPAA be modified for lawful notification of family members of a patient with an opioid overdose? Such an attempted modification could be seen as an erosion of privacy and end up blocked by Congress. Quibbl about it here.
The price of treatment
Beyond the concrete policy changes, the major outcome in declaring a national emergency could be the increased attention paid to subtler aspects of the opioid crisis. National focus on the situation may add political steam to ongoing efforts on Capitol Hill to bring down the price of Naloxone, a drug commonly used in the treatment of opioid overdose. On August 2, Sen. Claire McCaskill, D-Mo., sent letters asking what the pharmaceutical companies that make Naloxone are doing to provide discounted prices for emergency management and public health agencies. Will we see new legislation targeting the price of Naloxone introduced by the end of 2017? Quibble about it here. As his recent tweet @Merck on its CEO’s way out the door of a now-defunct presidential business council indicates, President Trump is aware that publicly fighting for lower drug prices is a winning political strategy. So too may be his response to the opioid crisis.