By Noam N. Levey
President Donald Trump, who campaigned on a pledge to take on the deadly opioid epidemic, directed the U.S. Department of Health and Human Services on Thursday to declare a limited 90-day public health emergency in response to the crisis.
But despite his sweeping rhetoric about the human toll of drug use, the president stopped short of declaring a broader national emergency and will not make any additional federal money available to confront a crisis that last year killed more than 64,000 Americans.
Senior administration officials say they hope Congress will provide more funding in a spending bill later this year, though officials would not say how much money the White House is seeking.
"We cannot allow this to continue," Trump said in a lengthy address at the White House. "We can be the generation that ends the opioid epidemic. Let's do it."
Trump has been under pressure for months to step up the federal government's response to the drug epidemic and has been promising since the summer that he would declare an emergency, a technical step that can free up funding and loosen regulations.
The new order will allow some limited new steps, such as allowing patients in rural parts of the country to access medication for addiction treatment through telemedicine, administration officials said.
The order also should allow federal agencies to move around some existing grant money to focus on opioid-addicted patients.
But many public health officials have been urging White House to take more sweeping steps, and the administration's own opioid task force, led by New Jersey Gov. Chris Christie, called this summer for a stronger federal drug strategy.
Despite rising public alarm about the epidemic, the unmet need for treatment remains enormous, with just 1 in 10 addicted Americans getting specialty treatment, according to the U.S. surgeon general.
And although Congress appropriated some additional funding last year, most state leaders, public health officials and addiction specialists say much more is needed.
"We certainly agree that it is a health emergency, and anything that highlights the problem is helpful," said Dr. Joe Parks, medical director at the National Council for Behavioral Health. "If we want to take care of this epidemic, we need more health insurance coverage, not less."
The administration still doesn't have a permanent Health and Human Services secretary or a director of the Drug Enforcement Agency, and Trump's pick for drug czar, Rep. Tom Marino, R-Pa., recently withdrew his nomination.
At the same time, the Trump administration has worked for most of the year to roll back the Affordable Care Act, which has helped many states on the front line of the epidemic expand treatment for patients with substance abuse disorder.
Republican plans to repeal the 2010 law, often called Obamacare, would have cut hundreds of billions of dollars of federal health care aid to these states and others.
Senior administration officials stressed Thursday that the Trump administration has already taken steps to bolster the federal response to the opioid crisis.
These steps include prosecuting distributors of fentanyl, a deadly synthetic opioid, and strengthening guidelines for how opioids are prescribed for pain.
And this week, Food and Drug Administration Commissioner Scott Gottlieb said his agency plans to encourage wider use of medications such as methadone and buprenorphine to treat patients with opioid addiction, a step widely seen as critical to addressing the crisis.
These so-called medication-assisted treatments continue to be stigmatized in many places.
But it remains unclear what impact Trump's new order will have on the crisis.
And even as the president expressed a commitment to more steps, his administration has pushed unprecedented cuts in federal aid to states for their Medicaid programs. Medicaid has emerged as one of the most important tools in combating the crisis.
The government health care safety net, which was expanded through the 2010 health care law, allows states to get patients on medications to combat addiction, such as methadone and bupremorphine, and provide additional services.
Medicaid, which insures some 70 million low-income Americans, historically covered primarily poor children, pregnant mothers and the low-income elderly.
But in recent years, funding made available through the Affordable Care Act has allowed states including Ohio, West Virginia and Kentucky to open Medicaid to poor, working-age adults, a population traditionally not eligible for coverage but often most likely to face substance abuse issues.
In Ohio, for example, more than a third of the approximately 700,000 people who enrolled in Medicaid after the expansion began in 2014 reported some drug or alcohol dependence, according to a recent study by the state.
The vast majority did not previously have health insurance.
(c)2017 Los Angeles Times