President Donald Trump has been formally urged to declare a federal state of emergency to deal with the opioid epidemic, with Gov. Chris Christie and other members of a White House task force issuing the recommendation in a report released Monday afternoon.
The report — viewable in full below — also calls for a dramatic shift in the way the federal government responds to the opioid crisis, and advocates for expanded access to rehab and medically-assisted treatments such as Suboxone.
Trump established the “President’s Commission on Combating Drug Addiction and the Opioid Crisis” on March 29, and since then the commission — chaired by Christie — has been studying how to respond to the recent surge in fatal drug overdoses.
In a conference call Monday, Christie said the commission’s interim report offers Trump “immediate steps to deal with crisis.” Here are the key recommendations:
Declare a national emergency
The report calls for Trump to use either the Public Health Service Act or the Stafford Act to declare a state of emergency and “use every tool at our disposal to prevent any further American deaths.”
“Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the Executive Branch even further to deal with this loss of life,” the report states. “It would also awaken every American to this simple fact: if this scourge has not found you or your family yet, without bold action by everyone, it soon will.”
Rapidly increase treatment capacity
The report calls for Trump to “quickly eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases DRAFT 3 (IMD) exclusion within the Medicaid program.” This rule prohibits federal Medicaid funds from being used to reimburse inpatient treatment facilities that have more than 16 beds. The report calls this move “the single fastest way to increase treatment availability across the nation.”
“The Commission recognizes that legislation would be necessary to repeal the exclusion in its entirety,” the report states. “However, certainly after an emergency declaration by the President (and arguably even without it) the Department of Health and Human Services (HHS) Secretary would be empowered to immediately grant waivers to each state that requests one.”
There report also suggests increased enforcement of the Mental Health Parity and Addiction Equity Act, which requires insurers to handle drug treatment like any other disease. Rep. Patrick Kennedy, a member of the commission, said Monday that insurers have been flouting the law, and called enforcement “an issue of equity and medical civil rights.”
Enhance access to medication-assisted treatment (MAT)
Drugs such as Suboxone, Subutex, and methadone have proven to be the most effective type of treatment for people are recovering from addiction, but access to these forms of MAT are still limited.
The report calls for the White House to take steps that improve access to MAT in federal prisons and require all federally-qualified health centers “to mandate that their staff physicians, physician assistants, and nurse practitioners possess waivers to prescribe buprenorphine.” It also calls for research into developing new forms of MAT.
Expand access to naloxone
The fast-acting overdose antidote naloxone (aka Narcan) has saved thousands of lives. The report calls for steps to “equip all law enforcement” in the country with the drug, and require naloxone to be included with every “high-risk” opioid prescription.
The report also urges all states to adopt “Good Samaritan” laws that encourage people to report overdoses by giving people who call 911 immunity from criminal prosecution. Currently, all but 12 states have some type of Good Samaritan law on the books.
Crackdown on fentanyl and synthetic opioids
While most of the report’s recommendations were public health focused, Christie’s commission also included some supply-oriented measures, specifically in regard to fentanyl, carfentanil, and other extremely potent synthetic opioids.
“Fentanyl defies detection at our borders, as the small quantities involved for psychoactivity of fentanyl and fentanyl analogs challenge Customs and Border Protection, USPS, and express consignment carriers’ ability to detect and interdict,” the report states. “We are miserably losing this fight to prevent fentanyl from entering our country and killing our citizens.”
Most of the synthetic opioids are manufactured in China, and the report calls for making a crackdown on these drugs “a top tier diplomatic issue” in discussions with Beijing.
Educate drug prescribers and increase prescription monitoring
It’s now common knowledge that doctors contributed to the opioid crisis by recklessly handing out millions of pain pills. As the report states, “four out of every five new heroin users begin with nonmedical use of prescription opioids.”
The report urges the Trump administration to create new “national training standards” to curb irresponsible prescribing, and increase information sharing between states about prescription drug monitoring programs. As many experts have pointed out, however, there’s a direct correlation between cutting off access to prescription painkillers and increases in fatal overdoses from heroin and other street drugs.
One issue that was not highlighted in the report but discussed Monday by another member of the commission, North Carolina Gov. Roy Cooper, is the fate of the Affordable Care Act and the expansion of Medicaid. Cooper called Obamacare “the elephant in the room.”
“We have to maintain and expand access to affordable and adequate health care that includes substance abuse treat for all Americans,” Cooper said. “I think it’s import on a federal level that we emphasize that need. We talk about treatment, we talk about prevention, we talk about insurance, but we need to make sure we have the resources to provide affordable coverage so that people can take advantage of medically-assisted treatment.”
So far, the commission has received more than 8,000 public comments. Thousands of those comments reportedly urged the commission to study whether medical marijuana could help solve the crisis, but the report made no mention of weed as a potential solution and it was not discussed during the call Monday.
The commission’s final report is due October 1.