After nearly two and a half months of failing to follow through on his pledge to declare a national state of emergency in response to the opioid crisis, President Donald Trump is finally taking action. Sort of.
Trump ordered the Department of Health and Human Services on Thursday to formally declare a public health emergency in response to an epidemic that caused at least 53,000 overdose deaths in 2016.
“As Americans, we cannot allow this to continue,” Trump said in a speech at the White House. “It’s time to liberate our communities from this scourge of drug addiction. Never been this way. We can be the generation that ends the opioid epidemic. We can do it.”
Experts who spoke with VICE News ahead of Trump’s speech expressed cautious optimism that the emergency declaration could lead to helpful policy changes at the federal level, but they also warned that the immediate impact would be negligible.
To start, Trump’s declaration unlocks just $57,000 in funding. Despite a recommendation from his opioid commission to tap into FEMA’s $4.28 billion Disaster Relief Fund, Thursday’s declaration only allows access to the Department of Health and Human Services’ (HHS) Public Health Emergency Fund, which is nearly depleted.
Congress could replenish the Public Health Emergency Fund beyond the current balance of $57,000, but that hasn’t happened since 1990, when the fund’s value peaked at $45 million. One estimate from a Harvard economist put the public health cost of the opioid crisis at $14 billion per year.
Leo Beletsky, an associate professor of law and health sciences at Northeastern University, called the $57,000 figure “laughably low” and said Trump’s announcement includes little in the way of substance. But, he added, the emergency declaration is still significant.
“Making a declaration has important symbolic value,” Beletsky said. “This is one of the worst public health crises in U.S. history. This announcement acknowledged its gravity and can marshall the resolve of the federal government and add urgency to its response, but the practical implications are sparse and unlikely to be a game-changer.”
During his speech, Trump alternated between hard-line, just-say-no rhetoric and more compassionate vows to “unlock treatment for people in need.” He promised that he will “be building a wall, that will greatly help in this problem” in the same breath that he vowed to pursue “efforts based on sound metrics, guided by evidence, and guided by results.” (There’s zero evidence a wall would stop drugs from getting into the country.)
Here are the big takeaways from Trump’s speech and the resulting policy changes:
Expanded access to drug treatment
One of the key recommendations from Trump’s opioid commission was to waive a rule that prevents addiction treatment facilities with more than 16 beds to be reimbursed through Medicaid. Trump said he’s doing away with these restrictions, adding “those approvals will come very, very fast.”
Trump’s version of “Just say no.”
Trump said he would launch a “massive advertising campaign” designed to “get people, especially children, not to want to take drugs in the first place. They will see the devastation and the ruination it causes to people and people’s lives.” He added that the campaign would feature “really tough, really big advertisings.” Trump noted that he has never drunk alcohol or smoked a cigarette and said the best solution would be “if we can teach young people not to take drugs, just not to take them.”
Trump later acknowledged that it’s also necessary to treat addiction and “confront the reality, right smack in the face, that a million of our fellow citizens are already addicted.”
“We want them to get the help they need,” Trump said. “We have no choice but to help these people who are hooked and suffering, so they can rebuild their lives.”
The war on drugs will continue
Trump vowed that the federal government will be “taking the fight directly to the criminals in places they’re producing this poison.” He specifically singled out China and Mexico. He said he would make the issue of illicit fentanyl a “top priority” during his upcoming trip to Beijing. He also called out drug users for funding “violent, cruel, and ruthless” Mexican cartels.
“We owe it to our children and our country to do everything in our power to address this national shame and our human tragedy,” Trump said. “We must stop the flow of all types of illegal drugs into our communities.”
At the same time, Trump said he would make “addiction treatment available to those in prison, to help them reenter society and become productive and law-abiding citizens.”
No increased access to the overdose antidote naloxone
Naloxone, which reverses the effects of an overdose, has saved countless lives, but it’s expensive. Trump’s declaration doesn’t devote any money to help states and municipalities cover the cost of naloxone or allow for a negotiated discount with drug manufacturers to lower the price. Those things could still happen in the future — but not right away.
No mention of marijuana
Trump repeatedly mentioned ongoing efforts to restrict the supply of prescription opioids and said he would be “pushing the concept of non-addictive painkillers very hard.”
“We have to come up with a solution,” he said. “We give away billions and billions a year, spending lots of money coming up with a non-addictive solution.”
He didn’t mention the possibility of studying medical marijuana, even though researchers have found “a compelling amount of evidence” that marijuana could be used as an alternative to opioids, creating “significant positive impacts on public health and safety.”
No safe places for people to use opioids
Trump made no mention of safe spaces where people can use opioids under supervision with naloxone readily available, which advocates have long argued are the most effective way to prevent overdoses and improve public health. These spaces also allow for easier referral to drug treatment and health services.
“It’s an important declaration, but the devil is in the details,” said Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at the Johns Hopkins Bloomberg School of Public Health. “The declaration itself isn’t going to move the needle unless the federal government takes substantial action as a consequence.”
Grant Smith, deputy director of national affairs at the Drug Policy Alliance, called the scope of Trump’s emergency declaration “limited” and said it “doesn’t deliver what we really need in terms of the public health response.”
“The measures are a small step in the right direction but they fall far short of what is needed,” Smith said. “We need a really robust and well thought out plan for expanding the infrastructure for treatment, focusing on the most effective and best possible use of opioid dollars, and we need new funding.”
Instead, Trump has essentially passed the buck to Congress.
Of course, all of the potential solutions that Trump chose not to implement with his declaration Thursday could still be accomplished legislatively. Federal lawmakers have shown bipartisan support for responding to the opioid crisis, but when — or if — that will happen remains to be seen.
“I remain very worried that we will not commit the necessary resources,” said Stefan Kertesz, professor of preventive medicine at the University of Alabama at Birmingham. “But let’s hope that the administration and our health leaders come together and do exactly that.”