Does the Opioid Epidemic Require an Emergency Declaration?

Recently, President Donald Trump announced that the opioid epidemic was a national emergency, which was in line with recommendations from the President’s Commission on Combating Drug Addiction and the Opioid Crisis.

The declaration of a national emergency allows for public health powers, mobilizes resources, and implements strategies to reduce the effects of the crisis, according to commentary in JAMA.

Millions of Americans experience chronic pain, with many receiving prescription opioids to manage this pain. Prescription opioids are highly addictive and statistics suggest that many individuals who have misused opioids eventually moved to heroin.

While effective pain management is crucial, opioids have had a devastating effect on the United States. The authors report that opioid overdoses have increased from 21,088 in 2010 to 22,091 in 2015, according to the study.

Overdose-related deaths have also increased 19% among teenagers, likely related to potent synthetic opioids, such as fentanyl, according to the commentary authors.

The opioid epidemic can also increase the risk of HIV or hepatitis through sharing needles. The CDC projects that 1 in 23 women and 1 in 36 men who inject drugs will acquire HIV in their life. Hepatitis C virus infections have tripled between 2010 and 2015, according to the article.

Over the last decade, the opioid epidemic has had a $92 billion economic impact in 2016—including costs for healthcare, labor, and criminal justice—highlight the extensive effect of the drugs.

The authors wrote that improved public health prevention would likely reduce death and morbidity, while being cost-effective.

In the past, public health emergency declarations have been primarily reserved for infectious diseases, biosecurity threats, and humanitarian disasters; however, the authors report that this model of public health emergencies has begun to change, with more states declaring emergencies over seasonal influenza and asbestos releases.

As early as 2011, 6 states and tribal governments have declared public health emergencies in response to the opioid epidemic, according to the article.

“Existing public health strategies are meaningful and necessary, but an emergency declaration could be a turning point for a national surge response,” the authors wrote. “Current response efforts include patient and prescriber surveillance, reduced medical prescribing, and counseling or treatment for persons at risk or already addicted.”

The FDA and National Institutes of Health have called for less addictive opioids, while the CDC has called for expanded education for physicians and pharmacists to mitigate unnecessary prescriptions. US Customs and Border Protection is currently working to restrict overseas shipments of opioids and law enforcement has cracked down on drug dealers and unethical physicians.

The emergency declaration deploys resources that are unavailable or are restricted under normal circumstances. The commission recommends improving Medicaid coverage for substance use treatment, increase funding for medication-assisted therapy, training for pain management approaches, and waivers of privacy information that inhibit access to data on fraudulent prescriptions, according to the article.

The authors also suggest implementing interventions focused on jails and prisons—where many individuals have opioid use disorder—would require overriding Medicaid laws that end coverage for those who are incarcerated. Additionally, getting rid of legal barriers to authorize safe-injection sites may help curb the spread of certain diseases.

While the opioid epidemic is scourging the country, the authors caution that utilizing the powers and resources may take attention from other problems, such as cancer, diabetes, and heart disease, according to the article. The declaration may also cause future health hazards to be portrayed as an emergency.

The authors report that despite potential pitfalls, the government was justified in the emergency declaration over the opioid epidemic.

“It may have taken years for this epidemic to reach crisis levels, but it could take only months for coordinated, bipartisan interventions across public and private sectors to take hold,” the authors concluded. “Preventable deaths and injuries attributable to opioid misuse will never be acceptable, but the emergency should come to an end when opioid addiction and death rates return to historic lower levels.”