President Donald Trump needs to declare a national state of emergency for the opioid epidemic, said the commission he created to combat the public health crisis.
Such a declaration was the “first and most urgent recommendation” in an interim report that detailed how the nation’s leaders could fight the pandemic that the New York Times says killed an estimated 59,000 people last year, said New Jersey Gov. Chris Christie, who chairs the Commission on Combating Drug Addiction and the Opioid Crisis.
Opioids “now kill more people than gun homicides and car crashes combined,” the commission wrote in its report, saying that with nearly 150 Americans dying every day, “America is enduring a death toll equal to September 11th every three weeks.”
“By declaring state of emergency, the president would put the full weight of his office behind this emergency,” Christie said as he read from the report during a call Monday afternoon to release the report.
The commission also recommended opening up more treatment beds in all 50 states with waiver approvals under Medicaid’s federal Institutes for Mental Diseases exclusion. With the waivers, facilities with more than 16 beds could accept patients seeking inpatient mental health treatment, including substance use disorders, and Medicaid would reimburse providers for the care.
“This is the single fastest way to increase treatment availability across the nation,” the commission’s draft interim report said.
Fellow commission member and former Rhode Island Rep. Patrick J. Kennedy said insurance companies and the Department of Labor need to ensure more access to treatment. They should also provide greater transparency and accountability for individuals with substance use disorder, who often shoulder the burden of “unfair denials” for coverage, Kennedy said.
“If this were any other public health issue, our response as a nation would be dramatically different than it is simply because these diseases are shunned and shamed by society,” Kennedy said.
Under current “well-intentioned” patient privacy laws, the commission said physicians and families alike face great difficulty in coordinating care or even knowing if an individual is struggling with substance use disorders, “restraining physicians’ ability to make informed healthcare decisions,” the report said.
Other recommendations from the commission included:
- Establish mandatory opioid prescriber education at medical and dental schools across the country to spread awareness about safe prescription practices.
- Create and fund a federal effort to offer all three forms of approved medication-assisted treatment — methadone, naltrexone and buprenorphine — at each facility licensed to distribute them and to ensure treatment “decisions are based on what is best for the patient” (the report says only roughly one out of every 10 U.S. drug treatment facilities offer medication-assisted treatment for opioid use disorder).
- Craft model legislation to encourage states to make naloxone — an antidote used to prevent fatal opioid overdoses — more readily available.
- Enhance border control and law enforcement efforts to screen and catch fentanyl entering the United States, including through packages shipped through the U.S. Postal Service.
- Improve prescription drug monitoring programs to better track patients who have been blocked from accessing prescription opioids but clearly still need help.
- Make sure insurance companies do not offer worse coverage to people for mental health and substance use diagnoses than for physical health issues.
The interim report’s recommendations are not intended to be comprehensive; the commission is scheduled to release its final report in October. Christie said the upcoming report will explore how to use big data to develop a national prevention strategy, ways that federal agencies can make medication-assisted treatment and more non-opioid pain therapies more accessible, how to reduce the nation’s supply of heroin, fentanyl and fentanyl analogs, and more.
Commissioners voted 4-0 to pass the interim report and pass it onto President Donald Trump’s office for executive approval.
One of those commission members, Bertha Madras, served on the White House Office of Drug Control Policy under the President George W. Bush administration and is now a psychobiologist at Harvard Medical School. In remarks delivered during Monday’s call, Madras said while U.S. prescription opioid use subsides, an unmistakable rise in heroin, fentanyl, fentanyl analogs and counterfeit pills presents a clear-and-present danger to public health nationwide.
“We should be tracking those supplies in the same way we track infectious diseases in our country,” Madras said.
Trump signed an executive order to establish the commission, chaired by New Jersey Gov. Chris Christie, in March. Since then, the commission met and received more than 8,000 comments from the public. That was why the commission missed initial deadlines for the report it unveiled Monday, Christie said.
In November, former Surgeon General Vivek Murthy released a historic report called “Facing Addiction in America” that assessed a series of recommendations called “Turn the Tide Rx,” designed to curb the opioid crisis.
“How we respond to this crisis is a moral test for America. Are we a nation willing to take on an epidemic that is causing great human suffering and economic loss? Are we able to live up to that most fundamental obligation we have as human beings: to care for one another?” it read.