Trump’s 49 seconds on the opioid epidemic: 5 questions from the front lines

President Trump’s State of the Union address was 80 minutes long. He spent just 49 seconds on the opioid epidemic, something he has declared to be a public health emergency.

The brevity of his remarks on opioids is indicative of the lack of action taken by the federal government in the three months since the emergency declaration. For us on the front lines of the epidemic in Baltimore, as elsewhere around the country, the declaration has had no impact at all. The federal government continues to delay committing new funding to treating addiction as the disease that it is, while hundreds of people die every day from overdoses.

In his speech, the president pledged to increase law enforcement efforts against illicit opioid use. That will not work. Incarcerating people who have a disease will not help them get better, and history tells us that the war-on-drugs approach hasn’t worked. Those of us on the ground know what works. With scarce resources, we have used evidence-based methods to save lives, but our efforts are limited by lack of action on the federal level.

We look to the president and his opioid commission to answer the following questions:

Why is there still no commitment to funding more than 90 days after the declaration of a public health emergency? When natural disasters strike, or infectious diseases wreak havoc, it’s understood that billions of dollars are required to repair infrastructure and deliver antidotes. The same understanding applies to stopping the opioid epidemic. Baltimore and other cities and towns across the country desperately need these resources. Studies show that only 1 in 10 people with addiction receive the treatment they need — a statistic we would never find acceptable for any other disease. As I told the House Oversight Committee in November, and Acting Secretary of Health and Human Services Eric D. Hargan and U.S. Surgeon General Dr. Jerome Adams earlier this month, the president needs to announce a specific dollar amount for new funding, not repurposed dollars that take away from other key health priorities.

Will funding go directly to communities of greatest need — a “Ryan White” approach for the opioid epidemic? Cities and counties have been fighting this epidemic for years. We know what works, and local officials should not have to jump through additional hoops to obtain the resources we need. Delays cost lives. The federal government should make a decision now about how to allocate funding based on which areas are hardest hit. Local jurisdictions should not have to wait to receive direct, necessary funding that is substantial, long-term, and formula-based to allow us to provide all the services that need to be wrapped around addiction treatment in order for it to be successful.

Will the federal government engage its powers to the full extent and negotiate prices of the opioid overdose antidote naloxone? In October 2015, I issued a standing order — a blanket prescription — that allows every one of Baltimore’s 620,000 residents to receive naloxone. Since then, residents have saved 1,500 lives. Unfortunately, Baltimore is out of funds to purchase naloxone, forcing us to ration it and make decisions about who can receive this lifesaving medication. If we were talking about an infectious disease for which an antibiotic is readily available, there would be no question that we do everything in our power to obtain it and issue it to all those in need. The president can direct the Department of Health and Human Services to negotiate directly with the manufacturers of naloxone. He can invoke the federal government’s power under the Code of Federal Regulations to buy naloxone at a below-market price and distribute it to areas of highest need.

Will the president push for regulations to increase addiction treatment? Addressing the supply of drugs through law enforcement and reducing overprescription will not work unless we focus on the millions of people who already have the disease of addiction. Untreated addiction will continue to fuel the demand for drugs and contribute to the rising toll of overdose deaths. The federal government can take swift action, such as enforcing insurance parity and ensuring that all three forms of medication-assisted treatment (the medical gold standard for opioid treatment) are available through any insurance plan, without pre-authorization and without a duration limit. Bold steps can be taken to require all health care systems to have adequate numbers of trained providers who can treat patients with substance use disorders.

Will the president reverse proposals that are detrimental to treating addiction? Gutting Medicaid would hurt the 1 in 3 patients with addiction who depend on Medicaid for addiction treatment. Other patients on private insurance could find themselves without access to treatment if addiction is no longer part of their health plan, or is listed as a pre-existing condition that would disqualify them from receiving care. Furthermore, budget cuts to the Centers for Disease Control and Prevention and the National Institutes of Health will impede progress in controlling the epidemic. The state of emergency declaration about the opioid crisis should recognize the direct and immediate effects of these policy decisions and reverse these proposals before it is too late.

The president’s comments were disappointing in their length and their omission of concrete, evidence-based, and actionable steps to address the opioid crisis. Communities like Baltimore have lost thousands of lives from addiction. This is particularly tragic because the science is clear. We know what works to treat addiction.

The president has an opportunity to put the full force of the federal government to address the opioid epidemic as the emergency that it is. I urge him and his administration to go beyond rhetoric and deliver the resources that communities so desperately need to treat this devastating disease.

Leana S. Wen, M.D., is the commissioner of health in Baltimore.