In White House opioid plan, advocates see a major puzzle piece missing: naloxone

WASHINGTON — The Trump administration’s designation of the opioid crisis as a public health emergency on Thursday paves the way for officials to increase access to inpatient addiction treatment, redirect some federal resources, and launch a major public education campaign.

But the announcement included nothing about access to naloxone, the overdose-reversal drug that first responders across the country have credited with saving innumerable lives.

“I think this was a missed opportunity,” said Regina LaBelle, the chief of staff for the Office of National Drug Control Policy under former President Barack Obama. “They could have purchased naloxone and distributed it to hard-hit areas, to local governments as well as to community groups.”

Another policy expert in Capitol Hill circles indicated the administration could also put out a bid document for drug manufacturers for naloxone and addiction treatment drugs. After negotiating a new and deeper price discount, the federal government could allow state and local governments access to the drug at the cheaper price point — an action the administration has not yet taken.

While LaBelle and other drug policy authorities celebrated the administration’s push to expand treatment capacity and allow telemedicine-based access to medication-assisted treatment, many said President Trump’s announcement had fallen short of recommendations from a commission he created in March to address the opioid crisis.

In an interim report, the commission — chaired by New Jersey Gov. Chris Christie (R) — wrote that by declaring such an emergency, Trump could “empower the HHS Secretary to negotiate reduced pricing for all governmental units” for naloxone.

Sixteen Senate Democrats and two independents wrote to Trump on Wednesday to encourage him to follow through on that recommendation in his emergency declaration.

Trump, instead, may have left the issue for another time — perhaps next week.

“I know it will be included in the president’s commission recommendations next Wednesday,” said Gary Mendell, the CEO of the addiction advocacy group Shatterproof who testified before the commission in June. “They’re going to have 20 specific recommendations, and greater access to naloxone is going to be one of them. But I suspect [that recommendation] will not be as complete as I believe it should be.”

The American Public Health Association, in a statement, said Trump’s declaration came up short, and that any effective and comprehensive plan would “increase access to overdose reversal drugs and provide dedicated funding to health agencies responding to the crisis.”

Already, some municipalities are struggling to obtain stockpiles of the drug and to pay for it.

Dr. Leana Wen, Baltimore’s health commissioner, said her city has had to start rationing naloxone because officials do not have the resources to purchase what they need. The shortage is a reflection not only of the fact that the city has been so aggressive in its distribution of the medication, but also because overdoses and use of more potent synthetic opioids like fentanyl, which require higher doses of naloxone to overturn, have become more frequent.

Baltimore has fewer than 10,000 units of naloxone on hand; those units have to last between now and July 2018. Wen said that the city could distribute that many units in a few weeks if it was fully meeting demand.

“We should never have to ration a lifesaving medication,” she said.

Now, the health department is prioritizing doling out the medication to high-risk populations. That means people who visit the city’s syringe exchange van can still get doses, but that officials are having to turn down requests from churches and neighborhood groups.

“There is not a specific commitment to new funding,” Wen said of Trump’s emergency declaration. “It is repurposing existing funds.”