Two weeks ago, the Trump Administration issued a statement that directed the executive branch to “use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic.” This declaration couldn’t have come any sooner. The National Center for Health Statistics reported that in the third quarter of 2016, overdose deaths reached a record-breaking 19.9 people per 100,000. If this trend continues, our localities will need all the help the federal government can offer to battle this growing epidemic.
How bad is the opioid epidemic?
While education on the opioid crisis is getting better in the U.S., the crisis itself is still quite severe and doesn’t show significant signs of slowing. The National Center for Health Statistics (NCHS) data shows a sharp increase in overdose deaths in the first nine months of 2016. In 2015, the last full year of data available, the Centers for Disease Control and Prevention (CDC) found that 33,091 American deaths were caused by prescription and illicit opioids. Ninety-one people die from an opioid-related overdose every day. As many people are dying from opioid-related overdoses in one year than those that died during combat throughout the entire Korean War (1950-1953).
The U.S. is responsible for the majority of opioid consumption in the world – Cigna reports that Americans disproportionately take 80% of the world’s supply. An encouraging statistic from CDC is that the number of opioids prescribed in the U.S has decreased overall. However, the same report showed that three times as many opioids are being prescribed today than in 1999. There is also a lot of variation between counties. The CDC report showed that 22.6% of counties were still reporting opioid prescription rates higher than the national average, and that number is still rising.
Who does the opioid epidemic affect?
Chronic pain sufferers and veterans are two populations that are at high-risk for developing opioid abuse disorders. According to Congressman Tim Murphy, for the 50 million people in America that have chronic back pain, half are prescribed opioids for treatment. The National Institute of Drug Abuse reports that nearly 80% of heroin users have reported using prescription opioids prior to heroin, putting millions at risk unnecessarily. The Public Broadcasting Service (PBS) reported that 13 percent of U.S. veterans currently take opioids, and this population is twice as likely to die from an accidental opioid overdose.
What is perhaps the most difficult aspect of battling this epidemic? Opioid abuse disorders know no boundaries. It does not favor any demographic – age, educational level, socioeconomic status, or occupation. And it can develop in just about anyone, anywhere, at any time.
What does this national emergency declaration mean?
While the president has issued a statement declaring a national emergency for the opioid epidemic, a formal declaration has not yet been made. First, the Trump Administration must decide under which legislation they will declare the crisis. According to Governing magazine, this leaves the administration with two options they can employ individually or together:
- Emergency declaration through the Stafford Act. This option allows the president to declare the emergency. The Federal Emergency Management Agency (FEMA) provides financial and technical assistance to states and cities through this act. This option is typically used for natural disaster relief.
- Emergency declaration through the Public Health Service Act. This option allows the secretary of health and human services to declare the emergency. This would deploy medical professionals to the areas affected by the epidemic. This option is normally used in times of extreme public health crises.
Formally declaring a national emergency would have other positive implications for states and local governments. NPR pointed to four additional benefits under the national emergency declaration:
- Increased access to medication-assisted treatment. Federal rules could be waived on medications used to help treat opioid-related abuse and overdoses. The drug naloxone, used to treat opioid overdoses immediately, could be provided without a prescription. Restrictions on doctors to prescribe medication used to treat opioid addiction without a special certification could also be waived.
- More help to those on Medicaid. Regulation barriers could be removed to help Medicare patients. Under a national emergency, more Medicare patients may be able to get inpatient drug treatment. Medicare funding would also be provided to more treatment centers instead of limiting reimbursement to those with less than 16 beds.
- More money from Congress. The legislative branch may face increased pressure to provide money to help combat the opioid crisis after seeing executive action.
- States can request federal aid. Six states have already declared state emergencies in the face of the opioid epidemic. These states would be able to request federal funding for specific activities related to the opioid crisis.
What can local governments do to help combat the opioid epidemic?
A few weeks ago, NARC attended an event hosted by CQ Roll Call: Roll Call Live: Fighting the Opioid Crisis. Members of Congress, health care practitioners, insurance providers, nonprofit organizations, and local government representatives attended this discussion. Panels discussed what real-world solutions are available to fight this pressing issue.
These stakeholders proposed a very different solution to the crisis than the president. Trump supports a law-and-order approach that would crack down on federal drug prosecutions, sentence lengths, and illegal drugs entering the country (watch full comments here).
The local representatives and other stakeholders at the Roll Call Live event called for a much more holistic approach. You, our local government leaders, should tackle the crisis at all sides to help bring the opioid epidemic to an end. Law enforcement should only be an aspect of this fight. Focus on the following recommendations offered by the Roll Call Live stakeholders to address the opioid crisis:
- We must do all we can to fight the stigma of opioid abuse. Local outreach is necessary to start the conversation of how common an opioid abuse disorder is, and that it is not a moral failing to develop an addiction. Communities should be educated on the process of opioid-related treatment and on how they can help.
- Combine the efforts of patients, health care providers, governments, the pharmaceutical industry, insurance companies, and veterans to fight this epidemic. We all must work together and be on the same page.
- Local governments are the closest in proximity to the epidemic and know the needs of their constituency. You should take the lead on this national issue and recommend to the federal government not to micromanage local efforts.
- Ask your representatives and senators to dedicate federal funds towards opioid addiction treatment, outreach, and prevention. For every $1 that is spent on opioid addiction treatment, society saves $12.
- Be aware of this evidence-based fact: to treat someone that has already developed an opioid addiction, a combination of medication-assisted therapy, mental health treatment, counseling, and maintaining relationships with the patient is the best way to battle the addiction.
- Recommend to your local healthcare facilities to treat the individual – not the addiction. Treatments that focus on understanding a patient’s complex injury, creating an individual health care plan, monitoring a patient’s opioid use, and tailoring a treatment to help the patient achieve their personal life goals are most effective.
- Counties, cities, and regions must develop better drug monitoring programs so doctors can monitor patient trends and know when to make an intervention. And records for this should be available across state lines.
- Regions should work with medical professionals to focus on alternative methods of treatment and educate prescribers of the options. This should help with the issue of overprescribing opioids. Alternatives could include yoga, meditation, acupuncture, and mental therapy.
- Communities must be unified against this crisis. Education against drug abuse disorders must start as early as elementary school. Your constituents should also be open to having treatment centers in their communities throughout your region.
- Local leaders should help change the attitude of “quick fix” treatments in their communities.
The opioid epidemic is not going to end any time soon. It can take years for a patient to be completely weaned from opioids. The effects of the rise in addictions and overdoses are also going to have a ripple effect on families and communities in the middle of the crisis. Looking at evidence-based, long term strategies for these communities is the only way we’re going to be able to bring this crisis to an end.