It’s been 74 days since President Donald Trump said he’d declare a national emergency over the opioid epidemic, which killed over 33,000 nationwide in 2015 alone. Last Monday during a press conference, he said the formal declaration will be issued this week.
“That is a very, very big statement,” Trump said. “It’s a very important step, and to get to that step, a lot of work has to be done and it’s time-consuming work.” The commitment reportedly blindsided federal officials, who are still not in agreement on how to implement the order.
Former President Barack Obama declared an emergency over the swine flu epidemic and the Zika virus. Trump has done so as well when natural disasters devastated Texas, Florida, Puerto Rico, and California. But declaring a national emergency over a crisis like the opioid epidemic is unusual. “We don’t have a lot of federal precedent on a non-communicable disease,” Lainie Rutkow, associate professor at Johns Hopkins Bloomberg School of Public Health, told ThinkProgress.
Presidents issue a national emergency through two laws: the Stafford Act and the Public Health Service Act. Under the Stafford Act, the federal government delivers technical and logistical help to states. The president could also provide financial assistance through the federal disaster relief fund, which had about $3.3 million as of September. This directive is largely carried out through the Federal Emergency Management Agency (FEMA).
The Stafford Act could trigger a public health emergency response under which the Department of Health and Human Services (HHS) leads corresponding medical efforts; this is done under the Public Health Service Act. This act could allow the HHS secretary to waive certain federal rules.
“HHS Secretary could say we are waiving the no negotiating on drug prices rule for the large amount of naloxone [the overdose reversal medication] the government is buying under the second year of funding from [legislation] which is being doled out to states now,” Keith Humphreys, an addiction specialist at Stanford University who worked in the Office of National Drug Control Policy under Obama, told ThinkProgress over email. “There [are] at least some Members of Congress who would support this (I know this because their staff have called me and asked me how to do it).”
What these laws look like when implemented is contingent on what the Trump administration choices to prioritize. Trump could prioritize a “war on drugs” approach, as his “tough on crime” rhetoric has suggested. The president’s Commission on Combating Drug Addiction recommendations did prioritize public health initiatives.
Since there is no national precedent for declaring a state of emergency over a crisis like this, one good point of reference is to look at the states who’ve issued their own. So far, six states have: Alaska, Arizona, Florida, Maryland, Massachusetts, and Virginia. For more insight into what Trump’s declaration could look like, let’s see what the state of emergency looked like in each one:
In February 2017, Alaska Gov. Bill Walker (I) declared a disaster emergency over the opioid crisis. According to the Centers for Disease Control and Prevention (CDC), Alaska did not see a significant increase in overdose deaths between 2014 and 2015 compared to other states.
Even so, Walker issued the disaster declaration that established an “Overdose Response Program” and allowed law enforcement and the public more broadly to legally dispense and administer naloxone, widely known by its brand name NARCAN. The formal declaration did not cost the state any additional money, according to the Alaska Dispatch News. The federal government has provided some financial assistance to states, including Alaska, through the Comprehensive Addiction and Recovery Act (CARA) and 21st Century Cures Act. HHS made grants available for states and localities specifically for the overdose reversal medication.
In June 2017, Gov. Doug Ducey (R) issued an emergency in Arizona. Like Alaska, the state saw no significant increase in overdose deaths from 2014 to 2015, according to the most recent CDC data.
Ducey’s order enabled law enforcement to dispense and administer naloxone. Ducey also ushered help from his state health department, and asked that the agency along with its state attorney general, develop rules and guidelines for health professionals when prescribing opioids.
Additionally, the order required that the state’s health department issue its own recommendations, which it has in a report that includes 12 line items. The health department was also told to document opioid-related data in real-time, in a separate order issued by the governor.
Florida is among the hardest hit states, seeing a 22 percent increase in overdose deaths between 2014 and 2015. In an executive order in May 2017, Gov. Rick Scott (R) declared a state of emergency.
Scott’s directive allowed the state to immediately tap federal grants that weren’t technically afforded until July. Additionally, he authorized the Florida Department of Children and Families and the Florida Department of Law Enforcement to suspend rules that curtail efforts to appropriately address the crisis. His order also triggered the Florida Department of Health secretary to declare a statewide public health emergency. With this proclamation, the state was legally able to dispense naloxone to first responders. Scott also instructed the aforementioned state agencies to hold community workshops “to identify additional strategies.”
In March 2017, Gov. Larry Hogan (R) issued a state of emergency. Maryland saw a 20 percent increase in opioid-related overdose between 2014 and 2015, among one of the highest rates in the country.
The measure assigned an individual within the executive branch to administer authority under the Maryland Emergency Management Agency Act, coordinated agencies’ — from police to the health department — responses, instituted public awareness programs, and declared that the state would take “other necessary steps” to address the crisis. Three months later, the state’s health secretary issued a statewide standing order allowing Maryland-licensed pharmacists to dispense naloxone to anyone, without a prescription.
Massachusetts was the first state to declare a national emergency over the opioid crisis. In June 2014, Gov. Deval Patrick (D) declared a public health emergency after 140 died of heroin overdoses within the previous four months.
The order banned a “high-dosed opioid” (Zohydro, Zogenix), developed a plan for prescription monitoring, expanded naloxone access, and allocated funds for treatment services.
Given the order was issued nearly three years ago, public health experts were able to study the effects of declaring an emergency over a non-communicable disease. In September 2014, just three months after the declaration was first issued, health experts wrote in the New England Journal of Science that the changes were logical:
“There is also an instrumental reason to be concerned about the overuse of emergency powers…Governor Patrick’s declaration, in our view, does not venture far down this rabbit hole. Most of the policies that were advanced to address the opioid-addiction crisis in Massachusetts were prudent.”
Massachusetts saw 1,724 opioid-related overdose deaths in 2015, that’s 435 more than 2014.
Gov. Terry McAuliffe (D) did not issue an emergency declaration, but in 2016, Virginia’s health commissioner did declare a public health emergency. Maribeth Brewster, with the Virginia Department of Health, told ThinkProgress the declaration was meant “to bring awareness” to the crisis. The commissioner issued a standing order for naloxone and permits people to pick up the medication at any pharmacy in Virginia — in effect, a blanket prescription to all patients needed. This standing order could have been issued without the declaration given the commissioners authority under state code, said Brewster.