A Month Has Passed Since Trump Declared an Opioid Emergency. What Next?

The New York Times, Maggie Haberman, 9/10/2017

When President Trump announced in early August, following a presidential commission’s recommendations, that the opioid crisis was a “national emergency,” he called it “a serious problem the likes of which we have never had.”

A month has now passed, and that urgent talk has yet to translate into urgent action. While the president’s aides say they are pursuing an expedited process, it remains to be seen how and by what mechanism Mr. Trump plans to direct government resources.

While the president’s opioid commission, led by Gov. Chris Christie of New Jersey, has urged him to move swiftly, Mr. Trump and his cabinet — primarily his health secretary, Tom Price — are trying to determine how best to move forward amid warnings from deficit hawks within the administration about the potential costs.

As with many of his campaign promises, Mr. Trump is discovering the realities of limited government resources, slow-moving agencies and the competing agendas of cabinet members, even as they try to push in the same general direction. The hurricanes that have struck Texas and Florida, and the costly recovery that will follow, appear to have complicated the process.

Mr. Christie, in a statement issued to The New York Times, said that the White House Commission on Combating Drug Addiction and the Opioid Crisis was “continuing its work” and was eager to “begin to push back on this scourge, which is killing so many Americans unnecessarily.”

Patrick J. Kennedy, the former Democratic congressman from Rhode Island, who also serves on the commission, said that Mr. Trump and Mr. Price “both know this is going to mark their time in office.”

During the primary campaign last year, Mr. Trump surged to victory in New Hampshire in part on his promise to focus on the opioid crisis, which has claimed tens of thousands of lives and shown little sign of abating. The issue was championed most forcefully in that primary by Mr. Christie, who has spoken about the need for benevolence in treating addiction as a disease rather than a crime.

A Times study of reports of drug deaths in 2016 found that there were most likely more than 59,000, the highest on record.

In an interim report issued on July 31, Mr. Christie’s commission recommended a declaration of a national emergency. In a statement that caught most of his advisers by surprise, and which contradicted what Mr. Price had said days earlier, Mr. Trump told reporters on Aug. 10 that he was moving forward.

“The opioid crisis is an emergency. And I’m saying officially right now, it is an emergency. It’s a national emergency,” the president said at the time. “We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis.”

His statements have left advisers scrambling to fulfill his pledge, creating a long lag between a presidential statement and an actual action to follow it.

A White House official, speaking on the condition of anonymity to discuss private deliberations, said the administration was reviewing options and putting the report through an expedited legal process.

Mr. Christie and other members of the commission are aware that the chances of pushing a funding bill through a log-jammed Congress are slim.

A law known as the Stafford Act is the option that would be likely to free up the most money. But it would be allocated by the Federal Emergency Management Agency, which traditionally focuses on recovery after physical disasters, such as the Sept. 11, 2001, terrorist attacks, or the recent hurricanes.

The report calls the roughly 142 Americans who die from opioid overdoses every day “a death toll equal to September 11th every three weeks.” Among its recommendations is a law shielding people who report overdoses, an expansion of Medicaid-funded drug treatment, and a requirement that law enforcement officers carry naloxone, which counteracts the effects of an overdose.

Administration officials said that cabinet officials were seriously considering the possibility of making naloxone widely available. But other recommendations in the report appear less certain to be acted on swiftly.

When Mr. Christie presented the report to Mr. Trump’s advisers roughly six weeks ago, he was greeted with some skepticism over the Stafford Act recommendation, according to two people briefed on the discussion. Among them was Thomas P. Bossert, the president’s Homeland Security adviser, who took issue with the prospect that resources could be moved away from responding to a natural
disaster, according to the two people briefed.

Mr. Christie left it in the report, and the president made the declaration — but without a clear directive. The president is said to be aware that there are not enough treatment options available, that opioids are being overprescribed by doctors and that there needs to be a greater effort toward deterring people from using drugs in the first place.

One administration official, who was not authorized to speak publicly, said the Stafford Act option was extremely unlikely, especially as hurricanes have slammed into the coasts of Texas and Florida in the last few weeks.

Kellyanne Conway, the White House counselor, who has become the point person within the West Wing on the issue, has repeatedly traveled the country with Mr. Price to address what she called a “nonpartisan issue.”

“No state has been spared, and no demographic group is untouched,” she said. “We hope politicians of all persuasions and leaders across many industries will join us in educating and engaging a public grappling with rampant addiction and a rise in deaths.”

But beyond Ms. Conway, it is not clear who among the senior administration officials is pushing Mr. Trump to make good on his statement.

John F. Kelly, the president’s second chief of staff, has become engaged with the issue and is getting up to speed, but has come to the table late in the process. He is said to be interested in a swift solution.

The Office of American Innovation, led by Mr. Trump’s son-in-law, Jared Kushner, helped establish the commission, but is not expected to play a strong role, two White House officials said. The director of the Office of Management and Budget, Mick Mulvaney, has been concerned about the potential cost.

And the message of benevolence toward drug users has been at odds with the tone set by the president’s attorney general, Jeff Sessions, who has been pushing more aggressive, war-on-drugs-style tactics in cities. The president himself has been prone to such language at times, creating a whipsaw effect.

In the meantime, several governors have declared states of emergency over the opioid crisis, including Florida’s.

While the federal funding for a national emergency declaration may not come from a pot for disaster relief, Mr. Kennedy said the twin hurricanes that have ravaged the United States had, if anything, clarified the scale of the challenge. “It’s going to require, obviously, a state of emergency” to deal with opioids, said Mr. Kennedy, himself a recovering addict. “And it’s going to require however many dollars are necessary to meet the demand, however we ultimately assess that demand.”

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