A year ago Friday, President Donald Trump directed his government to designate the "opioid crisis" a national public-health emergency. Nearly 64,000 Americans had died of drug overdoses in the previous year—most of them after taking synthetic opioids such as fentanyl—amounting to a rate that was three times higher than the overdose death rate in 1999.
Now, a year later, what has the emergency declaration accomplished? Not much, outside experts say.
Declaring a public-health emergency legally opens up certain powers for the government to move more quickly, and with less oversight, to respond to important health problems. Since Trump's first announcement, the Department of Health and Human Services has renewed the national opioid emergency four times, most recently on October 18th. In this past year, officials have used the declaration to run and expedite studies of the problem, and to help two states launch anti-addiction programs faster than usual, according to a new report from the Government Accountability Office, which conducts investigations for Congress.
Officials could have done much more with the declaration, experts say. "I think what the report highlighted was the lack of leveraging [of] these powers under the opioid public-health emergency," says Rebecca Haffajee, a professor who specializes in health law at the University of Michigan.
"I don't think it's doing anything," says Keith Humphreys, a psychiatrist who studies addiction policy at Stanford University. He was also an adviser to the Obama White House's anti-addiction efforts.
When asked whether the declaration has helped Ohio, which had the nation's second-highest opioid overdose rate in 2016, Eric Wandersleben, a spokesman for the Department of Mental Health and Addiction Services there, replied with an email that addressed major federal funding programs, but not the emergency declaration, which didn't give states any money. When pressed, Wandersleben wrote that "the federal emergency declaration did not directly impact our approach in Ohio."
The Department of Health and Human Services didn't respond to a request for comment.
Officials' descriptions of what they did with the emergency declaration don't suggest Ohio, or the vast majority of states, saw big results from it. Officials used the declaration to take three main actions, according to the Government Accountability Office, which interviewed Department of Health and Human Services officials and other federal leaders for its report. The federal health department surveyed 13,000 doctors and nurses about whether they prescribed burprenorphine, a crucial medicine for treating opioid addiction. The emergency state let officials send out the survey without White House approval, speeding up the process. The department approved two Medicaid programs, in New Hampshire and Louisiana, aimed at treating opioid addiction. Again, the emergency declaration let officials move faster than usual, this time by skipping the two-and-a-half-month public comment and waiting period such projects normally require. Finally, officials expedited National Institutes of Health funding for research on opioid addiction.
Haffajee and Humphreys wanted to see the government use the emergency declaration to negotiate with pharmaceutical companies for a lower price on naloxone, the medicine that reverses opioid overdoses. Officials could then give naloxone out, for free, to clinics, schools, and families. Haffajee suggested the president ask Congress to give more money to the Public Health Emergency Fund—which has only $57,000 in it, according to the Government Accountability Office—and use that toward anti-addiction efforts. An emergency declaration lets officials access the fund, but the government hasn't touched that money since 1993, when it was used to respond to a Hantavirus outbreak.
At the same time, Haffajee worries about keeping the emergency state open for too long. Although she thinks the government has been judicious so far, technically, an emergency declaration allows officials to ignore certain privacy protections in the name of public health. Haffajee wants to see that situation returned to normal. "At some point, this power becomes inappropriate for this particular epidemic," she says. "These powers weren't conceived of for chronic, long-term, health harms." They were meant—and historically were used—for shorter, more acute health disasters, such as infectious-disease outbreaks, or severe storms.
The government does have other programs intended to help states deal with their drug-overdose problems. Congress just passed a large opioid bill, which Trump signed on Wednesday. Wandersleben pointed out various funding and expertise-sharing programs Ohio has taken advantage of. But the emergency declaration was one of the higher-profile actions Trump took early in his administration's efforts to address addiction nationwide. A year later, it seems almost forgotten, yet it remains open, with no clear hints as to when it might close. As Mary Denigan-Macauley, acting director for health care at the Government Accountability Office, says, "They did not give us any indication of when they would stop using it."