“…the president.. reversed course to instead declare opioids a public health emergency, a move that releases no new funding to contend with a drug crisis….”

“The current opioid epidemic is the deadliest drug crisis in American history. Overdoses, fueled by opioids, are the leading cause of death for Americans under 50 years old — killing roughly 64,000 people last year, more than guns or car accidents, and doing so at a pace faster than the H.I.V. epidemic did at its peak.
President Trump declared the opioid crisis a “public health emergency” on Thursday, though he did not release additional funding to address it. Had he declared it a “national emergency,” as he promised to do in August, it would have led to the quick allocation of federal funds.” (A)

“Trump pledged throughout his 2016 campaign to make the opioid crisis a priority as president, and established a commission in June to address the problem, which Trump said killed 64,000 Americans last year alone. Just since he first suggested that he would declare a national emergency to attack the crisis on Aug. 10, some 10,700 Americans have died from overdoses, according to the commission’s estimates.
Instead, Trump’s presidency has brought an aggressive push for new healthcare legislation that guts funding to Medicaid, the primary source of coverage for mental health and substance use disorders. That prompted Republican senators from hard-hit states to propose separate funding of $45 billion to absorb the blow, a figure receiving pushback from some within the administration.
The declaration alone provides no additional money to combat the problem but allows existing grants to be redirected to better deal with the crisis. (B)

“In July, the White House opioid commission recommended that the president “make an emergency declaration” in order to “force Congress to focus on funding,” as the commission put it in their report. Trump announced shortly after that he would be making the move. But while Congressional Republicans, along with some law enforcement and physicians’ groups, have praised Trump’s directive on Thursday, others have said it falls short of the drastic effort required to combat the opioid crisis.
Trump did not, for instance, designate the epidemic as a national emergency, which is different than a public health emergency and would have released funds from the Federal Emergency Management Agency. Instead, the declaration frees up money from a public health emergency fund—which is currently worth only $57,000, according to Lev Facher of STAT. Experts have estimated that it will take billions of dollars to effectively address the opioid epidemic.” (C)

“Three months after calling for a national emergency declaration from President Donald Trump to deal with a surge in opioid overdoses, Gov. Chris Christie told Fox News on Friday that such a move was never his preference.
“That wasn’t the one I would have embraced the most,” said Christie, appearing on “Fox and Friends.”
In July, Christie’s opioid commission issued its interim report, informing the president that “the first and most urgent recommendation of this Commission is direct and completely within your control: Declare a national emergency under either the Public Health Service Act or the Stafford Act.”
Such a national emergency declaration under the Stafford Act would have given the federal government immediate access to billions of dollars in emergency relief funds to expand opioid treatment….
The president isn’t devoting any new funding to the fight against an opioid crisis. So what does his declaration do?
On Friday, Christie insisted the president had acted in accordance with his wishes.
“I would have gone for either one, either what he did yesterday, or the Stafford Act,” the governor told Fox News….
“Congress appropriates the money,” said the governor. “The president’s now said, he wants the money, and he wants it to be aggressive.”
The president has not made a specific request for funding from Congress.” (D)

“Here 7 takeaways that show what the declaration really means:
1. Trump didn’t declare a ‘national emergency,’ and that’s significant
2. So what does declaring a ‘public health emergency’ do?
3. Some drug treatment providers are ‘bitterly disappointed,’ others ‘hopeful.’
4. The feds are going to sue some drug companies
5. He’s cutting some red-tape to increase treatment availability
6. He wants to educate doctors and young people to ‘just say no’
7. He’s waiting on Christie’s final report to do more (E)

“The trips to resorts in the sun traps of Florida, Arizona and California were a great chance for medics to network, take a break from patients and learn about new treatments. There were even freebies – fishing hats, cuddly toys to take back for the kids, music CDs. And the visits were all expenses paid.
But such events laid the groundwork for a national crisis.
From 1996 to 2001, American drug giant Purdue Pharma held more than 40 national “pain management symposia” at picturesque locations, hosting thousands of American doctors, nurses and pharmacists.
The healthcare professionals had been specially invited, whisked to the conferences to be drilled on promotional material about the firm’s new star drug, OxyContin, and recruited as advocates, the US government later documented.
The pill comprises oxycodone, a semi-synthetic opioid loosely related to morphine and originally based on elements of the opium poppy. Such strong painkillers were traditionally used to ease cancer pain, but beginning in the mid-1990s, pills based on oxycodone and the similar compound hydrocodone began being branded and aggressively marketed for chronic pain instead – a nagging back injury from manual labor or a car accident, for example.” “(F)

“But while outrage ferments across the country, there’s one arena where a deafening silence remains: the nation’s largest wholesale drug distributors.
McKesson (MCK, -5.25%) , Cardinal Health (CAH, -3.43%) , and Amerisource Bergen (ABC, -4.17%) —collectively known as the “Big Three”—distribute a vast majority of the country’s prescription opioids. And the investigation found that they’ve spent millions of dollars on well-connected lobbyists and campaign contributions to get Congress to look the other way while they poured hundreds of millions of opioids into our communities, fueling the rampant epidemic of opioid addiction. They successfully stymied the Drug Enforcement Administration’s anti-diversion enforcement efforts and saddled the government’s ability to combat suspicious opioid orders.
Not only was this a deadly abuse of corporate power, it was duplicitous. After a decade of repeated enforcement actions by the DEA resulting in hundreds of millions of dollars in fines for failures to report suspicious orders of prescription opioids, the Big Three knew they needed to shift public perception. So the companies made public promises to strengthen their anti-diversion programs and compliance practices to avoid further scrutiny. However, behind the scenes, they continued to divert critical resources to circumvent the existing regulatory system.
Viewed in this light, the industry’s much-touted recruitment of former DEA employees appears more an exercise in gaming the system than developing best-in-class compliance practices.” (G)

“Democratic Sen. Joe Manchin of West Virginia slammed pharmaceutical companies on Thursday, arguing they should be held legally liable for their role in the ongoing opioid crisis.
“This is a business plan. They are liable,” Manchin told CNN’s Jake Tapper on “The Lead” when asked if he believes the pharmaceutical industry needs to be found legally liable in some cases for the prevalence of opioids in the United States.” (H)

“Here are five things the Trump administration could do today to ease America’s opioid crisis:
Equip all police officers in the US with naloxone
Expand medication-assisted treatment (MAT)
Mandate fresh training on opioids for doctors and dentists
Allow Medicaid to be used for in-patient addiction treatment facilities
Stop health insurers discriminating against addicts (I)

“Food and Drug Administration Commissioner Dr. Scott Gottlieb says the practice of over-prescribing opioids has helped drive opioid abuse. The Centers for Disease Control and Prevention reports that 33,000 people died from opioid overdoses in 2015 and more than 2 million people are addicted to the drugs.
The CDC found that most people who abuse narcotics got their first pills as legitimate prescriptions. Studies have shown the use of opioids during and after surgery as well as to treat injuries and chronic pain have skyrocketed in recent years, and addiction, overdoses and other abuse have tracked right along.
“It’s like cooking. You give a little of this, a little of that, and it’s better.”
“We need to take a little bit of ownership with this whole opioid epidemic and say, ‘what can we do?’” said Dr. Charles Hannon of the orthopedic surgery department at Rush who helped design a new approach to using fewer opioids among knee and hip replacement patients.
“Maybe it is something we can take on to play our own role in curbing this epidemic.”
Starting this past spring, the team tried a controversial approach, dialing back the amount of opioids used during surgery, and limiting what patients were given afterwards. Instead, they are sent home with Tylenol, the anti-inflammatory arthritis drug celecoxib, and an epilepsy drug called gabapentin that can also help manage pain….
Non-steroidal anti-inflammatory drugs (NSAIDs) such as celecoxib or ibuprofen not only help pain, but reduce inflammation.
“You take the Tylenol round the clock. You take the NSAID round the clock. You take gabapentin round the clock. Then if you have pain, then you take the opioid.” (J)

“There’s a quick and simple way President Trump could immediately help Americans addicted to opioids.
Here it is: allow Medicaid to start paying for treatment at large institutions for mental disease (known as IMDs). Under a current policy known as the “IMD exclusion,” people on Medicaid can’t get substance abuse treatment at facilities with more than 16 beds.
This policy shift isn’t explicitly part of the emergency declaration Trump issued yesterday at the White House, but the president did make a brief mention of it in his address.
“As part of this emergency response, we will announce a new policy to overcome a restrictive 1970s-era rule that prevents states from providing care at certain treatment facilities with more than 16 beds for those suffering from drug addiction,” Trump said…
Trump’s opioid commission, led by New Jersey Gov. Chris Christie (R), identified removing the IMD exclusion as the top way to make treatment available to patients immediately. “This is the single fastest way to increase treatment availability across the nation,” the report said.” (K)

“Yes, this is the most widespread and deadly drug crisis in the nation’s history. But there has been a long string of other such epidemics, each sharing chilling similarities with today’s unfolding tragedy.
There was an outbreak after the Civil War when soldiers and others became addicted to a new pharmaceutical called morphine, one of the first of many man-made opioids. There was another in the early 1900s after a different drug was developed to help “cure” morphine addiction. It was called heroin.
Cocaine was also developed by drugmakers and sold to help morphine addiction. It cleared nasal passages, too, and became the official remedy of the Hay Fever Association. In 1910, President William H. Taft told Congress that cocaine was the most serious drug problem the nation had ever faced.
Over the next century, abuse outbreaks of cocaine, heroin, and other drugs like methamphetamine, marketed as a diet drug, would emerge and then fall back….
Health officials are fighting the current epidemic on three fronts: Preventing overdose deaths, helping people recover from addiction, and preventing new addictions.
There appears to be some success on the first front. The number of new addictions may be receding…
The other two fronts — preventing deaths and treating addiction — are not so promising, despite more attention and money flowing to programs. Deaths are still rising, and University of Pittsburgh researchers estimate as many as 300,000 will die from overdoses over the next five years.” (L)

“Hear the rattle in the holler — that ain’t no snake,” crooned Marcus Oglesby, making a sound with his mouth like a shaken bottle of pills.
The song, performed by Oglesby’s Appalachian blues band Creek Don’t Rise, silenced the bar. It told the Barboursville, West Virginia patrons a story they already knew, about how opioids had unraveled families and leveled communities in West Virginia and across the nation.
The title of the song “White Coat Man” is a reference to the doctors who prescribed and the pharmacists who sold opioid pills in the state. The Charleston Gazette reported that during a six-year-period, pharmaceutical companies flooded 780 million opioid pills into West Virginia, where some 2 million people live.
“Things in the holler, they ain’t the same,
People in the holler can’t stand the pain.
Used to owe it to the company store,
Now the white coat man’s gonna own your soul.”
The song is infused with blues and country and paints a bleak picture. A hungry baby cries after a mother spends grocery money on pills. A miner is injured on the job, and “there came the pills.” A woman blames the doctor for her struggle with addiction after she was prescribed painkillers.” (M)

(A) The Opioid Epidemic: A Crisis Years in the Making, by Maya Salam, https://www.nytimes.com/2017/10/26/us/opioid-crisis-public-health-emergency.html
(B) Trump’s Emergency Declaration on Opioid Crisis Will Require Further Funding, by VIVIAN SALAMA, https://www.nbcnews.com/storyline/americas-heroin-epidemic/trump-s-emergency-declaration-opioid-crisis-will-require-further-funding-n814416
(C) Trump Declares the Opioid Crisis a Public Health Emergency. What Does That Mean?, by Brigit Katz, https://www.smithsonianmag.com/smart-news/trump-declares-opioid-crisis-public-health-emergency-180966998/
(D) Trump Declares Opioid Crisis a ‘Health Emergency’ but Requests No Funds, by JULIE HIRSCHFELD DAVIS, https://www.nytimes.com/2017/10/26/us/politics/trump-opioid-crisis.html
(E) 7 takeways from Trump’s opioids public health emergency: What it really means, by Claude Brodesser-Akner, http://www.nj.com/politics/index.ssf/2017/10/5_takeaways_from_trumps_public_health_emergency_de.html#incart_river_index
(F) America’s opioid crisis: how prescription drugs sparked a national trauma, by Joanna Walters, https://www.theguardian.com/us-news/2017/oct/25/americas-opioid-crisis-how-prescription-drugs-sparked-a-national-trauma
(G) The Big 3 Are Fueling the Opioid Epidemic. Now They Need a Watchdog, by Ken Hall, http://fortune.com/2017/10/20/60-minutes-opioid-crisis-big-three/
(H) Manchin: Pharmaceutical companies are liable for opioid crisis, by Amanda Golden, http://www.cnn.com/2017/10/26/politics/opioid-crisis-companies-liable-joe-manchin-the-lead/index.html
(I) Five things Trump could do right now to ease the opioid crisis, by Joanna Walters, https://www.theguardian.com/us-news/2017/oct/23/five-things-trump-help-ease-opioid-crisis
(J) To Fight the Opioid Crisis, These Doctors Cut Back on Opioids, by MAGGIE FOX, https://www.nbcnews.com/storyline/americas-heroin-epidemic/fight-opioid-crisis-these-doctors-cut-back-opioids-n814636
(K) The Health 202: There’s a no-brainer way to solve the opioid crisis, by Paige Winfield Cunningham, October 27 https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/10/27/the-health-202-there-s-a-no-brainer-way-to-solve-the-opioid-crisis/59f2058830fb0468e7653dc0/?utm_term=.b46a49804013
(L) Today’s opioid crisis shares chilling similarities with past drug epidemics, by Mike Stobbe, http://www.chicagotribune.com/news/nationworld/ct-drug-epidemics-history-20171028-story.html
(M) LISTEN: This blues song tells the story of the opioid crisis — and the ‘white coat men’ who started it, https://www.pbs.org/newshour/arts/listen-this-blues-song-tells-the-story-of-the-opioid-crisis-and-the-white-coat-men-who-started-it

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