York leaders welcome Trump opioid declaration, but would like more funding
WASHINGTON — In ringing and personal terms, President Donald Trump on Thursday pledged to "overcome addiction in America," declaring the opioid crisis a nationwide public health emergency and announcing new steps to combat what he described as the worst drug crisis in U.S. history.
While York County leaders in fighting the opioid crisis locally appreciated the declaration, they also expressed concern that, with funding merely redirected and not increased, the change will do little to help them combat the epidemic here.
Trump's declaration, which will be effective for 90 days and can be renewed, will allow the government to redirect resources, including toward expanded access to medical services in rural areas. But it won't bring new dollars to fight a scourge that kills more than 100 Americans a day.
"As Americans we cannot allow this to continue," Trump said in a speech at the White House, where he bemoaned an epidemic he said had spared no segment of American society, affecting rural areas and cities, the rich and the poor and both the elderly and newborns.
Local response: Though Dr. Matthew Howie, York City Bureau of Health medical director and executive director of the York Opioid Collaborative, said he was pleased that Trump identified the urgency of the situation with a public statement, he said he’s not sure the president has given the country the necessary tools to fight the opioid issue.
“Numbers locally have continued to go up for overdose deaths,” he said. “I am concerned that we’re not getting ahead of it, despite working very hard to do so.”
Howie said he is concerned that no new funding will mean taking money from one area to support another, as was the case when resources were shifted from the Ebola fund to temporarily fund fighting the Zika outbreak.
“We need additional resources, not just redirected resources,” he said.
York County, chief deputy prosecutor Dave Sunday said additional resources at the county level are "desperately needed."
"A lot of this does revolve around money, " he said, "and that’s a reality."
"We here in York County have treated this an an emergency crisis for the last three years, and our hope is this declaration will result in additional financial resources at the local level," Sunday said.
York County Coroner Pam Gay said she sees Trump's declaration as a positive step. She commended the commission led by New Jersey Gov. Chris Christie that Trump organized to study the opioid problem for having a “thorough knowledge and understanding of what many states are dealing with right now.”
But she believes those suffering from opioid addiction are not getting into treatment quickly enough and efforts need to be aggressive to avoid losing a generation.
Grants: States received $1 billion in grants in the 21st Century Cures Act, which requires 80 percent of those funds to be spent on opioid addiction treatment. The states received half of that grant money in April, with the remainder to be distributed next year. Howie said the money received statewide from 2016 Cure Act grants was in the millions, and the county is starting to see the benefits to treatment efforts.
At the local level, that money went to the York/Adams Drug & Alcohol Commission as well as other programs that were specified in a plan submitted to the federal government, Howie said.
A grant program, the Pennsylvania Coordinated Medication-Assisted Treatment (PacMAT) program, designed by Pennsylvania Physician General Dr. Rachel Levine to expand and better integrate medication-assisted treatment, is a statewide recipient of the grant money, Howie said. The plan was modeled after Vermont’s "hub and spoke" plan and modified to fit Pennsylvania’s specific needs.
Officials said they also would urge Congress, during end-of-the year budget negotiations, to add new cash to a public health emergency fund that Congress hasn't replenished for years. The Public Health Emergency Fund currently contains just $57,000, according to the Department of Health and Human Services, a negligible amount. Officials would not disclose how much they were seeking.
Critics: But critics said Thursday's words weren't enough.
"How can you say it's an emergency if we're not going to put a new nickel in it?" said Dr. Joseph Parks, medical director of the nonprofit National Council for Behavioral Health, which advocates for addiction treatment providers. "As far as moving the money around," he added, "that's like robbing Peter to pay Paul."
Democratic House leader Nancy Pelosi called the new declaration "words without the money."
Sen. Bob Casey, D=Pa., said a declaration is not enough to address the opioid problem.
"I introduced legislation (Wednesday), the Combating the Opioid Epidemic Act, that would invest $45 billion over 10 years to fund opioid treatment and prevention, as well as research on pain and addiction, " he said in a released statement. "In order to help families suffering from the opioid crisis, there must be substantial investments in treatment and increased access to care."
He continued by saying the administration and congressional Republicans should stop pursuing changes to health care that will "decimate Medicaid", ultimately denying Americans’ coverage for substance use disorders.
Resources: Sunday said he has seen impact from resources, energy and expertise coming from the federal Department of Justice to fight drug traffickers.
York City gang leader Marc Hernandez recently received a life sentence for drug trafficking, among other charges. Assistance from the U.S. Attorney’s office in the Middle District of Pennsylvania, which covers York County, has been instrumental in catching these criminals, and federally, the government has ramped up work on a local level, Sunday said.
The county coroner also has seen positive effects of increased funding.
In the last three years, more methodone slots have opened in a Springettsbury Township clinic, allowing for more capacity and more patients. A methodone clinic opened in Hanover as well, and detox and rehab beds in York County have increased, Gay said.
“If we continue to increase, we would see far fewer deaths and the longer term treatment that is required for opioid addiction, " she said. Additional funding could also support other avenues of treatment such as outpatient efforts and job training so addicts don’t fall back into using, she said.
Funding can also help rural communities that might not fall under the initial reach.
Gay said people in more outlying areas in Pennsylvania had to go out of state for treatment facilities until recently, but there is more work to do. She said some coroner colleagues don’t even have a rehab facility nearby, and the closest is a county or two away.
Pennsylvania Attorney General Josh Shapiro said the declaration was a step in the right direction.
"As this epidemic claimed the lives of over 64,000 Americans and more than 4,600 Pennsylvanians last year, we need the federal government’s help and support on multiple fronts," he said in a news release.
Though the announcement by the president is "overdue, " he said it is welcome news. He said additional funding, however, is essential in fighting this crisis in Pennsylvania.
Speech: Trump's audience Thursday included parents who have lost children to drug overdoses, people who have struggled with addiction and first responders who have used overdose reversal drugs to save lives.
Trump also spoke personally about his own family's experience with addiction: His older brother, Fred Trump Jr., died after struggling with alcoholism. It's the reason the president does not drink.
Trump described his brother as a "great guy, best looking guy," with a personality "much better than mine."
"But he had a problem, he had a problem with alcohol," the president said. "I learned because of Fred."
Trump said he hoped a massive advertising campaign, which sounded reminiscent of the 1980s "Just Say No" campaign, might have a similar impact.
"If we can teach young people, and people generally, not to start, it's really, really easy not to take 'em," he said.
As a presidential candidate, Trump pledged to make fighting addiction a priority.
"When I won the New Hampshire primary, I promised the people of New Hampshire that I would stop drugs from pouring into your communities. I am now doubling down on that promise and can guarantee you we will not only stop the drugs from pouring in, but we will help all of those people so seriously addicted get the assistance they need to unchain themselves," Trump told a crowd in Maine weeks before last November's election.
Once in office, Trump assembled the Christie commission to study the opioid problem. The commission's interim report argued an emergency declaration would free additional money and resources, but some in Trump's administration disagreed.
Christie, in a statement, said Trump was taking "bold action" that shows "an unprecedented commitment to fighting this epidemic and placing the weight of the presidency behind saving lives across the country."
What's next: Officials said the administration had considered a bolder emergency declaration, under the Stafford Act, which is typically used for natural disasters such as hurricanes. But they decided that measure was better suited to more short-term, location-specific crises than the opioid problem. Drug overdoses of all kinds kill an estimated 142 Americans every day.
As a result of Trump's declaration, officials will be able to expand access to telemedicine services, include substance abuse treatment for people living in rural and remote areas. Officials will also be able to more easily deploy state and federal workers, secure Department of Labor grants for the unemployed and shift funding for HIV and AIDS programs to provide more substance abuse treatment for people already eligible for those programs.
In hearing that Trump planned to shift federal funds from HIV/AIDS programs to opioid treatment, Howie urged officials to think about how closely the two issues are related. One of the means for transmission of HIV is IV drug use, he said. Howie said management of HIV/AIDS at the local level has limited resources as it is, so there is a need to address both, not one or the other.
Trump said his administration would also be working to reduce regulatory barriers, such as one that bars Medicaid from paying for addiction treatment in residential rehab facilities larger than 16 beds. Shapiro said he's led an effort of 39 attorneys general and the National Association of Attorneys General urging Congress to change this law. Trump also spoke of efforts to require federally employed opioid prescribers to undergo special training, talked about the Postal Service and Homeland Security Department's ramped-up inspection of packages, the Justice Department's targeting of opioid dealers and efforts to develop a non-addictive painkiller.
But Sen. Richard Blumenthal, D-Conn., said the effort falls far short of what is needed and will divert staff and resources from other vital public health initiatives.
"Families in Connecticut suffering from the opioid epidemic deserve better than half measures and empty rhetoric offered seemingly as an afterthought," he said in a statement. He argued, "An emergency of this magnitude must be met with sustained, robust funding and comprehensive treatment programs."
Democrats also criticize Trump's efforts to repeal and replace the "Obamacare" health law. Its Medicaid expansion has been crucial in confronting the opioid epidemic.
Adopted by 31 states, the Medicaid expansion provides coverage to low-income adults previously not eligible. Many are in their 20s and 30s, a demographic hit hard by the epidemic. Medicaid pays for detox and long-term treatment.
Rep. Seth Moulton, D-Mass., said in a statement that many people addicted to opioids don't have insurance and more must be done to expand coverage.
"We cannot keep having conversations about gutting the ACA while simultaneously talking about the opioid epidemic. And we cannot declare a public health emergency without actually allocating resources to help combat it," he said.
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