The Opioid Crisis

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Laura Caccioppoli
August 22, 2017

Opioids have been a topic of much discussion in the health policy world, amongst health care professionals, and sadly, at many dinner tables as communities cope with the impact of overdoses. According to the Centers for Disease Control (CDC), opioids killed more than 33,000 people in 2015. In fact, the CDC has stated the United States is “in the midst of an opioid overdose epidemic.” The numbers for 2016 are expected to be even higher, though due to a significant lag time in certifying drug deaths, the CDC does not yet have the numbers for 2016. And while it seems some areas are hit harder than others, the opioid crisis is very visible in Pennsylvania, including Philadelphia — where I live. In Philadelphia, the sixth largest city in the U.S., opioids were present in 80 percent of all drug overdoses. Moreover, the number of deaths attributed to opioids continues to rise dramatically — In Philadelphia, 2016, there were about 725 drug deaths were opioids were found. To put things in perspective, in 2015, deaths from overdoses were more than double the number of deaths from homicide. On the national level, opioids are responsible for killing more than 100 people daily. But what will be done?

Unfortunately, there are many challenges to addressing the opioid crisis. The first is that many Americans get hooked on opioids through prescriptions. The fact is, 2015 more than 15,000 people died from overdoses involving prescription opioids and between 1999-2015, nearly 185,000 people died from prescription opioids. While opioid prescriptions have dropped, they are still extremely high — four times higher than opioid prescription rates in Europe. An individual may switch to nonprescription opioids, such as heroin, as a cheaper alternative or misuse prescription medications in order to achieve the same high. While there have been great strides in making access to overdose-reversing medications more widely available—In fact, now 46 states have standing orders for naloxone—which means an individual can purchase naloxone without a prescription. Unfortunately, naloxone and other overdose-reversing medications do not cure the addiction; rather, they help reverse the effects of an overdose. While harm-reduction strategies are absolutely important, the fact remains these are temporary solutions which prolong life, but do not get at the heart of the addiction.

Another challenge is getting people the opioid addiction treatment they need. According to a Pew Charitable Trusts report, “less than half of the 2.2 million people who need treatment for opioid addiction are receiving it.” Shortages of trained workers, bias against addiction medications, affording effective medications and treatment programs, are all factors working to accelerate the opioid crisis.

The problem is widespread, impacting many counties and states across the country. Moreover, it crosses geo-political boundaries. A person may reside in one area, and travel to obtain opioids and overdose in a different county which impacts reporting, and perhaps leads to underestimating the needs for a community looking to address the crisis. Given the amorphous geopolitical boundaries, and that states budgets are already strained, it is clear efforts must be made on the federal level in order for there to be any real chance at stopping this crisis. So what is being done?

On Thursday, August 10, President Trump informally stated that he was declaring the opioid crisis a national emergency. A reversal from just two days earlier where he and Secretary of Health and Human Services, Tom Price, were not ready to declare an emergency. It remains to be seen if Donald Trump is aware that declaring a state of emergency takes more than a short speech or tweet. It is six days later (as of my writing) and there has been no substantial progress forward on truly declaring the opioid crisis a national emergency.

If Donald Trump were in fact to declare the opioid crisis a national emergency, there are two ways he could declare the national emergency: the Stafford Act or the Public Service Health Act. Depending on the law used, it would impact the types of resources that could be made available. The Stafford Act, usually reserved for natural disasters, could open up FEMA (Federal Emergency Management Agency) money to the states to the tune of about $1.5 billion.

Another possibility is to declare the national emergency through the Public Health Service Act. This would need to be declared by the Secretary of Health and Human Services (HHS), Tom Price. Declaring the emergency through these means would free up resources on the medical end of things – reallocating public health workers and resources in order to address the opioid crisis.

Either route would also allow the HHS to waive or modify Medicare and Medicaid requirements in order to better meet the needs of the individuals. Examples include waiving some licensing requirements so physicians (who are licensed in another state) can provide services in state where they do not have a license.

With the intense law enforcement rhetoric of the Administration, we should also be prepared for a declaration to result in increased funding for law enforcement or the war on drugs. However, hopefully appropriate action will be taken, and soon.

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Author: Laura Caccioppoli is a doctoral student in health policy at University of the Sciences. She has an MA in political science and a graduate certificate in nonprofit management from Villanova University. Laura serves on the board of The Consortium in Philadelphia and is Secretary of Americans for Democratic Action Southeastern Pennsylvania Chapter. Her research interests are in health and food policy, cultural competency and social justice. The views listed are her own, and do not represent the views of USciences, The Consortium, or Americans for Democratic Action.

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