shows six men and women sitting at a long table
Members of the President’s Commission on Combating Drug Addiction and the Opioid Crisis listen to presentations at their most recent meeting on Friday, Oct. 20. Gov Roy Cooper is seated second to right, between Gov.Chris Christie (NJ) and former Rep. Patrick Kennedy. Photo credit: Screenshot of Commission webcast.

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By Taylor Knopf

It’s been more than a week since President Donald Trump said he would officially declare the opioid epidemic a national emergency.

“It’s a very important step,” Trump told reporters on Oct. 16 in Washington, D.C. “We’re going to be doing it in the next week.”

However, Trump also said he would make this emergency declaration back in August.

The President’s Commission on Combating Drug Addiction and the Opioid Crisis urged Trump to make the official emergency declaration in its interim report. North Carolina Gov. Roy Cooper is on the six-member commission chaired by New Jersey Gov. Chris Christie.

“The first and most urgent recommendation of this Commission is direct and completely within your control,” the commissioners wrote to the president. “Declare a national emergency under either the Public Health Service Act or the Stafford Act. With approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks.”

However, Politico reported that Health and Human Service staff are not ready for such a declaration.

Trump has been silent on the issue since last week, but Christie tweeted Monday the action was coming soon.

“I know that POTUS supports fighting this epidemic aggressively. In the days ahead, his actions will speak louder than anything else,” Christie said.

What a declaration does

Legally, if Trump puts the declaration in motion, a number of federal resources would be freed up to help states and local agencies. For example, when a state of emergency is declared during a hurricane, the Federal Emergency Management Agency (FEMA) is able to provide relief to affected states.

“Federal assistance is provided under the Stafford Act if an event is beyond the combined response capabilities of state and local governments,” according to the website of the Association of State and Territorial Health Officials.

One expert said a national emergency declaration allows the federal government to act immediately. Usually, the wheels of government turn slowly.

“Trump’s declaration would allow his administration to remove several barriers to treatment,” said Rita Anita Linger, executive director of Recovery Communities of North Carolina (RCNC).

“Some of what may happen for North Carolina is that once that declaration is made we can take advantage of the President’s Commission recommendation to waive a federal rule that limits the number of Medicaid recipients who can receive residential addiction treatment,” Linger said.

She also said the state might be able to work around current federal laws restricting Medicaid from paying inpatient facilities that treat addiction or mental illness if they have more than 16 beds.

“A national emergency would also work toward improving access to treatment with help of bridge medications to recovery like suboxone, methadone and others,” she added.

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Meanwhile, Alaska, Arizona, Florida, Maryland, Massachusetts and Virginia have all declared a state of emergency over the opioid problem. Of the three governors on the president’s opioid commission urging a national emergency declaration, only Massachusetts Gov. Charlie Baker has initiated a statewide opioid emergency. Neither Christie nor Cooper have officially declared one in their respective states.

“While North Carolina generally already has in place the tools that an emergency declaration has provided in other states (e.g. a standing order on naloxone and mandatory reporting to prescription drug databases), we will keep every option on the table as we continue to take all possible steps to save lives and support our communities,” Cooper’s spokesman, Ford Porter, said in an email Tuesday.

Porter referred to the state’s Opioid Action Plan that Cooper and Mandy Cohen, the secretary of Health and Human Services, released this summer. He said it outlines “the steps we and our partners can take together to prevent and treat opioid use disorder and mitigate the harm in our communities.”

President’s Opioid Commission asks

Last Friday, the presidential commission held its fourth of five scheduled meeting. This time, they met with insurance executives from across the country to hear what those insurers have been doing to combat opioid addiction and to hear their recommendations.

Generally, there was wide support for limiting initial opioid prescriptions, expanding access to Medication Assisted Treatment for addiction, and the dissemination of the CDC Guidelines for Prescribing Opioids for Chronic Pain to medical providers.

Anuradha Rao-Patel, medical director with Blue Cross Blue Shield of North Carolina, explained what her company has been doing across the state, which serves about 4 million North Carolinians.

She said BCBSNC supported the STOP Act which Cooper signed into law earlier this year.

The new law sets a five-day limit on initial prescriptions for acute pain. Providers are also required to consult the North Carolina Controlled Substance Reporting System — a database of all prescriptions for opioids and other drugs that can be abused — before writing an opioid prescription in an effort to cut down on patients who “doctor shop” and ensure they aren’t receiving opioids from multiple providers.

Rao-Patel and others talked about analyzing claims data for opioid prescribing patterns and the need to expand telemedicine to include mental health and addiction treatment.

BCBSNC has partnered with Walgreens to install drug take-back kiosks. Rao-Patel said there are currently 20 across the state and Blue Cross will soon fund an additional 22.

“Our goal is to get these medications off the streets,” she said.

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The commission has met with experts from different fields such as law enforcement, nonprofits,  medical professionals and those in the addiction recovery community to inform its recommendations for the final report to the President. The plan is to submit the report by the commission’s fifth and final scheduled meeting on Nov. 1.

Notes and videos of the meetings, as well as written statements from presenters are available on The White House’s website.
As health insurance heads met with the commission on Friday, Cooper spoke only once and pointed out that 49 percent of the folks showing up in North Carolina emergency departments for drug overdoses are uninsured.

“I know I sound like a broken record,” Cooper said, reiterating the need for increased access to insurance coverage. North Carolina is one of 19 states that chose not to expand Medicaid. HHS Sec. Cohen has also emphasized the need for insurance in order to keep people in long-term addiction in recovery.

“It’s important to understand with any sort of addiction that it’s a chronic lifelong disease,” Cohen said during a press conference at the North Carolina Opioid Summit this summer.

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...