THE PROGNOSIS

President Trump declined yesterday to declare the opioid epidemic sweeping the United States a national emergency, despite a recommendation last week by his own commission. Trump's top health administrator, Health and Human Services Secretary Tom Price, argued that extra step wouldn't have helped much anyway -- and experts tend to agree.

Presidents have declared national emergencies dozens of times, but mostly for threats contained within a specific time and place. The Obama administration declared an emergency last August in Puerto Rico over the Zika virus, for example. In October 2012, Obama signed federal emergency disaster declarations from more than half a dozen states affected by Hurricane Sandy. And in 2009, he declared the H1N1 swine-flu virus a national emergency.

The opioid abuse crisis, on the other hand, has slowly emerged over decades and affects regions around virtually the entire country. It's become a huge, sweeping problem; the government released new estimates yesterday that deaths from drug overdoses rose sharply in the first nine months of 2016, reaching a record 19.9 deaths per 100,000 people. In 2015, the most recent year for which statistics are available, more than 52,000 people fatally overdosed on drugs.

Here's a video from The Post laying out the staggering opioid abuse statistics:

Trump briefly addressed the problem yesterday, meeting with health officials and members of his administration to receive an update on the crisis and speaking to reporters. He said the “best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place.”

“If they don’t start, they won’t have a problem. If they do start, it’s awfully tough to get off,” Trump told reporters at the clubhouse at his private golf club in New Jersey. “So if we can keep them from going on — and maybe by talking to youth and telling them: ‘No good, really bad for you in every way.’ But if they don’t start, it will never be a problem.”

He said a lot less about the problem -- and offered fewer specifics -- than many had anticipated.

Toronto Star's Daniel Dale: 

There's widespread consensus that opioid abuse, which most often begins with addiction to prescription painkillers and can lead to heroin use, is a deep-rooted problem, likely requiring many years and many layers of response to stem the tide. In an address shortly after Trump's speech, Price said that HHS and other government agencies already have the tools to begin that response, without the declaration of a national emergency.

"We believe at this point the resources that we need or the focus we need to bring to bear to the opioid crisis at this point can be addressed without the declaration of an emergency," Price said, although he added that "all things are on the table for this president."

Price has a point. Declaring a problem a "national emergency" frees up some additional federal funding and provides a few more routes to address the issue via programs like Medicaid. But not by much, experts say.

"It's symbolic mostly and it actually involves a lot of reporting and paperwork," Richard Frank, a professor of health economics at Harvard Medical School, told me.

Consider this: The Public Health Emergency Fund, created by Congress in 1983, can get an infusion of only $45 million every year, leaving it only a meager resource when it comes to dealing with big public health problems. To put the fund's size in perspective, Congress provided a total of $1 billion over two years in its 2016 21st Century Cure Act to fight opioid abuse. Lawmakers have called for beefing up the fund, including 20 bipartisan House members who want to supply it with $300 million that could be available for swift responses to disease outbreaks like Zika.

There would be one other policy result should Trump declare opioid abuse a national emergency: The label could provide a little more flexibility for how Medicaid recipients are treated through temporary waivers. For example, Medicaid can't currently reimburse drug treatment in large residential facilities (16 or more beds) but that could be waived in an emergency. Yet experts say the shift would be only around the edges; Medicaid already has broad waiver authority, which it often exercises specific to state requests.

Still, state officials dealing with the opioid abuse crisis on the ground were eagerly watching Trump's address yesterday to see whether he'd take the extra step of an emergency declaration. The governors of four states -- Arizona, Florida, Maryland and Virginia have already declared their own states of emergency -- while in Alaska, Gov. Bill Walker (I) has issued a disaster declaration.

Alaska Chief Medical Officer Jay Butler told me it's hard to say exactly how such a declaration could help his state without specifics from Trump, but predicted it would "open the possibly for a faster stream of resources" from the federal government to the state. Alaska's disaster declaration prompted a more coordinated response among policymakers, Butler said. He feels the opioid crisis is serious enough to justify an emergency declaration from the Trump administration.

"I think when we have a single cause of death that has increased as dramatically as the rate of opioid overdose and particularly to the magnitude we’ve reached now, it is an unusual situation that requires unusual measures," Butler said.

Others argue that if the Trump administration is serious about tackling abuse, it wouldn't have backed extensive Medicaid cuts in the GOP effort to overturn big parts of the Affordable Care Act -- and would have proposed a funding increase for drug treatment in the president's 2018 budget. Even after Trump's address yesterday, it remains unclear exactly how he plans to approach the problem. Nor did Price give many specifics, either, saying only that "the president and First Lady are absolutely and fully engaged."

Some criticisms from around Twitter:

The Atlantic senior editor Ronald Brownstein: 

The Post's Christopher Ingraham: 

Trump had touted the briefing earlier in the day:

And First Lady Melania Trump:

From Price, earlier in the day:

The Washington Examiner's Kelly Cohen had a funny observation:

AHH, OOF and OUCH

AHH: The cost of health plans offered to employees of large companies will grow an average of 5 percent next year -- a rate that certainly exceeds inflation but better than the double-digit increases seen in the marketplaces where people without employer-based coverage generally shop. Nearly 150 large employers responding to a new survey said plans will cost an average of more than $14,000 per employee, largely because of expensive specialty drugs and individuals with high medical costs, The Post's Carolyn Y. Johnson reports.

"According to the survey, employers will shoulder approximately 70 percent of those health costs, leaving employees on the hook for an average of $4,400, through premiums, out-of-pocket costs and contributions to health savings accounts," Carolyn writes.

"The survey found that an ongoing shift toward high-deductible plans will continue, with 40 percent of employers offering one as the only plan option next year -- an increase from last year. Nearly all employers -- 90 percent -- will offer at least one high-deductible plan in 2018....The average deductible in such a plan was $1,500 for an individual and $3,250 for a family, although the employer often makes a contribution to a health savings account that significantly reduces the cost to individuals."

OOF: New Hampshire sued Purdue Pharma yesterday, joining several state and local governments in accusing the OxyContin maker of engaging in deceptive marketing practices that have helped fuel the opioid addiction epidemic. According to Reuters, the lawsuit filed in Merrimack County Superior Court claimed that Purdue Pharma significantly downplayed the risk of addiction posed by OxyContin and engaged in marketing practices that "opened the floodgates" to opioid use and abuse.

"New Hampshire continues to experience a severe opioid epidemic," New Hampshire Deputy Attorney General Ann Rice said in a statement. "Last year alone nearly 500 overdose deaths occurred - almost ten times more than in 2000." Purdue denied the allegations but said "we share New Hampshire officials' concerns about the opioid crisis and we are committed to working collaboratively to find solutions."

OUCH: Somewhere in a U.S. city, a small nonprofit organization has been hosting a secret, illegal site where users can inject drugs under the supervision of trained staff who provide clean needles and guard against overdoses. The site has been operating for three years, according to a paper published in the American Journal of Preventive Medicine. It's copying a “harm reduction” strategy adopted by 98 facilities in 10 other countries where supervised injection sites operate legally.

The program is open by invitation only to drug users who are known to the staff members of the nonprofit organization, according to the paper's authors, who surveyed more than 100 users who gave themselves 2,574 injections there. Eighty percent are homeless, 91 percent are men and 80 percent are white. The vast majority injected heroin, but some used methamphetamine, cocaine or prescription opioids. On average, they injected drugs about 114 times per month.

The clandestine program operates four to six hours a day, five days a week and is staffed by people trained to respond to overdoses and to provide advice on safe and hygienic injection. It has five small spaces where users can inject drugs and a second room with couches where they can remain afterward, The Post's Lenny Bernstein reports.

Such a facility isn't allowed under federal law, but some states and cities are considering the approach. "The controversial approach has been debated in the United States for many years, but it is gaining popularity in some places as the number of overdose deaths from illegal drugs continues to skyrocket," Lenny writes. "California, New York City, Boston and Ithaca, N.Y., are exploring the idea. The county that includes Seattle has approved opening two locations.

HEALTH ON THE HILL

--Senate GOP leader Mitch McConnell levied some of his harshest criticisms yet at President Trump in a speech at home in Kentucky on Monday. Trump. The president, who often expressed his opinions about the Senate's messy health-care endeavor via Twitter, should keep his private opinions, well, private, McConnell said.

"I've been and I will be again today, not a fan of tweeting and I've said that to him privately," McConnell told attendees, according to CNN. "I think it would be helpful if the president would be a little more on message."

McConnell allowed that "our new president, of course, has not been in this line of work before, "I think he had excessive expectations about how quickly things happen in the democratic process," he said.

McConnell also argued that Congress is working as it should despite the reality that it has not yet passed major legislation this year. "Part of the reason I think people think we're underperforming is because of too many artificial deadlines unrelated to the reality of the legislature which may have not been understood," he said.

Fox News host Sean Hannity, a prominent defender of Trump, apparently responding to McConnell's critique:

--Like other Republican lawmakers before him, Rep. Doug LaMalfa of California faced boos, catcalls and verbal barbs for voting for the House health-care bill overturning parts of the ACA, at his town hall meeting Monday.

At one point, a constituent even told LaMalfa he should "die in pain."

“I think that your vote to throw 22 million people off of health is reprehensible and in the service of the rich,” the man said. “I hope you suffer the same painful fate as those millions that you have voted to remove health care from. May you die in pain."

"It was the most recent of a declining number of health-care-focused town hall meetings charged by emotional pleas and debates between constituents and their representatives, meetings that have sparked anxiety among GOP lawmakers heading home to face tough questions," The Post's Alex Horton reports. "The audience was armed with blunt questions, harsh comments and red placards they used to signal their disapproval of audience queries or LaMalfa’s responses. Green cards were used to show approval."

A video from the raucous meeting:

--Save My Care, a group that backs the ACA, didn't waste time in targeting vulnerable Republicans for supporting unpopular Obamacare repeal-replace bills. The advocacy group has launched a five-figure digital ad campaign targeting Arizona GOP Sen. Jeff Flake, Nevada Sen. Dean Heller and West Virginia Sen. Shelley Moore Capito for voting for the Senate's "skinny repeal" bill. It also went after seven House members for voting for that chamber's health-care bill, the American Health Care Act, in May.

The ads cite Congressional Budget Office estimates that the measure would have left millions more Americans uninsured and opposition from medical societies. "Sen. Flake broke his promise to Arizona and voted for the health-care bill that would have taken coverage from 16 million people," the ad targeting Flake says.

Targeted House Republicans include Reps. Dave Brat of Virginia, John Faso of New York, Darrell Issa of California, Tom MacArthur of New Jersey, Peter J. Roskam of Illinois, Pete Sessions of Texas and David Valadao of California.

A few more reads from The Post and beyond: 

MEDICAL MISSIVES
Rebecca Siegel of the American Cancer Society says there appears to be a “a true and perplexing escalation in disease occurrence” of colorectal cancer among white men and women.
Ariana Eunjung Cha
From birth, she coped with oddly floppy limbs.
Sandra G. Boodman
"We were all a bit dumbfounded. It wasn't what I was expecting to find at all,” one of the woman's doctors said.
Kristine Phillips
INDUSTRY RX
Outcry has been building over the rising cost of brand-name medications, but the price of generic drugs has been moving in the opposite direction.
New York Times
STATE SCAN
As mayor of Nashville, Megan Barry has dealt with an increase in the number of overdose deaths, a problem that touches all corners of the country. Now it's a tragedy that touches her own family; her son Max died after an apparent overdose late last month.
PBS Newshour
DAYBOOK

Coming Up

  • The House Committee on Veterans Affairs will hold a hearing on veteran care in rural areas on Thursday.
  • The Center for Global Development holds an event on implementing clinical trials during epidemics on Thursday
  • Ravina Daphtary, director of state strategies at All* Above All moderates a panel on abortion rights at the Netroots Nation conference in Atlanta, which starts on Thursday

  • Congress is on recess until September 5. 
SUGAR RUSH

HHS Secretary Tom Price says fighting the opioid crisis is the Trump administration’s ‘absolute priority’:

 

Price: ‘Nobody is interested in cutting Medicaid:’

 

Nashville mayor says she's thankful for support after son's death:

A quadriplegic drummer turns to technology to regain his ability to play: