A jug of used needles at a needle exchange in Camden, N.J. (Mel Evans/AP)

The President's Commission on Combating Drug Addiction and the Opioid Crisis issued a preliminary report on Monday stating that its “first and most urgent recommendation” is for the president to “declare a national emergency under either the Public Health Service Act or the Stafford Act.”

“With approximately 142 Americans dying every day,” the report notes, “America is enduring a death toll equal to September 11th every three weeks.”

The commission, led by New Jersey Gov. Chris Christie, states that the goals of such a declaration would be to “force Congress to focus on funding” and to “awaken every American to this simple fact: if this scourge has not found you or your family yet, without bold action by everyone, it soon will.”

In 2015, according to Centers for Disease Control and Prevention figures, heroin deaths alone surpassed gun homicides for the first time. More than 33,000 people died of opioid overdose, with another 20,000 dying from other drugs. A recent federal study found that prescription painkillers are now more widely used than tobacco.

Prescription overdose deaths began to rise in the mid-2000, following aggressive marketing and widespread prescribing of the drugs starting in the late 1990s. In response, state and federal authorities began cracking down on prescription opiate availability, introducing “abuse-deterrent” formulations, tighter prescribing guidelines and operations targeting “pill mills” that made the drugs widely available.

Dr. Andrew Kolodny, Co-Director of Opioid Policy Research at The Heller School for Social Policy and Management at Brandeis University discusses strategies for controlling America's addiction problem at the state and federal level, including  better public health surveillance. (Washington Post Live)

But in response to these interventions, many painkiller abusers appear to have switched to illicit street drugs. As prescription painkiller deaths started to fall, heroin overdoses increased dramatically. The latest development has been the emergence of powerful synthetic opiates like fentanyl, which are sometimes mixed with heroin with fatal consequences for unsuspecting users.

As more and more parents are lost to opioid addiction, the foster care system is struggling to keep up. But a unique solution may keep one drug-affected family in Maine together. (Whitney Shefte/The Washington Post)

In his inaugural address, President Trump cited “drugs that have stolen too many lives and robbed our country of so much unrealized potential,” vowing that “this American carnage stops right here and stops right now.” Trump established the opioid commission to study the issue in March, with a mandate to “study ways to combat and treat the scourge of drug abuse, addiction, and the opioid crisis.”

In addition to declaring a national emergency, the commission's first report includes a number of recommendations that public health experts and drug policy reformers have been advocating for years. They include:

  • Expanding capacity for drug treatment under Medicaid;
  • Increasing the use of medication-assisted treatments, like buprenorphine and suboxone, for opioid disorders;
  • Encouraging the development of non-opioid pain relievers;
  • Mandating that every local law enforcement officer in the nation carry naloxone, the drug that rapidly reverses opiate overdose;
  • Broadening “good Samaritan” laws that shield individuals from prosecution when they report a drug overdose to first responders or law enforcement officials.

Notably absent from the report are a number of tough-on-crime measures that Trump and Attorney General Jeff Sessions have repeatedly offered up as solutions to the opioid crisis, including building a wall on the Mexican border, expanding the use of mandatory minimum sentencing for drug crimes, and seizing more cash and property from individuals suspected of drug crimes.

“The interim report is mostly appropriately focused around dealing with the opioid crisis as the health issue that it is,” said Grant W. Smith of the Drug Policy Alliance, a group that advocates for a more public health-centered approach to drug issues. “It offers a sharp contrast to the overall approach that the Trump administration has been taking to escalate the war on drugs.”

Respondents who took part in The Washington Post-Kaiser Family Foundation survey on long-term, opioid painkiller use share their experiences of living with pain. (Monica Akhtar,Erin Patrick O'Connor/The Washington Post)

However, Smith had some concerns about whether an emergency declaration would expand the powers of the president and attorney general in a way that could allow abuse of law enforcement authority. He also noted that the Medicaid cuts discussed under various plans to repeal the Affordable Care Act could have devastated drug treatment availability, contrary to what the report recommends.

The commission's report repeatedly addresses the president directly and encourages him to use his bully pulpit to raise awareness of the issue. “Our country needs you, Mr. President,” it concludes. “We know you care deeply about this issue. We also know that you will use the authority of your office to deal with our nation’s problems.”