President Trump on Thursday called the nation's opioid epidemic the "worst drug crisis in American history," saying his administration is declaring it a public health emergency and putting its full resolve into overcoming the widespread scourge.
The announcement, however, fell well short of what many health advocates had urged and was roundly criticized by Democratic lawmakers, particularly for what they said is insufficient funding to truly address a crisis claiming an estimated 100 lives or more per day.
"As Americans, we cannot allow this to continue," Trump said during an event in the East Room of the White House, where he was joined by first lady Melania Trump, who has taken on an elevated role in highlighting the impact on families. "It is time to liberate our communities from the scourge of drug addiction. . . . We can be the generation that ends the opioid epidemic. We can do it."
With Trump's declaration, the federal government will waive some regulations, give states more flexibility in how they use federal funds and expand the use of telemedicine treatment, according to senior administration officials.
But the president stopped short of declaring a more sweeping national state of emergency that would have given states access to funding from the federal Disaster Relief Fund, as they would after a tornado or hurricane. Officials who briefed reporters said that such an emergency declaration would not be a good fit for a longtime crisis and would not offer authorities that the government doesn't already have.
Trump first announced he would declare a national emergency in August, and his event Thursday was characterized by critics as too little, too late.
"America is hemorrhaging lives by the day because of the opioid epidemic, but President Trump offered the country a Band-Aid when we need a tourniquet," said Sen. Edward J. Markey (D-Mass.). "Today's announcement is nothing more than a dog-and-pony show in an attempt to demonstrate the Trump administration is not ignoring this crisis."
Markey lambasted Trump for not requesting emergency funding from Congress and for indicating he would reallocate money from other programs. Markey was among the sponsors of a bill introduced this week that would direct $45 billion in new money toward prevention and treatment related to opioids.
Even some Republican lawmakers, including Sen. Shelley Moore Capito (R-W.Va.), who praised Trump for "a significant step forward," acknowledged that more money is essential. "Of course, the president's action is just part of what must be a larger and broader national effort," Capito said, adding that she would "continue pushing and advocating for much-needed resources."
The presidential memorandum signed by Trump on Thursday orders Eric Hargan, the acting secretary of health and human services, to declare a nationwide public health emergency and direct all federal agencies to use any emergency authorities that they have to reduce the number of opioid overdose deaths. The last time that a national public health emergency of this scope was called was in 2009 in response to the H1N1 influenza virus. The emergency status will last 90 days but can be repeatedly renewed.
Shortly after Trump's event, Hargan said he had declared the emergency and noted that in the current fiscal year his department has invested nearly $900 million in "opioid-specific funding" to support the efforts of state and local governments and others.
In making his appeal, Trump — who is often accused of lacking empathy — invoked the story of his brother Fred Trump, who died of complications related to alcoholism. The president credited his brother for warning him of the effects of drinking and said a concerted national advertising campaign could keep people from becoming addicted to opioids and other drugs.
"I learned because of Fred. I learned," Trump said.
He continued: "I think that's going to end up being our most important thing — really tough, really big, really great advertising so we get to people before they start, so they don't have to go through the problems of what people are going through."
Trump spoke to an audience that the White House said included family members of those affected by the opioid crisis, along with an array of administration officials and elected leaders from across the country.
"We are here today because of your courage," the first lady told the audience. "The opioid epidemic has affected more than 2 million Americans nationwide, and sadly the number continues to rise. . . . No state has been spared, and no demographic has been untouched."
Also on hand was New Jersey Gov. Chris Christie (R), chairman of a presidential commission on combating the crisis. Trump said he would carefully review the commission's final report, which is due next week, and consider other recommendations by the group.
One important step authorized by Thursday's emergency declaration was the waiver of a 1970s-era policy that blocked Medicaid payments to inpatient treatment facilities with more than 16 substance-abuse beds. That should make treatment more widely available.
President Trump also said the Food and Drug Administration is requiring "a specific opioid, which is truly evil, be taken off the market immediately." Trump did not specify the drug, but in June the FDA successfully sought the removal of the opioid Opana ER from the market. Its manufacturer, Endo Pharmaceuticals, reformulated the drug in 2012 to make it more difficult to crush and snort, but the FDA said that move actually led to more injections — and a major HIV outbreak.
Trump said the Postal Service and the Department of Homeland Security are strengthening package inspections in an attempt to reduce the flow of the street drug fentanyl, much of which is synthesized in China, sent to the United States and mixed with powdered heroin by dealers.
Trump also said the federal government might file suit against companies he called "bad actors," presumably those in the pharmaceutical industry that have allowed painkillers to reach the black market. Private attorneys have already filed some lawsuits, and a coalition of 41 state attorneys general is investigating the role of some companies in the epidemic.
Officials said that the White House is working with Congress to find additional funding for the crisis — which experts say will cost tens of billions of dollars to properly address — but they declined to share any exact figures.
Critiques of the administration's efforts began even before Trump spoke.
Leana Wen, the health commissioner in Baltimore, which has been battling a stubborn opioid epidemic for years, said she is happy that Trump's announcement "is drawing attention" to the drug crisis. But she pointed out that after hurricanes and other national disasters, billions of dollars in relief is quickly made available to victims.
"The same thing should happen when it comes to stopping an epidemic," Wen said. "We should not have to depend on repurposed dollars that take away from other health priorities."
The money is needed to expand treatment for people with substance-abuse disorders and to provide more of the antidote naloxone to first responders and the public, Wen said. Baltimore is currently paying $70 to $90 for a two-dose pack of naloxone, she said.
Rebecca Farley David, vice president for policy and advocacy at the National Council for Behavioral Health, said Trump's call to use telemedicine to bring help to people in remote areas was encouraging.
"Certainly we're very glad that the president has acknowledged what we already knew — that this opioid crisis is a national emergency," David said.
But like others, she regretted that the president did not make new funding available for treatment, the opioid antidote naloxone and other critical needs. "I'm really disappointed that his speech did not touch on the need for increased resources," she said.
The strong overlap between mental illness and substance abuse — more than 40 percent of people with substance-abuse disorders also suffer from depression, anxiety or another mental illness — means treatment should address both diseases, David said.
"One cannot be addressed in isolation from the other," she said.
Trump deviated several times Thursday from his scripted remarks, including in a description of the scope of the opioid crisis.
He called it "the worst drug crisis in American history, and even, if you really think about it, world history."
"This is all throughout the world," Trump added. "The fact is this is a worldwide problem."
In fact, many nations do not have a prescription opioid problem. In some poor countries, there are shortages of the drugs.