Declare a true state of emergency

Several weeks ago, President Trump stated that the opioid crisis was a “national emergency.” To many of us in public health, it was a confusing statement. Just a few days earlier, the president and Secretary of Health and Human Services Tom Price stated that they would not declare a state of emergency, claiming that emergencies are time-bound and resource-finite situations.

As an emergency physician and Commissioner of Health in Baltimore City — where approximately two people a day die from overdose — I can tell you that is not the case. Addiction is a disease, treatment exists and communities around the country are succeeding in fighting the epidemic.

In Baltimore, we employ a three-pillar strategy that has shown results.

{mosads}First, we focus on saving lives from overdose. Nearly two years ago, I issued a blanket prescription for the opioid antidote, naloxone, for all of Baltimore City’s 620,000 residents. This, accompanied by targeted outreach efforts, has resulted in more than 1,200 lives saved by everyday residents.

However, our success is constrained by lack of resources. We are having to ration this life-saving medication and have to decide every day who should get it and who should go without. Last November, I joined directors of health departments from 11 cities to urge then-President-elect Trump to work with manufacturers to reduce the price of naloxone so that those of us working on the frontlines do not have to ration our ability to save lives. If this were an outbreak of an infectious disease and a treatment exists, there would be no question that the federal government would ensure that nobody is priced out of the ability to live.

Second, we work to increase access to treatment. Throughout the U.S., only 1 in 10 people who have the disease of addiction are able to obtain treatment. Nearly one-third of all those who did not seek treatment cite cost or lack of insurance coverage as a reason. In Baltimore, we are launching a stabilization center — based on successful models in San Antonio and San Francisco — that will operate 24 hours a day, seven days a week and provide clients with medical screenings and referrals to treatment for substance use disorders and mental health needs. Following the example of Vermont’s “hub-and-spoke” programs, we are also working to expand buprenorphine, a medication used to treat opioid addiction, to hard-to-reach patients who may not seek treatment through the traditional health-care system.

The president should focus on identifying, highlighting and scaling effective strategies like ours. He should state how much funding he is putting forth to treat this national epidemic. In particular, support for evidence-based interventions, such as medication-assisted treatment (MAT), is critical to saving lives and debunking the myth that MATs “substitute one drug for another” — a misconception that has been stated by none other than the HHS secretary. Such misguided rhetoric is stigmatizing and harmful and further discourages people from seeking the treatment they need to recover.

President Trump must also recognize that dismantling the Affordable Care Act will disproportionately affect low-income Americans and exacerbate the opioid crisis. Medicaid covers 1 in 3 patients with substance use disorders. Many others could lose insurance coverage if addiction treatment is no longer covered as part of essential health benefits. For millions of patients, their health insurance is their lifeline. To truly address the opioid crisis, the president must protect and expand health insurance coverage to treat this devastating disease and provide funding for proven, evidence-based treatment at the time that people need it.

Third, work to fight stigma with science and education. Our Don’t Die campaign teaches Baltimore residents about the disease of addiction and encourages individuals to seek treatment. Recognizing the role of health-care providers, we have worked with our Emergency Departments to implement protocols for all of them to screen patients for opioid use disorders, refer patients to specialized care when needed and offer peer counseling and connections to social services such as housing. We collaborate with our police department and prosecutors in programs such as the Law Enforcement Assisted Diversion Program, which offers treatment rather than incarceration for those caught with small amounts of drugs. Each of these initiatives is changing the conversation so that addiction is treated with the same compassion and dignity as we treat other chronic illnesses.

To be sure, law enforcement is important to stem the flow of illicit drugs — including the synthetic opioid fentanyl. However, the president’s language and comments by Attorney General Jeff Sessions recall the rhetoric of the “war on drugs.” Treating addiction as a crime has been shown time and time again to be ineffective, unscientific and inhumane. Starting a new war on drugs is the last thing we should be doing, especially in communities like ours that have already been hit hard by decades of systemic racism and the mass incarceration of predominantly poor, minority populations. As long as there are millions of people with untreated addiction, demand will fuel supply.

It is long past time for the president to declare a state of emergency around the opioid epidemic, and this declaration must go beyond just words. We are saving lives, but we need to do much more. With sufficient resources, we can end this crisis. Those of us on the frontlines in cities and counties across the U.S. know what works. Hundreds of people are dying from a preventable and treatable illness every day. We have no time to wait.

Wen is the Baltimore City Health commissioner. You can find her on Twitter @DrLeanaWen and @BMore_Healthy.