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About Mental Health

President Donald Trump Thursday said he is drafting an order to declare the opioid crisis a national emergency just days after HHS Secretary Tom Price indicated there was no need to take such an action.

“The opioid crisis is an emergency, and I am saying, officially, right now, it is an emergency. It’s a national emergency,” Trump said at a press conference held Thursday. “We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis.”

Trump did not offer details on the plan or funding the White House would implement.

Last week, the president’s Commission on Combating Drug Addiction and the Opioid Crisis led by New Jersey Gov. Chris Christie urged Trump to declare the opioid crisis a national emergency in order to expedite emergency funding and resources to places hardest hit by the crisis. The declaration would release millions in emergency funding and resources that could quickly be distributed to states.

But Price on Tuesday appeared to suggest the White House would not follow the commission’s recommendation, saying a declaration of emergency was not yet necessary.

The declaration would give HHS broad authority, said Dr. David Rosenbloom, professor of health policy and management at Boston University’s School of Public Health.

He said the agency could negotiate drug prices for medication-assisted treatments like buprenorphine to ensure providers maintained adequate supplies. That might help lower the cost of the overdose-reversal drug naloxone, which has risen steadily over the last few years. Also, current rules banning federal reimbursement for the cost of administering methadone at outpatient clinics could be waived.

The declaration of emergency would exempt providers from complying with certain requirements that often prevent them from getting paid. For example, HHS could temporarily lift Medicaid rules that limit how long patients can receive mental health or substance use disorder treatment in residential facilities with more than 16 beds. Currently the program covers the costs for up to 15 days.

“Waiving that requirement would allow many, many more facilities to be able to accept patients, and maybe reduce waiting lists and get people the kind of help that they need when they need it,” said Tom Coderre, a senior adviser with the Altarum Institute and a former chief of staff and senior adviser to the Assistant Secretary at the U.S. Substance Abuse and Mental Health Services Administration during the Obama administration.

Coderre said in a state of emergency, the federal goverment could directly distribute both MAT and naloxone to municipalities and states.

Some experts say an emergency declaration could have a more direct impact on healthcare providers beyond reimbursement coverage.

Rosenbloom believes the declaration could also require hospital emergency rooms to provide treatment for covered patients with addictions instead of just holding those patients until they’re stabilized and then referring them to an addiction medicine specialist before they are discharged.

Studies have shown patients given medication-assisted treatment while in the ED are more likely to enter treatment after 30 days compared to patients who are only given a referral.

“Making hospital emergency rooms places where methadone and buprenorphine could be started immediately would obviate a lot of the need for the inpatient detoxification,” Rosenbloom said.

Since 2014, Massachusetts, Virginia, Maryland, Alaska, Florida and Arizona have all made emergency declarations that temporarily allowed state health officials to launch statewide initiatives like blanket naloxone orders and mandates for opioid prescribers to use prescription drug monitoring programs.

The commission’s other recommentations include setting requirements for physicians to take continuing medical education courses on opioid prescribing and tougher enforcement of mental health and substance abuse treatment parity laws, establishing a federal fund to expand greater access to medication-assisted treatment, and providing support to the National Institutes of Health for the development of new medication-assisted treatments and non-addictive pain management therapies.

Dr. Leslie Dye, vice president and editor in chief of Point of Care Content for healthcare analytics company Elsevier, warned those actions would require further steps. For example, “if you increase treatment capacity, but a primary care physician has nowhere to go to find out who needs treatment it’s not going to do much good.”