Friday, October 20, 2017

Officials scramble to draft opioid plan after Trump says emergency declaration to come next week

On July 31 a bipartisan commission asked President Trump to declare the opioid crisis a national emergency. Such a declaration would allow the U.S. Public Health Service to target highly affected areas, free up funding to fight the epidemic and would allow Congress to negotiate with drug companies for lower prices on naloxone, used by first responders to revive overdose victims. At first Trump demurred, but amid mounting pressure, on Aug. 11 he abruptly announced that he would do so. He has not declared a state of emergency as of today, but on Oct. 16 told reporters he will sign the declaration next week.

But his off-script Oct. 16 statement "blindsided" top agency officials, who say there's no consensus on how to implement an emergency declaration.  When he first announced his support for the declaration in August, "the commitment quickly got bogged down in White House infighting and concerns about the order’s scope and cost," Politico reports. "Members of Trump’s Domestic Policy Council, budget director Mick Mulvaney and former HHS Secretary Tom Price opposed the plan for months because of the multibillion-dollar price tag, legal issues and questions about how it would be implemented."

Multiple sources interviewed by Politico said that agency heads hadn't been asked to create response plans at any time since Trump's promise in August. But staffers are now scrambling to draw up plans in response to Monday's announcement. That will be more difficult since four key agencies in the effort have no leader: Health and Human Services Sec. Tom Price resigned in September; Acting Director of the Drug Enforcement Agency Chuck Rosenburg resigned in September; the nominee to lead the Office of National Drug Control Policy, Rep. Tom Marino, withdrew his nomination a few days ago, and the nominee to lead the Deptartment of Homeland Security, Kirstjen Nielsen, hasn't been confirmed yet.

"It is very difficult to make a big change in direction when the heads of almost every relevant agency are either not appointed or been forced to quit," said Peter Lurie, most recently the associate commissioner for public health strategy and analysis at the Food and Drug Administration.

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