Nothing -- at least not yet.
First, the White House has to decide what kind of emergency the opioid epidemic is, exactly. There are several different kinds of emergency declarations. While they accomplish similar things, they serve different purposes.
The President’s Commission on Combating Drug Addiction and the Opioid Crisis recommends that the disaster be declared through either the Stafford Act or the Public Health Service Act. The Stafford Act is usually initiated for natural disasters, such as hurricanes and tornadoes, and normally requires a request from a governor. It would trigger the Federal Emergency Management Agency (FEMA) to dole out financial and technical assistance to states and cities.
The Public Health Service Act, on the other hand, allows the secretary of health and human services -- not the president -- to declare a public health emergency and deploy medical staff to areas in need. This was used for the outbreak of the Zika virus and the H1N1 virus, for example.
No matter which route White House officials decide to take, “a whole set of tools kick in,” says Jay Butler, medical director of Alaska and president of the Association of State and Territorial Health Officials. Either way, states would essentially receive extra grants and manpower to start new programs and aid existing ones. It would also ease bureaucratic rules so states can enact programs and policies more easily.
It’s possible that the Trump administration could invoke both the Stafford Act and the Public Health Service Act -- something that has usually been reserved for the most serious disasters like Hurricane Sandy and Hurricane Katrina. This would allow the federal government to relax certain Medicaid, Medicare or Children’s Health Insurance Program requirements to get more people care (and make sure more providers get reimbursed).
Trump's commission recommended several actions that many states and cities have already undertaken. The group proposed increasing access to naloxone, the drug that reverses opioid overdoses, as well as medication-assisted treatment and strengthening prescription drug monitoring programs, which have been criticized as being ineffective.
There are some things, however, that only the feds can do.
It’s possible, for instance, the federal government could decide to fast track the Food and Drug Administration's review to make naloxone available over the counter nationwide. Right now, some states have more or less achieved that goal.
As public health officials wait to see Trump's plan of action, they hope he doesn’t single-mindedly focus on the law and order aspect of the crisis.
“That is very important, but I hope there’s an emphasis on the public health and treatment aspect of this. I want the White House to not lose track of that,” says Geoffrey Mwaungulu, senior program analyst of public health preparedness and law at the National Association of County and City Health Officials.
In the meantime, the opioid crisis is continually top-of-mind for governors and mayors. Six states -- Alaska, Arizona, Florida, Maryland, Massachusetts and Virginia -- have already declared a state of emergency. Some cities, like Baltimore, have issued standing orders to make naloxone available to anyone.
“States know what’s best for them,” says Jim Blumenstock, chief of health security for the Association of State and Territorial Health Officials. While state and local officials wait for federal guidance, he says “now is the time to review their state of play, and move forward as appropriate."
Butler agrees that states and cities should be proactive at this time.
"We do have to ask ourselves how we want to proceed with this because we have a limited amount of time to talk."
