WASHINGTON (AP) — President Donald Trump's plan to declare the opioid crisis a nationwide public health emergency won't bring new dollars to fight a scourge that kills nearly 100 Americans each day, but will expand access to medical services in rural areas and shift some federal HIV money to help addicts, among other changes, White House officials said Thursday.
Trump intended to use an afternoon speech to announce that he was directing his acting health and human services secretary to take those steps, according to the officials, who weren't authorized to publicly discuss the matter in advance and briefed journalists on condition of anonymity.
Administration officials said they would urge Congress, during end-of-the year budget negotiations, to add new cash to a public health emergency fund that Congress hasn't replenished for years. They made clear that the declaration, which lasts for 90 days and can be renewed, comes with no dedicated dollars.
"An emergency declaration without significant new funds will likely be unsuccessful," Becky Salay, director of government relations at Trust for America's Health, a Washington-based public health research and advocacy organization, said in advance of the president's announcement. "The problem is enormous and requires a similar investment in a comprehensive strategy that includes primary prevention."
"Show me the money," said House Democratic leader Nancy Pelosi, who called the declaration "words without the money."
Leading up to the announcement, Trump had said he wanted to give his administration the "power to do things that you can't do right now." As a candidate, he had pledged to make fighting addiction a priority, and pressed the issue in some of the states hardest hit.
"When I won the New Hampshire primary, I promised the people of New Hampshire that I would stop drugs from pouring into your communities. I am now doubling down on that promise, and can guarantee you we will not only stop the drugs from pouring in, but we will help all of those people so seriously addicted get the assistance they need to unchain themselves," Trump told a crowd in Maine weeks before last November's election.
Once in office, Trump assembled a commission, led by Gov. Chris Christie of New Jersey, to study the problem, and he said an emergency designation would free additional money and resources.
Christie, in a statement, said Trump was taking "bold action" that shows "an unprecedented commitment to fighting this epidemic and placing the weight of the presidency behind saving lives across the country."
Officials said the administration had considered a bolder emergency declaration, under the Stafford Act, which is typically used for natural disasters like hurricanes. But they decided that measure was better suited to more short-term, location-specific crises than the opioid problem. Drug overdoses of all kinds kill an estimated 142 Americans every day.
Trump was also expected to direct other departments and agencies to exercise their own available emergency authorities to address the crisis.
At a congressional hearing Wednesday, lawmakers from both parties expressed frustration.
"I don't understand why more resources aren't flowing to help out a rural state like West Virginia," said Rep. David McKinley, R-W.Va.
Added Rep. Ben Ray Lujan, D-N.M.: "People at home don't feel like they're getting help."
On the other hand, some health advocates worry that devoting more public health resources to opioids could divert attention and money from cancer, diabetes, heart disease and other health concerns. They were looking for new sources of money and a willingness by Washington to work closely with state and local governments.
Nearly a year ago, Congress approved $1 billion to tackle the crisis. Money is gradually reaching places where it can do some good, but with some setbacks and delays along the way.
In some locations, addicts are starting to get treatment for the first time. In others, bureaucratic hurdles prevent innovation, driving home the point that gaining ground on the epidemic will be difficult.
The $1 billion for states is part of last year's 21st Century Cures Act, which also addressed cancer research and medical innovation. States got half their Cures Act grants in April and will get the rest next year. They must spend 80 percent on opioid addiction treatment. That's an incentive for some states to expand access to methadone, the oldest of the treatment drugs.
Places such as Fellowship House in Birmingham, Alabama, are using drugs like Suboxone, a combination of buprenorphine and naloxone, with patients for the first time.
"When I took Suboxone, it was like a miracle," said one Fellowship House patient, 43-year-old John Montesano, a former long-haul truck driver with a 20-year pill addiction, chronic pain and no health insurance. "I'd be dead now" without it, he said. "Or worse, not dead" and still using.
Montesano recently marked six months without a relapse. He attends daily recovery meetings, works at a sandwich shop and plans to reunite with his wife. As long as the money goes for treatment "the way Fellowship House does it," he said, Congress "should release all the money they can spare."
AP Medical Writer Carla K. Johnson reported from Chicago.