Good afternoon, friends. President Trump is declaring a national emergency over the opioid crisis, everyone's glued to the president's latest Twitter feud and Paul Ryan is just trying to pass a bill. So, we're basically back in August 2017.
President Trump is expected to deliver a major address on Thursday where he'll formally declare the opioid crisis a national emergency. Sharp-eyed readers of this newsletter will recall we wrote an almost identical sentence in August — after which Trump said he wouldn't declare a national emergency, then reversed himself a day later and said he would, then shelved the issue for two months.
In fairness, declaring a national emergency for an epidemic as complicated as the opioid crisis is, well, complicated: the federal government's emergency funding systems are usually applied to natural disasters and infectious diseases, ABC News reported this week, not chronic crises like addiction. (Also, Trump no longer has a candidate for drug czar.)
But in the meantime, in places like Philadelphia, on track for 1,200 overdose deaths this year, the conversation about how to save lives in an unprecedented crisis is light-years beyond the feds. And advocates are concerned about how this administration, in particular, will approach the epidemic.
"I don't know what direction the funding is going to go in — will it be warped by the beliefs from the war on drugs? It could go toward building more prisons," Jen Bowles, who has a doctorate in public health from Drexel and worked with women addicted to drugs in Philly for years, told me at a roundtable on the crisis Monday night. And Trump's sluggish response hasn't made her more optimistic: "I don't think it's on the forefront of his mind. Tens of thousands are dying — when will those folks mean something?"
This is, unquestionably, an emergency, with overdose deaths across the country now topping the death toll at the height of the AIDS crisis. But with a president in office who campaigned on law-and-order rhetoric, advocates like Bowles are worried that officials like AG Jeff Sessions, who speaks about the heroin crisis almost exclusively in terms of gang violence and drug cartels, might use the emergency declaration to return to war on drugs-style tactics, pursuing low-level drug offenders and instituting harsh sentencing policies.
Advocates in Philly have a different idea, one that's rapidly gaining traction among city pols: safe injection sites. They're a controversial measure that didn't make it into the otherwise widely praised set of public health recommendations that Gov. Chris Christie's opioid task force put out earlier this year. (Christie, by the by, spent Monday denying reports that he'd said Trump was finished if he didn't do something about the heroin crisis.)
Safe injection sites, where people addicted to heroin can use drugs and access medical treatment and social services, are used in Canada and several other countries, and decades of evidence suggest they save lives, stop people from using in public, and help get more people into treatment. In Philly, Larry Krasner, the Democratic DA candidate, and two city council members have signed onto opening one here. The mayor's office is still weighing the decision. That said, there's no telling what, say, Jeff Sessions might do if Philly opened one.
At the roundtable on safe injection sites last night, though, Temple law professor Scott Burris made the case for just opening one, feds be damned. In the 1990s, he said, needle exchanges faced similar legal and political challenges, with detractors claiming they were facilitating drug use. "That didn't stop the city," Burris said — the Kensington needle exchange Prevention Point has been operating for 25 years, and is doing some of the most crucial work on the front lines of the crisis now.
Philly is allowed to make its own decisions on what public health treatments work here, as long as they don't run afoul of existing law. The feds could argue that such sites aid and abet criminal activity. But, Burris argued, safe injection sites are treatment — and people have already purchased drugs by the time they arrive at there: "The crime's already over." The city, he says, should dare the federal government to shut down a safe-injection site.
"Jeff Sessions and the justice department is a little more scary," Burris said. But if the feds say they're committed to stopping the heroin epidemic, advocates in Philly think the city should call their bluff. "We have to have the courage to tell Sessions to bring it on," Burris said. "If he wants to shut down a lifesaving public health initiative — bring it on."
"Can we do this on the cheap, or are we going to be serious about saving lives?"— former U.S. Rep. Patrick Kennedy, a member of Christie's opioid commission, characterizing the debate within the commission about how to combat the heroin crisis.
"He was stumbling on my husband's name – that's what hurt me most. He's out there fighting for our country, why can't you remember his name?" — Myeshia Johnson, the widow of Sgt. La David Johnson, on her conversation with President Trump after her husband's death.
"I had a very respectful conversation with the widow of Sgt. La David Johnson, and spoke his name from beginning, without hesitation!" — President Trump, after Myeshia Johnson's interview aired Monday morning, marking a week since he touched off a controversy over calling Gold Star families in the first place.
A non-political palate cleanser