President Trump's advisers said Tuesday that he would not declare a national emergency over the opioid crisis, despite an "urgent" recommendation from the commission he appointed to study the epidemic.
"Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the Executive Branch even further to deal with this loss of life," the commission, chaired by New Jersey Gov. Chris Christie, wrote in its report. But Health and Human Services Secretary Tom Price told reporters that the government could deploy the necessary resources without declaring an emergency.
"Most national emergencies that have been declared in an area of public health … have been focused on a specific area, a time-limited problem, an infectious disease, or a specific threat," he said, citing the outbreak of the Zika virus and the aftermath of Hurricane Sandy.
The opioid commission had issued a draft report last week that called for a declaration of a national emergency and focused entirely on public-health recommendations to address the crisis. It received widespread bipartisian support, including from Pennsylvania Gov. Wolf, a Democrat.
In brief remarks to reporters before meeting with Price on Tuesday, Trump didn't mention the report or its recommendations. He stressed border protection and "strong law enforcement" as key to combating the heroin epidemic.
He added that he would work with health care officials as well, and said that added drug-prevention programs were the "best way" to keep people from becoming addicted or overdosing. "If they do start, it's awfully tough to get off, so if we can keep them from going on and maybe by talking to youth and telling them: No good, really bad for you in every way," Trump said. "But if they don't start, it will never be a problem."
Thomas Farley, the commissioner of the city's Department of Public Health and the co-chair of Mayor Kenney's opioid task force, said the president's comments "show he doesn't understand the opioid crisis."
"He spoke about protecting young people. About law enforcement. About stopping drugs coming across the border," he said. "But most people who are getting addicted to opioids are middle aged and are supplied by their doctors."
Speaking to the press, Price said the commission's report was being "reviewed at all levels" and echoed some of its public-health approach: providing resources for "prevention, treatment and recovery" and making the overdose-reversing drug Narcan more available.
Experts have said that declaring a national emergency could help free up federal funding for states dealing with an overdose crisis that, the commission said, kills 142 Americans a day, though some advocates worried the Trump administration would have used the declaration to return to war-on-drugs style policies.
Some experts in Philadelphia said declaring an emergency wouldn't have had much impact. "Access to medicine, access to care, these are the big issues. We don't need words at this point," said Scott Burris, a law professor at Temple University and the director of the school's Center for Public Health Law Research.
Farley said the president would do well to heed the words of his own commission.
"It had a number of excellent recommendations," he said, adding that an emergency declaration would at least helped "as a way of focusing attention on the problem."
City officials and advocates had praised the commission's report for its emphasis on prevention and treatment – which dovetails with the recommendations produced by the city's own opioid task force. The crisis, they said, has moved beyond politics.
Jose Benitez, the executive director of Prevention Point, the needle exchange and advocacy program that serves people suffering from addiction in Kensington, said before Trump's remarks on Tuesday that he had been encouraged by the report after years of tough-on-crime federal drug policy.
"It really is time to look at this as a public health issue," said Benitez. About three Philadelphians die each day from an overdose, he said, and countless more are revived with Narcan.
The federal commission's recommendations also include funding an expansion of medically-assisted addiction treatments – which studies have shown are effective but underutilized, mostly because of a persistent stigma that such treatments don't count as recovery, the commission wrote. (Indeed, Philadelphia's own medically-assisted treatment programs still have slots open. The stigma, health officials say, makes them difficult to fill.)
Last week city officials said that federal support for their goals could help achieve them sooner.
"One of the things we've been really pushing for is to have all forms of medically assisted treatment available at all our licensed facilities," said Geoffrey Neimark, chief medical officer at Community Behavioral Health, the city agency that handles Medicaid claims for substance-abuse treatment. "But that's a big change of practice, and a culture change. Having a report like this, which has expert consensus behind it, is going to help us push that forward."
Benitez said an influx of federal funding would be crucial in places like Philadelphia, where the heroin is the purest and cheapest in the country, and where he and his staff are working against a death toll that could hit 1,200 by year's end.