Speaking from Bedminster, New Jersey, in early August, President Donald Trump vowed to formally dub the U.S. opioid crisis a “national emergency.”

But nearly a month later, the president has yet to officially declare a state of emergency — a move that would enable the federal government to pump funds into addressing the drug epidemic.


In the latest episode of the Women Rule podcast, two women on the front lines of the opioid fight — June Sivilli, the chief of the public health division in the White House Office of National Drug Control Policy, and Dr. Cece McNamara Spitznas, ONDCP’s senior science policy adviser – try to explain why Trump still hasn’t made that formal declaration.

“What the powers are related to a national emergency and trying to determine how would that apply in this situation — it requires a lot of specialist eyes to take a look,” Spitznas told POLITICO editor Carrie Budoff Brown. “And a lot of people to sit around and sort of go through exactly what we can do legally, and across all the different parts.”

“I think we’re in that phase of looking at [it] and leaving no stone unturned on what is it that we can possibly do,” Spitznas added.

Not everyone in Trump’s administration sees the need for an emergency declaration to combat the crisis.

While the White House’s bipartisan Commission on Combating Drug Addiction and the Opioid Crisis had recommended an official declaration, Health and Human Services Secretary Tom Price downplayed the idea in early August, before Trump weighed in.

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"We believe that at this point, the resources that we need or the focus that we need to bring to bear to the opioid crises can be addressed without the declaration of an emergency," Price said.

When it comes to the broader national strategy to halt the opioid problem, ONCDP also defended Trump’s recent law-and-order push, in combination with other public health-oriented approaches.

“The view is that we need to get people who need care the care that they need,” Sivilli said. “And if people are breaking the law, then they need to be prosecuted.”

Drawing a line between opioid users and drug traffickers, Sivilli added: “We can forget that there are a lot of bad people out there trafficking a lot of drugs to our communities. And so serious traffickers are not users who are trying to just address their habit. So we want people who have an addiction to get treatment, but if they’re criminals they should not be treated as if they’re not.”

In the wide-ranging podcast roundtable, the two ONDCP officials weighed in on all aspects of drug control policies — from personal family struggles with addiction and alcoholism to the unique effect the opioid crisis has had on women.

Read below for highlights:

8:02 It was in 2008 when the U.S. Centers for Disease Control and Prevention first started tracking the increase of drug poisoning deaths from prescription drugs — and for Sivilli, it was the “first data that came to our attention that made us realize there’s a problem” with opioids in the U.S.

Spitznas noted that America is unique in its higher consumption of opioids because that class of drugs are “really easily prescribed.”

11:22 Spitznas details how her work in addiction medicine had been heavily influenced by her own family’s struggles with alcoholism and her father’s experience in a treatment program.

“When I was 7 years old, my father wrecked my mother’s Volkswagen Bug,” Spitznas said. “He was drinking. He had a DUI.”

16:39 The duo discusses how the opioid crisis has specifically impacted women.

“If you look at women, the drug that is still involved in most female deaths … are still the prescription opioids,” Spitznas says.

Sivilli recommends that “a woman’s treatment program should probably be a segregated program” because of a “variety of additional supports that women need,” including child care.

Later, the two also weigh in on the Catch-22 for pregnant women who may suffer from an opioid addiction.

“If they go to, say, a provider for pre-natal care, if they have children at home, and the provider learns that they have been misusing substances… then in some states, they are mandated to report that to child welfare,” Spitznas points out. “That is, for some women, an impediment to seeking pre-natal care.”

It’s a “tough” call in the policy space, Spitznas says, “because you don’t want there to be a child safety issue.”

22:45 What does the current national strategy for combatting the opioid crisis look like?

Since the start of the Trump administration, Sivilli says “we just continue to do what we’ve been doing.” She goes on to explain the administration’s combination of approaches, including a law-and-order approach, decreasing access to opioids and other drugs (including preventing such drugs from coming into the country), increasing access to the overdose reversal drug naloxone, and further funding addiction treatment programs.

While President Trump has yet to officially declare a national emergency on the issue, Spitznas is hopeful that the attention paid will mean that the administration is “leaving no stone unturned on what it is that we can possibly do.”

“I think when he says, ‘It’s an emergency,’ we need to look at all the tools in our tool kit,” Sivilli says.

28:24 The two discuss the intersection of law enforcement and public health as it relates to the opioid crisis.

“The view is that we need to get people who need care — the care that they need,” Sivilli says. “And if people are breaking the law, then they need to be prosecuted.”

She emphasizes that sometimes prison is the only way those addicted to opioids have received help for their substance abuse disorders.

“You hear over and over from people in these treatment programs, ‘Jail was the first time I had an opportunity to get treatment,’” Sivilli notes.

40:18 Sivilli discusses how reducing prescriptions for opioids would help alleviate the opioid crisis, and Spitznas voices her wish that every person who is able to subscribe an opioid also be trained in addiction treatment.

44:09 Though the Office of National Drug Control Policy has been around for nearly three decades, it’s never been led by a woman. Sivilli and Spitznas discuss women’s roles in the department and ponder on the potential for female leadership.

“There are a lot of women who are stakeholders, who are leaders in our field, who are leaders in addiction medicine,” Sivilli says. But to lead the office, she notes, is a “very demanding job.”

“You don’t have any life except the job,” she adds. “That’s all you have is the job.”

When Spitznas was asked whether she would consider a job helming the agency, she demurred.

“That is something that might be something I could think about in the future,” she says. “But currently, I’ve been with the federal government for 17 years, and I am uniquely placed, I think, right now to be able to make a really great impact.”

