President Donald Trump speaks at a meeting with administration officials, including Counselor Kellyanne Conway (L) and Health and Human Services Secretary Tom Price (C), on the opioid addiction crisis at the Trump National Golf Club in Bedminster, New Jersey, on August 8, 2017. Nicholas Kamm | AFP | Getty Images

A little more than a week after a White House commission gave its recommendations for what to do about the opioid epidemic, President Donald Trump seems ready to defy one of its big proposals. On Tuesday, Health and Human Services Secretary Tom Price said that the Trump administration will not declare a national emergency over the crisis, although the option remains "on the table." "We believe at this point that the resources we need or the focus that we need to bring to bear to the opioid crisis, at this point, can be addressed without the declaration of an emergency," he said. More from Vox:

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Trump's scary tweets about nuclear weapons, explained A national emergency declaration was the first proposal from Trump's commission — which pointed out that due to drug overdoses, there are "approximately 142 Americans dying every day, [and] America is enduring a death toll equal to September 11th every three weeks." And it looks like the Trump administration isn't making it a priority. But would declaring a national emergency actually do much to address the crisis? I turned to public health experts to answer the question. From the top, they were clear that there's a lot of uncertainty. Typically, national emergency declarations are held for immediate, short-term crises like hurricanes and contagious disease epidemics, such as H1N1. There's no precedent for declaring a national emergency for a long-term public health issue like the opioid crisis. But a declaration could potentially unlock some support to address the crisis, including some funding and special regulatory waivers that could bolster prevention programs as well as access to addiction treatment and the opioid overdose antidote naloxone. This wouldn't be enough to solve the crisis by any means, but, Lainie Rutkow of Johns Hopkins Bloomberg School of Public Health said, it "could make a difference, or it could at least jump-start things that would then be helpful in the longer term."

How an emergency declaration could work

The Trump administration could declare a national emergency through two different laws: the Stafford Act or the Public Health Service Act. The Stafford Act would involve a declaration from the president, and it would unlock resources typically reserved for natural disasters like hurricanes and tornadoes. The Public Health Service Act would require a declaration from the secretary of health and human services, and it would unlock other resources and tools focused more on the medical side. The immediate impact of such a declaration, experts said, is it would send a message. "When an emergency is declared, whether it's by the president or by a state governor, the first thing that it does is give the public notice," Rutkow said. "In many ways, it's a communication tool to express how severe a particular threat is." Generally, the effect of a declaration through either law is that it expedites access to resources and different tools in response to a crisis. But depending on which law the administration uses to declare an emergency and what guidance the administration gives along with such a declaration, the resources that are unlocked could vary. The Stafford Act could be used to mobilize and coordinate different federal and state agencies to home in on the opioid crisis. This could also come with limited funding from the federal disaster relief fund, which amounts to about $1.4 billion as of June. That money could possibly be used to scale up law enforcement or addiction treatment in response to the crisis. The Public Health Service Act would allow the mobilization and deployment of medical staff in underserved areas. Rutkow said this could be used to staff up or train providers for medication-assisted treatment, which is considered the gold standard for opioid addiction care. Or it could be used to waive state licensing requirements for doctors, letting addiction specialists go into areas that currently don't have enough access to such care. A declaration through either law could also allow Section 1135 waivers for Medicaid. This would let the HHS secretary bypass regulatory hurdles that normally apply to the public health program. For example, under the Social Security Act, federal Medicaid funds can't reimburse services from inpatient facilities that treat "mental diseases," including addiction, with more than 16 beds. Eliminating this barrier through 1135 waivers would let states open more treatment options. Rutkow also pointed to the emergency declarations that several states have made in response to the opioid crisis, which allowed them to use more funding to, as one example, scale up treatment and the use of naloxone. For instance, Alaska Gov. Bill Walker's declaration allowed Jay Butler, chief medical officer of the Alaska Department of Health and Social Services, to issue a standing order for naloxone across the state, making the drug accessible to anyone without the prescription it typically requires. Still, with much of this, there's a lot of uncertainty. Rutkow cautioned, "No one can point you to the exact model for how this would work for an emergency that's been declared for a noncommunicable health condition. This is a new thing." Some experts are skeptical. Tom Frieden, the former head of the Centers for Disease Control and Prevention (CDC), said the Stafford Act "doesn't seem appropriate or useful" for this situation, because it's usually saved for immediate, short-term crises. As for the possible benefits of the Public Health Service Act, he said that "it's an in-depth legal question of what these are and whether they'd be helpful." For one, he argued that the message sent by an emergency declaration wouldn't do much. "There's always the argument that declaring something an emergency increases attention to it, but in this case there's a lot of attention — just not a lot of effective action so far," Frieden said. He added, "[I]t could help, in the right context, as part of a comprehensive response, and if it encourages both funding and better collaboration between public health and law enforcement. If it's just a political statement not backed by money or commitment to more action, and if it's a way to propagate the criminalization of addiction, then it would be counterproductive. So, no easy talking point, but it depends on how it's done." This, at least, seems to be a point of agreement about an emergency declaration: It all comes down to how it's done, and it should only be one part of a broader solution.

The opioid epidemic needs a more comprehensive fix