The emergency declaration was a start. Here’s how else Trump plans to combat the opioid epidemic

President Trump’s remarks Thursday that he was directing his administration to declare the opioid epidemic a public health emergency mostly focused on the extent of the problem and highlighted in broad strokes that the country would find ways to combat the crisis.

But Trump also laid out ways in which his administration would be attempting to combat the opioid epidemic.

Here are a few of the steps Trump mentioned.

Treatment beds

By law, federal Medicaid dollars cannot go to facilities that treat mental illness or substance use disorders if they have more than 16 beds, a policy that dates to a time when federal officials did not want to be in the practice of reimbursing state psychiatric hospitals. But with the opioid epidemic, some advocates have called for abandoning this policy.

Read more: What’s in the White House’s opioid emergency declaration — and what’s not

Trump said that his administration would announce a new policy that would “overcome” the rule, suggesting officials would focus on granting waivers that allow states to expand treatment options.

The Obama administration in 2015 started offering waivers that states could apply for so larger clinics get reimbursed, and at least four states have received waivers to improve access to treatment. Trump seemed to suggest that his administration’s policy would be focused on expediting the process.

“Those approvals will come very, very fast,” Trump said.

Changing the policy entirely — which is known as the IMD exclusion — would take congressional action.

“While clearly overturning it may not be in the scope of what the executive branch can do, laying out a clear vision for how waivers could be used to improve the system on a state-by-state basis would be a significant and welcome improvement,” Matt Salo, the executive director of the National Association of Medicaid Directors, wrote in an email to STAT after Trump’s address.

There are some concerns that in-patient treatment should not always be prioritized, and that treatment in such facilities takes people out of their communities, which can provide a stable source of support for people embarking on recovery. Many advocates who favor changing Medicaid rules have also noted that Trump’s administration has backed cutting and reshaping Medicaid in a way that would lead to fewer people having coverage overall.

Prescriber training

Trump said he would require prescribers who work for the federal government to “receive, finally, special training” for prescribing opioids. It’s not clear what sort of education campaign Trump is envisioning, but the Obama administration in 2015 also announced a training program in opioid prescribing for prescribers who worked for the federal government.

Pain treatment

Federal health officials are going to launch a task force to come up with best practices for treating pain, Trump announced. This speaks to something that is often lost when discussing the opioid epidemic: There are still lots of patients who need pain medication, and there are some concerns that because of new prescribing limits and the fear of feeding addiction, they are not able to get access to them.

Whatever best practices the task force comes up with will likely be scrutinized by advocates both for pain patients who worry about not being able to get medication they feel they need and those who support stronger prescribing limits. (At the event, Trump highlighted CVS Caremark’s recent announcement that it was imposing prescription limits for first-time opioid prescriptions.)

‘Bad actors’

Trump said the federal government will “pretty soon” start suing “bad actors,” including people and companies that are “hurting our people.” He offered no specific, but dozens of cities, counties, and states have filed lawsuits against drug makers and drug distributors for their alleged roles in seeding the opioid crisis.

Public education

Trump said “it’s really, really easy” not to use drugs if you never start — and suggested public education would be an important strategy for the government.

He told the story of his brother Fred, who struggled with alcoholism and died in his 40s from complications of the disease; Fred’s life instilled in Trump the commitment to never drink and never smoke.

But that’s also an explanation that overlooks how some people become addicted to opioids. Although the epidemic is increasingly being driven by heroin and the illicit use of synthetic opioids like fentanyl, many people developed addictions after being prescribed opioids by their doctors for legitimate pain treatment — a fact that first lady Melania Trump highlighted as she told stories of people she had met has she has learned more about the epidemic. Those people did not have a choice to, as Trump said, “not to take drugs, just not to take them.”

Meanwhile, Trump’s opioid commission, led by New Jersey Gov. Chris Christie, is set to release its final recommendations on Nov. 1. Trump said he will move to implement appropriate recommendations.

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