Emergency Declarations and Opioid Overdose Prevention

June 08, 2017|3:49 p.m.| Andy Baker-White

This week, Arizona became the latest state to declare a statewide emergency in response to the opioid epidemic. Five other states— Alaska, Florida, Maryland, Massachusetts, and Virginia—have also issued emergency declarations. The declarations allow the state to allocate funds for addiction services, expand access for opioid antagonists, develop prescribing guidelines, procure supplies, and establish statewide response programs. Below is a summary of the emergency declarations issued by these states as well as links to the declarations, as available.

On June 5, Arizona Gov. Doug Ducey issued an emergency declaration activating the state’s emergency response and recovery plan for the direction and control of state assets. The declaration also authorizes the Arizona Department of Health Services (ADHS) to “coordinate all matters pertaining to the public health emergency response.” Additionally, the ADHS director is instructed to identify and recommend an enhanced surveillance advisory, initiate emergency rulemaking for opioid prescribing and treatment by healthcare institutions, develop prescribing guidelines for healthcare providers, develop and provide training to local law enforcement on protocols for opioid antagonists, and report any findings and recommendations to the governor by Sept. 5. Cara Christ, MD, director of ADHS, wrote a blog post with more information.

In May 2017, Florida Gov. Rick Scott issued an executive order declaring a state of emergency and authorizing the Florida Department of Children and Families and the Florida Department of Law Enforcement to suspend certain laws to the extent necessary to allow state agencies to more efficiently procure of needed resources. The order also directs additional funding for state and local agencies to address the emergency and instructs Celeste Philip, MD, state surgeon general and secretary of health for the Florida Department of Health, to declare a statewide public health emergency and issue a standing order for opioid antagonists for emergency responders.

In March 2017, Maryland Gov. Larry Hogan declared a state of emergency and directed the Maryland Department of Health and Mental Hygiene and other state agencies to assist, engage, deploy, and coordinate available resources to address the opioid crisis. The declaration also provided direction for the institution of public information and awareness programs. The initial order can be found here. An order renewing the declaration can be found here.

In February 2017, Alaska Gov. Bill Walker declared an emergency and authorized the establishment of a statewide overdose response program and a statewide standing order for dispensing naloxone. Jay Butler, MD, chief medical officer of the Alaska Department of Health and Social Services, used this authority to issue a statewide standing order for naloxone. Legislative action soon followed the governor’s declaration, including a new law authorizing the state’s chief medical officer to issue a statewide standing order for an opioid overdose drug. Two days after declaring an emergency, Gov. Walker also issued an administrative order directing the establishment of an incident command structure to “develop strategy and implement responses to address the heroin and opioid abuse epidemic.”

In 2016, Marissa Levine, MD, commissioner of health for the Virginia Department of Health, declared a public health emergency as a call for awareness and action to address the opioid crisis. While the declaration "has no force of law and is not a Governor's emergency declaration," Levine also issued a statewide standing order for the dispensing of opioid antagonists.

In 2014, Massachusetts Gov. Deval Patrick declared a public health emergency, empowering the public health commissioner to expand naloxone access, develop a plan for mandatory prescription monitoring, and prohibit the prescribing and dispensing of certain pain medication. It also allocated funds for addiction treatment services.   

In light of the Massachusetts declaration, public health law researchers reviewed the use of state emergency powers to address non-communicable disease outbreaks like opioid overdose deaths and examined potential benefits and drawbacks to using emergency powers for such events. The emergency declarations for opioid overdoses that have been issued since the Massachusetts declaration have concentrated on the benefits of using this authority and avoided the drawbacks mentioned by the researchers. For example, the declarations in Florida and Arizona provide mechanisms for accessing funds to address the problem, and the declarations in Alaska and Maryland direct coordination between state agencies. Also, as noted above, the Alaska declaration led to quick political action when the state legislature passed a bill allowing the chief medical officer to issue a statewide standing order. As to the potential drawbacks identified by the researchers, declarations since the one issued in Massachusetts have been clear (or clear in statute) about their termination points, have not interfered with business interest—while the Massachusetts declaration prohibited the prescribing of certain drugs, the more recent declarations have directed the creation of prescribing guidelines for opioids and expanded access to opioid antagonists—and show the public that action is being taken to address the opioid epidemic.

Whether more states choose to declare emergencies to address the opioid epidemic remains to be seen. It must, however, be noted that the use of emergency declarations to respond to opioid overdoses aligns with ASTHO’s 2017 President’s Challenge to explore primary, secondary, and tertiary public health approaches to preventing substance misuse, addictions, and related consequences. For example, primary prevention efforts to control access to opioids can be seen in Arizona’s directive to develop prescribing guidelines for providers and secondary prevention efforts in Arizona’s requirement to initiate emergency rulemaking for opioid treatment. Tertiary prevention efforts are seen in several of the declarations through the expansion of access to opioid antagonists via statewide standing orders. As the nation’s opioid epidemic continues and the need to address overdoses grows, interest in the use of emergency declarations for the epidemic will likely increase.