Emergency Declarations in Eight States to Address the Opioid Epidemic

January 11, 2018|3:55 p.m.| ASTHO Staff

South Carolina and Pennsylvania recently joined Arizona, Florida, Maryland, Alaska, Virginia, and Massachusetts in issuing statewide emergency declarations to address the opioid epidemic. (A review of the earlier declarations can be found here). While emergency declarations typically address natural disasters or infectious disease outbreaks, the growing trend of invoking emergency powers for opioids highlights the actions states are willing to take in response to an increasing number of overdose deaths. As more states leverage their emergency authorities to address opioids, the sophistication and creativity of using such powers is emerging.

On Dec. 11, 2017, South Carolina Gov. Henry McMaster issued Executive Order 2017-42 and proclaimed a statewide public health emergency “relating to opioid misuse and abuse, opioid use disorder, and opioid-related death.” The order established an Opioid Emergency Response Team to “ensure coordination and collaboration among government agencies, private entities and associations, and state and local law enforcement authorities in the fight against the opioid crisis.” The team is co-chaired by the director of the Department of Alcohol and Other Drug Abuse Services and chief of the Law Enforcement Division, and includes representatives from key government agencies, such as the South Carolina Department of Health and Environmental Control, the state attorney general, non-state partners and actors, such as health plans, coroners, and individuals in recovery, as well as federal partners. The team, specifically tasked with developing an Opioid Abuse State Plan by June 2018, is also identifying resources to implement and coordinate activities to limit duplicative services. In addition, Gov. McMaster issued Executive Order No. 2017-43, tasking the South Carolina Department of Health and Human Services with implementing a five-day opioid prescription limit on initial prescriptions for acute and post-operative pain for healthcare providers who receive reimbursements through the department. The emergency will remain in effect until modified, amended, or rescinded by a subsequent executive order.

On Jan. 10, Pennsylvania Gov. Tom Wolf issued a statewide disaster declaration to address the heroin and opioid abuse crisis. The declaration, which expires in 90 days, identifies thirteen, state-specific initiatives, organized around three focus areas:

1) Enhancing Coordination and Data Collection to Bolster State and Local Resources

  • Establishes an Opioid Command Center located at the Pennsylvania Emergency Management Agency with representatives from the department of health, department of human services, the Department of Drug and Alcohol Programs, the Pennsylvania Emergency Management Agency, the Pennsylvania Commission on Crime and Delinquency, and the Pennsylvania state police.
  • Expands access to the state’s prescription drug monitoring program to improve treatment outcomes and monitor prescribers.
  • Adds overdoses and neonatal abstinence syndrome as reportable condition for better public health surveillance.
  • Authorizes the emergency purchase of a drug and alcohol hotline vendor services.

2) Improving Tools for Families, First Responders, and Others to Save Lives

  • Amends the statewide standing order for naloxone to allow emergency medical technicians to dispense naloxone.
  • Waive regulations to allow pharmacists to partner with other organizations (e.g., prisons and treatment programs) to make naloxone available to at-risk individuals.
  • The immediate temporary rescheduling of all fentanyl derivatives to align with the federal Drug Enforcement Agency (DEA) schedule. 
  • The emergency purchase of a contract for a body scanner pilot program at a community corrections center.

3) Speeding Up and Expanding Access to Treatment

  • Waive the face-to-face physician requirement for narcotic treatment program admissions and allow initial intake reviews by certified registered nurse practitioners and physician assistants. 
  • Expand access to medication-assisted treatment (MAT) by permitting dosing at satellite facilities and counseling the treatment program’s base.
  • Allow bi-annual licensing for high-performing drug and alcohol treatment facilities.
  • Waive the fee copies of birth certificates so individuals can access treatment without increased financial burdens.
  • Waive certain state licensing requirements for hospitals and emergency departments to allow physicians to administer short-term MAT consistent with DEA regulations.

The most recent state emergency declarations for opioids are being used to coordinate statewide responses, waive and streamline regulatory and legal procedures, and tap into emergency management infrastructure, funding, and other resources. They are also proving an important tool in fostering a rapid response and raising public awareness. However, the opioid epidemic remains a complex and multi-faceted public health crisis, which requires responsive and responsible interventions from policymakers and practitioners at local, state, tribal, and federal levels.