Lawmakers, law enforcement officials and the nation's health care community are cheering President Trump's move Thursday to officially designate the nation's opioid crisis a public health emergency, even as many of them openly wonder if he has gone far enough.
The action – a 90-day declaration that Trump could then extend – expedites staffing at the Department of Health and Human Services, while directing other agencies to prioritize the crisis.
"As Americans, we cannot allow this to continue," Trump said from the East Room of the White House. "It is time to liberate our communities of this scourge of drug addiction. We can be the generation that ends the opioid epidemic – we can do it."
Trump had previously promised to declare the crisis a national emergency, the same designation placed on states and regions hit by natural disasters. That designation would have allowed federal dollars to be quickly directed to communities across the nation reeling from a crisis-related surge in overdoses, addicts in need of treatment and crime.
Declaring the opioid crisis a public health emergency opens up access to the Public Health Emergency Fund, though USA Today reports there's only $57,000 left in that account. The new designation also allows states to divert some money they received for HIV/AIDS treatment to their efforts to stem the opioid epidemic.
"This is a public health emergency – the president is spot on," Republican Rep. Andy Harris tells Rolling Stone. "This is not a hurricane. This is not a tornado. But it is a public health emergency."
But with more than 59,000 overdose deaths in 2016 alone, and more than 100 people a day overdosing this year, some Democrats are critical that the White House isn't asking for more federal funding.
"What I would say to the president on that is, 'Show me the money,'" House Minority Leader Nancy Pelosi told reporters at the Capitol.
Other lawmakers say their job now is to keep pressure on the administration to follow through with the order.
"It has to be more than an announcement. There has to be substance behind this," Democratic Sen. Claire McCaskill tells Rolling Stone. "There's just a lot of work that needs to be done, and I'm going to be optimistic that it's going to be forthcoming – but I'm going to be loud and angry if this is just an announcement without any substance."
The Missouri senator says thus far the president and White House have sent mixed signals on the crisis.
"The vast majority of these addicts are in fact dependent on a Medicaid bed. And that's what's ironic about this: The president has supported ... now three [Obamacare] replace[ment] plans that will remove Medicaid dollars – not add treatment beds, but in fact subtract treatment beds," McCaskill says. "That doesn't sound like an emergency to me. That sounds like making the crisis worse."
McCaskill is part of a bipartisan group of senators involved in an ongoing congressional investigation into the drug industry, which she says has to be a part of stopping the epidemic.
"We're looking into both the manufacturers – their sales and marketing techniques – and the distributors in terms of whether or not they should exercise more care in the way they are moving these drugs around the country," McCaskill says.
Some Democrats are questioning why the announcement took so long. "I'm glad he's doing it. I don't know why there were so many months of delay," Ohio Democratic Sen. Sherrod Brown tells Rolling Stone. "I hope the president's not going to try to use this to arrest his way out of it like Jeff Sessions seems to want to, but instead to marshal the forces of the federal government. I totally support that if that's the direction he goes in."
In unveiling the declaration, Trump echoed Nancy Reagan's "Just Say No" campaign. "This was an idea that I had: if we can teach young people not to take drugs," the president said. "The fact is, if we can teach young people and people generally not to start, it's really really easy not to take them. And I think that's going to end up being our most important thing. Really tough, really big advertising, really great advertising, so we get to people before they start."
That idea seems to be en vogue in the GOP these days, from controversial, tough-on-crime Attorney General Jeff Sessions to congressional leaders.
"We've got to ask people to, I know it's hard, but exercise self-control: Don't take the damn things. And I know that's easier said than done because some people get addicted accidentally," Republican Sen. John Kennedy tells Rolling Stone.
That thinking has Democrats worried the president and others in the GOP don't fully understand the extent of the crisis.
"The 'Just Say No' campaign, having grown up in that time, was kind of a joke among my friends," Democratic Rep. Rick Larsen tells Rolling Stone. "It just wasn't an effective campaign. Talking about [drugs] with kids is important, but that isn't enough. We should have learned that isn't enough. And I think that we need to be more aggressive on treatment and recovery and on compassion for people who are addicted to drugs."
The president also called for research into new, non-addictive painkillers, which turned many heads now that marijuana is legal for medicinal purposes in 29 states and the District of Columbia.
"This is insane," says Oregon Democratic Rep. Earl Blumenauer. "It's so ironic and pointless. On the campaign trail he said, 'The states ought to be able to ... do what they want.' He ought to cooperate with the states, allow us to research it and deal with actual treatment and not expensive, punitive incarceration and prohibition that has not and will not work."
Blumenauer is a leading advocate for medical marijuana in Congress, including pushing a provision to allow veterans to access marijuana from VA hospitals in states where it's legal – an effort that's focused on getting vets off opioids. Marijuana advocates are also trying to pressure the Department of Justice into allowing the Drug Enforcement Agency to allow more research on weed. Blumenauer doesn't understand why the administration wants to research a new wonder drug, when there seems to be one right under their noses.
"These people are just completely out of it," the congressman says. "They could eliminate the federal roadblocks to research on marijuana, which is less addictive than all sorts of legal substances and has no recorded overdose."
That's why Democrats are urging the administration officials to broaden the scope of their thinking to combat the opioid crisis: They say there are tools at their disposal that they're not using.
Last year, lawmakers passed a law to facilitate better coordination between the federal government, states and local community leaders, and allocated $1 billion toward the epidemic. But experts say that falls woefully short of what's needed. Just take Ohio: A new report shows the Buckeye State alone has spent as much as $8.8 billion addressing the crisis.
To shore up the Medicaid cuts they proposed in one of their failed efforts to repeal and replace the Affordable Care Act, Republican senators from the states hardest hit by the crisis tried earlier this year to direct $45 billion toward combatting it. But that effort was derailed.
"Really it's a question of funding, I think. The legislation that we passed last year gives a lot of good authorities and clears a lot of obstacles out of the way. But ultimately if you don't provide treatment, it's like sending a fire department to the fire without any water," Independent Sen. Angus King tells Rolling Stone.
Staffing issues within the Trump administration aren't helping the situation. The president's pick to be his drug czar, Rep. Tom Marino, recently had to withdraw after The Washington Post and 60 Minutes found he ushered a bill through Congress at the behest of pharmaceutical companies that allegedly made it harder for the DEA to clamp down on the flow of illegal pills. The president also has yet to announce a new nominee to serve as HHS secretary, and no one's been named as head of the Bureau of Alcohol, Tobacco, Firearms and Explosives or the Drug Enforcement Administration.
King says not staffing those key posts to combat this multi-faceted crisis makes him fear the administration doesn't grasp the breadth of the epidemic.
"I think it's unfortunate, because, as I say, it's a public health crisis. ... If the terrorists were killing four people an hour in the United States, we'd be on it pretty thoroughly," Sen. King says. "And that's what we are talking about here."