Updated 5:30 p.m. | President Donald Trump on Thursday declared the nations’s opioid crisis a “national health emergency,” saying the country would fight the drug epidemic as a “national family.”

“This is a worldwide problem,” he said, flanked by public health officials, families with small children and first lady Melania Trump in the East Room of the White House. “It’s just been so long in making. Addressing it will require all of our effort.”

“We can be the generation that ends the opioid epidemic,” the president said.

The public health emergency on opioids will be effective Thursday. It directs all federal agencies to use all resources to fight the drug problem. Trump said the number of addicts “will start to tumble downwards” if the federal government does its job. “It will be a beautiful thing to see,” he predicted.

Melania Trump, who spoke first, said she had met with families affected by the crisis who had encouraged her to not stigmatize the problem. “No state has been spared,” she said.

Trump Talks About Wall, Brother During Opioid Crisis Speech

The declaration fulfills Trump’s promise to officially designate the opioid crisis an “emergency,” and marks the rare use of emergency authorities to deal with a long-simmering chronic health issue instead of disease outbreaks or natural disasters. Public health emergencies were recently declared after wildfires in California and hurricanes in Gulf Coast states and Puerto Rico.

Public health emergencies expire after 90 days and must be renewed thereafter. But the opioid emergency could last for a very long time.

Where’s the money?

Senior administration officials on Thursday said they were working with Congress to ensure that an unspecified amount of extra funding for opioid abuse would be in a fiscal 2018 spending measure. Rep. Tom Cole of Oklahoma, who oversees the House Appropriations subcommittee that funds HHS, said he had not yet heard specifics from the administration. Sen. John Kennedy, who sits on the Senate Appropriations Committee, said there is interest among panel members to include more money for opioids.

“But I think it’s going to take more than money to solve this problem,” the Louisiana Republican said.

While most lawmakers support more funding to address drug abuse, some fear that it could come at the expense of other health programs.

“Where would this money come from? That’s really the point,” said Minority Leader Nancy Pelosi. “Are we talking cannibalizing other aspects of the health care in our country?”

In some respects, the public health emergency declaration could do just that. State employees with jobs funded by federal dollars usually have specific job descriptions, but the emergency declaration could make it possible for states to reassign those employees to focus on opioid prevention and treatment. The declaration would also allow states to use some of about $2.3 billion for HIV/AIDS programs and refocus it to prioritize the many HIV/AIDS patients who have co-occurring opioid use disorders.

Local public health officials shared Pelosi’s concern and questioned why the administration wasn’t treating this as a more traditional emergency. Without greater funding, the impact of the declaration is limited. 

“When hurricanes hit communities, it’s understood that there are billions required to rebuild homes,” said Leana Wen, the health commissioner in Baltimore. “There are already such limited dollars for public health, to take funding away from existing programs to fund the opioid epidemic does not seem to be the right approach.”

Fractured response

The epidemic is a growing concern. Of the more than 50,000 deaths due to drug overdoses in 2015, around 33,000 were caused by a prescription opioid, heroin or fentanyl, a powerful opioid derivative, according to the Centers for Disease Control and Prevention. Preliminary data indicates there were closer to 65,000 drug overdose deaths in 2016, with the share caused by opioids likely to rise.

The public health declaration would expand some of the allowable uses of telemedicine, according to a fact sheet released by the White House. For instance, while most patients who receive addiction treatment medication need to meet with doctors face to face to get the prescription and receive counseling, the emergency order could make it possible to conduct some of those sessions remotely.

The White House said the Department of Labor could use dislocated worker grants to assist workers who have lost their jobs over opioid abuse. But Democratic staff on the Senate Appropriations Committee pointed out that Trump’s budget request would cut the total for those grants by about $500 million.

Trump also said the administration would undertake an advertising campaign to try and prevent people from using drugs in the first place, citing his brother Fred, who encouraged him never to drink or smoke. “He would say it over and over and over again,” he said.

Trump said he had never had a drink or smoked in his life as a result. 

The president said he would prioritize opioid abuse prevention and treatment. Some of his appointees have followed through on his earlier instructions to address the issue.

Food and Drug Administration Commissioner Scott Gottlieb and his team have begun examining how to improve education for opioid prescribers and whether they can impose stricter dosing requirements.

On Wednesday, the FDA announced it would work on outreach related to treating addiction and try to lift the stigma involved with taking drugs that treat addiction. The FDA also increased the number of employees stationed at international mail facilities to screen for shipments of illicit fentanyl, which is usually sent from overseas.

The National Institutes of Health has begun working with drug companies on research into more effective drug treatments and non-opioid pain alternatives.

Otherwise, the administration has simply been carrying out policies put in place under President Barack Obama. HHS distributed $485 million in state grants authorized at the end of Obama’s term.

Former HHS Secretary Tom Price took little other action before resigning in September. He left after revelations about his use of private aircraft to travel around the country, trips which were sometimes scheduled to speak with local officials about the opioid crisis.

There has also been a leadership vacuum at the White House. Senior Counselor Kellyanne Conway has acted as a spokesperson, but there is not yet a “drug czar” to coordinate the response across the federal government.

Rep. Tom Marino, a Pennsylvania Republican, was nominated to lead the Office of National Drug Control Policy but withdrew himself from consideration last week. His withdrawal came after The Washington Post and “60 Minutes” reported his involvement in a law that allegedly made it harder for the Drug Enforcement Administration to go after manufacturers involved in suspicious sales. The DEA itself is also being run by an acting administrator, Robert W. Patterson, who took over earlier this month. The previous DEA chief, Chuck Rosenberg, was also serving in an acting capacity and resigned because of a dislike for Trump.