President Trump's commission on the opioid crisis called Wednesday for more drug courts, more training for doctors and penalties for insurers that dodge covering addiction treatment.
The panel's final report stopped short, however, of calling for new dollars to address the worst drug crisis in U.S. history. Instead, the commission asked Congress for "sufficient funds" and suggested giving the White House drug czar's office the ability to review federal spending on the problem.
"If we are to invest in combating this epidemic, we must invest in only those programs that achieve quantifiable goals and metrics," the report said. The drug czar's office "must establish a system of tracking and accountability."
But adding a new layer of oversight was met with skepticism from addiction treatment advocates. The Office of National Drug Control Policy, known as the drug czar's office, "is not a watchdog agency," said Andrew Kessler, a behavioral health consultant in Washington, D.C.
Trump launched the commission seven months ago, tapping his friend and former rival New Jersey Gov. Chris Christie to lead the fight. Since then, it has held five meetings and, in July, issued an interim report urging the president to elevate attention by declaring a national emergency.
Last week, Trump did so, talking in a White House speech about his brother's alcoholism and declaring the crisis a national public health emergency.
"The president did exactly what I asked him to do," Christie said Wednesday, addressing reports that a different type of emergency declaration, one overseen by the Federal Emergency Management Agency (FEMA) would have been stronger. Christie said he wanted the Department of Health and Human Services to take the lead, not FEMA.
"It's now incumbent on Congress to step up and put money in the public health emergency fund," Christie said. Congress hasn't replenished the fund for years, and it contains just $57,000.
More than 64,000 Americans died from drug overdoses last year, most involving a prescription painkiller or an illicit opioid like heroin.
The panel's report contained 56 new recommendations and called for streamlining funding to states by using block grants, which would give states more flexibility.
What's missing is more money, said Dr. Mitchell Rosenthal of Phoenix House, a nonprofit addiction treatment provider. "We need significantly more funding to the states on the front lines of this crisis, otherwise they won't be able to implement the prevention and treatment programs that can save so many lives," Rosenthal said.
The commission urged White House support for the Prescription Drug Monitoring Act, which would require states with federal grants to share information on narcotics users in a federal data-sharing hub.
The panel recommended training doctors who prescribe opioids and allowing more emergency responders to administer overdose reversal drugs. It called for establishing drug courts in all 93 federal judicial districts to get more treatment to drug offenders rather than send them to prison.
Alternatives to incarceration are needed, said Lindsey Vuolo of the National Center on Addiction and Substance Abuse and author of a recent strategy guide for states. "It's not enough to say addiction is a disease. We have to treat it as one," Vuolo said.
Massachusetts Gov. Charlie Baker, a member of the opioid commission, said in a statement Wednesday he's proud that among the recommendations to the White House and Congress, several of them originated from state policies.
“This report contains an extensive list of recommendations, including federal funding increases, prevention education for schools, increased access to treatment and stricter drug enforcement policies, that can start making a difference in every state if acted upon by the White House and Congress," Baker said.
With reporting by Carla K. Johnson, AP Medical Writer