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Four weeks after President Trump said he would declare a national emergency in response to the opioid epidemic, the White House has not yet taken that dramatic step.
The monthlong delay has left some lawmakers and advocates wondering whether Trump plans to follow through on a promise that could expand access to treatment and increase the availability of overdose reversal drugs.
On Monday, a group of 10 Democratic senators wrote to Trump asking why there was a hold-up in making the emergency declaration. They said the delay reinforced other concerns about the Trump administration's approach to the epidemic.
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"Your lack of action … causes us to question your commitment to ending the opioid use disorder and overdose crisis," reads the letter, led by Sens. Sherrod Brown, D-Ohio, and Edward Markey, D-Mass.
A White House spokesman said the official declaration was still in the works.
"The President's policy advisers are working through the details with all of the relevant components and agencies," the spokesman said. "Right now these actions are undergoing a legal review."
The push for a national emergency declaration came from Trump's own opioid commission, created in March to study the epidemic and recommend action. The commission's first report, issued in July, included the emergency declaration as its "first and most urgent recommendation."
Such a step would give the executive branch expanded powers and more resources to address the epidemic. The administration could, for example, lift the current cap on Medicaid reimbursements to inpatient mental health facilities that have more than 16 beds.
Many advocates say that 16-bed cap unnecessarily limits access to treatment, particularly for low-income patients who don't have private insurance.
"This is the single fastest way to increase treatment availability across the nation," the opioid commission wrote in its July report.
The White House spokesman would not elaborate on what its legal review entails and did not respond to questions about whether there was internal dissension about Trump's announcement on Aug. 10 that he would issue the declaration.
"We're going to make it a national emergency," Trump told reporters then. "It is a serious problem the likes of which we have never had."
Two days before Trump's remarks, his Health and Human Services secretary, Tom Price, said the administration did not need to make any such emergency order. A spokeswoman for HHS, asked about that previous opposition, pointed to a statement the secretary issued on Aug. 10 endorsing Trump's decision.
"Today's announcement demonstrates our sense of urgency to fight the scourge of addiction that is affecting all corners of this country," Price said in that statement.
In their letter, Brown and Markey ask the White House for specific details about the timeline for a declaration and which agencies are involved in the review process.
"Regardless of whether you chose to declare a state of emergency, continued inaction on this issue is deeply concerning," the Democrats said. They noted that Trump has not acted on any of the opioid commission's other recommendations either.
• Mandating physician education initiatives to ensure that health care providers do not over-prescribe opioids, a major driver of the epidemic.
• Increasing funding for medicated-assisted treatment, a highly effective regime to curb opioid addiction.
• Encouraging states to expand access to Naloxone and allow HHS to negotiate reduced prices for that life-saving opioid reversal medication.
Richard Baum, Trump's acting drug czar, said in an interview on Friday that the legal review had not hindered or slowed the administration's response to the epidemic.
"The way we in the administration are responding to this issue is as a crisis," Baum told USA TODAY. "We view it as an emergency."