President Trump made sweeping new promises Thursday to mobilize the federal government against the deadly opioid epidemic, but his language contrasted sharply with an order that stopped well short of a major new commitment of resources for a crisis that last year killed more than 64,000 Americans.
Trump directed the U.S. Department of Health and Human Services to declare a limited 90-day public health emergency, but he declined to declare a broader national emergency or ask Congress to fund any expansion in treatment or insurance coverage for Americans struggling with addiction.
Senior administration officials say they hope Congress will provide more money in a spending bill later this year, but officials would not say how much the White House will seek.
Speaking at the White House on Thursday, surrounded by the families of Americans touched by the epidemic, Trump insisted he is committed to an unprecedented new effort to take on the spread of opiates, including heroin, prescription painkillers and dangerous synthetic drugs such as fentanyl.
"We cannot allow this to continue. It is time to liberate our communities from this scourge of drug addiction," the president said in a lengthy address. "We can be the generation that ends the opioid epidemic."
Trump, who campaigned extensively on the issue last year, has been under pressure for months to step up the federal government's response. He has been promising since the summer that he would declare an emergency, a technical step that can free up funds and loosen some regulations.
The new order will allow some limited new steps, such as enabling patients in rural parts of the country to access medication for addiction treatment through telemedicine, administration officials said.
The order also should allow federal agencies to redirect some existing grant money to focus on opioid-addicted patients.
And it may make it easier for state Medicaid programs to pay for inpatient treatment for people with substance-abuse disorders, a practice that was restricted decades ago amid widely publicized abuses at many institutions.
But many public health officials have been urging White House to take more aggressive steps in response to an epidemic that is killing more people than AIDS did at the height of that crisis.
Despite rising public alarm about the epidemic, the unmet need for treatment remains enormous, with just 1 in 10 addicted Americans getting specialty treatment, according to the U.S. surgeon general.
Although Congress appropriated some additional money last year, most state leaders, public health officials and addiction specialists say much more is needed.
"We certainly agree that it is a health emergency, and anything that highlights the problem is helpful," said Dr. Joe Parks, medical director at the National Council for Behavioral Health. "If we want to take care of this epidemic, we need more health insurance coverage, not less."
The administration still doesn't have a permanent Health and Human Services secretary or a director of the Drug Enforcement Administration, and Trump's pick for drug czar, Rep. Tom Marino (R-Pa.), recently withdrew his nomination.
At the same time, the Trump administration has worked for most of the year to roll back the Affordable Care Act, which has helped many states on the front line of the epidemic expand treatment for patients with a substance abuse disorder.
Republican plans to repeal the 2010 law, often called Obamacare, would have cut hundreds of billions of dollars of federal healthcare aid to these states and others.
The president stressed Thursday that the Trump administration has already taken steps to bolster the federal response to the opioid crisis.
Trump also ticked off other efforts his administration is taking, including prosecuting drug traffickers, educating physicians about how to safely prescribe opioids and supporting research into nonaddictive pain medicines.
This week, Food and Drug Administration Commissioner Scott Gottlieb said his agency plans to encourage wider use of medications such as methadone and buprenorphine to treat patients with opioid addiction, a step widely seen as critical to addressing the crisis.
These so-called medication-assisted treatments continue to be stigmatized in many places.
Those efforts — and some of the new steps announced by the president Thursday — could be helpful, said Dr. Corey Waller, an addiction specialist who has led efforts to confront the epidemic for the American Society of Addiction Medicine. Waller said he was particularly encouraged by Trump's emphasis on prevention.
But it remains unclear what impact Trump's new order will have on the crisis.
And even as the president expressed a commitment to more steps, his administration has pushed unprecedented cuts in federal aid to states for their Medicaid programs. Medicaid has emerged as one of the most important tools in combating the crisis.
The government healthcare safety net, which was expanded through the 2010 healthcare law, allows states to get patients on medications to combat addiction, such as methadone and bupremorphine, and provide additional services.
Medicaid, which insures some 70 million low-income Americans, historically covered primarily poor children, pregnant mothers and the low-income elderly.
But in recent years, funding made available through the Affordable Care Act has allowed states including Ohio, West Virginia and Kentucky to open Medicaid to poor, working-age adults, a population traditionally not eligible for coverage but often most likely to face substance abuse issues.
In Ohio, for example, more than a third of the approximately 700,000 people who enrolled in Medicaid after the expansion began in 2014 reported some drug or alcohol dependence, according to a recent study by the state.
The vast majority did not previously have health insurance.
1:35 p.m.: This article was updated with additional reaction.
12 p.m.: This article was updated after Trump's speech.