Dear Director Redfield:
We write to express our concern that the public health departments of the large metropolitan areas we represent, including Los Angeles County, Chicago, Houston, New York City, and Philadelphia, were excluded from receiving additional funds to address the opioid epidemic, despite having been pre-approved for funding under a public health crisis funding mechanism. At a time when we are losing approximately 115 Americans each day to the epidemic, our public health departments must be able to access the resources they need to confront the crisis.
To ensure rapid disbursement of funds in a public health emergency, CDC issued a Notice of Funding Opportunity (NOFO) for "Cooperative Agreement for Emergency Response: Public Health Crisis Response" last fall. Under this mechanism, eligible jurisdictions could be pre-approved to receive funds in the event of a public health crisis. Our local health departments were eligible to apply for pre-approval, along with the 50 states, 8 territories, and Washington, DC. All jurisdictions, including our public health departments, were granted approval and were put on an "approved but unfunded" list until funding is available to address public health crises.
We approved additional funding for the CDC to fight the opioid epidemic and scale up prevention activities in the FY 2018 Consolidated Appropriations Act and Accompanying Report because we wanted states, territories, and the large cities and counties to be able to fight this epidemic most effectively. All approved jurisdictions under the Crisis NOFO mechanism, except our public health departments, are now eligible to receive a portion of this new funding. It is our understanding that there are no other forthcoming funding opportunities in FY 2018 under which our public health departments could receive these funds.
Together, we represent the metropolitan areas covered by five of the largest cities and counties in the country, all of which have been hard-hit by the opioid epidemic, which demands our continued attention and action. In 2016 alone, drug overdoses claimed the lives of more than 63,000 Americans. Nearly two-thirds of these deaths involved prescription or illicit opioids, with heroin and synthetic opioids like fentanyl and carfentanyl driving overdose deaths by illicit opioids.
Local public health authorities are on the front-lines of public health crises, and the opioid epidemic is no exception. With their deep knowledge of the diverse communities we serve and the health challenges they face, our public health departments are well-equipped to ensure funding is executed efficiently and directly to reach those most in need. In many cases, our metropolitan areas have gone above and beyond to incubate some of the most promising and effective responses to the epidemic. Los Angeles County distributed safe prescribing guidelines on the administration of pain medication in emergency departments and urgent care centers. Chicago created pharmaceutical representative licenses and Philadelphia made naloxone available in libraries. New York City created a new nonfatal overdose response system and will distribute 100,000 naloxone kits citywide annually. Our public health departments are creating and implementing best practices and saving lives. It was our intent, when our chamber approved an increase in appropriations to CDC to combat the opioid epidemic, that pre-approved jurisdictions, including these large urban public health departments, would be eligible to receive direct funding to fight the opioid crisis. Without direct funding for our public health departments, our cities and counties will be limited in their capacity to address the opioid epidemic and the health needs of our large and complex populations--when overdose deaths are still climbing.
We respectfully urge you to ensure that pre-approved, directly-funded urban public health departments are eligible to receive public health crisis funding under this and future public health crisis funding announcements.