The United States faces a daunting opioid epidemic that the Trump administration declared a public health emergency (PHE) on October 26, 2017, now extended through April 24, 2018. There is some justification for declaring a PHE, or an urgent situation requiring immediate action to avoid serious harm.¹ Nevertheless, the federal government appears to be largely conducting business as usual, neglecting to implement emergency actions to supplement the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act, both enacted in 2016, which have longer-term goals. A recent Congressional infusion of $6 billion across 2 years can begin to triage opioid emergencies if the funds are allocated toward these purposes. However, the epidemic, whose burden cost the United States $115 billion in 2017 and is projected to cost $200 billion by 2020, requires much greater funds, quickly.² The failure to act urgently threatens to delegitimize PHE powers¹ and foregoes the opportunity to address acute opioid-induced harms.