WASHINGTON (AP) — President Donald Trump has declared the opioid epidemic a national public health emergency and urged prosecutors to seek the death penalty against drug dealers. Congress has provided targeted grants for treatment, recovery and prevention and made numerous policy changes to help people struggling with addiction get access to services. From the National Institutes of Health to Veterans Affairs and the Agriculture Department, government agencies are deploying their own specialized skills. Still, the addiction crisis will not easily release its grip on the nation, even as progress is made providing resources and improving coordination.
Here's a look at the extent of the epidemic, and what the federal government has been doing.
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HOW MANY PEOPLE ARE DYING DUE TO OPIOID OVERDOSES?
Some 47,600 Americans died of opioid overdoses in 2017, according to federal numbers. That's more than die as a result of traffic crashes. Opioid deaths were 13 percent higher compared to 2016, up a notch in a 20-year onslaught. The street drug fentanyl — an extremely powerful opioid — is the top killer today, displacing heroin and pain pills. But prescription painkillers are still a problem, contributing to 14,495 deaths in 2017.
It's too early to say for sure, but experts are watching a potential indicator that opioid overdose deaths may be peaking. Month-to-month data reported to the Centers for Disease Control and Prevention have shown a leveling off in deaths, said Bob Anderson, a CDC senior statistician. However, those numbers are considered preliminary, because investigations have not been completed in all cases.
"We may start to see a decline," said Anderson. "This reminds me of what we saw with HIV in the '90s." Final numbers for 2018 won't be available until the end of this year, and things could also get worse, not better.
Although overdose deaths get the most attention, that's not the only way for users to die. People who inject drugs can get heart infections, HIV and hepatitis C. The risk of infection is higher than the chance of dying from an overdose.
Counting all fatal drug overdoses, not just opioids, the CDC puts the number at 70,237 for 2017.
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WHERE DO THESE DRUGS COME FROM?
Many people got started on the path to addiction with painkillers, prescribed by a doctor for treatment of injuries, post-surgical pain or a chronic condition — or purchased illegally from a dealer. Much of the heroin sold in the U.S. comes from Mexico, and the drug is more potent than in the 1970s, during a previous crisis. China is the major source of fentanyl, which is used as an additive in street drugs.
The multitude of opioid drugs, the increasing lethality of some and their varied routes to market make the crisis especially challenging. Some effective responses can be surprisingly simple: In a recently reported experiment, doctors were sent a letter from the medical examiner's office telling them of a patient's fatal overdose. They responded by prescribing fewer opioids.
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WHAT HAS THE U.S. GOVERNMENT DONE TO ADDRESS THE CRISIS?
Starting under former President Barack Obama, the government has been providing grants to states — to help treat people addicted to opioids and to prevent others from getting hooked. The expansion of the Medicaid health program under Obama's health care law has also played a role in financing treatment.
With the exception of Medicaid expansion — which Trump and the Republican Congress unsuccessfully tried to repeal — the federal response to the opioid crisis has been bipartisan.
Various federal agencies are bringing specialized expertise. CDC is closely tracking the epidemic's toll. NIH is researching pain management and ways to treat addiction. The Agriculture Department is focusing on opioid misuse in rural areas, where treatment resources are scarce. And Veterans Affairs maintains an opioid safety initiative dating to 2013 to help its doctors reduce unnecessary prescriptions.
On the enforcement side, drug, cybercrime and money laundering sleuths are targeting major suppliers. In the 1980s, cocaine from Colombia was smuggled via speedboats, and bales of marijuana were flown in on small planes, but now fentanyl from China can be marketed online and shipped by mail. The Food and Drug Administration is deploying more inspectors at international mail facilities to intercept packages of fentanyl.
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HOW MUCH MONEY IS THE GOVERNMENT DIRECTING TOWARD THE CRISIS?
It's difficult to get a complete and authoritative accounting, since spending is across many agencies and programs. That includes entitlements like Medicaid, that don't require annual funding approval from Congress, as well as dozens of other programs that do — in addition to specific grants. Experts say the government is spending billions of dollars, there's no doubt that's increasing, and it's still probably not enough.
In its last year in office, the Obama administration secured a commitment to expand treatment, and Congress reserved $1 billion for grants to states . Last year, Congress provided another $1 billion to states under a new grant program. The Trump administration recently awarded those grants. That comes on top of nearly $1.9 billion for the government's main drug treatment, recovery and prevention program, according to the National Association of State Alcohol and Drug Abuse Directors.
Additional funding is allocated across other agencies and programs. A study sponsored by the nonpartisan Robert Wood Johnson Foundation highlighted Medicaid's role. It found that the federal-state health program for low-income people covers more than 1 in 3 of those with opioid addiction. Even before Medicaid was expanded, researchers estimated it spent more than $9 billion in 2013 on care for low-income people addicted to opioids.
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