The opioid epidemic began in the 1990s, when doctors became increasingly aware of the burdens of chronic pain. Pharmaceutical companies saw an opportunity, and pushed doctors — with misleading marketing about the safety and efficacy of the drugs — to prescribe opioids to treat all sorts of pain. Doctors, many exhausted by dealing with difficult-to-treat pain patients, complied — in some states, writing enough prescriptions to fill a bottle of pills for each resident. The drugs proliferated, landing in the hands of not just patients but also teens rummaging through their parents' medicine cabinets, other family members, friends of patients, and the black market.
Eventually, many opioid users progressed to heroin and the synthetic opioid fentanyl. Not all painkiller users went this way, and not all opioid users started with painkillers. But statistics suggest many did: A 2014 study in JAMA Psychiatry found 75 percent of heroin users in treatment started with painkillers, and a 2015 analysis by the CDC found people who are addicted to painkillers are 40 times more likely to be addicted to heroin.
As a result, a lot of people are dying: In 2015, more than 52,000 people died of drug overdoses, about two-thirds of which were linked to opioids. And in 2016, 59,000 to 65,000 are believed to have died of drug overdoses, according to an early analysis by the New York Times. These are the highest death tolls from overdoses recorded in any single year in US history.
This is a result of essentially two simultaneous crises — which Keith Humphreys, a Stanford University drug policy expert, explained as the dual problems of "stock" and "flow." On one hand, you have the current stock of opioid users who are addicted; the people in this population need treatment or they will simply find other, potentially deadlier opioids to use if they lose access to painkillers. On the other hand, you have to stop new generations of potential drug users from accessing and misusing opioids.
A full solution to the opioid crisis would address both problems. And it would require a big public investment, which experts say could total in the tens of billions of dollars a year. (For reference, a 2016 study estimated the total economic burden of prescription opioid overdose, misuse, and addiction at $78.5 billion in 2013.)
As I noted in my explainer about how to stop the opioid epidemic, we have a pretty good idea of what these resources would go to: They could be used to boost access to treatment, pull back lax access to opioid painkillers while keeping them accessible to patients who truly need them, and adopt harm reduction policies that mitigate the damage caused by opioids and other drugs. (More details in the full explainer.)
Yet Trump and Congress haven't taken much action. The only notable bill Congress has passed is the 21st Century Cures Act, which was signed into law last year by President Barack Obama and added $1 billion over two years for drug addiction treatment.
Since Trump took office, however, the federal government has actually worked against some of the solutions to the crisis. Trump's budget proposal would do little to nothing to boost prevention or access to addiction treatment. Congress, with Trump's support, has worked (unsuccessfully — for now) to repeal Obamacare and, as a result, reduce access to insurance that can pay for treatment.
Instead, Trump has talked up the role of the border wall and law enforcement — neither of which would have a significant effect on the opioid crisis, according to experts.
"We're also working with law enforcement officers to protect innocent citizens from drug dealers that poison our communities. Strong law enforcement is absolutely vital to having a drug-free society," Trump said on Tuesday. "We're also very, very tough on the southern border, where much of this comes in. And we're talking to China, where certain forms of man-made drug comes in, and it is bad."
This has left public health advocates and experts hoping for anything to address the crisis. So even if a national emergency declaration may not amount to much, it would at least be something to address the deadliest drug overdose crisis in US history.
"The big question I haven't seen answered is if the opioid crisis isn't an emergency, I'd like to hear a little more about what's the definition of an emergency," said Butler of Alaska, who's also president of the Association of State and Territorial Health Officials. "I recognize that people will say that this is a problem that has evolved over 20 years, but I don't think that changes the fact we're in a situation that requires an unusual, more enhanced response right now."
For more on the solutions to the opioid epidemic, read Vox's explainer.