States have since cracked down on prescription opioid abuse, creating drug-monitoring programmes and arresting unscrupulous doctors. Pharmaceutical companies have reformulated their drugs to make them less prone to abuse. Unfortunately, as the supply of painkillers has dropped, many addicts have turned instead to heroin (see chart), which is cheap and plentiful. In 2014 more Americans sought treatment for heroin than for any other drug. In 2015, as total opioid deaths grew by 15%, heroin deaths increased by 23%.
To stem the tide of deadly overdoses, states rely increasingly on naloxone, a drug that reverses heroin’s effect on the brain and jump-starts breathing in addicts who have overdosed. First approved by the Food and Drug Administration in 1971, naloxone has been used by doctors and paramedics for decades. In recent years, states struggling with a surge in overdose deaths have passed laws making the drug available to police officers, firefighters and addicts’ friends and family. A recent working paper suggests that such laws—which are now on the books in 45 states and in Washington, DC—reduce opioid-related deaths by 9-11%.
That is still not enough. Data released in recent months show that the opioid epidemic is worsening, driven largely by the rise of fentanyl, a synthetic opioid painkiller 50-100 times more powerful than morphine. In 2016 fatal overdoses increased by 26% in Connecticut, 35% in Delaware, and 39% in Maine. During the first three quarters of 2016, deadly overdoses in Maryland jumped by a whopping 62%, prompting the state’s governor to declare an official state of emergency. Mr Trump’s promise to end the scourge of opioid abuse in America is looking more challenging by the day.