The opioid crisis is different from other public-health crises in one important way: Unlike the epidemic of cocaine use that ravaged low-income communities in the 1980s, the epidemic of opioid abuse is a symptom of forces that “have reshape the economy” in the past decade, as Governing.com explains.

“That makes the current crisis different from previous drug epidemics involving methamphetamines or crack cocaine. And it’s why some health experts say that cities and states need to reframe the whole way they think about the opioid outbreak.

It’s not simply about the rise of a new class of addictive drugs that now take the lives of some 91 Americans every day. The opioid crisis is a jobs crisis; it’s an affordable housing crisis. The same forces that have reshaped the economy over the past decade have left a void that’s been filled, in many places, by opioids.”

Indeed, the opioid crisis has continued to worsen, despite – and in one important way, because of – the federal government’s efforts to curb the rising death toll. According to preliminary data, more than 60,000 Americans died of drug overdoses in 2017, an-all time high, and a 50% increase since 2011. A federal crackdown on addictive painkillers, meant to “solve” prescription-painkiller abuse, only made the problem worse by forcing addicts to switch to heroin, a cheaper and more powerful alternative.

The migration of users toward heroin coincided with the introduction of powerful opioid analogues like fentanyl and carfentanil into the American heroin supply, causing the number of overdose deaths to skyrocket.

The rash of deaths has forced some of the hardest-hit US states to consider tactics that would’ve been politically unfeasible a year or two ago. Needle exchanges, once found in only a handful of cities like New York, have proliferated, with more than 198 now operating across the country.

“Other leaders are also exploring approaches that seemed politically unthinkable just a short time ago, including safe injection sites, where addicts can shoot up heroin under the supervision of a health-care professional and without fear of being arrested. The idea is to prevent people from overdosing while also offering them information about treatment. Vancouver, British Columbia, established a site in 2003 and has prevented nearly 5,000 overdoses since then, according to the clinic’s website. For years, the notion of setting up a sanctioned safe injection facility in the U.S. was a nonstarter. But now, Seattle lawmakers have approved a site that they hope to start building on soon. The idea is also being considered by leaders in Boston and San Francisco, where Mayor Ed Lee only recently dropped his opposition to them. “I had to kind of force myself to be open to the idea, he told a reporter in January, ‘because it doesn’t come as a natural thing.’”

This local pattern of liberalization in the public approach to treating opioid dependency is at odds with a more conservative approach favored by Attorney General Jeff Sessions. And it’s causing local leaders to reconsider whether methods like needle exchanges and safe injection sites, which have proven to lower the incidence of opioid overdoses, are worth pursuing.

“The future of such facilities, however, could be shaped by the federal government. Attorney General Jeff Sessions hasn’t commented on safe injection clinics specifically, but he has signaled a tough-on-drugs approach that would presumably not include such facilities. Leana Wen, Baltimore’s health commissioner, recently said that Sessions’ stance has given her pause on whether a safe injection site is even worth pursuing. She’s asked the federal government how it would respond if the city were to establish safe injection sites, but said she hasn’t heard back. “I’m not one to shy away from a fight,” she said, “but we need further guidance from the feds if we’re going to proceed with this.”

To try and reduce the rising number of overdoses, states have begun distributing naloxone to first responders and police. The drug, which typically comes in the form of a nasal spray or intramuscular injection, reverses the effects of opioid overdose, and has been credited with saving thousands of lives. But critics say the policy is a band-aid that won’t help reduce the number of addicts.

“Naloxone can reverse overdoses in an emergency, but it doesn’t reduce addiction rates. Prescription databases prevent people from doctor-shopping for more pills, but those users often just start buying their drugs illegally. Limiting the supply of prescription opioids like Oxycontin has only led to a surge in fentanyl, an opioid that’s 50 times stronger than heroin and 100 times more potent than morphine.”

Ultimately, working to alleviate the opioid crisis by any means necessary should be a top priority for the Trump administration, considering that many of the counties with the highest number of deaths from despair – defined as suicides, drug overdoses and alcohol poisoning – went for Trump in the election.

“The opioid crisis is a jobs crisis; it’s an affordable housing crisis. The same forces that have reshaped the economy over the past decade have left a void that’s been filled, in many places, by opioids. A University of Pennsylvania study after last November’s election found that President Trump had overperformed in counties with the highest rates of “deaths of despair,” which include suicide, drug overdose and alcohol poisoning. It supports the fact that there are many Americans who feel left behind by the changing economy, and who fundamentally don’t believe the current political and policy framework is helping them.”

The resistance of Pence, Sessions and others within the Trump administration is an obvious obstacle to widespread adoption of “harm reduction” treatment methods. But as time passes, and the death toll from opioids continues to climb, ideas that once seemed radical might become more mainstream. The only question is how many more will die in the meantime?