Donald S. Burke, a physician, is dean of the University of Pittsburgh Graduate School of Public Health.

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As an epidemiologist, I’m exasperated. Facing a raging epidemic — of drug addiction and overdose deaths — we dither. Even an ounce of prevention would look good at this point.

This epidemic of drug overdoses has been growing at an exponential rate for at least four decades. Counts of overdose deaths in the United States have increased relentlessly, doubling every eight years.

Deaths are mounting at an accelerating pace: two-fold, then four-, eight, 16- and 32-fold over the past 40 years. But it is the preternatural predictability of the epidemic growth pattern that is most worrisome.

U.S. overdose deaths, 1979-2015

Source: Mortality Information and Research Analytics (MOIRA) system, Pitt Public Health | Graphic: James Hilston/Post-Gazette

As drugs come and go — cocaine, prescription drugs, heroin, fentanyl — the curve goes up. As law enforcement and treatments change, the curve goes up. As the epidemic demographics evolve from urban to rural, black to white, male to female, the curve goes up. There is no end in sight to this inexorable upward trajectory. We are on track for another 300,000 overdose deaths in the next five years. The growth curve of overdose deaths here in Allegheny County is also inexorable and exponential.

Allegheny County overdose deaths, 1979-2015

Source: Mortality Information and Research Analytics (MOIRA) system, Pitt Public Health | Graphic: James Hilston/Post-Gazette

Across the nation, the public is keenly aware of the toll — and the pathos — of the epidemic: In Ohio, parents were found passed out in the front seat of their car with toddlers crying in the back seat; in Pennsylvania, a young couple overdosed, leaving their abandoned baby to starve to death; in Virginia, a prom princess was found dead.

Year after year, the same front-page story reports that this year (again) death counts were higher than last year. By now, everyone seems to know someone who OD’d. Governors in five states have taken the extraordinary step to declare the epidemic a public emergency.

Overdose death rates, Allegheny County and U.S. Per 100,000 population, 1979-2015

Source: Mortality Information and Research Analytics (MOIRA) system, Pitt Public Health | Graphic: James Hilston/Post-Gazette

The financial consequences are staggering. According to an analysis by the Centers for Disease Control and Prevention, in 2013 the opioid epidemic in the United States cost $78 billion, including lost productivity, crime and law enforcement, prevention and treatment, and other costs. One quarter of these costs were born by the public sector.

No up-to-date estimates are available for 2017, but if the growth of the financial burden has paralleled the growth of the death burden, then the costs now probably exceed $100 billion per year, with a plausible forecast of another half-trillion dollars over the next five years.

Based on the federal funding response, though, you would never know we are in a crisis. Let’s follow the money.

Three key federal agencies are responsible for control of drug addiction: the National Institute of Drug Abuse of the National Institutes of Health, the Substance Abuse and Mental Health Agency within the Department of Health and Human Services and the Drug Enforcement Agency within the Department of Justice. Over the past decade, as the opioid epidemic has exploded, federal funding for these three front-line agencies not only has failed to keep pace with the epidemic curve, it has failed to keep pace with inflation! Today we are investing less in addiction research than we were a decade ago.

As with the government, philanthropic foundations also have been slow in taking on the epidemic. For a decade now, there has been no new funding for research on ways to treat, measure, prevent or cure addiction. Not only have we lost the War on Drugs, we have surrendered.

Why has the response been so feeble?

A benign view is that, like the proverbial frog that never jumps out of a gradually heated pot, the average yearly increase of overdose deaths of 9 percent never provided quite enough of a societal jolt to evoke a serious response. A more cynical view is that, because this was an epidemic confined to “junkies” it never merited a response from all the “good people.” Another explanation is that the nonexistent opioid epidemic response was just another casualty in the intractable Washington budgetary gridlock.

Regardless of the reasons, the failure to respond has been politically bipartisan; declining budgets for responding to opioid addiction stretch back across both Republican and Democratic administrations. True, in this past year, modest funds were made available to reduce over-prescribing by physicians and to expand treatment programs for persons with substance-use disorders. These are welcome signs of a long-overdue response.

One school of thought claims that we already know everything we need to know to control the epidemic, that all we need to do is expand what we are already doing. More naloxone to resuscitate overdoses, more medication-assisted treatment, more behavioral therapy, more needle exchange and harm-reduction programs, and more public education.

While no one disputes the value of these interventions in saving lives, it is far from clear that conventional interventions will be enough to reverse this unconventional epidemic. Indeed, the inexorable exponential growth pattern suggests that, in addition to these standard methods, creative new approaches will be necessary,

To bend the epidemic curve downward, we will need new ideas, new data and new research. And we will need a new a generation of addiction experts, mental health specialists and behavioral epidemiologists.

We could gamble that traditional methods alone will be sufficient. But with new investments in training and research, it should be possible to find better — and more cost effective — ways to quell the spread of opioid use among youth, to discover new non-addictive ways to relieve pain and to develop more effective treatments for persons with substance-use disorders.

An immediate doubling of the neglected budgets of the agencies on the front lines of the opioid epidemic would be a good start: increasing the 2018 budgets for NIDA (from $1.1 to $2.2 billion), for SAMHSA (from $3.6 to $7.2 billion) and for the DEA (from $2.1 billion to $4.2 billion). These would be sensible and relatively modest investments in the face of an impending 300,000 deaths and a half-trillion dollar societal price tag.

Let’s hope it’s not too late.

First Published: October 22, 2017, 4:00 a.m.