After years of inaction, Congress finally put serious money toward fighting the opioid epidemic

After years of a crisis that has killed tens of thousands of Americans annually since 2010, Congress has finally put some serious funding toward addressing the opioid painkiller and heroin epidemic.

The money is included in the 21st Century Cures Act. The act mostly focuses — in a very controversial way, as Julia Belluz explained for Vox — on speeding up the drug approval process and other medical issues. But it also includes $1 billion for combating the opioid epidemic.

Here’s what the law will do in regard to opioids:

The money isn’t as expansive as some would like. Hillary Clinton’s plan for dealing with drug abuse, for instance, called for $10 billion over 10 years. But her plan also dealt with other drugs, not just opioids, to prepare for the next major drug crisis, whatever it may be — something the Cures Act’s funding won’t be able to do, given its limited focus on opioids over just two years.

Still, it’s at least notable that Congress is finally putting some serious money to fight the opioid epidemic. Earlier this year, federal lawmakers passed a bill to fight the opioid epidemic, but they didn’t initially attach the funding necessary to the law to actually commit to the fight. This time, they’re putting some actual dollars toward one of the worst public health crises in decades.

In 2014, more Americans died of drug overdoses than any other year on record — more than 47,000 deaths in just one year. That’s higher than the nearly 34,000 who died in car crashes, the almost 34,000 who died from gun violence, and the more than 43,000 who died due to HIV/AIDS during that epidemic’s peak in 1995.

This latest drug epidemic, however, is not mainly about illegal drugs. It began with a legal one.

Back in the 1990s, doctors were persuaded to treat pain as a serious medical issue. There’s a good reason for that: About one in three Americans suffer from chronic pain, according to a 2011 report from the Institute of Medicine.

Pharmaceutical companies took advantage of this concern. Through a big marketing campaign, they got doctors to prescribe products like OxyContin and Percocet in droves — even though the evidence for opioids treating long-term, chronic pain is fairly weak, despite their effectiveness for acute, short-term pain. Painkillers proliferated, landing in the hands not just of patients but also teens rummaging through their parents’ medicine cabinets, other family members and friends of patients, and the black market.

In 2014, nearly 19,000 Americans died from overdoses linked to opioid painkillers — sometimes opioids alone, other times involving drugs like alcohol and benzodiazepines (typically prescribed to relieve anxiety).

Seeing the rise in opioid abuse and deaths, officials began to crack down on prescriptions for painkillers. Law enforcement, for instance, threatened doctors with incarceration and the loss of their medical licenses if they prescribed the drugs unscrupulously.

Ideally, doctors should still be able to get painkillers to the patients who truly need them — after, for example, evaluating whether the patient has a history of drug abuse. But doctors who weren’t conducting even such basic checks are now being told to give more thought to their prescriptions.

Yet many people who lost access to painkillers were still addicted. So some who could no longer access prescribed painkillers — or perhaps could no longer afford them — turned to cheaper, more potent opioids: heroin and fentanyl.

Not all painkiller users went this way, and not all heroin users started with painkillers. But statistics suggest many did: A 2014 study in JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 analysis by the Centers for Disease Control and Prevention found that people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.

So heroin abuse and overdoses rose: In 2014, more than 10,000 deaths in the US were linked to heroin. And in several states, deaths related to fentanyl are also on the rise.

That doesn’t mean cracking down on painkillers was a mistake. It appeared to slow the rising number of painkiller deaths, and may have prevented doctors from prescribing the drugs to new generations of potential addicts.

But the likely solution is to get opioid users into treatment. According to 2014 federal data, at least 89 percent of people who met the definition for a drug abuse disorder didn’t get treatment. Patients with drug abuse disorders also often complain of weeks- or months-long waiting periods for care.

So federal and state officials have pushed for more treatment funding, including medication-assisted treatment like methadone and Suboxone.

Some states, like Louisiana and Indiana, have taken a “tough on crime” approach that focuses on incarcerating drug traffickers. But the incarceration approach has been around for decades — and it hasn’t stopped massive drug epidemics like the current opioid crisis.