ON TUESDAY February 28th, in an address to a joint session of Congress, Donald Trump vowed to end America’s “terrible drug epidemic”. When discussing America’s social ills, Mr Trump has a tendency to exaggerate. But on the subject of drugs, the president’s characteristically dark and apocalyptic tone may well have been warranted.

In 2015 more than 52,000 Americans died of drug overdoses, according to the Centres for Disease Control and Prevention. That is an average of one death every ten minutes. Approximately 33,000 of these fatal overdoses—nearly two-thirds of them—were from opioids, including prescription painkillers and heroin. Although the absolute death toll from opioids is greatest in big cities like Chicago and Baltimore, the devastation is most concentrated in rural Appalachia, New England and the Midwest (see map). Many of the victims hail from white middle-class suburbs and rural towns.

The opioid epidemic has its roots in the explosive growth of prescription painkillers. Between 1991 and 2011, the number of opioid prescriptions (selling under brand names like Vicodin, Oxycontin, and Percocet) supplied by American retail pharmacies increased from 76m to 219m. As the number of pain pills being doled out by doctors increased, so did their potency. In 2002 one in six users took a pill more powerful than morphine. By 2012 it was one in three.