Why are more Americans than ever dying from drug overdoses? Deaths from drug overdoses in the US reached staggering new heights in 2017, according to newly published figures. Trump called the crisis a “national shame and human tragedy” – but what is fuelling it?

The growing drugs crisis sweeping across the US is deadlier than gun violence, car crashes or Aids, none of which have killed as many Americans in a single year as overdoses did in 2017.

Newly confirmed figures released by the Centers for Disease Control and Prevention (CDC) show the increasing scale of the crisis.

The drugs epidemic is not confined to a small number of states nor to lower-income areas, but instead has spread across the whole country. While there are concentrations around the midwest, and regional differences in the type of substance, overdose deaths are happening everywhere.

Major cities and rural areas are now in the grip of the crisis

One factor fuelling the problem is that illegal narcotics are more readily available than ever, as drug distribution networks have expanded to rural and suburban areas.

But there are other elements at work. Part of the reason illicit drug traders are able to proliferate so widely across the midwest and other regions is to do with the market there. These areas are home to thousands of people who first developed an addiction to prescription pills.

Roots of the crisis

The US medical sector has historically been a leading consumer of opioids – substances that produce morphine-like effects. In the 1990s opioid-based painkillers became a common remedy for a variety of conditions, such as back pain and arthritis.

Pharmaceutical companies aggressively lobbied doctors to prescribe new formulations such as OxyContin, which they claimed could provide effective pain relief with no real addiction risk even to long-term patients.

The US medical sector ranks second in the world for opioid use

Opioid consumption in the medical retail sector per year and per capita, in morphine equivalents

As a result, medical opioid consumption more than tripled, soaring far beyond levels seen in other countries. Today, the US medical sector ranks second in the world for opioid use behind only Canada, which is struggling with its own overdose crisis.

Frontline services battling the epidemic identify prescription opioids as a key factor underpinning the crisis.

Tiffany Lombardo, Director of Addiction Services at a local mental health board in Butler County, Ohio, says: “There was high access in terms of doctors prescribing opiates and us as a society not having a clear picture of what the impact of that would be long term.”

Across the state border in Pennsylvania, Tim Phillips, who heads a drug overdose task force, also suggests availability has been a key driver: “A lot of it has been diversion from folks who were just selling a surplus, overprescribing, the pharmaceuticals, things like that.”

Why does it keep getting worse?

The crisis has sent federal and local officials scrambling for ways to prevent and treat addiction, and punish those responsible.

States have since filed a ream of lawsuits against opioid makers such as Purdue Pharma, which makes the powerful drug OxyContin. Members of the family that owns Purdue are under criminal investigation.

The drug was reformulated in 2010 to make it more difficult to abuse, and in 2016 the CDC issued guidelines encouraging doctors to restrict the prescription of opioids. After years of increasing, opioid prescriptions have been on the decline.

But efforts to rein in the abuse of prescription drugs have had a limited effect because users have turned to cheap, readily available and dangerous street drugs such as heroin and fentanyl. Overdose deaths from prescription opioids decreased slightly in 2012, but deaths from heroin and synthetic opioids have soared.

Recent research led by Dr Hawre Jalal has brought these shifting dynamics into the spotlight.

While overall mortality rates have trended upwards, specific substances have surged at different times

What is being done?

Donald Trump declared opioid addiction a national emergency in 2017; a year later he signed a bill to promote the development of non-addictive pain medications.

While some local services express gratitude for the federal resources, there is also a call for a greater emphasis on the broader issues of addiction.

“We appreciate the money and the focus on the opioid epidemic but you can’t silo substance abuse. You’ve got to see what the trends are, it’s got to evolve with you, and the state and federal funds sometimes fall behind the actual epidemic as it evolves,” says Scott Rasmus, executive director at the Butler County mental health board.

Meanwhile, overdose outreach teams in the county continue to venture into the streets to stem the crisis. Lombardo, who coordinates the addiction recovery services, wants to reach people with a clear message: “Listen, we’re a community that cares and we want make sure that people get the help they need so they don't end up as a statistic."