Illustration by Golden Cosmos

In September, 2016, Donald Trump delivered a speech at the Economic Club of New York. “Today, I’m going to outline a plan for American economic revival,” he said. “It is a bold, ambitious, forward-looking plan to massively increase jobs, wages, incomes, and opportunities for the people of our country.” He went on to talk about lowering taxes and removing regulations, renegotiating trade deals and building a border wall. But he overlooked one of the most pressing issues facing the American economy today: the opioid crisis.

Politicians tend to talk about the crisis in moral terms, focussing on the ways in which opioid addiction has ravaged families and communities. The New Jersey governor, Chris Christie, whom Trump appointed to lead a commission to study the issue, has compared opioid-overdose fatalities to terrorist attacks, saying, “We have a 9/11-scale loss every three weeks.” Opioids, which include prescription painkillers and drugs like heroin and fentanyl, are indeed responsible for large-scale human suffering. According to the National Survey of Drug Use and Health, 97.5 million Americans used, or misused, prescription pain pills in 2015. Drug-overdose deaths have tripled since 2000, and opioid abuse now kills more than a hundred Americans a day. But often omitted from the conversation about the epidemic is the fact that it is also inflicting harm on the American economy, and on a scale not seen in any previous drug crisis.

In July, when economists at Goldman Sachs analyzed how the 2008 financial crisis and its aftermath may have contributed to levels of opioid addiction, they noted that fewer prime working-age men are participating in the labor force than in the past, and that many of these men have been found to be taking prescription pain medication. Research by the Princeton economist Alan Krueger, published last week, indicates a definitive link between the two.

Other studies have tried to put an exact figure on the cost of the epidemic. A study published in the journal Pain Medicine in 2011 estimated that health-care costs related to prescription opioid abuse amounted to twenty-five billion dollars, and criminal-justice-system costs to $5.1 billion. But the largest cost was to the workplace, which accounted for $25.6 billion, in the form of lost earnings and employment. “There are major consequences to the economy, not just to the employer and employee who are losing productivity but also to civil society,” Howard Birnbaum, a health-care economist with the Analysis Group and one of the authors of the study, told me recently. “If people don’t have jobs, they don’t have money to spend in the grocery store, on gasoline. It’s the old multiplier effect: the socioeconomic burden is much broader than on any individual or any firm.” The study estimated a total cost to the economy of $55.7 billion, but, Birnbaum said, “I suspect it is even larger now.”Another study, just two years later, reached a total of $78.5 billion.

When I spoke with Anupam Jena, a health economist and physician at Harvard Medical School, he argued that such figures don’t include the most dramatic cost: the economic value of the loss of life. Taking a conservative estimate of twenty to thirty thousand opioid-related deaths a year and multiplying those numbers by five million dollars—a figure commonly used by insurance companies to value a human life—Jena estimated that loss of life alone costs the economy an additional sum of between a hundred and a hundred and fifty billion dollars a year. All these figures suggest that addiction prevention and treatment should be a part of any serious policy discussion about how to strengthen the U.S. economy.

Trump has an obvious incentive to address the crisis, since it disproportionately affects the rural white population that makes up much of his voter base. Earlier this year, he took some promising steps. In March, pledging to combat the epidemic, he signed an executive order creating the commission led by Christie. In late July, the commission released an interim report urging Trump to declare the opioid epidemic a national emergency, a designation usually reserved for natural disasters, like the flooding in Houston, or infectious-disease outbreaks, like Zika. Trump initially made rambling comments suggesting that he would heed the advice, but he has yet to follow through with an official declaration and the concomitant resources. There have been other discouraging signs, such as Trump’s proposed health-care-reform bill, which promised large cuts to programs providing drug treatment, and the fact that certain key health-care-policy positions have yet to be filled. (Dr. Jerome M. Adams was sworn in as Surgeon General only last week.)

If Trump were running the U.S. government like a business, as he often claims to be doing, then he would have made tackling an inefficiency of such scale a priority. “The number of people who lose their lives from prescription opioids is larger than the number who’ve lost lives to motor-vehicle accidents,” Jena told me. “Think of all the things that we do to make sure people don’t die from motor-vehicle accidents. We have air bags, speed limits, cops giving out tickets for speed violations. There are a lot of things we do to reduce deaths from motor vehicles. The deaths coming from prescription opioids is exceeding that now.” ♦