On Wednesday, the House began considering the 21st Century Cures Act. It will, among other things, allocate $1 billion to help states “combat heroin and painkiller addiction and recovery.”

To explain support for the funding, Huffington Post reporters point out that heroin overdose rates doubled in 28 states between 2010 and 2012, according to the Centers for Disease Control and Prevention. A record-breaking 28,000 Americans died of opioid overdoses in 2014.

The truth is that many of those deaths are completely preventable and result not from painkillers, but from the war on drugs.

Most victims who overdose do so using heroin or other black market opioids. And the war on drugs has ensured that people continue to turn to these opioids by making them cheaper and easier to get than prescription painkillers.

Policymakers would be wise to make sure that states don’t use that $1 billion to make the problem worse.

Who’s taking opioids?

Marine corporal Craig Schroeder served in the “Triangle of Death” region, south of Baghdad. A makeshift-bomb explosion left him with traumatic brain injury. In addition to hearing and memory loss, he suffers from chronic pain from his broken foot and ankle and a herniated disc in his back.

A study in the Journal of the American Medical Association showed that half of all troops who return from Iraq and Afghanistan suffer from chronic pain.

It’s not just recent members of the military, either. Retired Army corporal Mike Davis fell from a Pershing missile during maneuvers in Germany in 1979, shattering his left arm from the elbow to the fingertips. He’s been on painkillers ever since.

In an unpublished paper, Dr. Harvey L. Rose told the story of a 28-year-old man with persistent pain in one leg due to a work accident. Lumbar disc surgery didn’t cure his pain, as is often the case. Rose also treated a 78-year-old woman who suffered from chronic back pain after surgery for degenerative cervical disk disease.

Chronic pain can result from accidents, failed surgery, degenerative conditions, or all of the above. It can hit anyone at any time.

Forcing users into the black market

Since the 1970s, the Drug Enforcement Administration has worked hard to make prescription painkillers difficult to obtain. It started with reporting requirements. Many doctors stopped prescribing painkillers to avoid having to order triplicate forms and turn them over to the government. Many others were afraid of having armed men arrest them for filling out forms incorrectly, as happened to Ronald Blum, associate director of New York University’s Kaplan Comprehensive Cancer Center.

The result was predictable. Psychiatrists Richard M. Marks and Edward J. Sachar reported widespread pain undertreatment in the February 1973 Annals of Internal Medicine.

As of 2015, the DEA also requires patients to see their doctor, in person, every month in order to get refills for hydrocodone-based medicine. So now, men and women who lost limbs serving in Iraq and Afghanistan have to fight to get appointments at overburdened VA health facilities located many miles from their homes just to treat their pain.

After the DEA rules change, Schroeder’s VA doctor couldn’t see him for nearly five months. Schroeder spent those months bedridden in crippling pain and opioid withdrawal. Another Iraq vet can’t drive due to shrapnel in his femur and pelvis. Getting his medications requires a monthly two-hour bus ride for “a one-minute consult.”

The black market solution

Going without painkillers isn’t an option for many people who need them. Chronic pain sufferers who can’t get their medication experience withdrawal symptoms that “feel like a panic attack and the flu at the same time,” according to the Washington Post.

Dr. Rose’s 28-year-old turned to alcohol and street drugs after his doctor prescribed an antidepressant instead of the strong painkiller he needed. Eventually he hanged himself in his garage. The 78-year-old woman Rose tried to kill herself four times–slashing her wrists, taking overdoses of Valium and heart medication, and getting into a bathtub with an electric mixer — after a series of physicians refused to prescribe an effective dose of painkillers.

In 2000, the age-adjusted drug overdose death rate was 6.2 per 100,000 persons. By 2014, it had more than doubled, to 14.7, according to the CDC. What happened?

Patients who couldn’t find legal opioids because of the DEA turned to heroin and other black market opioids. Patients who knew their dose of legal prescription opioid medication had to estimate the purity of the drugs they purchase illegally. Too often, they guessed wrong.

The CDC suspects that many, if not most, of the people who died of opioid overdoses in 2014 were taking black-market fentanyl.

When the CDC reports on opioid deaths, that includes street drugs like heroin and synthetic opioids. Toxicology tests used by coroners and medical examiners can’t distinguish black-market fentanyl and prescription fentanyl. But we do know that there was more of the illegally-manufactured, synthetic opioid-derived fentanyl available in 2014 than in previous years, according to law enforcement reports. This coincided with the 2014 jump in deaths from opioid overdoses.

In addition, we know that patients combine drugs when they can’t get enough painkiller. Combinations of opioids and drugs like alcohol make up 60% of deaths ruled opioid overdoses by the CDC.

Dependence isn’t addiction

Jacob Sullum pointed out that bureaucrats accept “dependence” on heart or cholesterol medicine. Nobody talks about being addicted to Lipitor. But are willing to make criminals of people who depend on certain types of painkillers.

This is nothing new. In 1973, Drs. Marks and Sachar looked at why patients were complaining about pain after doctors gave them medication. They found that, in “virtually every case.” doctors and nurses were under-prescribing pain medication. Further surveys of patients and doctors found “a general pattern of undertreatment of pain with narcotic analgesics, leading to widespread and significant distress.” The problem was, and is, that doctors don’t understand the difference between tolerance and physical dependence, causing “excessive and unrealistic concern about the danger of addiction.”

An article in a 1993 National Institute on Drug Abuse newsletter said narcotics “are rarely abused when used for medical purposes” and lamented that “thousands of patients suffer needlessly.”

“It’s just insulting to the veteran to assume they are abusing these drugs,” Linda Davis said of her husband Mike Davis. “I’m fully aware that people doctor-shop, some docs overprescribe. But I think they need to realize that there’s a real difference between addiction and dependence.” VA patients suffer nearly double the overdoses of the national average, according to a 2011 American Public Health Association study.

This moralizing and dearth of empathy fuels policies that spend tax dollars to “make our lives more difficult and painful,” Sullum wrote.

Will this money fund more of the same?

The Huffington Post reporters begin their story by noting that the pharmaceutical industry has spent billions of dollars over the last decade encouraging doctors to prescribe OxyContin and other opioids. True as that may be, that’s not the reason opioid pain reliever deaths are up.

The irony of blaming prescriptions of OxyContin for opioid deaths is twofold. First, underprescribing of painkillers is still widespread. Second, opioids are actually safer than most other pharmaceuticals. The most serious common side effect of long-term opioid use? Constipation.

The DEA’s efforts to keep chronic pain sufferers from accessing prescription painkillers is literally killing them, by forcing them into the black market to deal with their pain.

And yet no one seems to understand this connection. New Hampshire Senator Jeanne Shaheen supports the 21st Century Cures Act. “My goal has been trying to get funding to address the heroin and opioid epidemic,” Shaheen told Huffington Post. “And there is significant funding in this bill.” She also supports increasing federal funding “for all aspects of Drug War.”

Next week, the Senate will consider the 21st Century Cures Act. With bipartisan agreement and strong support from the Obama administration, it looks likely to pass. Let’s hope the Trump administration doesn’t fuel the overdose epidemic by ramping up the war on painkillers. As Psychiatrist Jerome H. Jaffe, Richard Nixon’s drug czar, put it, “No patient should ever wish for death because of his physician’s reluctance to use adequate amounts of potent narcotics.”