Pittsburgh, PA—Salvatore Lamendola has been a priest since the early 1990s. But in the last six months, he has presided over more funerals than in his past ten years. The opioid epidemic is ravaging his community.

“It’s something you don’t like to think about because they’re very difficult and painful experiences,” Lamendola told The Daily Beast last Saturday morning. “As a church, we have to be there for everybody in good times and in bad. Unfortunately, these were painful times for everybody. But you have to embrace it and try to bring some type of spiritual comfort or healing to the bereaved and families who have lost, usually young people, to opioids.”

Lamendola, 61-years-old with oval glasses and a speckling of gray in a short-cropped beard, was assigned to Derry Township in Westmoreland County, Pennsylvania, in early July last year. Originally a native of Long Island, Lamendola still has remnants of a New York accent, a kind of anomaly in the area. He presides over two congregations, St. Martin Parish and St. Joseph Parish, that are just two miles apart. They are respectively made up of 450 families and 250 families. So when there is a tragedy, the “social fabric”—as Lamendola put it—is torn a bit.

And there have been tragedies. According to data from the Westmoreland County coroner’s office, there were 174 reported overdose deaths in 2016 just in that small southwestern swath of the state. That number, according to current figures, jumped to 190 in 2017.

In Pennsylvania overall, the crisis is even more severe. The state was fourth in the nation in terms of the most drug overdose deaths in 2016, according to the Centers for Disease Control and Prevention. There were an estimated 4,627 deaths in 2016 across the state and that number is only expected to rise for 2017. That is a staggering 37.9 deaths per every 100,000 residents of the state.

The opioid crisis is so rampant in Lamendola’s community that Bishop Edward C. Malesic, who presides over the Diocese of Greensburg, of which Lamendola’s congregations are a part, gave out the book “Dreamland,” which chronicles the country’s problems with opioids, as a Christmas gift to all the priests.

Everyone is deeply aware of the problem too, even if they’re not directly affected by it.

“We’re from a rural area, you don’t see suboxone clinic signs where we live,” Bill Burkholder, a 63-year-old veteran from Somerset, Pennsylvania, told The Daily Beast last Friday. “There aren’t any. But then you drive more towards Pittsburgh and the signs are everywhere.” The government’s response, Burkholder added, is “putting a band-aid on it instead of the fixing the problem.”

Burkholder’s main gripe is with the governor’s office. But the Trump administration, despite its frequent promises to address the country’s ongoing opioid epidemic, hasn’t done much either. A year into this administration, the president has declared a public health emergency in response to the epidemic and appointed his top adviser Kellyanne Conway to lead an “opioids cabinet,” But that cabinet’s work could only be described as organized chaos, with reports that it is now relying more on political staff than drug policy professionals.

Conway did not immediately respond to a request for comment from The Daily Beast. Communities like Lamendola’s, meanwhile, have been reduced to reading books to try to gain insight.

Lamendola has done a lot of listening and learning and praying during his brief time in the area east of Pittsburgh. In particular cases, the horror of what’s going on, is tough to comprehend.

“A woman, she was in her thirties, she struggled with addiction,” Lamendola said, trying to find the words to convey the story. “She lost the child in her womb while she OD’d. That was pretty tough. The mother and the child were lost. That was a hard one.”

This exposure to trauma has taken a toll on the priest. And the experiences have led him to ask more existential questions about the very nature of the human condition.

“I often ask myself,” he said, “what is the quality of life? Why are people living in darkness in some ways?”

Health officials see Pennsylvania’s opioid epidemic in increasingly grave terms. The consensus is that while the federal and state governments are trying to mitigate a crisis, they are not yet fully grasping its severity.

“Currently, it would be fair to say the federal response is not well coordinated,” Dr. Donald Burke, dean of the University of Pittsburgh Graduate School of Public Health told The Daily Beast. “We have a response which is, to my way of thinking, woefully underfunded and not coordinated. Things need to change dramatically.”

It wasn’t supposed to happen this way. Throughout the campaign, Donald Trump made assurances that he would end the epidemic. “If I win, I’m going to stop it,” Trump said in Ohio in 2016, stressing that a wall at the southern border would help turn the situation around.

Burke didn’t fault the Trump administration alone, saying that the absence of serious investment in trying to fight the epidemic extends back to the Bush years. He did say however, that the recent resignation of the Trump administration’s CDC director and a proposed budget that would cut a reported 95 percent of funding for the Office of National Drug Control Policy would only compound the existing problem.

The Office of National Drug Control Policy, in particular, appears to be in shambles. Taylor Weyeneth, a 24-year-old top appointee announced that he would be stepping down following a Washington Post investigation demonstrating that he had no relevant experience for the role. The president has also not appointed a permanent “drug czar,” to be at the head of the ONDCP. And in the fall of last year, the Justice Department had to name a new acting head of the Drug Enforcement Administration after the previous head of the agency stepped down.

Trump’s State of the Union address was, for many, emblematic of an overall approach that is heavy on lofty promises but short on specifics or results. The president’s comments on the opioid epidemic, which resulted in an estimated 42,249 drug overdose deaths nationwide in 2016, lasted only a few seconds even though his address was nearly an hour and a half long.

“I wish that there was not just a real commitment but action on funding,” Sen. Bob Casey (D-PA) told The Daily Beast. In October, Casey introduced a bill that would allocate an additional $45 billion for state governments to fight the crisis.

It has gone nowhere.

Absent federal help, state governments have tried to fill the void. On Jan. 10, Pennsylvania Gov. Tom Wolf declared a public health emergency in the state. The declaration, which lasts 90 days, waived 13 different regulations in order to combat the epidemic more directly. It also established an Opioid Operational Command Center at the Pennsylvania Emergency Management Agency allowing for easier coordination between nine different state agencies.

The command center has been meeting every week to find out what each agency can do and how they can partner with each other. Additionally Wolf’s declaration allows physicians to approve addiction treatments without the prerequisite of an in-person meeting. And first responders can leave the anti-overdose drug Naloxone with families after they depart from a residence when called to respond to an overdose.

In an interview at the Pennsylvania State Capitol in Harrisburg last Thursday, Wolf said he anticipates that some of the changes in the declaration can actually become law next. He also told The Daily Beast that the number of deaths due to overdoses is only going to rise when there are final numbers available for 2017. He anticipates that it will be over 5,000 people.

“That’s more than die in traffic accidents every year,” he said. “It’s a real medical epidemic and we need to fight it as an epidemic.”

Wolf has gone around the state and participated in dozens and dozens of roundtables to figure out what can be done. But while advocates in the state welcomed his attention to the issue, some are also hoping for more from the state capital.

For one, Alice Bell, Overdose Prevention Project Coordinator at Prevention Point Pittsburgh, hopes that syringes get removed from the state’s paraphernalia code. She fears that a public health crisis could very well emerge in the wake of the epidemic itself.

That’s what happened in Scott County in southeastern Indiana beginning at the end of 2014. An HIV outbreak ravaged the community, with some 181 people testing positive for the disease. A study released the following year from the New England Journal of Medicine determined that a “close network” of residents were sharing needles and other communities in the country could be at risk for a similar outbreak. Bell is terrified that Pennsylvania could experience something similar.

“We’re at high risk for an HIV outbreak,” she told The Daily Beast.

Currently, Philadelphia and Pittsburgh are the only major cities in the state that have legal authorization to operate a syringe exchange program, according to Bell. But Pennsylvania is a largely rural state and if people are using and sharing needles, the risk for spreading infectious diseases is high. A CDC report from 2015 found a jaw-dropping 364% increase in Hepatitis C among people aged 30 or younger in four rural states between 2006 and 2012.

While Pennsylvania wasn’t included in the study, Bell surmised that it has a similar rural makeup, making it subject to a potential outbreak.

“We’ve seen heroin and fentanyl in the same kind of markets as heroin in rural and suburban communities across the state,” Bell said in an interview. “You can buy it in any small town. They have no access to sterile injection equipment.”

Experts said that implementing more clean needle exchanges gives health care providers the opportunity to provide guidance to users when they’re not overdosing, in addition to providing medical experts with a chance to counsel those individuals who come in for syringes. But the politics of the policy still are divisive. Though everyone acknowledges that the opioid crisis is an epidemic, not everyone agrees on exactly what to do and in what order.

“In a perfect world, there would be nobody shooting anything into their bodies,” Wolf told The Daily Beast, indicating that he is first thinking about getting people treatment and cutting off supply.

In Pennsylvania, like many other states hit hard by the opioid epidemic, politicians are still grappling with how to tackle the issue.

Conor Lamb, the Democratic candidate and a former prosecutor running in the congressional special election this March, told The Daily Beast that he’d be eager to work with President Trump on the epidemic. He even praised the president for bringing attention to the problem, even though, he acknowledged, the federal response has been “too slow, too little and long overdue.”

“I’ll give the president credit: he was the one who came forward and called the epidemic a public health emergency,” Lamb said. “That didn’t happen in the prior administration. But we have to do more than call it that. We have to treat it like one and I hope that he and I can work together on that.”

His Republican opponent, state Representative Rick Saccone, has spoken about the issue in serious terms. Pennsylvania, he said, “cannot continue on this path where young men and women in Pennsylvania with so much life to live and so much potential are choosing to use opioids and heroin, leading to destructive consequences.”

But, like Lamb, Saccone also seems to be struggling to find the right policy response. In a recent panel on parental opioid addiction, flagged by the liberal American Bridge PAC, he raised a question about constituents who might not want to be held responsible for the health problems of others.

“What about the constituents who would say, ‘Look, it’s not the taxpayers, it’s not the rest of us’ responsibility to pay for that—it’s the grand—it’s family's responsibility to take away, when they've had a family crisis, to take responsibility for these actions and step up and do that,” Saccone asked. “It’s not for the taxpayers themselves to step in and pay for that, necessarily.”

Saccone’s campaign did not make him available for an interview.

While politicians look for answers, voters are losing patience. At campaign events throughout the weekend, some were critical of efforts to distribute naloxone, viewing it as a means of allowing for dependency. Others were simply hoping that they would see an increased uptick in federal and state response.

Marsha Haley, a Republican physician who came to support Saccone at the Bethel Park Community Center last Friday, may have summed it up best.

“I think we’re a little bit behind the 8 ball,” she told The Daily Beast.

—with additional reporting by Jackie Kucinich