The nation’s opioid epidemic has been called today’s version of the 1980s AIDS crisis.

In a speech Monday, President Donald Trump pushed for a tougher federal response, emphasizing a tough-on-crime approach for drug dealers and more funding for treatment. And Congress is upping the ante, via a series of hearings — including one taking placde on Wednesday and Thursday — to study legislation that might tackle the unyielding scourge, which has cost an estimated $1 trillion in premature deaths, health care costs and lost wages since 2001.

Dr. Leana Wen, an emergency physician by training and the health commissioner for hard-hit Baltimore, said Capitol Hill has to help communities at risk of becoming overwhelmed.

“We haven’t seen the peak of the epidemic. We are seeing the numbers climb year after year,” she said.

Provisional data from the Centers for Disease Control and Prevention suggest that almost 45,000 Americans died from opioid overdoses in the 12-month period ending July 2017, up from about 38,000 in the previous cycle. (Those data are likely to change, since many death certificates have not yet been reported to the CDC.)

“It’s not going to get any better unless we take dramatic action,” Wen said.

And the time for most meaningful change could be dwindling. Advocates say what they need most is money, which would most likely come through the government spending bill that’s due March 23. But they aren’t holding their breath.

Show Me The Money

The federal budget deal, which was signed into law in early February, promised $6 billion over two years for initiatives to fight opioid abuse. Congress is still figuring out how to divvy up those funds. The blueprint is expected to be included in the spending bill this week.

Last month, a bipartisan group of senators introduced a bill that would add another $1 billion in funding to support expanded treatment and also limit clinicians to prescribing no more than three days’ worth of opioids at a time.

That legislation is likely to have wide support in the Senate, but its path through the House is less certain.

This cash infusion is still not going to be enough, predicted Daniel Raymond, policy director for the Harm Reduction Coalition, a national organization that works on overdose prevention.

“It’s not clear whether there’s a real appetite to go as far as we need to see Congress go,” he said. “To have a fighting chance, we need a long-term commitment of at least $10 billion per year.” Academic experts said that assessment sounded on target.

California appears to have been spared when it comes to opioid deaths. However, the Golden State ranks at the top when it comes to specific number of drug-overdose deaths with more than 4,600 victims in 2016. That year, 1,925 Californians died from opioid overdoses.

While California ranks seventh nationwide for drug deaths—11 deaths per 100,000 residents—experts warn that overdoses vary widely from county to county, with some regions hit even harder than the national average. Far more Californians die from drug poisoning each year than died in car accidents. What’s more, twice as many California die of drug overdoses than are murdered.

Opioids, the primary prescription for pain relievers, along with heroin are the main drugs associated with overdose deaths statewide. Northern California, for instance, leads the state in opioid overdoses. A Kaiser Family Foundation report from 2016 found that of the 2,024 drug overdose deaths in California that year, opioids constituted five deaths out of every 100,000 persons. Prescription opioid fatalities amounted to 3.5 persons dying out of every 100,000 residents.

This week, State Sen. Ricardo Lara (D-Bell Gardens) took a step toward rooting out insurance fraud and improving care for patients in recovery from addiction with the introduction of SB 1228, the Substance Use Disorder Patient Protection Act.

“California needs to raise the bar for patient care and protect people in recovery from patient brokering, where quality care takes a backseat to profits and insurance fraud,” Lara said. “We are starting to break through the stigma and meet the need for recovery from opioids, alcohol, and other substances. California has to watch out for desperate families and patients so low-quality care and shady businesses don’t make them repeat victims of the opioid and substance abuse crisis.”

Recently, the drug fentanyl has witnessed a sharp rise in use and it is often sold on the streets as a look-alike to oxycodone pills. Fentanyl is a powerful pain reliever that can kill in extremely small amounts. Individuals may use fentanyl over long periods of time and develop a tolerance to the drug only to crave more when pain resumes. This was the scenario discovered in the untimely deaths of rock stars Prince and Tom Petty.

The California Opioid Overdose Surveillance Dashboard reported in 2016 that there were roughly 234 fentanyl deaths statewide. Despite Northern California being at the top of the regions where most opioid deaths occur, that year San Diego led the state with a reported 239 deaths in representing about 12 percent off all opioid deaths statewide.

“We provide enough opioids every year to kill every Californian more than twice,” said Dr. Kelly Pfeifer of the California Health Care Foundation in Oakland.