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Understandably, the coronavirus pandemic ranks as the nation's top public health priority, with first claim on limited public funds and public attention. Yet more of both must be devoted to the publichealth catastrophe that dominated the headlines before the coronavirus hit early this year, and that has not disappeared since: opioid addiction.

In fact, the likelihood is that the coronavirus pandemic has worsened the opioid crisis. Treatment for addiction is expensiveand time-consuming and requires health-care professionals to sustain direct personal interaction with patients. All of that has been made more difficult by the diversion of medical personnel and hospital space to covid-19 and by necessary restrictions on individual movement. Joblessness and social isolation create emotional stress that may interfere with recovery. One in eight adults surveyed in June by the Centers for Disease Control and Prevention reported increased substance use since the pandemic began, according to the Wall Street Journal. The American Medical Association recently declared itself "greatly concerned" by reports of increased death from overdoses, particularly of the synthetic opioid fentanyl.

To be sure, definitive overdose-death statistics for 2020 are not yet available, but trends were heading in the wrong direction even before this year, as provisional CDC figures released in July show. Drug overdose deaths in the United States rose 4.6% in 2019 to 70,980, including 50,042 involving opioids, reversing what had been a 4.1% decline between 2017 and 2018 - the first such decrease in decades. What's more, data gathered by Hawre Jalal and Donald Burke of the University of Pittsburgh suggest that the 2018 decline did not reflect improved access to treatment or better treatment methods. Rather, it traced to a short-term drop in supply of a particularly deadly Chinese-made synthetic opioid - carfentanil.

The Obama administration deserves credit for pressuring China on this point late in its second term, and the Trump administration has followed up. Yet supply-side interventions, while welcome and necessary, must be augmented by effective demand reduction. A study by Stanford psychiatric researcher Chelsea Shover and colleagues shows that fentanyl consumption has just begun to spread from the Eastern United States to the previously less affected states west of the Mississippi, whose share of fentanyl deaths roughly quadrupled between 2017 to 2019.

In 2016, President Donald Trump promised lasting progress on opioids, but clearly he has not delivered. It's not so much that he has done nothing - his administration has spent $3 billion per year in new money on the problem. Rather, the spending still isn't substantial enough. Meanwhile the president has wasted time on irrelevancies such as the death penalty for traffickers or backed actually harmful ideas such as abolishing Obamacare. Democratic presidential nominee Joe Biden has a comprehensive and aggressive plan that would boost the federal commitment to $125 billion over 10 years, but you don't hear much about it - not even from him. That should change in what remains of the campaign, lest it be forgotten that the legacy of the past nearly four years includes not one but two major pieces of unfinished business in public health.

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