Washington, DC - In May 2016, a group of national health experts issued an urgent plea in a private letter to high-level officials in the Obama administration. Thousands of people were dying from overdoses of fentanyl — the deadliest drug to ever hit U.S. streets — and the administration needed to take immediate action. The epidemic had been escalating for three years.

The 11 experts pressed the officials to declare fentanyl a national “public health emergency” that would put a laserlike focus on combating the emerging epidemic and warn the country about the threat, according to a copy of the letter.

“The fentanyl crisis represents an extraordinary public health challenge — and requires an extraordinary public health response,” the experts wrote to six administration officials, including the nation’s “drug czar” and the chief of the Centers for Disease Control and Prevention.

The administration considered the request but did not act on it.

Between 2013 and 2017, more than 67,000 people died of synthetic-opioid-related overdoses — exceeding the number of U.S. military personnel killed during the Vietnam, Iraq and Afghanistan wars combined. The number of deaths, the vast majority from fentanyl, has risen sharply each year. In 2017, synthetic opioids were to blame for 28,869 out of the overall 47,600 opioid overdoses, a 46.4 percent increase over the previous year, when fentanyl became the leading cause of overdose deaths in America for the first time.

In Washington, Tom Frieden, the CDC chief during the Obama administration, notified several senior administration health officials about the increasing fentanyl overdoses, including a doubling of deaths in New Hampshire in one year.

Frieden believed one of his roles was to alert government officials to dangerous trends in the field. In October 2015, the CDC issued a nationwide health advisory about the increasing dangers of fentanyl. It was up to the various agencies to take action, he said.

“I felt like I was a bit of a voice in the wilderness,” Frieden recalled in a recent interview. “I didn’t have the sense that people got this as a really serious problem.”

That November — eight months after the DEA issued its national fentanyl alert — the Obama administration sent its annual National Drug Control Strategy to Congress. The 107-page report devoted one sentence to fentanyl, noting that it was showing up in heroin.

“It caught a lot of people by surprise,” said Jon DeLena, the associate special agent in charge of the DEA’s New England Field Division. “People didn’t understand until it was really put in their face. People weren’t paying attention to how rapidly this evolved and they weren’t prepared for it.”

The situation had become so desperate that health experts from around the country banded together to make an impassioned plea to the highest levels of the Obama administration.

On May 4, 2016, a month after Obama’s Atlanta appearance, the 11 public health experts wrote to the six administration officials, requesting the emergency declaration. Among the experts were Rich and Green, the two Rhode Island epidemiologists who had seen the devastation firsthand.

[M]any leading voices in the field feel an emergency declaration could have saved lives by shining a bright spotlight that would have galvanized the administration, awakened the public and warned users of the danger they faced.

“A great deal would have been done by the White House simply saying we have this horrible danger out there,” said Walters, the earlier drug czar. “We saw more action by the White House over an outbreak of tainted food, giving out news releases telling people what to look for, telling people to protect their friends and family, than you did for fentanyl. It’s a little ridiculous that we don’t use the bully pulpit to at least provide a national warning.”

In the summer of 2016, a few months after the fentanyl letter, the Obama administration declared the Zika virus to be a public health emergency and had already requested $1.9 billion from Congress to address it. Two people in the United States died of Zika-related illnesses.

At the same time, the DEA warned, counterfeit pain pills laced with fentanyl were posing a “global threat.”

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