Opioids are on the White House agenda Thursday — President Trump plans to talk with members of his administration about the crisis. Meanwhile, all around the United States, state legislators, treatment providers, families and many others will be listening.
The administration's other opioid efforts have, so far, yielded no new money. Congress authorized funds in its recent budget deal -- but those dollars aren't flowing yet, and states say they are struggling.
The Oklahoma agency in charge of substance abuse has been told by the state's legislature to cut more than $2 million from this fiscal year's budget. And that has the providers of opioid addiction treatment on edge.
"Treatment dollars are scarce," says Randy Tate, president of the Oklahoma Behavioral Health Association, which represents addiction treatment providers.
It's like dominoes, Tate says. When you cut funding for treatment, other safety net programs feel the strain.
"Any cuts to our overall contract," he says, "really diminish our ability to provide the case management necessary to advocate for homes, food, shelter, clothing, primary health care and all the other things that someone needs to really be successful at tackling their addiction."
In just three years, Oklahoma's agency in charge of funding opioid treatment has seen more than $27 million dollars chipped away from its budget — thanks to legislative gridlock, slashed state taxes and a drop in oil prices (with the additional loss in state tax revenue that resulted).
Jeff Dismukes, a spokesman for Oklahoma's Department of Mental Health and Substance Abuse Services, says the already lean agency has few cost-cutting options left.
"We always cut first to administration," he says, "but there's a point where you just can't cut anymore."
The agency may end up putting off payments to treatment providers until July — the next fiscal year. Tate says that could be devastating.
"Very thinly financed, small rural providers are probably at risk of going out of business entirely — up to and including rural hospitals," he says.
Getting treatment providers to open up shop in rural areas is really hard, even in good times, and more financial uncertainty could make that problem worse. In the meantime, according to an Oklahoma state commission's opioid report, just 10 percent of Oklahomans who need addiction treatment are getting it.
That statistic is similar in Colorado. And as 2018 began, Colorado's escalating opioid crisis got worse, when the state's largest drug and alcohol treatment provider, Arapahoe House, shut its doors.
The facility provided recovery treatment to 5,000 people a year. Denise Vincioni, who directs another treatment center, the Denver Recovery Group, says other facilities have scrambled to pick up the patients.
Most of Arapahoe's clients were on Medicaid. Autumn Haggard-Wolfe, a two-time Arapahoe House client who is now in recovery, worries the facility's closing will have dire consequences, especially for people who need inpatient care, as she did.
"I feel like the only other option right now in therapy would be jail for people," she says, "and people die in there from withdrawing."
Arapahoe House's CEO blamed its closure on the high cost of care and poor government reimbursement for services.
The mother of Colorado state lawmaker Brittany Pettersen struggled with addiction, and was treated at Arapahoe House. Pettersen says treatment centers rely on a crazy quilt of funding sources and are chronically underfunded — often leaving people with no treatment options.
"We have a huge gap in Colorado," Pettersen says, "and that was before Arapahoe House closed."
She is pushing legislation in the state to increase funding for treatment. But to get tens of millions of dollars in federal matching funds, Colorado lawmakers need to approve at least $34 million a year in new state spending.
That price tag may simply be too high for some lawmakers. But either way, she adds, "It's going to take a lot to climb out of where we are."
Colorado did get new federal funds to fight the opioid crisis through the 21st Century Cures Act, passed in December of 2016, but it was just $7.8 million a year for two years — divvied up among a long list of programs.
This story is part of NPR's reporting partnership with StateImpact Oklahoma, Colorado Public Radio and Kaiser Health News.