BALTIMORE -- As Republicans in Congress and the Trump White House continue to craft a health care bill 30 miles to the south, two people overdose on opioids and die every day in Maryland's largest city.

On a street corner in west Baltimore, the extent of the opioid epidemic that has ravaged large swaths of the country was in stark relief Wednesday against the backdrop of a brick wall emblazoned with the words "No Shoot Zone" in spray paint.

In 95-degree heat, men and women of all ages -- black and white -- filed one by one into a white van and dumped out bundles of used needles. Workers with the Baltimore City Health Department handed out brown paper bags containing clean syringes, cookers, filters and rubber bands in exchange. Those who came to turn in their old equipment were users of heroin, fentanyl and carfentanil, a toxic synthetic opioid.

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MIDDLETOWN, Ohio – The coroner here in the outer suburbs of Cincinnati gets the call almost every day.

Man “slumped over the dining room table.” Woman “found in the garage.” Man “found face down on the kitchen floor of his sister’s residence.” Man “on his bedroom floor – there was a syringe beneath the body.” Coroner Lisa K. Mannix chronicles them all in autopsy reports.

With 96 fatal overdoses in just the first four months of this year, Mannix said the opioid epidemic ravaging western Ohio and scores of other communities along the Appalachian Mountains and the rivers that flow from it continues to worsen. Hospitals are overwhelmed with overdoses, small-town morgues are running out space for the bodies, and local officials from Kentucky to Maine are struggling to pay for attempting to revive, rehabilitate or bury the victims.

As their budgets strain, communities have begun questioning how much money and effort they should be spending to deal with overdoses, especially in cases involving people who have taken near-fatal overdoses multiple times. State and local officials say it might be time for “tough love”: pushing soaring medical costs onto drug abusers or even limiting how many times first responders can save an individual’s life.

“It’s not that I don’t want to treat overdose victims, it’s that the city cannot afford to treat overdose victims,” said Middletown Council Member Daniel Picard, noting this industrial town in northern Butler County might have to raise taxes in response to the crisis.

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To reverse a still-spiraling American crisis fueled by prescription narcotic drugs, a panel of experts advising the federal government has recommended sweeping changes in the ways that physicians treat pain, their patients cope with pain, and government and private insurers support the care of people living with chronic pain.

In a comprehensive report on what must be done to staunch the toll of opiates in the United States, a panel of the National Academies of Science, Engineering and Medicine makes clear that steps needed to prevent the creation of future opiate addicts will drive some people who are now dependent on these medications toward street drugs such as fentanyl and heroin.

“It is therefore ethically imperative to couple a strategy for reducing lawful access to opioids with an investment in treatment for the millions of individuals” already hooked on the painkillers, the panel wrote.

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