The Trump administration -- not known for its consistent approach to policy targets -- has chased one goal with unusually steady determination: Taking on the opioid epidemic.
During President Donald Trump's chaotic first 15 months in office, his administration has fought for more funding in the federal budget to the crisis that he first learned about during the 2016 campaign as he stumped in the hard-hit state of New Hampshire. He has also signed legislation aimed at combating the sale of deadly synthetic opioids.
Still, there is a grim reality confronting the White House as officials acknowledge that, despite the effort, the situation isn't improving.
"Obviously, the crisis next door, the opioid epidemic ... didn't start on the first day President Trump got here or even last year or last decade," said Kellyanne Conway, Trump's senior counselor and the top aide President's dealing with the crisis in a recent interview. "It has been increasing for quite a while and we are fully aware that these numbers could get worse before they get better."
There were more than 63,000 overdose deaths in the United States in 2016, including over 42,000 that involved an opioid, according to the Centers for Disease Control and Prevention. Even as the number of opioid prescriptions in 2016 fell to 236 million from a high of 282 million in 2012, experts expect the number of overdoses will grow in 2017. Conway said that there is some indication that the national overdose death numbers could plateau in 2017, but said the administration would not know for months.
The possibility of more negative news on the opioid front has the Trump administration taking stock of their attempts to curb the crisis during the President's first year in office. Ever the defender of the President, Conway was blunt in her assessment of what needs to happen next in the fight against opioids: Congressional action.
Conway told CNN that while the President will continue to push for executive action on opioids, he is now looking down Pennsylvania Avenue for the next steps, hoping a backlog of legislation can be cleared by Congress before a new set of lawmakers takes over in 2019.
Conway, the face of the administration's efforts on this issue, has crisscrossed the country to work with state lawmakers and experts on combating the opioid epidemic and her comments came as she toured "Stop Everyday Killers," a traveling exhibit station on The Ellipse park near the White House that looks to put a face on the thousands of people who have died of opioids overdoses.
The exhibit is a harrowing reminder of the crisis' toll: Set against a black matte wall are thousands of small pills, similar to the ones Americans everywhere find in their medicine cabinets. But on these pills, the National Safety Council, a nonprofit health organization, has etched a face, a representation of one life lost to an opioid overdose.
The exhibit moved those who toured it Wednesday with Conway, including Interior Secretary Ryan Zinke, Health and Human Services Secretary Alex Acosta and Missy Owen, whose son, Davis, died of an opioid overdose in 2014.
Flanked by the etched pills, Conway said Trump sees taking on the epidemic as a bipartisan issue that could be addressed before Washington's attention fully turns to the midterm elections in the fall.
"I will tell you when the President hears nothing else can be done in Congress, nothing else will pass, one of the first things we think of is all of those pieces of legislation that deal with the opioid crisis that really can't wait for election day, really can't wait for a new Congress," Conway said.
Congressional leaders on Capitol Hill -- namely Sen. Lamar Alexander, head of the Senate Committee on Health, Education, Labor, and Pensions, and Rep. Greg Walden, chair of the House Committee on Energy and Commerce -- have put a renewed focus on the issue in early 2018, with dozens of bills currently under consideration by the committees. Republican aides from both chambers are hopeful that legislation could make its way to the floor by late May.
Trump, Conway said, has had many conversations with lawmakers about more legislation on combating opioid crisis, but lamented "so much of it sitting there and we hope it will start moving."
Conway wouldn't directly comment on whether the President supports specific opioid legislation. But said the White House is currently looking at "a number of pieces of legislation" to put their weight behind.
The response from the community of treatment advocates and health professionals to the White House actions so far has been mixed.
Trump's decision to link his push for a wall along the U.S.-Mexico border to stopping the flow of opioids from Mexico made some in the treatment community cringe, worried that the focus will take away from other ways to respond to the crisis. Others have said that Trump - looking to come down hard on drug dealers - has used harsh rhetoric and proposed the death penalty for certain high intensity traffickers and dealers.
While Conway is sensitive to criticism of Trump's call for the penalty, she has tried to clarify his comments ever since he made them, stressing that they are aimed at a specific set of traffickers, not those drug dealers working in small quantities.
When CNN asked Conway at a Wednesday press conference about Trump's comments and how the administration can allay concerns that they are seeking to punish their way out of the issue, she replied by slamming the question as inaccurate reporting.
"It's really fun to get clicks and kicks, but we're talking about life and death here," Conway said.
But Trump himself has backed the death penalty proposal, telling a New Hampshire audience in March that the US is "wasting" time if they aren't tough on drug dealers.
"If we don't get tough on the drug dealers, we are wasting our time," he said. "And that toughness includes the death penalty."
Just as the issue loomed large in the 2016 campaign -- with Trump driving much of that focus -- it has already drawn attention in key congressional races that will decide the fate of Congress in 2018.
Conway said Wednesday that she is not advising Republican candidates to talk about the opioid crisis as a political issue during the midterms, but said that the fact that Democrats who are up for reelection in 2018 are willing to stand with the President to act on opioids signals that it is politically expedient to do so.
"It is not a coincidence that Democratic senators of West Virginia and Ohio" -- Joe Manchin and Sherrod Brown, both of whom are up for reelection in 2018 -- "were flanking the president when he is signing the Interdict Act into law," Conway said. "Democrats know it is a nonpartisan" issue.
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