America’s drug overdose crisis is out of control. Washington, despite a bipartisan desire to combat it, is finding its addiction-fighting programs are failing.

In 2018, Republicans, Democrats and then-President Donald Trump united around legislation that threw $20 billion into treatment, prevention and recovery. But five years later, the SUPPORT Act has lapsed and the number of Americans dying from overdoses has grown more than 60 percent, driven by illicit fentanyl. The battle has turned into a slog.

Even though 105,000 Americans died last year, Congress is showing little urgency about reupping the law since it expired on Sept. 30. That’s not because of partisan division, but a realization that there are no quick fixes a new law could bring to bear.

“We are in the middle of a crisis of proportions we couldn’t have imagined even five years ago when the original SUPPORT Act was passed,” said Libby Jones, program director of the Overdose Prevention Initiative at the Global Health Advocacy Incubator. “If they can’t pass this, it’s really sad.”

Congress is not coming to the rescue. The House is without a speaker after Republicans fired Rep. Kevin McCarthy (R-Calif.) earlier this month and the GOP has made no progress in replacing him. That’s brought legislation to a standstill.

Asked why the Senate committee with responsibility for the law hasn’t even begun to consider it, Chair Bernie Sanders (I-Vt.) said other priorities had precedence. “We’re working on a myriad of problems,” he said after listing his efforts to shore up the primary care system and lower drug prices.

Sanders’ attitude reflects the course of the fight against fentanyl, the synthetic opioid that accounts for most of the deaths. Fentanyl’s addictiveness, its affordability, and broader trends driving people to use drugs are overwhelming efforts to convince them not to — and to treat them when they do.

Congress can continue to fund opioid-fighting efforts without passing a new version of the SUPPORT Act. But failing to pass another law forfeits the opportunity to try new approaches. That has advocates discouraged.

Despite its dysfunction, the House is further along legislatively than the Democratic-controlled Senate. The House Energy and Commerce Committee unanimously approved a new SUPPORT Act in July. But that measure’s limited ambition suggests a reason for the lack of urgency to pass it.

In the Senate, the ranking Republican on the Health, Education, Labor and Pensions Committee, Bill Cassidy of Louisiana, has proposed a bill, but no Democrat has.

Missing the deadline to reup the SUPPORT Act “puts vital resources in jeopardy,” Sen. Cassidy said in a statement.

President Joe Biden is frustrated as well, even as he has not openly pressured lawmakers to pass the bill.

“The White House has called on Congress to help us continue taking aggressive action to stop drug trafficking and save lives, and the Administration will continue working tirelessly to ensure all Americans have the resources and support they need,” a spokesperson for the Office of National Drug Control Policy said in a statement.

‘We’ve been lobbying this since January’

It’s not that lawmakers have stopped caring about the opioid crisis.

Aiming to expand access to treatment, Congress in December eliminated the waiver and training requirements physicians needed to prescribe buprenorphine, which helps patients wean themselves from addiction. The Drug Enforcement Administration recently extended eased pandemic rules for prescribing it via telemedicine through the end of 2024.

A bipartisan group of representatives focused on mental health and substance use has proposed more than 70 bills this Congress to fight the overdose crisis, but none of them has inspired the kind of urgency lawmakers showed five years ago when they packaged bills into one landmark package: the SUPPORT Act.

The law’s expiration on Oct. 1 means states are no longer required to cover all of the FDA-approved treatments for opioid use disorder through Medicaid but public health advocates don’t expect any state to drop that coverage.

Grants to improve access to treatment and recovery have expired but the funding will continue if Congress already appropriated the money.

The SUPPORT Act also gave states the option to use federal Medicaid funds to cover up to 30 days of services for people with opioid use disorder in mental health institutions, an exemption to a 1965 law prohibiting addiction treatment in large mental health institutions.

When that option ended on Sept. 30, the two states which used it — South Dakota and Tennessee — steered their Medicaid recipients with substance use disorder toward treatment facilities not subject to the “IMD exclusion,” state officials told POLITICO.

The House Energy and Commerce Committee proposes to repeal the 1965 rule in the SUPPORT Act reauthorization bill it approved in July. The bill from the panel’s Health Subcommittee chair, Brett Guthrie (R-Ky.), also would prohibit states from disenrolling people from Medicaid when they are incarcerated, so their coverage would automatically resume upon release, in an attempt to provide them with health care access at a time when they’re most vulnerable to dying from an overdose.

The bill would also permit pregnant people in pretrial detention to retain their Medicaid coverage.

“We were hoping to get this moving forward faster,” Guthrie said. “But we’re now currently where we are,” adding that he wanted to see new legislation “as soon as possible.”

The House Judiciary Committee, which has partial jurisdiction over the bill, advanced the legislation at the end of September on a 29-3 vote. The panel included a measure that would make the horse sedative xylazine — which drug traffickers are adding to illicit fentanyl to deadly effect — a Schedule III controlled substance, for three years, subject to additional DEA regulation.

The Judiciary amendment softens language in the Energy and Commerce bill, which would permanently schedule the veterinary drug, also known as tranq.

In the Senate, the HELP Committee hasn’t made any moves. Sanders’ staffers said he was working on it.

That’s frustrated public health advocates. “We’ve been lobbying this since January,” said an exasperated mental health and substance use lobbyist who was granted anonymity to speak frankly.

That stands in stark contrast with the bipartisan effort in Congress to pass the sweeping SUPPORT Act in 2018. President Trump promised the law would end the scourge of drug addiction in America or at least make a big dent in it, as he signed the bill in October of the year.

“It really was a monumental accomplishment,” said Jones.

‘Not a success’

But it hasn’t ended the scourge.

“Over 100,000 deaths is not a success in this country. It’s not a policy success,” said Regina LaBelle, a former White House Office of National Drug Control Policy acting director in the Biden administration who now leads the Addiction and Public Policy Initiative at Georgetown University’s O’Neill Institute for National and Global Health Law.

Part of the problem was likely out of lawmakers’ control.

Addiction is often described as a disease of isolation, and the pandemic provided a lot of it. It changed circumstances in people’s lives that affect health, such as social and community support, and it worsened an existing mental health crisis, according to researchers and doctors working on substance use issues.

At the same time, fentanyl has proved a relentless foe.

It is deadly in small amounts. Combining it with other drugs like tranq makes it harder to reverse an overdose. The drug is cheap and easy for cartels in Mexico to make and disguise as legitimate pills.

The stigma that comes with addiction, the lack of addiction specialists and services and financial barriers are among the reasons most people with opioid use disorder are not in treatment. Those issues add to the already hard task of convincing people with an addiction to seek treatment.

American Society of Addiction Medicine President Brian Hurley thinks Congress should permit access to methadone, which like buprenorphine is used to help people achieve and maintain recovery, by allowing pharmacies to dispense it. That, he said, would mark “bolder change in light of the worst overdose crisis in American history.”

Currently, methadone is strictly controlled by the DEA and only available at specialized clinics because it, too, is an addictive opioid that can cause fatal overdoses.

Some lawmakers are on board, but some physicians licensed to prescribe it are opposed, warning it could lead to more deaths from methadone overdose.

That’s a shame, public health advocates said. In their view, Congress should take some risks, considering the magnitude of the crisis.

“Simply reauthorizing it with some tweaks around the edges is not going to change the system and it’s not going to change the trajectory that we’re on,” Jones said.

Megan Messerly contributed to this report.

CHICAGO — Operatives in charge of the Democratic convention in Chicago next year are starting to plan for an unconventional type of election year problem: a flood of migrants bussed mostly from Texas to the host city.

The city has seen fluctuating numbers of busloads of migrants, adding to the difficulty of planning for arrivals. Last week, 28 busloads landed in Chicago, but as many as 60 have arrived in one week. The mayor’s office told POLITICO it’s seen a noticeable increase of migrants since Chicago was announced as the host city for the Democratic National Convention.

Now, however, the topic is coming up in meetings about convention planning, according to two people familiar with the matter. The mayor’s office is in the process of identifying occasions to build tent camps to accommodate the influx. The goal is to get the new arrivals off the floors of police stations and other public spaces before winter comes.

Officials are also incorporating concerns over migrants into their security planning for the convention. And the governor’s office has begun a public pleading and shaming campaign with the Biden administration to do more to stem migrant flows to the border and open up resources for states and municipalities to deal with migrant buses being sent to them.

Speaking to reporters recently, Illinois Gov. JB Pritzker said he is “confident” that local officials will be able to handle whatever spate of migrants arrive in the leadup to the convention — as long as they get sufficient federal support.

“We will manage it but we need to have the city and the state working together. We need the federal government at the table here,” he said during a discussion put on by the University of Chicago’s Institute of Politics.

Pritzker recently told CBS’ “Face the Nation” that “someone needs to work in Texas with these border politicians to have them stop sending people only to blue cities and blue states.”

That convention planners are having to strategize around a flow of migrants at all shows the degree to which migrants have become both a headache for Democrats in major cities and a national political issue.

Chicago Mayor Brandon Johnson’s office said that it’s trying to get a handle on the migrant situation now so it won’t be a problem when the Democratic Party’s luminaries gather at the United Center to formally nominate a presidential nominee.

The administration sent a delegation to Texas border towns last week to better understand the process of moving migrants across the country.

“I don’t know if it’s a concern or just an additional challenge that we know that we’re going to have to deal with,” Johnson’s chief of staff Richard Guidice told POLITICO. He is tasked with helping to manage the behind-the-scenes logistical planning for the convention.

“Optically you certainly want to show Chicago in its best light,” said Guidice. “As part of the process, you identify all things that potentially could happen in any large scale event.”

The challenge for Chicago is trying to find inhabitable space. It costs money to remove asbestos in empty structures and make them livable, for example. Operations to get asylum-seekers off the floors of the airport and police stations before Chicago’s notoriously frigid winter is challenging, too. And neither the city nor the state budgets have the surpluses needed.

“It’s expensive,” said Jason Lee, the mayor’s chief adviser. “But there is potentially a pathway to being able to manage the influx.”

The confluence of incoming migrants just as the convention is revving up could also be “a major security issue” as well, added Lee. Extra bodies around creates a headache for security officials who need clear pathways for high-profile individuals.

Officials with the convention host committee in Chicago and the Democratic National Convention Committee largely dismissed the idea that the bussing of migrants could cause some sort of disruption or embarrassment.

“The convention team supports the efforts of city and state officials working around the clock to ensure that migrants being sent to Chicago are treated with the dignity and respect that all human beings deserve,” the convention planners said in a joint statement.

The party has sought to position itself as welcoming of immigrants. And Chicago, run by Democratic officials, also wants to be a welcoming city — inside a welcoming state.

But Republicans have argued that such posturing is largely bluster and that, presented with the migrant numbers they face on a daily basis, blue states would change their tune. Chicago has seen more than 18,000 asylum seekers since Texas Gov. Greg Abbott started sending buses to Chicago in August 2022, according to Johnson’s administration.

And frustration is mounting. Pritzker blamed Republican governors for sending “people to our state like cargo in a dehumanizing attempt to score political points.” It was part of a letter the Democratic governor wrote to President Joe Biden that called for more help in managing asylum seekers coming to Chicago.

His comment was a jab at Abbott, who has sent migrants to Chicago as well as New York City and Washington, D.C., over the past year.

Andrew Mahaleris, a spokesperson for Abbott, acknowledged that Texas has increased the number of migrants being sent to Illinois and other states. “Texas has ramped up our busing mission to help our local partners in Eagle Pass and other border towns, and we are prepared to provide as many buses as necessary to provide relief to our overrun and overwhelmed border communities,” he said in a statement to POLITICO.

Other cities — including Denver and New York — are sending asylum seekers to Illinois, too, often because the new arrivals request to go there.

After sending his letter, Pritzker said he got a quick response from White House officials. Representatives from the Department of Homeland Security, which is managing the humanitarian effort, visited Chicago recently to see first-hand the situation that has migrants sleeping on the floors of police stations and Chicago O’Hare International Airport — where Democratic delegates will be arriving when they come for the convention next year.

The DHS team “is working with Chicago officials to assess the current migrant situation and identify ways that the city and the federal government can improve efficiencies and maximize resources,” said a person who didn’t have authority to be named.

Tim Scott’s old friend and former colleague in the Senate, Cory Gardner, kept pleading with him to get on TV more.

It was one thing, Gardner told Scott in multiple recent conversations, to appear regularly on Fox News, according to two people with knowledge of the talks. But a wider audience would form high opinions of Scott, Gardner suggested, if they actually saw and heard from him.

In a strategy shift, Scott over the past two weeks has done just that, appearing eight times on CNN, CBS, ABC and CNBC after spending a summer engaging almost exclusively with the conservative press.

The shake-up may come too late to energize Scott’s faltering campaign.

After months of staying out of the conversation, the South Carolina senator is now sputtering below 2 percent in national polls. On Saturday, Scott’s hometown newspaper called for the Republican field to coalesce not around Scott, but rival South Carolinian Nikki Haley, to take on Donald Trump directly. Even some prominent Scott fans are beginning to acknowledge Scott’s presidential campaign has been a disappointment, and that his path forward appears dim.

“In talking to people here at home, what they have told me is that it’s unfortunate that the Tim that they know in South Carolina is not the Tim that people may be perceiving in Iowa and New Hampshire and other states,” said Mark Sanford, the former South Carolina Republican governor and U.S. representative who attended Scott’s May campaign launch.

Sen. John Cornyn (R-Texas) praised his colleague as a “spokesman” for the “Reagan, hopeful, optimistic message,” but conceded it hasn’t seemed to convince the party’s voters.

“I’m disappointed, because he’s such a terrific guy and has got a great message,” he said.

Asked if he hopes Scott can stay in the race until Iowa, Cornyn demurred: “At some point, there’s going to have to be consolidation when the outcome is inevitable.”

It wasn’t so long ago that expectations for Scott ran sky-high. South Dakota Sen. John Thune, the No. 2 Senate Republican, gave the opening prayer at Scott’s campaign launch. Larry Ellison, the billionaire founder of Oracle, was in the crowd, one of many donors intrigued by the prodigious Senate fundraiser. Big money, his allies maintained, was lining up for Scott ahead of the fall campaign. And even as recently as two months ago, Scott appeared to be in a far better position than he is now. He had reached double-digit poll numbers in Iowa, the first caucus state, behind only a weakened Ron DeSantis in the race to become the top alternative to Donald Trump.

But then came the first debate, a highly anticipated event where Scott spoke less than most of the other candidates and seemed to disappear for long stretches. Multiple Scott allies point to that moment — both the senator’s seeming lack of preparedness for the dynamics of the debate stage and refusal to embrace an aggressive earned-media strategy ahead of time — as a significant turning point. Ever since, Scott has trended down in Iowa, New Hampshire and in national polling. In an ominous sign for the campaign, his super PAC this week announced it was canceling millions of dollars in fall advertising.

Scott has yet to qualify for the third Republican debate, though he appears on track to do so. A person with knowledge of Scott’s campaign’s operations told POLITICO that the Republican National Committee has confirmed to the campaign that a little-noticed poll conducted by YouGov and The Liberal Patriot satisfies the committee’s polling requirement for the debate.

A spokesperson for the RNC did not immediately respond to a request for comment. Scott still must cross the committee’s 70,000-donor threshold before the Nov. 6 deadline.

“Tim Scott will be on the debate stage in Miami,” said Nathan Brand, campaign spokesperson. “The campaign is on track to meet the donor requirements.”

But getting on the debate stage is one thing. Nothing Scott has done in the first two debates appears to have helped his standing. Sen. Lindsey Graham (R-S.C.), who endorsed Donald Trump’s 2024 campaign but has remained complimentary of his home state colleague’s own presidential bid, said Scott has “a good message.” But, he added, “You’ve got to translate that into support. Trump drowns out everybody.”

That lack of oxygen in the primary has been a major problem for all of Trump’s rivals. But Scott’s campaign appeared to do less than others to force him into the conversation. At one point, from mid-July to early August, Scott went three weeks without a single national television hit, while making a handful of appearances on local radio, TV and podcasts. After an early June interview on “The View” — and as DeSantis and Haley this summer were being booked on networks like CNN and NBC — Scott didn’t appear on any mainstream news shows until mid-September, when he went on the morning business show “Squawk Box” on CNBC.

The senator’s team “fundamentally miscalculated what it means to run for president and generate news coverage,” said one influential Scott supporter, granted anonymity to speak candidly about the state of the race.

Scott also does not speak to reporters in the halls of the Capitol. Nor has he aggressively leveraged his role in the Senate to create the kind of attention-grabbing moments some prior senators seeking the presidency have.

Other close observers of Scott’s campaign have noted its high spending rate — $12.3 million burned, as opposed to $4.6 million raised in the third quarter — a very different strategy from the lean operation of Haley, though Scott has more cash on hand for the primary than her or DeSantis. Rivals like Haley, DeSantis and Vivek Ramaswamy declined to spend campaign dollars on television advertising, allowing their allied super PACs to handle air time. While Scott’s campaign got a more favorable candidate rate for television than his opponents’ super PACs — and launched with more cash on hand — his campaign had already spent nearly $9 million on television this year through the end of the third fundraising quarter.

Scott and his campaign are plowing ahead. In between his recent flurry of media hits, the senator this weekend launched a seven-stop bus tour in Iowa and announced he will give a speech Monday at a predominantly African American church on the south side of Chicago. At a cattle call in Iowa City on Friday night, before leaving with a plate of chicken lips on a stick, Scott mingled in a crowd of Republicans — and was the only one to gaggle with reporters.

His aligned super PAC, meanwhile, has pledged to boost Scott’s current grassroots efforts in the wake of its recent ad cancellations.

But it’s unclear just how much of the advertising dollars cut from television will go toward that outreach. This week, TIM PAC canceled roughly $15 million worth of ads, most of which were television reservations between Oct. 17 and Dec. 27 in Iowa, New Hampshire and South Carolina. A person familiar with the super PAC’s strategy confirmed the group intends to play a substantial role in organizing Scott’s future on-the-ground events — similar to the pro-Ron DeSantis Never Back Down super PAC — but declined to provide specifics.

In a statement to POLITICO, Gardner, who co-chairs the super PAC, reiterated the message he had reportedly delivered to Scott and others in private conversations: He needs to be out there more.

“The more voters hear from Tim the more likely they are to become reliable supporters,” Gardner said. “He’s the most favorably viewed candidate in this race because people want to feel good about America again and they believe Tim can bring that change.”

Andy Sabin, a GOP donor who is backing Scott in the primary, said he is puzzled by how the affable rising Republican star is still lagging behind the others. Scott, while not as widely known as some of his rivals, has long enjoyed the highest net favorability ratings of the Republican primary field.

“When I see him, talk to him, he comes across great,” Sabin said. “I don’t know what the issue is.

“Let’s see how he does in the next debate, see if he’s getting any momentum.”

It is still possible — if he qualifies for the debate, if his polling improves, if his fundraising comes back around — that Scott could find traction. Graham, who said he spoke to Scott last week, suggested that Scott could finish in third or fourth place in Iowa and still remain viable in the race — and that “his campaign is helpful for the Republican Party.”

“There are still a lot of undecideds,” Graham said. “He could break through.”

Sen. Mike Rounds (R-S.D.), one of two senators, along with Thune, to endorse Scott’s presidential bid, said that “sometimes you’ve just got to stick with it and wait until your opportunity is there.”

However, he said, it’s clear from examining primary polls that “right now, folks aren’t ready to move yet.”

Meridith McGraw and Steven Shepard contributed to this report.