Top federal scientists warned about an opioid crisis in 2006. It's not clear why nothing came of it.

The heads of the National Institute of Drug Abuse (NIDA) and National Institutes of Health (NIH) correctly identified the nascent opioid abuse epidemic in March 2006 and nearly convinced then-Surgeon General Richard Carmona to issue an official call to action, the most potent tool the surgeon general has to alert the public, Politico reported Wednesday. But for reasons that aren't fully clear, "the effort didn't lead to any real action, and the toll of death and addiction climbed."

"Why it then didn’t happen is still a mystery to me," Geoffrey Laredo, a former senior NIDA adviser who worked closely on the call to action, tells Politico. "We were facing what we believed was a public health crisis that needed to be addressed and we had what we thought was an agreement with the surgeon general to do a thing. We produced that thing ... and then it never saw the light of day."

Carmona told Politico he held a number of meetings about the call to action with Health and Human Services Department officials and the George W. Bush White House Domestic Policy Council, but his office was dealing with other big crises, like obesity and bioterrorism. "The [opioid] crisis was in its infancy," he said. "It wasn't like we dropped the ball." His term ended a few months after NIDA Director Nora Volkow pressed him for urgent action, and when an acting surgeon general took over, "what little momentum had built for a public warning evaporated," Politico says.

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"Had the call to action succeeded it would have been the first major attempt by the federal government to counteract the aggressive marketing of pharmaceutical companies that had led doctors to liberally — too liberally, in retrospect — prescribe the painkillers," Politico reports. Instead, "more than 133,000 people have died from prescription opioids since then — and hundreds of thousands more from street drugs including heroin and illicit fentanyl." Read more about the failed warnings at Politico.