The scientists’ March 15, 2006 memo, obtained under the Freedom of Information Act, shows that the directors from the National Institute on Drug Abuse and the National Institutes of Health flagged “disturbing” data showing a dramatic uptick in opioid addiction — including among teenagers — and requested urgent action. The agency directors wanted then-U.S. Surgeon General Richard Carmona to alert the public to the dangers of prescription drug abuse.

The memo from NIDA Director Nora Volkow led Carmona to agree to issue an official call to action — the most urgent and powerful tool his office has — to capture the public’s attention and raise awareness about emerging public health issues. Similar calls have been used to address threats including tobacco and to urge the public to wear seat belts.

“Given the startling statistics, efforts to heighten awareness of this problem should be a top public health priority,” Volkow wrote. But the action she initially sparked with the memo faded in months as the health agencies focused on other issues. Public health officials, including some who worked on substance abuse and mental health, didn’t fully grasp how much the problem would grow.