Consider This from NPR - Is there finally hope in America's overdose crisis?

Episode Date: October 7, 2024

In a twist that many addiction experts thought impossible, the decades long upward trend of opioid deaths in the United States has finally started to decline. And while there are plenty of theories, there are still very few answers as to why and how.For sponsor-free episodes of Consider This, sign up for Consider This+ via Apple Podcasts or at plus.npr.org. Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Kevin Donaldson uses fentanyl mixed with a powerful tranquilizer called xylosine in Burlington, Vermont. He knows how risky this kind of drug addiction can be. I feel like some of us have learned how to deal with the overdoses a lot better. But he's still alive, and he says fewer of his friends are dying. For a while there, we're hearing about it every other day, but it was the last overdose we heard about. A couple weeks still, maybe? That's pretty far and heard about a couple weeks ago maybe, that's pretty far and few between. The data backs up Donaldson's experience.

The Vermont Department of Health shows 22% fewer drug deaths in the first half of this year. And it's not just Vermont. Dennis Cushon is an advocate for addiction treatment in Ohio, where fatal overdoses have dropped by nearly a third. The deaths were just plummeting, and the data's never moved like this.

And in the Pacific Northwest, Brad Feingood heads the overdose crisis response in Seattle, where the latest data show a 15% drop in drug deaths this year. A year ago, when overdose deaths continued to rise, I was really struggling with hope. But today, I have so much hope. Consider this. We know I have so much hope. Consider this. We know that overdose deaths have dropped. What we don't know is why. From NPR, I'm Ari Shapiro.

You care about what's happening in the world. Let State of the World from NPR keep you informed. Each day we transport you to a different point on the globe We'll see you next time. from NPR. Vital international stories every day. You care about what's happening in the world. Let State of the World from NPR keep you informed. Each day we transport you to a different point on the globe and introduce you to the people living world events. We don't just tell you world news, we take you there and you can make this journey while you're doing the dishes or driving your car. State of the World podcast from NPR, vital international stories every day. Every weekday, NPR's best political reporters come

to you on the NPR Politics Podcast to explain the big news coming out of Washington, the campaign trail, and beyond. We don't just want to tell you what happened, we tell you why it matters. Join the NPR Politics Podcast every single afternoon to understand the world through political eyes. It's Consider This from NPR. Addiction experts have never seen a drop in overdose deaths like the one this year. The numbers are down at least 10% over the last 12 months. NPR addiction correspondent Brian Mann has been tracking this big improvement in overdose deaths, and he's here to talk about what it means. Hi, Brian.

Hi, Ari. Any idea what has caused this steep drop? You know, one of the things that's been really fascinating about covering this is that it's a mystery, right? This has been a crisis that has escalated and escalated starting in the 90s and then getting even worse during the era of fentanyl over the last five years. Now this pivot, and we don't know for sure why it's happening. One theory is that the United States has kind of flooded the field with naloxone. That's this overdose reversal medication that helps people who have overdosed on fentanyl. That's one possibility. There's also better medical care for people out there, medications

like Suboxone that can help people lower their risk of overdose. One darker possibility, Ari, there is a theory that a lot of vulnerable people have just died already. I spoke about this with Keith Humphries. He's a researcher at Stanford University. And here's what he said about this theory. During COVID, a lot of people who would have died otherwise, say this year, next year, year after, died already. And so that is horrible, you know, pull those deaths forward. But it does mean the population is smaller. The number of people left to die is smaller. Now, that's just one theory, and it's a controversial one. So the short answer right now is that this is something researchers are racing to try to understand,

in part because they want to build on it. They want to keep this trend going. So they're trying to understand why we've seen this very hopeful improvement. Sure. They want to know what they've been doing right. I mean, we described the dramatic top line number of deaths dropping. Once you break it down, are there certain populations that are doing better, that are more at risk? Yeah, that's a really good question because addiction does hit the United States very differently. And that is a pattern we're seeing right now. Some states are doing better right now. It appears that the drop in mortality for drug overdoses is bigger in the East than it is in the West. Another thing that's still really troubling is that people in the African-American community are still very vulnerable

to fatal overdose. And also Native American communities across the country and also Alaska Native communities have actually seen increases in drug mortality. So this is, again, part of the pattern that researchers say they really need to understand why is it that this is getting better so quickly for some parts of the American community, while others still seem to be really vulnerable. One theory is that the street supply of fentanyl has declined, and that might be what's causing the drop in overdose deaths. What do you hear from people who use the drug and have been trying to buy it on the street? Yeah, this is really a big focus right now, this question of what's

happening to the fentanyl supply that's out there on the streets. Remember, we always thought that fentanyl was basically impossible to stop. It's so cheap to make. It's a synthetic opioid, so you can cook it in a laboratory pretty cheaply and easily. But suddenly what we're seeing is that in many parts of the U.S., the fentanyl that's arriving at the street level, this illicit drug, is weaker. It's being cut heavily with other chemicals, including an industrial chemical called B-tamps. I spoke about this with Morgan Godvin. She's a researcher based in California who's been out on the streets talking to people who are buying and using fentanyl. Here's what she had to say. People are reporting getting dope sick, going into withdrawal despite smoking fentanyl,

because what they are using is such low percentage fentanyl. And everyone is searching and going through different suppliers. And the daily amount that they're spending trying to stay well has skyrocketed. So what you're hearing there, Ari, is that the drugs on the street have really changed. In some cases, that's really hopeful because what we're hearing is that people who can't find the drugs they want on the street, in some cases, they're going to clinics, public health facilities and saying, okay, it's time now for me to get healthcare because I can't find the fentanyl that I wanted

on the streets. And so there is an idea that for some people who've been caught in this life, there is a real opportunity for them to start healing. So if we work our way backwards up the supply chain from the diminishing supply of street fentanyl, does that suggest that the Mexican drug cartels that produce or transport the fentanyl that winds up on the streets, have they been hit? Are they weaker? You know, it's interesting. This is the second mystery, right? The first mystery, why are these drug deaths suddenly dropping? The second mystery, why is fentanyl suddenly being dil be in court in New York City facing sentencing and also a court hearing because there have been really high-level arrests, also a really aggressive targeting of the money supply, you know, the money launderers and the underground banks that handle fentanyl profits. The Biden administration says they're making real progress there. There have also been huge street fentanyl

seizures around the country. In the past, people thought that the supply chain was so resilient that this probably wouldn't have much of an impact. But we're now starting to hear from people that maybe these drug cartels really are being affected to a degree that it's going to be harder and more expensive to find fentanyl on the street. If that happens, if that kind of disruption works, it could save lives. Fentanyl has been such a huge issue on the campaign trail. Do we hear the candidates talking in a different way about it now that these numbers show such a dramatic change? The short answer is no.

You know, this is something that really has been a real flashpoint for politicians. And what we're hearing from Kamala Harris, the Democratic candidate, is, you know, she was down at the southern border and she promised to keep doubling down on efforts to stop fentanyl. She called it a scourge. And I think the Biden administration's being very cautious about declaring any kind of victory here because there are still so many people dying, right? This is a big improvement, but there's still tens of thousands of people dying every year from fentanyl and other drugs.

Meanwhile, Ari, Donald Trump has continued to spread disinformation and saying things about fentanyl that's just not true, claiming that it's being carried across the border by undocumented migrants, when in fact, it's normally being carried, typically being carried by American citizens. That's according to NPR's reporting. This is really still being linked by Trump's campaign with these wider fears about immigration and the border. So for now, at least in the debate leading up to the election, this improvement and this reduction in drug deaths, it's not part of what voters are hearing about from these candidates. That's NPR addiction correspondent Brian Mann. Thank you. Thank you for having me. This episode was produced by Mark

Rivers and Vince Pearson. It was edited by Jeanette Woods and Andrea DeLeon. Our executive producer is Sammy Yenigan. And one more thing before we go, you can now enjoy the Consider This newsletter. We still help you break down a major story of the day, but you'll also get to know our producers and hosts and some moments of joy from the All Things Considered team. You can sign up at npr.org slash consider this newsletter. It's Consider This from NPR. I'm Ari Shapiro. The NPR app cuts through the noise, bringing you local, national and global coverage. No paywalls, no profits, no nonsense.

Download it in your app store today. The day's top headlines, local stories from your community, your next podcast binge listen. You can have it all in one place, your pocket. Download the NPR app today.