Fentanyl deaths are plunging, but it's just the first step
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We've had an entire community swept away. You can't even think of all the people that I know that have died. That's Louise Vincent talking to NPR addiction correspondent Brian Mann a few years ago as fentanyl deaths in the U.S. were soaring. I mean, so many people are dead. My daughter died. Our mentors are dead.

I can barely stand to be here sometimes because of all the trauma and all the people that we've lost. Vincent, who says that she has used fentanyl and heroin since she was 13, runs what's called a drug users union. That's a group that seeks to treat drug users with dignity by giving them a place where they can get a meal, a cup of coffee, even treatment. She was speaking to Mann about harm reduction for drug users.

Vincent is one of the hundreds of thousands of Americans who have been affected by the nation's opioid crisis, a crisis that has reached almost every corner of the country, including the Cherokee Nation in Oklahoma.

That's where Brian Mann met Gary and Cassie Walker on their family farm a couple years ago. They've taken in nine Cherokee kids whose parents have been affected by drugs. All of the children we have adopted or fostered has been because of that.

Being in foster care and going to court cases, and sometimes I would sit there for four to five or six hours, and I would not only watch one court case, but I would watch 30 or 40 at the same time. And it really hit me then just how big the problem was.

Among the kids they have cared for are a brother and sister, Ransom, who's six, and Mazzy, who's nine and not the least bit shy. So I heard you live in New York. I do. I live in New York. She tells me she really wants to see New York, and her dad, Gary, speaks up. Tell them why you want to go there, Manny. Okay.

The Walkers began raising Mazzy and Ransom after their parents got caught up with pain pills and fentanyl. We always remind them that God gave them to us very special and that their parents were sick and so we were able to raise them. There is mothers out there that did lose their child and I was able to become their mother. So it's just a lot of emotions there.

Both Vincent and the Walkers spoke to Mann back in 2023, the same year that drug deaths in the U.S. reached their peak at 114,000, many of which were caused by fentanyl. Data now shows that overall drug deaths in the U.S. are down nearly a quarter, and that includes fentanyl and other illicit drugs. ♪

Consider this. Drug deaths in the United States are falling, but that good news comes with challenges, including caring for a larger population of people who may be surviving, but who are deeply unwell. From NPR, I'm Elsa Chang. This message comes from NPR sponsor, SADVA. Founder and CEO Ron Rudson shares the story of how he got started creating SADVA.

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The deadliest phase of the U.S. fentanyl crisis appears to be over. That's according to new research showing that fatal overdoses from fentanyl and other street drugs continue to plunge and have now dropped from their peak in all 50 states. NPR addiction correspondent Brian Mann dug into the numbers and what that drop could mean going forward.

When Nebra and Descupta's team at the University of North Carolina finished their new analysis of drug death data, they found a positive trend that seemed inconceivable a year ago. We are on track to return to levels of overdose before fentanyl emerged. Drug deaths tracked nationwide by the Centers for Disease Control and Prevention have already plunged 24% from peak levels. Every state has now seen improvement, with many states improving by 30%, 40%, even 50%.

Dasgupta says the number of lives being saved left him stunned. It has been a complete shock, the numbers declining in the way that they have been. I thought, hmm, it's even hard to talk about because it's, after all this time looking at overdose deaths, this is what we have been hoping for. Data is one thing. Reality on the street can feel very different. This is Kensington, long known as one of the country's most drug-plagued neighborhoods in Philadelphia.

On a warm afternoon, Elena and Vadim lean against a fence, smoking a mix of fentanyl and xylisi. NPR agreed not to use last names because their drug use is illegal.

I ask how this national shift feels here. And Elena says she's noticed the change. Yeah, I can tell, you know, the numbers drop. A lot more people also started smoking instead of shooting. I think that made a difference. Smoking fentanyl and xylosine is still incredibly risky, but it's considered safer than using needles. Vadim says many people who use fentanyl are also taking smaller doses. When fentanyl just came out, they were used to shooting heroin in the same amounts.

So that's why they were dying, because you need a lot less. They say there are more public health services here on the street, and people routinely carry naloxone or Narcan to reverse fentanyl overdoses. All this has contributed to nearly 2,000 fewer deaths a year in Pennsylvania alone compared with the peak. Dr. Nora Volkov, who heads the U.S. government's National Institute on Drug Abuse, says she believes the U.S. as a whole has reached a turning point.

It's very, very exciting to see that it's dramatically decreasing. While overall drug deaths are down 24%, Volkov says deaths linked specifically to fentanyl are dropping even faster, down more than 30%.

If that trend holds, the U.S. could soon return to levels not seen since 2016 when fentanyl hit. It would be exciting if one returns to those values because fentanyl just turned us all upside down. Volkov and Descupta also agree. This shift appears to be long-term and sustainable. Descupta's deep dive into CDC records found nearly half the states actually saw recoveries beginning much earlier than once understood.

with fatal overdoses peaking back in 2021 and 2022, then beginning a steady decline. This is a clear public health improvement, no matter how you measure it. It's been sustained in some states for years. The result nationally is roughly 25,000 fewer drug deaths every year. But does Gupta and other addiction experts say this isn't a time to declare victory?

They describe these improvements more as a crucial first step, meaning less death, but also a lot more people surviving with severe addiction and chronic illness needing help. Dr. Ben Cotillaro treats addiction patients here in Kensington. It does seem to be less lethal.

Not less dangerous, right? Because we're seeing plenty of other problems that come from it. Xylosine has really bad skin wounds. Metatomidine has just a terrible withdrawal syndrome. Desgupta says the trend creates a new challenge. Initially, it's been kind of this panic mode of preventing deaths. But now that we have found some effective ways to keep people alive, it's really important to try to reach out to them and help them improve their whole lives.

That's a tall order. The distance from where the U.S. is now in places like Kensington to that kind of public health response feels vast. On a late winter morning, Kaylee McLeod with Philadelphia's Overdose Response Unit sets off on foot across Kensington. She bends to check on a man huddled and unresponsive.

He's not dead, but he's not okay. The complicated reality is that more people surviving fentanyl overdoses will mean more people needing a whole network of care. When we say, you know, this person is ready to go to substance use treatment, oh, but they have an amputation, they have an open wound, they have incredibly high blood pressure. You know, historically, our system is not built for that person.

A few blocks down the street, I meet Tracy Horvath, who says she's lived in Kensington most of her life, much of that time using fentanyl. I relapsed like a week ago, but I'm trying to stay clean. She looks weary and cold, but she is one of the survivors. Horvath, too, says fentanyl might have killed her if Narcan weren't so widely available. I only used a little bit, and I still overdosed.

I ask what she'd need to move beyond this life, beyond addiction. Horvath says her first goal is a safe place to live. Stable housing.

Addiction care experts say getting people off the street into homes is often a crucial step. But there are so many needs here, it can feel overwhelming. Kayla McLeod says there has been progress building a network of services and support that didn't exist a decade ago. There's one of our partners, the Kensington Hospital Wound Care Van.

We pass a mobile health care team and a food pantry. There's a special police unit trained in addiction response and a group from a university dispensing buprenorphine, a medication that reduces fentanyl cravings. I meet Scout Gilson working at a syringe exchange run by a group called Prevention Point.

I was addicted to heroin and then eventually fentanyl. Gilson, who's in long-term recovery, says she knows firsthand how complicated the health impacts of drug use can be, from mental health challenges to lingering skin wounds. I'm covered in scars. Like, I am heavily scarred. I am pretty much marked forever as a drug user. But Gilson thinks deeper healing that moves people beyond survival is possible with the right help. It's not just pointless suffering. There's things that are happening. There's people doing the work.

And there's obvious ways we can improve and just figuring out how to do that. In my time in Philadelphia, I see examples of this hopeful work. And I meet people like Gilson who've managed to rebuild their lives. But the need is clearly growing here in Kensington and around the U.S. One question is whether there will be money to pay for these services.

So far, the Trump administration has focused largely on keeping fentanyl out of the U.S., not on programs that help people recover. Some Republicans in Congress are still talking about budget cuts that could affect Medicaid. That's the federal program that funds most addiction treatment in the U.S. I asked Kayleigh McLeod with Philadelphia's Overdose Response Unit if she's hopeful, despite all the desperate need and the uncertainty.

After a moment, she nods a cautious yes. And so we just, you know, work our best to help people be well and keep trying. But it took years to slow fentanyl deaths in the U.S. McLeod says healing people in neighborhoods like Kensington will take more resources and a lot more time. That was NPR's Brian Mann in Philadelphia.

This episode was produced by Taylor Haney, Brianna Scott, and Connor Donovan, with audio engineering by Arthur Laurent. It was edited by Courtney Dorning and Andrea DeLeon. Our executive producer is Sammy Yannigan. It's Consider This from NPR. I'm Elsa Chang.

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