Reporting on how America reduced the number of opioid deaths
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Every month, NPR reporter Brian Mann checks a grim statistic, the federal tally of overdose deaths across the country. For years, that number only went up. But then, toward the end of 2023... Suddenly, the data coming out of the Centers for Disease Control and Prevention showed this

Maybe it was a fluke. But the next month, same thing. One month, two months in a row it dropped. Three months. Brian also started hearing the same thing from sources on the street. Like this man, Kevin Donaldson, who is using fentanyl and xylosine in Burlington, Vermont. For a while there, we're hearing about it every other day. But when it was last overdose, we heard about a couple weeks ago maybe. That's it.

It's pretty far and few between. What I was hearing from people using drugs on the street, talking to frontline harm reduction people, listening to people in Washington looking at this, they were saying this feels different. The carnage feels like it's easing. Suddenly, there was a shift. Across the country, the number of overdose deaths has continued to drop to this day. This is a science fiction level event, like never before before.

in the history of America's drug crisis, and this goes even back before the pain pill crisis of the 90s, go back to heroin, go back to crack cocaine. We've never solved a drug epidemic in the way that these numbers suggest.

The best interventions with everybody throwing everything at the problem sometimes can ease the problem by 8, 9%. We're now seeing states where drug deaths are dropping 50% in a single year. 30%, 40% is now common. That level of decline, so many lives being saved.

Consider this. The recent decline in overdose deaths is an unprecedented public health victory, one that shocked even experts in the field. Today, for our Weekly Reporter's Notebook series, we're going to unravel the mystery of this rapid reversal with Brian Mann, NPR's addiction correspondent. From NPR, I'm Emily Kwong. ♪

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Support for NPR and the following message come from Boll & Branch. Experience the softness of 100% organic cotton sheets. Take 20% off during the annual spring event at bollandbranch.com with code NPR. Limited time only. Exclusions apply. See site for details. It's Consider This from NPR. In 2023, when federal data started to show a decline in overdose deaths,

Some public health experts were skeptical. It's something that's even hard for me to comprehend, having looked at overdose death data every workday for 20 years. This is Nabaran Dasgupta, a leading addiction researcher at the University of North Carolina, Chapel Hill. It has been a complete shock to see the numbers declining in the way that they have been. It is not something that I thought, hmm.

It's even hard to talk about because it's, this is what we have been hoping for.

This is the turnaround that we've been waiting 30 years to see. The skepticism is now gone. So the question is, how did this happen? All Things Considered co-host Scott Detrow picks up the conversation from here, talking with NPR's addiction correspondent Brian Mann about the reasons behind this surprising public health victory. Well, walk us through some of the biggest theories. What are the thoughts as to why this is happening? Okay, so...

I want to talk about the hopeful, happy parts in just a second, but let me begin with some of the maybe darker reasons this could be happening. So one thing is that a lot of people have died, Scott. I mean, this is, this has been bad. Like this has been terrifying. 114,000 people in one year, 110,000 in another year. So a lot of the most vulnerable people are gone and that's certainly some part of it.

Another thing that's happening is that people on the streets regularly tell me that they've learned how to use fentanyl, this really dangerous drug, more safely. Not safely. I don't want to sugarcoat this again, but they're better. They don't use it as carelessly as they used to. And so some people who are still in very severe, very unhealthy addiction to this toxic drug are

OK, so that is the dark side of this talk. Talk.

Talk me through some of the more positive thinking here, some of the policy related factors that could be going on. Yeah. And I think the data here is really strong that we have seen one of the most effective public policy responses to a health crisis ever.

in US history, right? So what the Biden administration did, they came in after a year when drug deaths had spiked 30%. That's what happened in the last year of the Trump administration. They inherit a raging burning crisis of death across the country.

And they immediately begin implementing really significant changes. First of all, they work to get naloxone, that medication that reverses overdoses. They really push to get that out on the street, get it everywhere. They just flooded the field with naloxone and Narcan. And I find it now...

And I want to introduce you to Scout Gilson. She actually works now as a harm reduction person in Philadelphia, but she was on the street. She was a fentanyl user. She talks about what it was like before the Biden team made naloxone really readily available. I remember having to decide if I was going to give somebody enough Narcan or not.

And realizing that that might mean I don't have any more because I don't know how to access it. Someone else might die. Wow. That kind of calculation, Scott, was happening immediately.

Every day on every street in America, people were thinking, do I help that person survive or do I save it for myself? And now that's not what it's like. Everybody has Narcan. There's also a whole range of other things, much of it funded by the expansion of Medicaid under the Affordable Care Act that made insurance coverage really widely available for people who need addiction treatment.

They also made it really easy comparatively to get buprenorphine and methadone. These are medications that help people avoid relapses into fentanyl use. All of those things hitting the field at the same time, the Biden team inherits a 30% increase in drug deaths. As they left the White House, drug deaths were dropping by about 25%. So that's the arc that they managed to pull off in four years. And you have now mentioned-

Yeah.

And yet I closely covered the campaign. This is not an area where the Biden administration seemed to really tell a high profile good news story or get a lot of credit, seemingly, at least as a top level issue. Why do you think that was? What did you see when you when you saw this play out in the campaign? It was really interesting.

powerful to watch as a journalist. On the one hand, Scott, day after day, I was seeing this data solidify, showing this public health victory, this policy victory. And then what I would do is turn on the radio and I would hear Kamala Harris, the vice president and the Canada talking about fentanyl as if it's sort of a problem that they can't really deal with. At one point in the debate,

with Trump, she referenced the fact that he and his political allies had torpedoed an effort to increase security, including drug security, on the southern border. Here she is. It would have allowed us to stem the flow of fentanyl coming into the United States. I know there are so many families watching tonight who have been personally affected

Meanwhile, let me let me pivot and give you a taste of how then candidate Trump was talking about this. Here he is out on the campaign trail. I will stop the drugs and fentanyl pouring into our country, killing our kids and our families. We will stop it. I had it down to the lowest number in 32 years.

And then these people took over. And what happened to our border? What happened to even the drugs pouring in? Times nine, they tell me, is nine times more than we had. And what now President Trump was saying there on the campaign trail is just not factual. You know, fentanyl was spreading rapidly in the U.S. during his first term. Drug deaths, as we've mentioned, were skyrocketing. And yet he was clearly the one with the more powerful message leading up to the election day.

I want to ask about you and how you think about this, because you cover a lot of different topics. You've covered wars for us. You've covered the Olympics for us. You have this whole subgenre of Brian Mann pieces where you go for a hike and make people very jealous listening to you going on a hike on the radio. But you keep coming back to this topic that's a really tough topic to think about and talk about.

What's the draw for you? You know, addiction destroyed my family. I have a beloved stepbrother who I grew up with, Rick, who, you know, got drawn into the prescription pain world.

epidemic and eventually died from complications relating to his addiction. My father was deep in addiction for much of my childhood and much of my adult life. And the thing that's really has been powerful for me is that I didn't understand any of that. I was like most Americans. I think I had deep stigma about it. I hated it. I was scared of it. And only when I started understanding

that there are treatments, there are really good medical-based, science-based ways of helping people recover, did I start to put those pieces together. And I have huge regret about how I thought about my own family, how I navigated my own life before getting into this. And so I do try to say to people that this addiction thing that is so scary and often ugly, frankly,

It is also something that does respond to policy. It does respond to healthcare and science. Data is really crystal clear that if you help people stay alive long enough, by overwhelming margins, they recover, they get healthy again, they go on with really good lives.

I didn't know enough about that in my own family to help get to those places. I turned away from it, honestly. And so that is a reason that I continue to be very loyal to this beat and this subject because I love the idea that

Bit by bit, more Americans are realizing there is another side to this story and another side to how we respond to this. That's interesting. I was going to ask if that personal history made you a better reporter, but you're saying that being a reporter actually made you a more understanding family member. Oh, a thousand percent. And there have been moments along the way that I've had these, you know,

real flinch moments when I learn something about this and I think, oh God, if I had known that a decade ago, 15 years ago, I would have known what to do. I would have had a better vocabulary for this. Is there a specific example that comes to mind that you could talk about? Yeah. I think my brother Rick, who was injured, you know, working in a factory and was put on pain pills for his back. And I can remember feeling how...

much of a personal failing it was for him to not kick his opioid addiction, his desire for that and his, he would relapse and he would relapse. And I felt like then at a point I gave up on him. I, that's just the truth. I gave, I said, that's that, you know, he doesn't have the character. He doesn't have the strength. That's not somebody I really want to associate with. And what I now know, Scott is that relapse is a cornerstone part of this illness. It says normal to this illness, but

But you're continuing to cover it now and help others.

help other people understand it. Yeah. And I think about him all the time. I, you know, when I'm on the streets and, you know, Philadelphia or Seattle or wherever, and I meet people who are so powerful in there and I'm not romanticizing it. They're very unwell oftentimes, but they're also, you

living real lives they are real people they have thoughtful framing of how they see the world and what they hope for in the future and so you know rick and my dad definitely are kind of along for the ride whenever i'm having those conversations and whenever i'm really trying to listen you know that's that circle kind of comes full then

Brian, thanks for helping us understand these trends and helping us understand how you approach the story. All right. Thanks, Scott. Thanks for having me. That was NPR's addiction correspondent, Brian Mann, speaking with All Things Considered co-host, Scott Detrow. This episode was produced by Noah Caldwell and edited by Adam Rainey. Our executive producer is Sammy Yannigan. It's Consider This from NPR. I'm Emily Kwong. ♪

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