EMILY KWONG, HOST:
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 toward the end of 2023...
BRIAN MANN, BYLINE: Suddenly, the data coming out of the Centers for Disease Control and Prevention showed this drop.
KWONG: Maybe it was a fluke, but the next month, same thing.
MANN: One month, two months in a row, a drop. Three months...
KWONG: Brian also started hearing the same thing from sources on the street, like this man, Kevin Donaldson, who was using fentanyl and xylazine in Burlington, Vermont.
KEVIN DONALDSON: For a while there, we were hearing about it every other day. But when was the last overdose we heard about? A couple of weeks ago, maybe - that's pretty far and few between.
MANN: What I was hearing from people using drugs on the street, talking to front-line 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.
KWONG: Across the country, the number of overdose deaths has continued to drop to this day.
MANN: This is a science-fiction level event, like never 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. And 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.
KWONG: Today, for our weekly Reporter's Notebook segment, we're going to unravel the mystery of this rapid reversal with Brian, who is NPR's addiction correspondent. ALL THINGS CONSIDERED co-host Scott Detrow picks up the conversation from here to talk about the reasons behind this surprising public health victory.
SCOTT DETROW, HOST:
Well, walk us through some of the biggest theories. What are the thoughts as to why this is happening?
MANN: OK, 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 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. And not safely - I don't want to sugarcoat this again, but they're better at it.
DETROW: It's incredibly dangerous. Yeah.
MANN: 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 surviving. They're living longer, and that is a good thing because it means they have more chances to recover, more chances to get out of this cycle. I don't want to say that they've recovered or they're healthy or they're off the street. They're still in a really dark place.
DETROW: OK, so that is the dark side of this. Talk me through some of the more positive thinking here, some of the policy-related factors that could be going on.
MANN: 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 in U.S. 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 noloxone - that medication that reverses overdoses - they really push to get that out on the street, get it everywhere. They just flooded the field with noloxone and Narcan, and I find it now everywhere. 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 noloxone really readily available.
SCOUT GILSON: I remember having to decide if I was going to give somebody enough Narcan 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.
DETROW: Wow.
MANN: That kind of calculation, Scott, was happening 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...
DETROW: Yeah.
MANN: ...In four years.
DETROW: And you have now mentioned kind of the black hole of politics that just about every conversation veers its way into. So let's get into that because you are talking about this incredibly positive track record on an issue a lot of Americans are worried about and care about. 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 saw this play out in the campaign?
MANN: It was really 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 candidate, 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.
(SOUNDBITE OF ARCHIVED RECORDING)
KAMALA HARRIS: 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 by the surge of fentanyl in our country.
MANN: Meanwhile, 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.
(SOUNDBITE OF ARCHIVED RECORDING)
PRESIDENT DONALD TRUMP: I will stop the drugs and fentanol pouring into our country, killing our kids and our families. We will stop it.
(CHEERING)
TRUMP: 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. It's nine times more than we had.
MANN: 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.
DETROW: 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?
MANN: You know, addiction destroyed my family. I have a beloved stepbrother who I grew up with, Rick (ph), who, you know, got drawn into the prescription pain 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 health care 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.
DETROW: That is NPR addiction correspondent Brian Mann. Brian, thanks for helping us understand these trends and helping us understand how you approach the story.
MANN: All right. Thanks Scott. Thanks for having me (ph). Transcript provided by NPR, Copyright NPR.
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