--:-- Host (Noel King): Welcome to Today Explained. I'm Noel King.
--:-- Lev Facher: Thanks for having me on the show.
--:-- Host (Noel King): So, the US has been dealing with an opioid epidemic for a generation. It's been bad. Hundreds of thousands of deaths in America. And then it got even worse during COVID.
--:-- Lev Facher: Last year, you might recall, Sean talked to a Wall Street Journal reporter who had started carrying Narcan in her purse, just in case. It's very small. You can fit it anywhere. I have two doses of it in my purse. I carry all the time. I hope I never have to use them. But, you know, it's pretty easy to carry around.
--:-- Host (Noel King): So this is how grim it had gotten. Ordinary people preparing themselves to intervene in case of an OD. But then, over the past year, something unexpected and very, very good happened. Overdose deaths started dropping fast.
--:-- Lev Facher: What on earth happened is ahead on Today Explained.
--:-- [Music transitions]
--:-- Host (Noel King): Support for Today Explained comes from the FIFA World Cup, of all things. The FIFA World Cup 26 is coming to North America next summer. It is the ultimate celebration of sports and culture.
--:-- Lev Facher: My name is Lev Fasher, and I am a reporter at STAT covering substance use and the U.S. overdose crisis.
--:-- Host (Noel King): Lev, the CDC released some data recently that has a lot of people feeling very optimistic. What does this data say?
--:-- Lev Facher: Essentially that drug overdoses are declining, and they're declining quickly. As of mid-2023, the running 12-month death count was about 111,000, more than 110,000 people dying in every 12-month period from drug overdoses. And now that number has dropped into the mid or even low 90,000 range.
--:-- Host (Noel King): So obviously that's nothing to brag about. That is still a horrific level of death. This is still a gigantic public health emergency, but fewer deaths is good.
--:-- Lev Facher: Okay, so what's been going on that's brought the numbers down? Well, that's the thing. It's kind of a mystery. There's no one event that happened about a year and a half ago that would explain this sudden significant decrease in drug overdose deaths.
--:-- Host (Noel King): So while there's a lot of optimism in the harm reduction and addiction medicine and recovery world, it's cautious optimism because people don't really know what's happening.
--:-- Lev Facher: And some of the explanations would be good news. And counterintuitively, some of the explanations for reduced deaths might actually not be good news at all.
--:-- Host (Noel King): I would say there are three main theories for why deaths might be decreasing. The first theory is just that the types of drugs that Americans are buying on the street, that people who use drugs are consuming are less toxic than they used to be.
--:-- Lev Facher: Now, there's not amazing data to support this idea. But as most Americans know, over the course of the last five or 10 years, fentanyl became incredibly prominent. Dealers started to lace fentanyl into the drugs they were already selling, like heroin, meth, cocaine, and counterfeit pills that look just like the real thing.
--:-- Host (Noel King): They've found rainbow fentanyl in 21 states. Milgram says it's a marketing ploy by the cartels. Fentanyl overdoses are now leading cause of death for Americans aged 18 to 49. That's according to a new analysis by The Washington Post.
--:-- Lev Facher: So one plausible theory is that fentanyl concentrations are lower. The fentanyl analogs, the specific chemical compounds in drugs, are less likely to cause overdose. But again, it's just a theory at this point.
--:-- Host (Noel King): A second explanation is just that drug use behavior is getting safer, which is to say that people are using drugs more slowly, maybe. There's been a shift from injecting fentanyl to smoking fentanyl.
--:-- Lev Facher: There's also been an increase in the availability of certain harm reduction services like test strips that people use to detect the presence of fentanyl or xylosine.
--:-- Host (Noel King): So people doing party drugs, people doing counterfeit pills that they bought on the Internet, they can actually test whatever they're using before they use it.
--:-- Lev Facher: So you don't have people unknowingly using fentanyl and dying of overdoses that way.
--:-- Host (Noel King): But then the third explanation is probably the most bleak. It's a concept called the depletion of susceptibles.
--:-- Lev Facher: And that's just to say that so many people have already died of drug overdoses that there aren't as many drug users left to die.
--:-- Host (Noel King): And, you know, that's not necessarily a mainstream theory. And even if it were accepted, it probably wouldn't explain the full significant sudden decrease in drug deaths.
--:-- Lev Facher: But when you think about it, when you have hundreds and hundreds of thousands of people dying of drug overdoses over the course of a pretty short span, it does make sense in some way that the population of people left to die is smaller.
--:-- Host (Noel King): That's how bad this crisis is.
--:-- Lev Facher: The opioid crisis has gone on for a generation, and Americans have come to expect our presidents to address it.
--:-- Host (Noel King): Joe Biden is the outgoing president. Donald Trump is the incoming president Donald Trump notably has served before.
--:-- Lev Facher: Did one of these two men approach this crisis better according to experts?
--:-- Host (Noel King): Yeah, of course depends who you ask Both presidents approached the crisis the way you would expect, given their respective parties' historic view of drug addiction and how to best combat that issue.
--:-- Lev Facher: Trump took a much more supply side approach, which is to say he focused more, he talked more about law enforcement, about drugs being smuggled in illegally via the southern border or even via the mail.
--:-- Host (Noel King): Fentanyl, heroin, meth and other lethal drugs are pouring across our wide open border.
--:-- Lev Facher: The U.S. Postal Service and the Department of Homeland Security are strengthening the inspection of packages coming into our country to hold back the flood of cheap and deadly fentanyl.
--:-- Host (Noel King): Unless you have the death penalty for drug dealers, you'll never get rid of the drug problem. Put that through your head, OK?
--:-- Lev Facher: Put that through your head.
--:-- Host (Noel King): Biden, on the other hand, took a much more demand-side approach.
--:-- Lev Facher: We made real progress together. We passed the law on making it easy for doctors to prescribe effective treatments for opioid addiction.
--:-- Host (Noel King): He focused more on treatment and even on harm reduction and was supportive of or at the very least not opposed to some tactics that are pretty effective but have historically been controversial like syringe exchange or even supervised drug consumption.
--:-- Lev Facher: And under Biden specifically, the Biden White House was historically supportive of harm reduction interventions like syringe exchange.
--:-- Host (Noel King): And they even kind of turned a blind eye to a pair of supervised consumption sites that are currently operating in Manhattan.
--:-- Lev Facher: And there's been a lot of cultural change, too, that happened during the past four years, though not necessarily because of the Biden White House.
--:-- Host (Noel King): But a lot of cultural change toward making drug use safer.
--:-- Lev Facher: One example I would give is an organization called Never Use Alone.
--:-- Host (Noel King): The concept is essentially that people overdose and die most often when they use by themselves because there's no one there to call 911.
--:-- Lev Facher: There's no one there to administer naloxone.
--:-- Host (Noel King): So this is just a hotline for people who want to use mostly opioids to call and someone will sit with them on the phone as they use.
--:-- Lev Facher: And if they stop responding over the phone, that person who's listening in will call 911.
--:-- Host (Noel King): So there's been a big cultural shift that I think some people credit, at least to an extent, with having helped reduce overdose deaths.
--:-- Lev Facher: But with every new administration, there's another opportunity to do it right or better.
--:-- Host (Noel King): Yeah, absolutely. And President Trump has continued to talk about the opioid crisis, though, again, mostly from the perspective of illegally smuggled, imported fentanyl.
--:-- Lev Facher: But he has, I think, two very interesting figures playing prominent roles in his administration who have talked about this issue quite a lot.
--:-- Host (Noel King): One is J.D. Vance, the incoming vice president.
--:-- Lev Facher: It was definitely something I saw growing up. And I remember when, you know, addiction hit our family and I found out that mom was addicted to prescription pain pills, as we called them back then.
--:-- Host (Noel King): I just didn't understand it. I didn't understand why anybody would be.
--:-- Lev Facher: I would actually say even more interesting is Robert F. Kennedy Jr., his nominee to serve as health secretary, also in long-term recovery and with some very, very fascinating ideas about how to combat the addiction crisis.
--:-- Host (Noel King): Our country, you know, has a form of kind of chronic inflammation, spiritually, mentally, emotionally.
--:-- Lev Facher: We need to start healing ourselves.
--:-- Host (Noel King): Lev Fasher of Stat News coming up.
--:-- [Music transitions]
--:-- Host (Noelle King): How do you build on this very, very real progress? Donald Trump's administration is going to get four more years to try.
--:-- Lev Facher: Support for Today Explained comes from Built Rewards.
--:-- Host (Noelle King): These days, it seems like everybody has a rewards program. You swipe your card and you get one cent on the hundred dollars.
--:-- Lev Facher: But with your rent, frequently, you just pay month after month. You never get anything from it other than that roof over your head.
--:-- Host (Noelle King): Not anymore, says Built Rewards.
--:-- Lev Facher: Built Rewards says it lets you earn points on your rent. By paying rent through Built, they say you can earn flexible points that can be redeemed toward hundreds of hotels and airlines, perhaps a future rent payment, your next Lyft ride, and so much more.
--:-- Host (Noelle King): Your home isn't just where you sleep. It's your community.
--:-- Lev Facher: And Built wants you to go out and do things in the community.
--:-- Host (Noelle King): You can eat at your favorite local restaurants, then earn more points.
--:-- Lev Facher: You can get VIP treatment at certain fitness studios.
--:-- Host (Noelle King): You can enjoy exclusive experiences. just for Bilt members every month.
--:-- Lev Facher: When you're ready to travel, they say Bilt points can be converted to miles or hotel points all around the world.
--:-- Host (Noelle King): You can earn points on rent and around your neighborhood wherever you call home by joining Bilt.com slash Explained.
--:-- Lev Facher: That's J-O-I-N-B-I-L-T dot com slash Explained.
--:-- [Music transitions]
--:-- Host (Noelle King): Every day, millions of customers engage with AI agents like me. We resolve queries fast. We work 24-7 and we're helpful, knowledgeable, and empathetic.
--:-- Lev Facher: We're built to be the voice of the brands we serve.
--:-- Host (Noelle King): Sierra is the platform for building better, more human customer experiences with AI.
--:-- Lev Facher: No hold music, no generic answers, no frustration.
--:-- Host (Noelle King): Visit sierra.ai to learn more.
--:-- Lev Facher: Support for the show today comes from LifeKit, the podcast from NPR.
--:-- Host (Noelle King): What's in your life kit? I'm asking.
--:-- Lev Facher: They didn't ask that.
--:-- Host (Noelle King): Every day you have to make choices that might shape the direction of your life, but you can't flip to the back of the book to find an answer key.
--:-- Lev Facher: Instead, you can listen to the Life Kit podcast from NPR.
--:-- Host (Noelle King): Life Kit offers real stories about common issues like relationships, finances, parenting, and your career.
--:-- Lev Facher: If you're looking to move with more intention or just need thoughtful guidance on living better, Life Kit delivers strategies to help you make meaningful, sustainable change.
--:-- Host (Noelle King): From fitness routines to mental resilience, navigating personal goals to tackling burnout, each episode is full of relevant insights and clear takeaways about things we all could use a little help with.
--:-- Lev Facher: Life Kit wants to help you approach your own life with confidence and clarity and walk away with a game plan you can implement right away.
--:-- Host (Noelle King): Enough from me. Go listen to the show, LifeKit.
--:-- Lev Facher: It's a podcast from NPR.
--:-- Host (Noelle King): This is Today Explained. I'm Noelle King back with Lev Fasher.
--:-- Lev Fasher: He's a reporter at Stat News who covers America's addiction crisis.
--:-- Host (Noelle King): He's been doing so since 2016 when one Donald J. Trump was elected president.
--:-- Lev Fasher: Lev, how bad were things when Trump came into the office the first time?
--:-- Host (Noelle King): They were bad. The number of people killed each year in the United States from opioid overdoses is at an all-time high.
--:-- Lev Fasher: Commonly abused opioids include prescription painkillers such as Vicodin, Percocet, and OxyContin.
--:-- Host (Noelle King): Everyone knew about how pervasive prescription painkillers had become and how in many cases those addictions led people to use illicit drugs like heroin.
--:-- Lev Fasher: But they weren't nearly as bad as they are today.
--:-- Host (Noelle King): We had something in the range of 40,000, 50,000 people dying of overdoses every year, and now it's roughly double that.
--:-- Lev Fasher: So hard as it was to imagine in 2016, things were about to get way, way worse.
--:-- [Music transitions]
--:-- Host (Noelle King): A deadly batch of drugs is making its way onto Chicago Street, sending more than a dozen people to the hospital in just one day.
--:-- Lev Fasher: Near Route 140 and Route 97 in Westminster, a person was found unconscious after falling victim to a drug overdose.
--:-- Host (Noelle King): Between 10 a.m. and noon, six more would follow.
--:-- Lev Fasher: According to the CDC, in 2017, there were more than 28,000 deaths involving synthetic opioids in the United States.
--:-- Host (Noelle King): Which is more deaths than from any other type of opioid.
--:-- Lev Fasher: The opioid epidemic.
--:-- Host (Noelle King): You remember that this was one of the glaring problems in pre-pandemic America.
--:-- Lev Fasher: Well, it got much worse during COVID.
--:-- Host (Noelle King): The drug epidemic affects many families here in West Virginia, but overdose numbers especially soared in the month of May.
--:-- Lev Fasher: There was a 55 percent increase in EMS responses to drug overdoses from May 29th.
--:-- Host (Noelle King): How did Donald Trump respond to the crisis during his first term?
--:-- Lev Fasher: One of the first things Trump did was to impanel a bipartisan commission of elected leaders and subject matter experts to get to the bottom of what was happening and kind of chart a path forward.
--:-- Host (Noelle King): We need help from the federal government in stopping drugs like fentanyl and others from coming into our country and fighting the drug kingpins and the traffickers.
--:-- Lev Fasher: But at the addiction level, we need treatment and prevention.
--:-- Host (Noelle King): So he had Chris Christie, the governor of New Jersey, and Roy Cooper, the governor of North Carolina.
--:-- Lev Fasher: He had Bertha Madras, a Harvard expert, and Patrick Kennedy, the former congressman, RFK's cousin.
--:-- Host (Noelle King): This is personal for me as it is for everyone else.
--:-- Lev Fasher: I also grew up in a family where addiction and alcoholism was rampant.
--:-- Host (Noelle King): And like today, it was something we never talked about.
--:-- Lev Fasher: And they put together this document of, I believe it was over 50 recommendations for specific policies that the U.S. should implement.
--:-- Host (Noelle King): And this was actually really a well-received document that talked about, sure, a lot of supply-side interventions and preventing drugs from coming into the country in the first place, but also some more active prevention measures in terms of helping people not become addicted and getting them help, access to treatment, and to an extent even harm reduction services once they were using.
--:-- Lev Fasher: We have been fighting this problem, and we have realized that we cannot arrest our way out of this problem, particularly at the user addiction level.
--:-- Host (Noelle King): The problem is that very few of these recommendations were fully implemented.
--:-- Lev Fasher: Congress did pass a bill in 2018 that put some resources toward this crisis.
--:-- Host (Noelle King): But again, advocates would tell you that it was nowhere near what it needed to be if Washington was serious about keeping people alive.
--:-- Lev Fasher: Did the Trump administration support any new treatment options, anything that previous administrations hadn't endorsed?
--:-- Host (Noelle King): The Trump administration was nominally supportive of medications used to treat opioid addiction, specifically methadone and buprenorphine.
--:-- Lev Fasher: But it didn't do that much to expand access.
--:-- Host (Noelle King): And there was even an incident where Tom Price, who was Trump's first health secretary, spoke about those medications in a very derisive way and caused a whole uproar that the health secretary wasn't following the evidence in terms of what works treating opioid addiction.
--:-- Lev Fasher: But no, nominally, they were supportive of access to many forms of evidence-based treatment.
--:-- Host (Noelle King): That's not the same thing, though, as facilitating some gigantic expansion in access.
--:-- Lev Fasher: All right. So now Donald Trump gets a chance to do it all again.
--:-- Host (Noelle King): Have we seen him float any new proposals for combating the opioid epidemic?
--:-- Lev Fasher: Him? No.
--:-- Host (Noelle King): But Robert F. Kennedy Jr., his incoming health secretary, yeah, absolutely.
--:-- Lev Fasher: He has a lot of very interesting ideas for how to beat this crisis.
--:-- Host (Noelle King): And worth noting that he himself is in long-term recovery from addiction to heroin, also to alcohol.
--:-- Lev Fasher: And he is a really frequent attendee of 12-step meetings, specifically Alcoholics Anonymous.
--:-- Host (Noelle King): I'm very active in recovery. I go to probably nine meetings a week.
--:-- Lev Fasher: He is certainly a 12-step proponent.
--:-- Host (Noelle King): And it's going to be interesting to see how that factors into public policy.
--:-- Lev Fasher: All right. So what is RFK saying?
--:-- Host (Noelle King): Well, his signature proposal is for a national network of wellness farms, I guess they're called, where people could go and spend time outdoors working with their hands, working with animals, etc.
--:-- Lev Fasher: And there's some evidence to suggest that this could be effective, though I think there's a lot of skepticism that you could implement this at scale, given the scope of the opioid crisis.
--:-- Host (Noelle King): And you also wouldn't want to do it at the expense of approaches that are known to be effective from a medical perspective, like those medications I mentioned, methadone and buprenorphine.
--:-- Lev Fasher: But that does seem to be RFK's big idea, these wellness farms that he has said he'd like to fund via a tax on legalized marijuana, fascinatingly.
--:-- Host (Noelle King): I would decriminalize marijuana. I will make safe banking laws for people who are selling it, but I will tax it federally and I will use that money to build these healing centers.
--:-- Lev Fasher: He actually filmed a documentary about addiction.
--:-- Host (Noelle King): The documentary is called Recovering America.
--:-- Lev Fasher: Talk about what a typical day is for people who have chores to do They get up at 6.30 a.m. They have a morning meditation first thing in the morning.
--:-- Host (Noelle King): After that, they will do their morning chores.
--:-- Lev Fasher: He has actually really endorsed the approach that Amsterdam in the Netherlands took to its drug crisis a couple decades ago.
--:-- Host (Noelle King): Which is super fascinating because, yeah, there was an element of police involvement.
--:-- Lev Fasher: There was kind of a carrot and a stick. There were consequences for people who didn't comply with Amsterdam's approach.
--:-- Host (Noelle King): But also the Netherlands does a lot of stuff that is seen as politically radical in the US.
--:-- Lev Fasher: They offer supervised consumption, which is illegal under federal law.
--:-- Host (Noelle King): They also prescribe prescription heroin to people who are not in a position to immediately stop using.
--:-- Lev Fasher: So RFK hasn't endorsed those policies specifically, but he's endorsed the Amsterdam approach writ large.
--:-- Host (Noelle King): And that's fascinating that he does seem to be open-minded about these various types of harm reduction interventions along with certainly having a greater police involvement.
--:-- Lev Fasher: It's worth noting RFK's own recovery began after he was arrested for heroin possession in the 80s.
--:-- Host (Noelle King): So there does seem to be a belief that people need to hit bottom, so to speak, before they can begin their recovery.
--:-- Lev Fasher: So I was arrested, which is the best thing that could have happened to me because I could have never gone into a 12-step meeting.
--:-- Host (Noelle King): It was just not even a place that I would consider going.
--:-- Lev Fasher: But now I got busted. Everybody knew. So now I could start going to 12-step meetings.
--:-- Host (Noelle King): He just wants the floor, he's said, to be higher than it currently is.
--:-- Lev Fasher: He doesn't want to see as many people homeless and destitute.
--:-- Host (Noelle King): He wants them to, I guess, hit bottom sooner so their recovery can start faster.
--:-- Lev Fasher: The Trump administration has at least one other player this time around who was not there last time, and that is J.D. Vance.
--:-- Host (Noelle King): J.D. Vance is from Middletown, Ohio. Ohio was hit very hard, as you know, by the opioid crisis.
--:-- Lev Fasher: And Vance has said he has loved ones who are opioid addicts.
--:-- Host (Noelle King): What have you heard from Vance over the years, and what influence do you think he might have?
--:-- Lev Fasher: Yeah, Vance talks a lot about the opioid crisis, you know, in his book, on the campaign trail.
--:-- Host (Noelle King): He talks about his own mother's experience with addiction.
--:-- Lev Fasher: And I think she is now in long-term recovery and doing very well.
--:-- Host (Noelle King): Our movement is about single moms like mine who struggled with money and addiction but never gave up.
--:-- Lev Fasher: And I'm proud to say that tonight my mom is here, 10 years clean and sober.
--:-- Host (Noelle King): I love you, mom.
--:-- Lev Fasher: He has also made this a signature issue.
--:-- Host (Noelle King): I want more of you and more of the families here in Philadelphia to get that second chance with a loved one.
--:-- Lev Fasher: I want them to have another opportunity to get back on that horse and get clean.
--:-- Host (Noelle King): I haven't heard as many concrete policy proposals.
--:-- Lev Fasher: And in fact, he had an addiction-focused nonprofit that shut down not long after being launched and was criticized for really not doing much.
--:-- Host (Noelle King): So it's certainly something he talks about a lot.
--:-- Lev Fasher: But whether it's going to be high on his policy portfolio, I'm not sure.
--:-- Host (Noelle King): Do you think in light of the progress that was somehow made in the last 18 months or so, that Donald Trump and J.D. Vance and this new administration have a chance of winning the war on opioid overdoses in America?
--:-- Lev Fasher: Do I think that there is a chance that over the course of the next four years, drug overdoses are going to really, really sharply drop?
--:-- Host (Noelle King): Yeah, absolutely.
--:-- Lev Fasher: Maybe that will be a credit to them. And the policies they implement, I think more likely it would be a continuation of the trend that we're currently seeing.
--:-- Host (Noelle King): But yeah, the good news here is everyone cares about this.
--:-- Lev Fasher: Every American wants fewer of their neighbors, actually zero of their neighbors, to die of drug overdoses.
--:-- Host (Noelle King): And it seems like we're trending in that direction, even though, of course, death rates are still horrifically high.
--:-- Lev Fasher: There are more than 90,000 people still dying every year of drug overdoses.
--:-- Host (Noelle King): But if we can sustain this momentum and if we can make progress, you know, getting the drug supply to be less toxic, getting people access to better treatment, better harm reduction.
--:-- Lev Fasher: Yeah, I really do think in the next four years, there's a chance that we could find ourselves in a much better place.
--:-- Host (Noelle King): Thank you. for the internet.
--:-- Lev Fasher: We use music by Breakmaster Cylinder.
--:-- Host (Noelle King): Today Explained is distributed by WNYC.
--:-- Lev Fasher: The show is a part of Vox.
--:-- Host (Noelle King): If you care to support our journalism by joining our membership program, you can do so today by going to vox.com slash members to sign up.
--:-- Lev Fasher: Our archives are always free and always open to the public.
--:-- Host (Noelle King): We welcome your five-star reviews and your inside jokes.
--:-- Lev Fasher: I'm Noelle King.
--:-- Host (Noelle King): It's Today Explained. Thank you.
--:-- Lev Fasher: work becoming revenue. It's more than a wire. It's payroll for your team. It's more than a deposit. It's landing your fundraise.
--:-- Host (Noelle King): The truth is, banking can do more.
--:-- Lev Fasher: Mercury brings all the ways you use money into a single product that feels extraordinary to use.
--:-- Host (Noelle King): Visit mercury.com to join over 200,000 entrepreneurs who use Mercury to do more for their business.
--:-- Lev Fasher: Mercury, banking that does more.
