Reporting on how America reduced the number of opioid deaths

Summary

Podcast Summary: Consider This from NPR
Episode: Reporting on How America Reduced the Number of Opioid Deaths
Release Date: March 30, 2025

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Introduction: An Unexpected Turn in the Opioid Crisis

In a remarkable shift, the United States has witnessed a significant decline in opioid overdose deaths, a trend that had long eluded public health experts. This episode of NPR's Consider This delves into the factors contributing to this unprecedented public health victory, exploring both the statistical trends and the human stories behind the numbers.

Unprecedented Decline in Overdose Deaths

Every month, NPR reporter Brian Mann scrutinizes federal overdose death statistics, a grim routine that had only revealed an upward trajectory in the opioid crisis. However, toward the end of 2023, Mann observed a surprising downturn:

Brian Mann [00:14]: "Suddenly the data coming out of the Centers for Disease Control and Prevention showed this drop."

This initial anomaly was quickly confirmed over the subsequent two months, signaling a potential turning point in America's battle against opioid-related fatalities.

Skepticism Among Experts

The sudden decrease in overdose deaths was met with skepticism from seasoned professionals in the field. Nabaran Dasgupta, a leading addiction researcher at the University of North Carolina, Chapel Hill, expressed astonishment:

Nabaran Dasgupta [03:33]: "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 this is what we have been hoping for."

Scott Detrow, co-host of All Things Considered, echoed this sentiment, highlighting the historical difficulty in reversing the opioid epidemic:

Scott Detrow [03:19]: "It's something that's even hard for me to comprehend, having looked at overdose death data every workday for 20 years."

Policy Changes and Public Health Interventions

Brian Mann attributes the decline to a combination of harm reduction strategies and effective public policy interventions spearheaded by the Biden administration. Key measures included:

1. Widespread Distribution of Naloxone: The administration ensured that naloxone, a life-saving medication that reverses opioid overdoses, became readily available across communities.

   Brian Mann [05:30]: "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 everywhere."

2. Expansion of Medicaid: Under the Affordable Care Act, Medicaid expansion facilitated broader access to addiction treatment services.

3. Increased Access to Treatment Medications: Medications such as buprenorphine and methadone became more accessible, providing individuals with tools to manage addiction and prevent relapse.

Mann highlights the effectiveness of these combined efforts:

Brian Mann [05:30]: "The Biden team inherits a 30% increase in drug deaths. As they left the White House, drug deaths were dropping by about 25%."

Real-World Impact and Personal Stories

The policies implemented had tangible effects on the ground. Kevin Donaldson, a former fentanyl user from Burlington, Vermont, observed a shift in overdose occurrences:

Kevin Donaldson [00:35]: "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 pretty far."

Scout Gilson, a harm reduction worker in Philadelphia, shared her experiences before and after the widespread availability of Naloxone:

Scout Gilson [02:40]: (Note: This segment is an advertisement and thus excluded from the summary.)

Brian Mann’s Personal Connection to the Crisis

Brian Mann's dedication to covering the opioid crisis is deeply personal. He shares his family's struggle with addiction, revealing how these experiences shaped his approach to journalism:

Brian Mann [10:13]: "Addiction destroyed my family. I have a beloved stepbrother who I grew up with, Rick, who got drawn into the prescription pain epidemic and eventually died from complications relating to his addiction."

He reflects on his initial misconceptions and the evolution of his understanding:

Brian Mann [12:04]: "A thousand percent. And there have been moments along the way that I've had these real flinch moments when I learned something about this."

Mann emphasizes the importance of viewing addiction through a compassionate and medical lens, advocating for policies that save lives and support recovery:

Brian Mann [13:28]: "This addiction thing... it also responds 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."

Conclusion: A Turning Point with Optimistic Prospects

The decline in opioid overdose deaths represents a monumental achievement in public health, achieved through a combination of compassionate policy-making, scientific intervention, and community-based harm reduction strategies. While challenges remain, the progress underscores the potential for effective responses to complex health crises.

Brian Mann [01:05]: "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."

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Notable Quotes:

• Brian Mann [00:14]: "Suddenly the data coming out of the Centers for Disease Control and Prevention showed this drop."

• Nabaran Dasgupta [03:33]: "It has been a complete shock to see the numbers declining in the way that they have been."

• Brian Mann [05:30]: "They just flooded the field with naloxone and Narcan, and I find it now everywhere."

• Brian Mann [10:13]: "Addiction destroyed my family... [and] eventually died from complications relating to his addiction."

• Brian Mann [13:28]: "Science data is really crystal clear that if you help people stay alive long enough by overwhelming margins, they recover."

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This episode of Consider This offers a comprehensive examination of America's strides in reducing opioid-related deaths, blending statistical analysis with poignant personal narratives to provide listeners with a nuanced understanding of this significant public health development.

Transcript

[Emily Kwong]

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.

[Brian Mann]

Suddenly the data coming out of the Centers for Disease Control and Prevention showed this drop.

[Emily Kwong]

Maybe it was a fluke, but the next month, same thing, one month, two.

[Brian Mann]

Months in a row, a drop three months.

[Emily 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're hearing about it every other day. But when it was last overdose, we heard about a couple weeks ago. Maybe that's pretty far.

[Brian Mann]

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.

[Emily Kwong]

Across the country, the number of overdose deaths has continued to drop to this day.

[Brian 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. 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.

[Emily Kwong]

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 and Pierre's addiction correspondent from NPR, I'm Emily Kwong.

[Nabaran Dasgupta]

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[Emily Kwong]

It's consider this from NPR. In 2023, when federal data started to show a decline in overdose deaths, some health experts were skeptical.

[Scott Detrow]

It's something that's even hard for me to comprehend, having looked at overdose death data every workday for 20 years.

[Emily Kwong]

This is Nabaran Dasgupta, a leading addiction researcher at the University of North Carolina, Chapel Hill.

[Scott Detrow]

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.

[Emily Kwong]

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.

[Kamala Harris]

Well, walk us through some of the biggest theories. What are, what are the thoughts as to why this is happening?

[Brian Mann]

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 surviving. They're living longer. And, 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.

[Kamala Harris]

Okay. 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.

[Brian 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 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 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 naloxone really readily available.

[Kevin Donaldson]

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.

[Kamala Harris]

Wow.

[Brian 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 in four years.

[Kamala Harris]

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. When you saw this play out in the campaign?

[Brian 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.

[Scott Detrow]

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.

[Brian Mann]

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.

[Donald Trump]

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.

[Brian 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 US 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.

[Kamala Harris]

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 sub genre 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?

[Brian Mann]

Addiction destroyed my family. I have a beloved stepbrother who I grew up with, Rick, who 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, 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. 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.

[Kamala Harris]

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?

[Brian Mann]

Oh, a thousand percent. And there have been moments along the way that I've had these real flinch moments when I learned 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.

[Kamala Harris]

Is there a specific example that comes to mind that you could talk about?

[Brian Mann]

Yeah, I think my brother Rick, who was injured 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. 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's as normal to this illness as things that you do for diabetes or you do for cancer. You have to expect relapse to happen. It's part of the arc. I know that there are medical treatments that he could have had that I could have helped guide him toward. All of that, even back then, was out there and available. And I just. I didn't clock it at the time.

[Kamala Harris]

But you're continuing to cover it now, and help other people understand it.

[Brian Mann]

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

[Kamala Harris]

Brian, thanks for helping us understand these trends and helping us understand how you approach the story.

[Brian Mann]

All right. Thanks, Scott. Thanks for having me.

[Emily Kwong]

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 Sami Yenigun. It's consider this from npr. I'm Emily Kwong.

[Scout Gilson]

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