A win in the opioid crisis

Summary

Podcast Summary: "A Win in the Opioid Crisis" — Today, Explained

Today, Explained by Vox delves into a cautiously optimistic development in the long-standing opioid epidemic in the United States. Hosted by Noel King and featuring insights from Lev Fasher, the episode titled "A Win in the Opioid Crisis," released on December 11, 2024, explores the recent decline in overdose deaths, investigates potential reasons behind this trend, and examines the roles of the incoming Trump administration in continuing the fight against opioid addiction.

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1. Introduction

Noel King sets the stage by highlighting the severity of the opioid epidemic, emphasizing the hundreds of thousands of deaths over the past generation. She references a poignant moment during the COVID-19 pandemic, where ordinary people like a Wall Street Journal reporter and herself carried Narcan—a life-saving overdose reversal drug—in anticipation of potential emergencies.

Noel King [00:00]:
"The US has been dealing with an opioid epidemic for a generation. It's been bad. Hundreds of thousands of deaths in America."

2. Recent Decline in Overdose Deaths

Lev Fasher presents alarming yet hopeful CDC data indicating a significant drop in drug overdose deaths over the past year. From a staggering 111,000 deaths in a 12-month period as of mid-2023, numbers have decreased to the mid or low 90,000 range.

Lev Fasher [02:35]:
"Drug overdoses are declining and they're declining quickly...now that number has dropped into the mid or even low 90,000 range."

While these figures remain devastating, the reduction suggests a positive shift in the opioid crisis dynamics.

3. Possible Reasons for the Decline

Fasher explores three primary theories behind the decrease in overdose deaths:

1. Less Toxic Drug Supply: There is speculation that the drugs circulating on the streets have become less potent. However, data supporting this is limited, especially considering fentanyl's prominence in recent years.

   Lev Fasher [04:16]:
   "One plausible theory is that fentanyl concentrations are lower...but again, it's just a theory at this point."

2. Safer Drug Use Behaviors: Improvements in harm reduction practices, such as slower drug consumption rates and increased availability of test strips to detect fentanyl, may be contributing to fewer accidental overdoses.

   Lev Fasher [04:26]:
   "People doing party drugs...can actually test whatever they're using before they use it."

3. Depletion of Susceptibles: A more somber theory suggests that the high mortality rate has reduced the population of individuals vulnerable to overdose, leaving fewer individuals at risk.

   Lev Fasher [05:40]:
   "There are more than 90,000 people still dying every year of drug overdoses. But if we can sustain this momentum..."

4. Presidential Approaches to the Crisis: Biden vs. Trump

The conversation shifts to contrasting the opioid strategies of Presidents Joe Biden and Donald Trump.

• Donald Trump's Supply-Side Approach:

  Trump prioritized law enforcement, focusing on preventing the influx of illegal drugs through border security and postal inspections.

  Donald Trump [07:24]:
  "Fentanyl, heroin, meth and other lethal drugs are pouring across our wide open border...Unless you have the death penalty for drug dealers, you'll never get rid of the drug problem."

  However, Trump's administration showed only nominal support for treatment expansions, with mixed messages regarding effective addiction medications.

  Lev Fasher [18:39]:
  "The Trump administration was nominally supportive of medications used to treat opioid addiction...but it didn't do that much to expand access."

• Joe Biden's Demand-Side Approach:

  Biden focused on treatment, harm reduction, and cultural shifts towards safer drug use practices. Initiatives included support for syringe exchanges and the emergence of community-driven solutions like the "Never Use Alone" hotline.

  Lev Fasher [07:53]:
  "He focused more on treatment and even on harm reduction...a lot of cultural change toward making drug use safer."

5. Key Figures in the Trump Administration's Efforts

With Donald Trump resuming the presidency, his administration includes influential figures like Robert F. Kennedy Jr. (nominee for Health Secretary) and incoming Vice President J.D. Vance, both of whom have personal connections to the addiction crisis.

• Robert F. Kennedy Jr.’s Proposals:

  RFK Jr. advocates for innovative solutions such as a national network of wellness farms, emphasizing holistic recovery methods.

  Lev Fasher [20:04]:
  "His signature proposal is for a national network of wellness farms...but that does seem to be RFK's big idea."

  Additionally, RFK Jr. endorses aspects of the Netherlands' Amsterdam approach, blending harm reduction with supportive policing.

• J.D. Vance’s Involvement:

  Coming from Middletown, Ohio, Vance has personal ties to the crisis through his family's struggles with addiction. While he emphasizes the issue, concrete policy proposals remain limited.

  Lev Fasher [23:44]:
  "He has also made this a signature issue, but whether it's going to be high on his policy portfolio, I'm not sure."

6. Future Prospects and Policy Proposals

The discussion turns to the potential impact of the Trump administration's renewed focus on the opioid crisis. Despite historical approaches leaning heavily on law enforcement, there is a slight pivot towards integrating harm reduction strategies.

Lev Fasher [24:54]:
"Every American wants fewer of their neighbors, actually zero of their neighbors to die of drug overdoses."

Fasher expresses cautious optimism that continued efforts, whether through policy shifts or sustained cultural changes, could further reduce overdose rates.

7. Conclusion

The episode wraps up with an acknowledgment of the complex nature of the opioid crisis. While the recent decline in overdose deaths marks a significant, albeit insufficient, victory, the battle against addiction continues. The interplay of governmental policies, societal attitudes, and innovative harm reduction strategies will shape the future trajectory of this public health emergency.

Noel King [24:39]:
"Do you think...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 [24:54]:
"If we can sustain this momentum and if we can make progress...there's a chance that we could find ourselves in a much better place."

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This comprehensive exploration underscores the multifaceted efforts required to combat the opioid epidemic and highlights both the progress made and the challenges that lie ahead.

Transcript

[Noel King]

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 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 that I carry all the time. I hope I never have to use them, but you know, it's pretty easy to carry. 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. What on earth happened? Is ahead on Today explained.

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[Lev Fasher]

This is TODAY Explained. My name is Lev Fasher and I am a reporter at STAT, covering substance use and the U.S. overdose crisis.

[Noel King]

Lev, the CDC released some data recently that has a lot of people feeling very optimistic. What does this data say?

[Lev Fasher]

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. 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.

[Noel King]

Okay, so what's been going on that's brought the numbers down?

[Lev Fasher]

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 drug overdose deaths. 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. 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. 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. 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.

[Donald Trump]

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.

[Advertisement Speaker]

They found rainbow fentanyl in 21 states. Milgram says it's a marketing ploy by the cartels.

[Noel King]

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 Fasher]

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. 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. 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 xylazine. So people doing party drugs, people doing cow counterfeit pills that they bought on the Internet, they can actually test whatever they're using before they use it. So you don't have people unknowingly using fentanyl and dying of overdoses that way. But then the third explanation is probably the most bleak. It's a concept called the depletion of susceptibles. 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. 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. 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. And that's just kind of the bleak reality we're facing. That's how bad this crisis is.

[Noel King]

The opioid crisis has gone on for a generation, and Americans have come to expect our presidents to address it. Joe Biden is the outgoing president. Donald Trump is the incoming president. Donald Trump notably has served before. Did one of these two men approach this crisis better, according to experts?

[Lev Fasher]

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. 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.

[Donald Trump]

Fentanyl, heroin, meth and other lethal drugs are pouring across our wide open border. 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. Unless you have the death penalty for drug dealers, you'll never get rid of the drug problem. Put that through your head, okay? Put that through your head.

[Lev Fasher]

Biden, on the other hand, took a much more demand side approach.

[Donald Trump]

We made real progress together. We passed a law on making it easy for doctors to prescribe effective treatments for opioid addiction.

[Lev Fasher]

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. And under Biden specifically, the Biden White House was historically supportive of harm reduction interventions like syringe exchange, and they even kind of turned a blind eye to a pair of supervised consumption sites that are currently operating in Manhattan. 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, but a lot of cultural change toward making drug use safer. One example I would give is an organization called Never Use Alone. 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. There's no one there to administer naloxone. 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. And if they Stop responding over the phone. That person who's listening in will call 911. 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.

[Noel King]

But with every new administration, there's another opportunity to do it right or better.

[Lev Fasher]

Yeah, absolutely. And President Trump has continued to talk about the opioid crisis, though again, mostly from the perspective of illegally smuggled imported fentanyl. But he has, I think, two very interesting figures playing prominent roles in his administration who have talked about this issue quite a lot. One is JD Vance, the incoming vice president.

[Advertisement Speaker]

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.

[Lev Fasher]

I just didn't understand it.

[Advertisement Speaker]

I didn't understand why anybody would be.

[Lev Fasher]

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.

[Donald Trump]

Our country, you know, as a form of kind of chronic inflammation, spiritually, mentally, emotionally, we need to start healing ourselves.

[Noel King]

Lev Fasher of Stat News. Coming up, how do you build on this very, very real progress? Donald Trump's administration is going to get four more years to try. Support for Today Explained comes from Vanta. If you run a company, Vanta wants you to know that proving trust is more important than ever, especially when it comes to your security program. Vanta says they can help centralize program requirements and automates evidence collection for frameworks such as SOC2, ISO 27001 and HIPAA and so much more. You can save time and money and build customer trust. And with Vanta, you get continuous visibility into the state of your controls. You can join more than 8,000 global companies such as Atlassian, FlowHealth and Quora, who trust Vanta to manage risk and prove security in real time. Now that's a new way to grc. That stands for governance, risk and Compliance. In case you were curious, you can get $1,000 off Vanta when you go to Vanta.com explain. That's Vanta.com explained for $1,000 off. Support for Today Explain comes from Aura. Aura believes that sharing pictures is a great way to keep up with family. And Aura says it's never been easier. Thanks to their digital picture fr, they were named the number one digital photo frame by Wirecutter. Aura frames make it easy to share unlimited photos and videos directly from your phone to the frame when you give an Aura frame as a gift, you can personalize it, you can preload it with a thoughtful message, maybe your favorite photos. Our colleague Andrew tried an Aura frame.

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[Noel King]

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[Lev Fasher]

There is a section where I see my account stuff and then I have.

[Noel King]

There'S like different sections for each of my kids so that I can tap on the R for Ryan and I.

[Lev Fasher]

Can see how much he has in.

[Advertisement Speaker]

Savings, how much he's got to spend.

[Noel King]

How many chores he's done to see if he's earned any money. For allowances, you can sign up for greenlight today, greenlight.com explained. That's greenlight.com explained. To try greenlight today, greenlight.Com explained.

[Lev Fasher]

This is today Explained.

[Noel King]

I'm Noel King, back with Lev Fasher. He's a reporter at Stat news who covers America's addiction crisis. He's been doing so since 2016, when one Donald J. Trump was elected president. Lev how bad were things when Trump came into the office the first time?

[Lev Fasher]

They were bad. The number of people killed each year in the United States from Opioid overdoses.

[Noel King]

Is at an all time high.

[Lev Fasher]

Commonly abused opioids include prescription painkillers such as Vicodin, Percocet and Oxycontin. Everyone knew about how pervasive prescription painkillers had become and how in many cases, those addictions led people to use illicit drugs like heroin. But they weren't nearly as bad as they are today. We had something in the range of 40, 50,000 people dying of overdoses every year, and now it's roughly double that. So hard as it was to imagine in 2016, things were about to get way, way worse.

[Donald Trump]

A deadly batch of drugs that's making its way onto Chicago street, sending more than a dozen people to the hospital in just one day.

[Advertisement Speaker]

Near Route 140 and Route 97 in Westminst, a person was found unconscious after falling victim to a drug overdose between 10am and noon. Six more would follow.

[Donald Trump]

According to the CDC, in 2017, there were more than 28,000 deaths involving synthetic opioids in the United States, which is more deaths than from any other type of opioid.

[Lev Fasher]

The opioid epidemic, you remember that this was one of the glaring problems in pre pandemic America. Well, it got much worse during COVID.

[Noel King]

The drug epidemic affects many families here in West Virginia. But overdose numbers especially soared in the month of May. There was a 55% increase in EMS.

[Lev Fasher]

Responses to drug overdoses from May 29th.

[Noel 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.

[Advertisement Speaker]

We need help from the federal government.

[Donald Trump]

In stopping drugs like fentanyl and others.

[Advertisement Speaker]

From coming into our country and fighting the drug kingpins and the traffickers. But at the addiction level, we need treatment and prevention.

[Lev Fasher]

So he had Chris Christie, the governor of New Jersey, and Roy Cooper, the governor of North Carolina. He had Bertha Madras, a Harvard expert, and Patrick Kennedy, the former congressman, RFK's cousin.

[Donald Trump]

This is personal for me as it is for everyone else. I also grew up in a family where addiction and alcoholism was rampant. 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 US should implement. 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.

[Advertisement Speaker]

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.

[Lev Fasher]

The problem is that very few of these recommendations were fully implemented. Congress did pass a bill in 2018 that put some resources toward this crisis, but again, advocates would tell you that it was nowhere near what it needed to be if Washington was serious about keeping people alive.

[Noel King]

Did the Trump administration support any new treatment options? Anything that previous administrations hadn't endorsed?

[Lev Fasher]

The Trump administration was nominally supportive of medications used to treat opioid addiction, specifically methadone and buprenorphine. But it didn't do that much to expand access. 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. But no, nominally they were supportive of access to many forms of evidence based treatment. That's not the same thing, though, as facilitating some gigantic expansion in access.

[Noel King]

All right, so now Donald Trump gets a chance to do it all again. Have we seen him float any new proposals for combating the opioid epidemic?

[Lev Fasher]

Him? No, but Robert F. Kennedy, Jr. His incoming health secretary. Yeah, absolutely. He has a lot of very interesting ideas for how to beat this crisis. And worth noting that he himself is in long term recovery from addiction to heroin, also to alcohol. And he is a really frequent attendee of 12 step meetings, specifically alcoholics Anonymous.

[Donald Trump]

I'm very active in recovery. I go to probably nine meetings a week.

[Lev Fasher]

He is certainly a 12 step proponent, and it's going to be interesting to see how that factors into public policy.

[Noel King]

All right, so what is RFK saying?

[Lev Fasher]

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, et cetera. 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, at scale, given the scope of the opioid crisis. 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. But that does seem to be RFK's big idea, these wellness farms that he has said he'd like to Fund via attacks on legalized marijuana.

[Donald Trump]

Fascinatingly, 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]

We actually filmed a documentary about addiction. The documentary is called Recovering America.

[Donald Trump]

Talk about what a typical day is for people that have chores to do. They get up at 6.30am, they have.

[Advertisement Speaker]

A morning meditation first thing in the morning. 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, which is super fascinating because, yeah, there was an element of police involvement. There was kind of a carrot and a stick. There were consequences for people who didn't comply with Amsterdam's approach. But also the Netherlands does a lot of stuff that is seen as politically radical. In the US they offer supervised consumption, which is illegal under federal. They also prescribe prescription heroin to people who are not in a position to immediately stop using. So RFK hasn't endorsed those policies specifically, but he's endorsed the Amsterdam approach writ large. 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. It's worth noting RFK's own recovery began after he was arrested for heroin possession in the 80s. So there does seem to be a belief that people need to hit bottom, so to speak, before they can begin their recovery.

[Donald Trump]

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. It was just not even a place that I would consider going. But now I got busted, everybody knew, so now I could start going to 12 semester meetings.

[Lev Fasher]

He just wants the floor, he's said to be higher than it currently is. He doesn't want to see as many people homeless and destitute. He wants them to, I guess, hit bottom sooner so their recovery can start faster.

[Noel King]

The Trump administration has at least one other player this time around who was not there last time, and that is J.D. vance.

[Lev Fasher]

J.D.

[Noel King]

Vance is from Middletown, Ohio. Ohio was hit very hard, as you know, by the opioid crisis. And Vance instead, he has loved ones who are opioid addicts. 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, he talks about his own mother's experience with addiction. And I think she is now in long term recovery and doing very well.

[Advertisement Speaker]

Our movement is about single moms like mine who struggled with money and addiction but never gave up. And I'm proud to say that tonight my mom is here, 10 years, clean and sober. I love you, Mom.

[Lev Fasher]

He has also made this a signature issue.

[Advertisement Speaker]

I want more of you and more of the families here in Philadelphia to get that second chance with a loved one. I want them to have another opportunity to get back on that horse and get clean.

[Lev Fasher]

I haven't heard as many concrete policy proposals 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. So it's certainly something he talks about a lot, but whether it's going to be high on his policy portfolio, I'm not sure.

[Noel 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 gonna really, really sharply drop? Yeah, absolutely. 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. But, yeah, the good news here is everyone cares about this. Every American wants fewer of their neighbors, actually zero of their neighbors to die of drug overdoses. And it seems like we're trending in that direction, even though, of course, death rates are still horrifically high. There are more than 90,000 people still dying every year of drug overdoses. 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. Yeah, I really do think in the next four years, there's a chance that we could find ourselves in a much better place.

[Noel King]

Lev Fasher of Stat News. Halima Shah produced today's show. Aminah El Sadi edited. Laura Bullard did fact check. Patrick Boyd engineered. The rest of our team includes Rob Byers, Andrea Christian's daughter, Hadi Mogdi, Victoria Chamberlain, Amanda Llewellyn, Avishai, Artsy, Miles Bryan and Peter Balan Rosen. Matthew Collette is a supervising editor. Miranda Kennedy is our executive producer. Sean Ramas firm needs a clip. For the Internet, we use music by Breakmaster. Cylinder Today Explained is distributed by wnyc. The show is a part of Vox. If you care to support our journalism by joining our membership program, you can do so today by going to Vox.commembers to sign up. Our archives are always free and always open to the public. We welcome your five star reviews and your inside jokes. I'm Noel King. It's Today explained.

[Advertisement Speaker]

Amazon Q Business is the Generative AI Assistant from AWS because business can be slow, like wading through the mud. But Amazon Q helps streamline work so tasks like summarizing monthly results can be done in no time. Learn what Amazon Q Business can do for [e-mail] learnmore that's aws.com learnmore support for this show comes from Polestar. Polestar is an electric performance car brand that is focused on innovation for both cutting edge technology and design and their all electric SUV. Polestar 3 is for those unwilling to compromise, for those who believe they shouldn't have to choose between the spacious comfort of an SUV and the agile handling of a sports car. For those who need an intuitive infotainment system and a dashboard designed with minimalism in mind. Polestar 3 is for drivers who won't settle for anything less. Book a Test drive for [e-mail].