Lev Facher
Appearances
Today, Explained
A win in the opioid crisis
That's not the same thing, though, as facilitating some gigantic expansion in access.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
He is certainly a 12-step proponent, and it's going to be interesting to see how that factors into public policy.
Today, Explained
A win in the opioid crisis
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. And there's some evidence to suggest that this could be Though I think there's a lot of skepticism that you could implement this at scale, given the scope of the opioid crisis.
Today, Explained
A win in 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, fascinatingly.
Today, Explained
A win in the opioid crisis
He actually filmed a documentary about addiction. The documentary is called Recovering America.
Today, Explained
A win in the opioid crisis
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 involved. who didn't comply with Amsterdam's approach.
Today, Explained
A win in the opioid crisis
But also the Netherlands does a lot of stuff that is seen as politically radical in the U.S. They offer supervised consumption, which is illegal under federal law. 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.
Today, Explained
A win in the opioid crisis
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. So
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
Yeah, Vance talks a lot about the opioid crisis 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.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
My name is Lev Fasher, and I am a reporter at Stat covering substance use and the U.S. overdose crisis.
Today, Explained
A win in the opioid crisis
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? 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.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
But if we can sustain this momentum and if we can make progress 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.
Today, Explained
A win in the opioid crisis
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 enormously. 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.
Today, Explained
A win in the opioid crisis
This is still a gigantic public health emergency, but fewer deaths is good.
Today, Explained
A win in the opioid crisis
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. 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.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
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
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
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 xylosine. 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.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
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 dying left to die is smaller.
Today, Explained
A win in the opioid crisis
And that's just kind of the bleak reality we're facing. That's how bad this crisis is.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
Biden, on the other hand, took a much more demand-side approach.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
The concept is essentially that people overdose and die most often when they use drugs. 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.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
Yeah, absolutely. And President Trump has continued to talk about the opioid crisis, though, again, mostly from the perspective of, you know, 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 J.D. Vance, the incoming vice president.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
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 and now it's roughly double that so hard as it was to imagine in 2016 things were about to get way way worse
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
And they put together this document of, I believe it was over 50 recommendations for specific policies that the U.S. should implement. And this was actually really a well-received document.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
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.
Today, Explained
A win in the opioid crisis
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 effectively. treating opioid addiction. But no, nominally, they were supportive of access to many forms of evidence based treatment.