The US saw a significant drop in the number of drug overdose deaths. The Trump administration has a shot at keeping the trend going. STAT News's addiction reporter, Lev Facher, explains. This episode was produced by Haleema Shah, edited by Amina Al-Sadi, fact-checked by Laura Bullard, engineered by Patrick Boyd, and hosted by Noel King. An addiction recovery billboard in Minneapolis. Photo by Michael Siluk/UCG/Universal Images Group via Getty Images. Learn more about your ad choices. Visit podcastchoices.com/adchoices
Chapter 1: What is the opioid crisis?
The U.S. 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.
Chapter 2: Why have overdose deaths started to decline?
I carry all the time. I hope I never have to use them. But, you know, it's pretty easy to carry around. 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. Today Explained
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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.
Lev, the CDC released some data recently that has a lot of people feeling very optimistic. What does this data say?
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Chapter 3: What is the potential impact of drug use behavior changes?
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.
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.
Biden, on the other hand, took a much more demand-side approach.
We made real progress together. We passed the law on making it easy for doctors to prescribe effective treatments for opioid addiction.
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 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.
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.
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Chapter 4: How did Trump and Biden approach the opioid crisis?
Chapter 5: What are the main theories behind reduced overdose deaths?
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 dying left to die is smaller.
And that's just kind of the bleak reality we're facing. That's how bad this crisis is.
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?
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.
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.
Biden, on the other hand, took a much more demand-side approach.
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Chapter 6: What cultural shifts have contributed to harm reduction?
This is Today Explained.
I'm Noelle 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?
They were bad.
The number of people killed each year in the United States from opioid overdoses is at an all-time high. 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 and now it's roughly double that so hard as it was to imagine in 2016 things were about to get way way worse
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.
Near Route 140 and Route 97 in Westminster, a person was found unconscious after falling victim to a drug overdose. Between 10 a.m. and noon, six more would follow.
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.
The opioid epidemic. You remember that this was one of the glaring problems in pre-pandemic America. Well, it got much worse during COVID.
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