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Fentanyl overdose deaths spark debate over treatment


Americans are more divided than ever over how to tackle the escalating fentanyl crisis. The drug is killing an unprecedented number of people in the United States. I'm joined this morning by three reporters to talk about this crisis and what might come next. Brian Mann is NPR's addiction correspondent, Martha Bebinger is a health reporter with WBUR in Boston, and Aneri Pattani is a senior correspondent with KFF Health News. Thank you all for joining us.

BRIAN MANN, BYLINE: Thanks for having us.



KHALID: Brian, let's start with you. The opioid epidemic has been raging for quite some time. Why is this moment so much deadlier?

MANN: 2023 really was different. We're seeing more than 112,000 people dying every year in the United States. We used to think it was a catastrophe that 60 to 70,000 Americans were dying every year from drug overdoses. Now it's a lot worse. And the street supply of drugs keeps getting more toxic - not just with fentanyl, but also now we're seeing other deadly chemicals like methamphetamines and xylazine all mixed together in these drug cocktails. Louise Vincent is an activist helping people with addiction in North Carolina.

LOUISE VINCENT: We've had an entire community swept away. I can't even think of all the people that I know that have died. I mean, so many people are dead. My daughter died. Our mentors are dead.

PATTANI: Hey, Asma. This is Aneri. I just wanted to chime in because I think what Louise just said there, what we heard from her, is really reflecting what we're seeing in the statistics, too. I mean, overdoses are now the leading cause of death for people in America ages 18 to 45. And they're also one of the leading things killing pregnant women and women who've just given birth. So this is just an incredibly devastating moment. And I think we're hearing that from people.

KHALID: And, Brian, I've got a follow-up question here. The overdose death rate has been incredibly high now for years. So why are we not seeing solutions?

MANN: You know, the Biden administration says they are attacking this problem with a lot more money and policy ideas. But the bottom line - and every drug policy expert I talked to agrees on this - the tools we've used in the past to fight drug epidemics just aren't working.

BEBINGER: Brian, this is Martha. I'm going to jump in on that with another frustration. And that's that even as the death rates are this high, we're seeing some mainstream medical providers who aren't really helping. There are medications and treatments for addiction. You might have heard of drugs like buprenorphine or methadone. But there's a lot of stigma and a lack of training, and so many doctors don't use them. They won't prescribe them to their patients or they just don't take people in addiction as patients.

KHALID: Martha, sticking with you, you know, given that the tools that we've been talking about for dealing with addiction have not worked, people are turning to a strategy that's been used for years in other countries called harm reduction. Can you explain to us what that is?

BEBINGER: So harm reduction is about keeping people alive while they use drugs. And, Asma, that might mean handing out naloxone and needles or pipes so that people don't share equipment and spread diseases. Some harm reductions will even monitor drug use to prevent a fatal overdose. But harm reduction is also an attitude shift, and this is a really important part. It's about treating people who use substances with respect and kindness, not shaming and blaming them. Here's one harm reduction worker, Renae, describing her work.

RENAE: The stuff is just the carrot that I dangle before the horse. I'm wanting to make a connection with you.

BEBINGER: So, Asma, that connection that Renae and others talk about is meant to help restore dignity and self-respect and be a path to recovery. Now, some of what Renae and others do to keep people alive, like supervising drug use, is illegal. So we're not using her full name, and we have altered her voice.

KHALID: Harm reduction is widely accepted in Canada, also in Europe. It is still controversial, though, here in the United States. And the backlash against it does appear to be growing in some corners. And why is that?

BEBINGER: So, Asma, in short, it's seen as enabling drug use. Opponents see giving someone a needle or showing compassion - they see that as condoning drug use or condoning bad behavior. And they argue that the focus should be on sending or forcing people into treatment if needed. Now, I want to be clear, harm reduction is no magic fix. Overdoses and deaths are still high in states with lots of these programs, including Massachusetts, where I live. So there's a tug of war between the punishing or tough-love approach and the softer, more compassionate model of harm reduction that's happening daily.

KHALID: Aneri, I want to bring you into the conversation. You know, we have heard news that drug companies have agreed to pay more than $50 billion in compensation for their role in spurring the opioid crisis. Is that money helping? What is that money going towards?

PATTANI: So it really differs depending on which state you look at. And honestly, it's too soon to tell if it's helping across the country. But you're seeing a lot of the same issues play out that Martha and Brian were just talking about. So some states - even despite the urgency with people dying every day, some states haven't touched their settlement funds yet. Other places are looking at investing in naloxone or harm reduction techniques like Martha was talking about. And then you have places that are at the other end, saying, we need to give this money to law enforcement. So they've bought patrol cars, roadside cameras, body scanners for their jails.

The thing is, there's just not a lot of evidence that those sorts of investments will prevent overdoses or save lives. And a lot of families are upset. So, Carrie Spears in Ohio is one of them. She lost her 23-year-old nephew Tanner to a fentanyl overdose two years ago. Her small town has spent most of its settlement cash on surveillance equipment and training for their officers and canines, and she's just not sure how that's going to save people like her nephew.

CARRIE SPEARS: It's not that I don't support law enforcement or first responders. But what research did they look at that said, yeah, surveillance equipment and K9 helps people get into recovery and sobriety?

PATTANI: And what I'm hearing from my reporting is that just like in that town where Carrie lives, a lot of times decisions about the settlement money is not so much based on evidence, but on geography and politics of the place.

KHALID: Speaking of politics, I've got a final question for you all here. How is fentanyl, the fentanyl crisis, likely to play out as an issue in the 2024 election?

MANN: Let me take that one, Asma. Public policy experts I talked to really worry that this is going to get ugly politically, with a lot of politicians really weaponizing the fentanyl issue. There's a lot of disinformation out there about this topic and ideas that research suggests don't actually help save lives. A lot of promises are being made, for example, to stop fentanyl smuggling into the U.S. But no one, Democrats or Republicans, have plans that anybody thinks would actually do that. Real solutions to this crisis are likely going to be a lot more complex, involving things like reforming health care and expanding access to housing and mental health care. And, you know, trying to do that kind of work in 2024, in America's polarized political culture - everyone I'm talking to says it's going to be really tough, especially if these deaths keep rising.

KHALID: That is NPR's Brian Mann, along with WBUR's Martha Bebinger and KFF Health News' Aneri Pattani. Thank you all.

MANN: Thank you.

BEBINGER: Thank you.

PATTANI: Thank you. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Brian Mann is NPR's first national addiction correspondent. He also covers breaking news in the U.S. and around the world.