America's Other Public Health Crisis: 100,000 Overdose Deaths : The NPR Politics Podcast More than 100,000 people died from a drug overdose in the 12-month period beginning April 2020. Despite a growing consensus that recognizes addiction as a public health problem, many effective interventions like safe consumption sites and needle exchanges are politically unpopular and legally complex.

This episode: White House correspondent Tamara Keith, senior political editor and correspondent Domenico Montanaro, and addiction correspondent Brian Mann.

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America's Other Public Health Crisis: 100,000 Overdose Deaths

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MEGAN: Hey, NPR POLITICS. This is Megan (ph). I'm a Seattle expat who lives in a very flat Midwest, home visiting my parents and gazing at the beautiful Olympic Mountains. I'm about to dip my toes into Puget Sound for the first time in more than three years. This podcast was recorded at...


1:29 p.m. on Tuesday, the 23 of November.

MEGAN: Things may have changed by the time you hear it. OK, enjoy the show.


KEITH: I look forward to dipping my toes in the Pacific for the first time in nearly three years very soon.


KEITH: Love, love, family gatherings. Hey, there. It's the NPR POLITICS PODCAST. I'm Tamara Keith. I cover the White House.

MONTANARO: And I'm Domenico Montanaro, senior political editor and correspondent.

KEITH: And we have a difficult topic today. For the first time, drug overdose deaths in the United States surpassed 100,000 in the span of just one year. That's more Americans dead from overdoses than car crashes and gun deaths combined. And that's been driven largely by the rise of opioids in this country. NPR's Brian Mann covers this for us. And he's here to talk us through it all. Hey, Brian.

BRIAN MANN, BYLINE: Hey, guys. Thanks for having me on.

KEITH: Yeah. We're really glad to have you here with us because you are the expert. You are so immersed in this.

MANN: Yeah.

KEITH: For better or for worse. And we just got this report from the CDC last week about the number of deaths. Why are these numbers so high?

MANN: Yeah. These really were terrifying, are terrifying numbers - over 100,000 people dying in a 12-month span. And really, it's driven by a couple of things. First, there's just been this explosion of this very deadly form of opioid called fentanyl. It's a synthetic opioid that's really powerful, comes, usually, in from Mexico, Mexican drug cartels that are also shipping in really powerful methamphetamines.

And these drugs, both separately and taken together, are just extremely dangerous. Some people talk about this being a poisoning of the street drug supply so that people who were once, you know, able to maintain their addiction and sort of live with this illness, these days, it's - it - you know, one shot of heroin, one pill that you think is OxyContin and you can be dead. So it's a whole new world and a much more dangerous world out there than it was just a couple of years ago.

MONTANARO: So, Brian, when you talk about fentanyl and it being synthetic and how it's a more dangerous world, you know, if someone's thinking about, OK - you know, they had back pain. They went to their doctor. They're prescribed something. You know, is this people going off-label and trying to get something - to get more? And the fentanyl is, you know, sort of laced into what they think they're getting? Or are people seeking out fentanyl on its own?

MANN: Yeah. Those are really good questions. So the basic narrative that we think, that public health experts think happened here is that there was this big push back in the '90s and over the decades that followed by drug companies, by the medical community to use opioids much more widely. And that created this big reservoir of addiction, people out there in America who are dependent on opioids. And once those pills started being pulled back, people with addictions started looking for other sources. And a lot of them turned to heroin, other street drugs.

And now what these Mexican drug cartels have found is that the cheapest thing that they can produce is this synthetic fentanyl. It's cheap to make. It's easy to smuggle. And increasingly, what we're seeing is that they're lacing it into these other drugs, in part to get people even more addicted.

But another thing that's really troubling, Domenico, is that we are seeing people who are starting to seek fentanyl. They're actually looking for this as their drug of choice. And that just puts them in incredible danger, incredible risk every single time they use.

KEITH: Yeah. It's absolutely terrifying because it is so incredibly potent. One thing I want to talk about here is timeline, because as you said, these are numbers from April of 2020 to 2021. That is the height of the COVID pandemic. Were some of these deaths of despair? Is that how it would be categorized?

MANN: Yeah. I think that is right. There is this kind of unholy convergence of different things. One is that this pandemic wrecked a lot of people's lives. It - you know, people lost jobs. People were forced into isolation.

And these are all situations where anyone who's ever dealt with addiction or people who might be, you know, sort of dragged into addiction, these are big risk factors. And treatment programs were disrupted. And support networks were disrupted.

And then when you layer on top of it this increasingly dangerous street drug supply with this much more toxic fentanyl and methamphetamines everywhere, all over the country now, all of that came together. So yeah, the pandemic has made it worse. And that's still something today that public health experts are trying to figure out, how do we keep people safer when so many of those support networks are still disrupted?

KEITH: Yeah. There's a newish movie series, "Dopesick," which is based on a book. And that was sort of about rural America being infiltrated with these prescription drugs. It's like this is the evolution of that. I'm wondering, where are these deaths? Has the opioid epidemic moved, evolved?

MANN: Yeah. It is moving and evolving. And one of the most painful things we're seeing right now is, you know, of course, it's still a big factor in places like West Virginia and rural Ohio and Indiana. But we are also seeing fentanyl and methamphetamines pushing into neighborhoods that were not a huge problem before, you know, Black neighborhoods, urban neighborhoods, communities of color across the U.S., Native American communities. Methamphetamines in particular, are absolutely devastating Native American communities all over the U.S.

And so - and that brings all kinds of complications. You know, whenever you bring race into a conversation, especially when it also intersects with drug policy and the drug war, that is really complex. And so, yeah, right now, a lot of people are getting hurt who, a couple of years ago, were not as vulnerable. And that's made the response to this even more challenging than it was before.

MONTANARO: And I think it's really fascinating how we've seen this shift. Certainly, we're not talking about these public policy solutions in the way that you heard in the 1980s, when we had the crack cocaine epidemic that was really hitting Black and brown communities much harder than we're seeing now. And you had First Lady Nancy Reagan talking about, just say no. Well, now we're talking about a more fuller array of potential public policy solutions when we see this now in what's, at least until recently, been a much more predominantly white, more rural area and, you know, frankly, with places that heavily supported former President Trump.

MANN: Yeah, that's really fascinating and complicated watching the Biden team try to thread that needle. So, you know, just a quick note, you know, Joe Biden, obviously was one of the architects of the war on drugs era policies that criminalized a lot of these things and made prisons and police the primary response to addiction for decades. And now Joe Biden as president finds himself with what most people now describe as a public health crisis, a thing that is going to be, you know, solved with medical care and treatment and hospitals rather than prisons. But they're still sort of high centered on that whole conversation. And, you know, so you have people out on the street saying, hey, there are things that would keep people alive. We could have safe drug consumption sites. We could hand out clean needles that would help people avoid HIV and hepatitis. We know what to do to reduce these terrible, terrible numbers.

Under our current drug war era laws, these people with this illness, with addiction as disease are viewed as criminals. And while they're still viewed as criminals, it's incredibly hard. On the one hand, you have the Biden team saying, let's get these people care, let's help them survive. But they're still navigating a situation where technically these people are criminals. They should be arrested for what they're doing. They should be locked up. And they - you know, that's what the laws on the books say. And so there's trying to juggle the legacy of these laws that are a criminalization model with this new thing that they talk about, which is harm reduction. And so far, you know, those two things just keep bouncing off each other in a way that, you know, leaves them again looking like they're playing catch up.

KEITH: All right. We are going to take a quick break. And when we get back, more on possible solutions to this problem.


KEITH: And we're back. And I want to get to policy solutions. What is in place now and what is being discussed that could try to reverse this really terrible situation?

MANN: I think it is really important to say that good policy can help. That's what all the public health experts say. That's what I've seen on the ground. And let me just point to one example that gets overlooked, which is the Affordable Care Act. Obamacare included provisions that helped millions of people with addiction get better care. There are a lot of people alive today because of the Affordable Care Act. What's challenging, as we've been discussing, is that there is this counter narrative, this kind of tough on crime, we're tired of people slumped on street corners.

And so that's the real issue here, is that the public health experts, the doctors, the scientists, they keep coming forward and saying, you know, just like we did with the pandemic, you know, we looked for what are the solutions - wearing masks, getting people vaccinated. Well, there are similar strategies now that could keep, you know, these numbers below 100,000 every 12 months and keeping these numbers from rising. But a lot of those have just so far proved, you know, unacceptable, politically unacceptable to the Biden team.

MONTANARO: Definitely. I mean, I think the White House is trying to balance public opinion here, as they do on every other subject that we can think about. But when, you know, you hear Brian talk about some of the potential policy solutions, I think there's a very different way that people think about, for example, clean needle exchanges, which have become much more acceptable as a public policy, although not everywhere.

But if you talk about something like safe consumption centers, what we're talking about is allowing people to do drugs when fentanyl isn't being filtered into them so that they don't die or don't overdose. I think that - and just imagine President Biden coming out and saying, OK, now we're going to create these safe consumption centers. Imagine what the political, especially conservative backlash would be considering that a lot of these policies that seemed more progressive that were going into place in some of these more rural, more white communities have also been rolled back by a lot of those conservative elected leaders.

KEITH: I mean, you talk about conservative backlash, but I could easily see liberal backlash, too, at the same time. But Brian, before I let you go, I just wonder, is there anything hopeful in all of this?

MANN: You know, Tam, I love this question, and it's - I think in my reporting, I lose track of this a lot. I don't say this enough that, you know, addiction, even this opioid addiction and methamphetamine addiction that are so deadly now, you know, this is an illness that people most often do survive. They - most people who become addicted do eventually recover. And what the science shows is that with proper health care - and there are better medications now, better treatments, better therapies all the time - that improves people's chances dramatically, as you would expect. And so, you know, we've been talking about the Biden administration playing catch-up and half measures, but the reality is that some of these things are going to help more people.

KEITH: In a way it isn't just talking about it like a disease. It's actually treating it like a disease.

MANN: Yeah. And in our society, because of all the baggage, the drug war, the racial dynamic, making that transition has proved to be really, really hard. But in covering this, over the years, I have seen progress. I have seen more doctors who know how to treat addiction just like they would treat other illnesses. I see more hospitals that know what to do when somebody comes through the door with an overdose. You know, they do better work there. And so, you know, in many parts of the country, this is getting better. If it weren't for this poisonous drug supply that's out there right now, if it weren't for this pandemic, I think we might see more progress. This is a very ugly moment. But yeah, as the country continues to pivot on some of this, hopefully, hopefully we'll see these numbers start to come down.


KEITH: All right. Well, let's leave it there on that hopeful note.

Brian Mann, thank you so much.

MANN: Thanks for having me on.

KEITH: I'm Tamara Keith. I cover the White House.

MONTANARO: I'm Domenico Montanaro, senior political editor and correspondent.

KEITH: And thank you for listening to the NPR POLITICS PODCAST.


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