Consider This from NPR
Reporting on how America reduced the number of opioid deaths
Sun, 30 Mar 2025
After reaching historic levels, fatal overdoses from opioids are dropping rapidly. Today we bring you a reporter's notebook from NPR's national addiction correspondent Brian Mann. He tells host Scott Detrow what it's been like to cover America's addiction crisis and explains the significance of the recent decline in opioid deaths. For sponsor-free episodes of Consider This, sign up for Consider This+ via Apple Podcasts or at plus.npr.org.Email us at considerthis@npr.org.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy
Chapter 1: Why are opioid overdose deaths declining in America?
Every month, NPR reporter Brian Mann checks a grim statistic, the federal tally of overdose deaths across the country. For years, that number only went up.
But then, toward the end of 2023... Suddenly, the data coming out of the Centers for Disease Control and Prevention showed this drop.
Maybe it was a fluke. But the next month, same thing.
One month, two months in a row it dropped. Three months.
Brian also started hearing the same thing from sources on the street. Like this man, Kevin Donaldson, who was using fentanyl and xylosine in Burlington, Vermont.
For a while there, we were hearing about it every other day. But when it was the last overdose, we heard about a couple weeks still maybe. That's pretty far and few between.
What I was hearing from people using drugs on the street, talking to frontline harm reduction people, listening to people in Washington looking at this, they were saying this feels different. The carnage feels like it's easing. Suddenly, there was a shift.
Across the country, the number of overdose deaths has continued to drop to this day.
This is a science fiction level event, like never before. in the history of America's drug crisis, and this goes even back before the pain pill crisis of the 90s, go back to heroin, go back to crack cocaine, we've never solved a drug epidemic in the way that these numbers suggest.
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Chapter 2: What are people on the street saying about overdose trends?
Okay. So that is the dark side of this. Talk me through some of the more positive thinking here, some of the policy-related factors that could be going on.
Yeah, and I think the data here is really strong, that we have seen one of the most effective public policy responses to a health crisis in U.S. history, right? So what the Biden administration did, they came in after a year when drug deaths had spiked 30%. That's what happened in the last year of the Trump administration.
They inherit a raging, burning crisis of death across the country, and they immediately begin implementing policies really significant changes. First of all, they work to get naloxone, that medication that reverses overdoses. They really push to get that out on the street, get it everywhere. They just flooded the field with naloxone and Narcan. And I find it now everywhere.
And I want to introduce you to Scout Gilson. She actually works now as a harm reduction person in Philadelphia, but she was on the street. She was a fentanyl user. She talks about what it was like before the Biden team made naloxone really readily available.
I remember having to decide if I was going to give somebody enough Narcan and realizing that that might mean I don't have any more because I don't know how to access it. Someone else might die.
Wow. That kind of calculation, Scott, was happening every day on every street in America. People were thinking, do I help that person survive or do I save it for myself? And now, That's not what it's like. Everybody has Narcan.
There's also a whole range of other things, much of it funded by the expansion of Medicaid under the Affordable Care Act that made insurance coverage really widely available for people who need addiction treatment. They also made it really easy comparatively to get buprenorphine and methadone. These are medications that help people avoid relapses into fentanyl use.
All of those things hitting the field at the same time, the Biden team inherits a 30% increase in drug deaths. As they left the White House, drug deaths were dropping by about 25%. So that's the arc that they managed to pull off in four years.
And you have now mentioned... Kind of the black hole of politics that just about every conversation veers its way into. So let's get into that because you are talking about this incredibly positive track record on an issue a lot of Americans are worried about and care about. And yet I closely covered the campaign.
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Chapter 3: How significant is the decline in opioid deaths?
That was NPR's addiction correspondent, Brian Mann, speaking with All Things Considered co-host, Scott Detrow. This episode was produced by Noah Caldwell and edited by Adam Rainey. Our executive producer is Sammy Yannigan. It's Consider This from NPR. I'm Emily Kwong.
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