Fentanyl deaths decline, but the crisis persists

MYRNA BROWN, HOST: Coming up next on The World and Everything in It: opioid deaths.

For the first time in six years, deaths from drug overdose are declining in the US…, and experts aren’t sure exactly why.

The most recent data from the Centers for Disease Control and Prevention shows fatal overdoses are down almost 15 percent. That’s about 16,000 fewer deaths than the year before. And in some states, even fewer people are dying of drug overdose.

MARY REICHARD, HOST: WORLD’s compassion reporter Addie Offereins investigated this and published her findings last week for WORLD Digital. She’s here now to help set up our next story. Good morning, Addie.

ADDIE OFFEREINS: Good morning, Mary.

REICHARD: Well, in just a moment we’ll hear from some experts who spoke with WORLD about this apparently good news. But in your reporting, you heard a surprising admission. What did you find out?

OFFEREINS: So some of my sources, specifically ministry sources, are concerned that fatal overdoses have kind of become the primary metric of how we're measuring whether our fight against addiction is successful. And so in a lot of mainstream circles, it's become about lowering risk, keeping people alive, keeping people safe. But these organizations and ministries, they want more for their clients, and they're really fighting back against this. They're fighting for sobriety. They're fighting for flourishing, and ultimately, life transformation.

REICHARD: Definitions of success can differ. Addie, excellent reporting and analysis. Nice work.

OFFEREINS: Thank you.

REICHARD: Here’s WORLD’s Anna Johansen Brown with more from Addie’s report.

WISE: Probably 15 years old, I started smoking marijuana, and it went really quickly to cocaine by the time I was 16 years old

ANNA JOHANSEN BROWN: By the time he was 25 years old, Jason Wise’s drug habit had turned into a full-fledged heroin addiction. And much of the heroin he was using also contained fentanyl, a deadly synthetic opioid that now contaminates most of the drugs on the street.

WISE: Probably 25 times I overdosed and had to be brought back

Wise remembers the last time he overdosed most vividly. He was snorting heroin on a baseball field in North Carolina. That time, he didn’t want to wake up.

WISE: I had just lost my cousin to an overdose, and I went and got the same drugs that she overdosed on and tried to overdose on, and when the guys I was with left me at the baseball field unresponsive.

But a passerby noticed his prone body on the field. Wise recovered. But only after spending five days in a hospital hooked up to a continuous drip of the anti-overdose drug naloxone.

WISE: I barely survived it, and honestly, that scared me so bad that I started searching for something else to fill that void.

That was in 2021. And that same year more than 107,000 people overdosed and died across the United States—a nearly 15% increase from 2020. Between 2019 and 2020 overdoses jumped 30%. The synthetic opioid fentanyl caused the majority of these deaths.

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But CDC data shows those dramatic increases stopped in their tracks last year. Northern and southeastern states experienced the most significant decline in deaths. Fatal overdoses dropped 30% in North Carolina.

Sounds like good news, right? But some experts say the decline in deaths points to a dark, underlying reality.

CAULKINS: There's an explosion in overdoses as fentanyl arrives. And then that peaks because everybody's using the fentanyl, that actually starts to decline, because there just aren't as many people around. They've died.

Jonathan Caulkins is a drug policy researcher and professor at Carnegie Mellon University. He says fentanyl wiped out a large number of vulnerable drug users first….and there are simply not many susceptible users left alive.

CAULKINS: The people who are using illegal opioids are not all the same. Some are doing things in an extremely risky way. They're using three times a day, not just once a day. They're using alone rather than with friends. And so the numbers of that subset have really gotten knocked down.

In some cases, social isolation policies and treatment center closures during the COVID pandemic accelerated deaths. But Caulkins argues the geography of fentanyl’s deadly progression across the United States played the largest role…. and helps make sense of the recent decline.

CAULKINS: So if we looked only at deaths in Ohio or New Hampshire, where it came first, it already peaked and was heading down before 2023.

National data didn’t reflect the beginning of this decline. That’s because fentanyl was still making its way across the country. It fueled a new spike in deaths every time it flooded a state’s illicit drug market for the first time. But now, the drug is everywhere.

CAULKINS: And so then this natural decline is no longer hidden by Fentanyl reaching yet another state.

Fentanyl reached the West Coast last. That explains why in some western states the decrease looks more like a slight variation in the data, and in others, like Alaska and Nevada, deaths are still going up.

Other experts credit the drop in deaths to the widespread availability of the anti-overdose drug naloxone, also referred to by the brand name Narcan. Van Ingram is the executive director of the Kentucky Office of Drug Control Policy.

INGRAM: I think we as a state have gotten better at Narcan distribution, putting it in the hands of people who are more likely to encounter an overdose.

Overdose deaths plummeted 20% in Kentucky. Last year, agencies in the state gave out 160,000 two-dose units of naloxone.

INGRAM: Just see more of a willingness of people to take it now than maybe we saw 2016 2017 you know, in fact, back in those days. I think they're a much greater awareness in 2024 of the risks for fentanyl exposure.

Last week, the Drug Enforcement Administration announced that its latest lab tests show fewer of the pills on the street contain a deadly dose of fentanyl.

Still others attribute the nationwide decline in deaths primarily to U.S. law enforcement activity. Activity that includes large-scale seizures of the drug at the U.S.-Mexico border and the arrests of top Sinaloa cartel leaders this summer.

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But Jonathan Caulkins at Carnegie Mellon University has his doubts that recent law enforcement activity has permanently obstructed the fentanyl supply chain.

CAULKINS: So the conventional wisdom is that it's really, really hard to stop supply for very long, and the conventional wisdom is that a really big enforcement success can rattle the market, but the market adapts.

Whatever the case, ministry leaders say the battle is far from over.

KEZIAH: Addiction really isn't going anywhere.

Wesley Keziah is the executive director of Ground 40, a Christian residential rehab program in North Carolina. It’s fighting for transformation, not just risk-free addiction.

KEZIAH: Just looking at death is not a good way to rate your success, because there are so many people who are still in bondage.

Jason Wise attended the program after his near-fatal overdose death on the baseball field. He now serves as its intake coordinator. He says that fear of overdosing on opiates like fentanyl is pushing some users to other drugs like methamphetamine. But others are yearning for freedom.

WISE: They're seeing people, the Lord's testimony of people that they know, and they're seeing them change, and that's giving them a hope to reach out to get the same kind of change that people are seeing and getting.

For WORLD, I’m Anna Johansen Brown.

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