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Fentanyl is one reason why the U.S. drug addiction crisis is roaring back

STEVE INSKEEP, HOST:

For the first time ever, the United States may top 100,000 overdose deaths in a single 12-month period. A big culprit here is black market fentanyl. It's a powerful synthetic opioid, and it now contaminates most street drugs. NPR addictions correspondent Brian Mann has been tracking this. Brian, good morning.

BRIAN MANN, BYLINE: Good morning, Steve.

INSKEEP: And we're also joined by Madelyn Beck of the Mountain West News Bureau in Boise, Idaho. Good morning to you.

MADELYN BECK, BYLINE: Good morning.

INSKEEP: Thanks for getting up early. Brian, I want to start with you. I keep thinking we've got our hands around this problem as a country. The public is paying attention. People know about it. People are trying to address it. Lawmakers try to address it. Things seem to be getting better. How is it actually getting worse?

MANN: Yeah. Public health experts, Steve, point to two big factors - the pandemic, of course, which put a lot of new stress on millions of Americans who struggle with addiction. The pandemic complicated the ability of people in recovery to find treatment, and that left people deeply vulnerable. And on top of that, we've seen this rapid spread of fentanyl, this synthetic opioid, which Mexican drug cartels now cook into almost every drug sold on the street, including fake pain pills. I spoke about this with Dr. Bradley Stein, who sounded really scared by these trends.

BRADLEY STEIN: I think it's going in one direction. I think the increase in overdose deaths is tragic.

MANN: Stein is a researcher at the RAND Corporation and heads RAND's Opioid Policy Center. And, Steve, he points out the devastation caused by fentanyl goes way beyond these fatal overdoses.

STEIN: The harms on families, the harms on individuals being able to get and keep jobs - with the headline-grabbing numbers of the deaths, sometimes we don't pay enough attention to those things, too.

MANN: So when we talk about that devastating 100,000 death milestone that we're approaching, that's really just kind of the tip of a very painful iceberg.

INSKEEP: Yeah, ripple effects, you could talk about millions. And of course, that's 100,000 deaths in one year, and it's an ongoing problem. Now, Madelyn Beck, it's been especially bad in Colorado, Nevada, New Mexico, where fentanyl-related deaths more than doubled last year. Do we know why it's getting so much worse where you are?

BECK: So one reason is overprescriptions. Like everywhere else, painkillers were overprescribed. People developed an addiction. Now, because of pressure from federal regulators, there's fewer prescriptions being written. So as Brian alluded to, though, Mexican cartels are meeting people's needs with fake pills. They look like OxyContin and other opioids, but they're fentanyl, which is way cheaper and unfortunately easier to overdose on. Jonathan Ellington developed an addiction after having a knee injury in high school in Kentucky. He got over that addiction, but when he got hurt again living in Colorado years later, he ended up buying OxyContin-looking pills from the wrong person. They were fentanyl, and he died. Dave Ellington is his father.

DAVE ELLINGTON: It was in a bottle that was a medication bottle, as if it came from a pharmacy. It had a person's name on it, the person that actually sold him that.

BECK: His story isn't unique, unfortunately. The DEA says about a quarter of fentanyl pills they seized have enough of the drug to kill. And they say the amount of fentanyl coming from Mexico has doubled every year for the last four years.

INSKEEP: Now, this is a delicate question because, of course, one way to avoid being killed by illegal drugs is not to take them, but people do buy them, people do take them. And if they're in that situation, is there a way they can tell if the drugs are contaminated?

BECK: So starting in April, states could start using federal grants to pay for things called fentanyl test strips to stem those overdoses. Those can be dipped into a solution of drug residue and water, and they act kind of like a pregnancy test where one line means it likely contains fentanyl, two means it likely doesn't. Jacqueline Goldman, a researcher at Brown University, says they can actually change people's behavior.

JACQUELINE GOLDMAN: We found overwhelmingly that people found the test strips to be a really important tool and that many of them took subsequent overdose prevention steps because of knowing that fentanyl was in their drugs.

BECK: Goldman is doing follow-up research on that now, but in some states like Idaho and Utah, those test trips are still technically considered illegal drug paraphernalia, though there are efforts to change that.

INSKEEP: Brian, that feels like a familiar story where there is a solution that could save lives, but it's illegal.

MANN: Yeah, this is a really complicated, painful part of this story. In the same way that solutions to the COVID-19 pandemic have become really political, solutions to this addiction crisis are polarizing. Most medical experts we talked to think drug addiction should be treated like an illness, something we respond to with harm reduction, like those test strips. It could also mean providing people with clean needles, even safe places to use drugs, more access to treatment and health care. And there is strong evidence that those programs keep people alive and give them a shot at recovery. But because of the politics of this, we're seeing many of those programs actually scaled back or banned, even in places like West Virginia, where drug deaths have ravaged whole communities. In many parts of the U.S., the frontline response to this crisis is still police and prisons, not health care providers and hospitals.

INSKEEP: Madelyn, is that true in the Mountain West where you are?

BECK: I mean, definitely there are police in the Mountain West who've told me that they've started to look at suspected fentanyl overdoses specifically as homicides. That way, they stay longer at a scene, collect more evidence that they give to prosecutors, who in the last couple of years have started giving fentanyl dealers mandatory minimum sentences of 20 to life. Now, groups like the Drug Policy Alliance think that's just a continuation of the drug war - that people of color and people in poverty will be impacted the most. They largely just argue, you know, if there's a demand, there will be supply. But just about every source I talked to, police and groups like the Drug Policy Alliance included, support more addiction treatment, mental health resources and education. Andrea Thomas' 32-year-old daughter died from a pill with fentanyl in it. She says her daughter left behind an 8-year-old son.

ANDREA THOMAS: You hear of overdoses all at the time, but the difference between what happened to my daughter and all of those stories that I heard about overdose before is that she didn't overdose. She was poisoned.

BECK: Thomas wants it to be talked about everywhere, including schools and colleges. Groups like Song for Charlie have sprung up specifically to highlight the risks to young people.

INSKEEP: Brian, how does the country address what is clearly a nationwide problem?

MANN: Yeah. The Biden administration has asked Congress for more than $10 billion to boost drug treatment programs like the ones Madelyn was talking about. They've also made it easier for doctors to prescribe buprenorphine. This is a medication that eases opioid cravings for people in recovery. There are efforts around the country to improve addiction treatment and get more mainstream doctors into this field. But, you know, Steve, there's no quick fix. There's no equivalent of the COVID vaccine for this problem. My sources at the DEA say there's more and more fentanyl coming in, and they don't really know how to stop it. So for now, public health experts and police seem really kind of shell shocked by this. One expert I spoke to on background said they believe this wave of drug deaths could hit 160,000 fatalities in a 12-year period before this crests.

INSKEEP: Takes your breath away. Brian, thanks so much.

MANN: Thank you, Steve.

INSKEEP: Brian Mann is NPR's addictions correspondent. Madelyn Beck reports for the Mountain West News Bureau, which is a public radio collaborative. Madelyn, thanks to you.

BECK: Thank you.

[POST-BROADCAST CORRECTION: In this report, we say that the Drug Enforcement Administration says about a quarter of the fentanyl pills it seizes contain enough of the drug to be lethal. That was true in 2019. The DEA says more recently published numbers show that the figure increased to 42% in 2020.]

(SOUNDBITE OF THE LAST SIGHS OF THE WIND'S "PHOBIA") Transcript provided by NPR, Copyright NPR.

Corrected: October 20, 2021 at 10:00 PM MDT
In this report, we say that the Drug Enforcement Administration says about a quarter of the fentanyl pills it seizes contain enough of the drug to be lethal. That was true in 2019. The DEA says more recently published numbers show that the figure increased to 42% in 2020.