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Kevin Donaldson uses fentanyl mixed with a powerful sedative called xylazine in Burlington, Virginia. He knows how risky this type of drug addiction can be.

KEVIN DONALDSON: I feel like some of us have learned how to deal with overdoses a lot better.

SHAPIRO: But he’s still alive, and he says fewer of his friends are dying.

DONALDSON: For a while we were hearing about it every other day, but when was the last overdose we heard about – a few weeks ago maybe? That’s quite a distance and they are few and far between.

SHAPIRO: The data supports Donaldson’s experience. The Vermont Department of Health shows a 22% drop in drug deaths in the first half of this year. And it’s not just Vermont. Dennis Cauchon is an advocate for addiction treatment in Ohio, where fatal overdoses have fallen by nearly a third.

DENNIS CAUCHON: The number of deaths just dropped and the data has never changed so much.

SHAPIRO: And in the Pacific Northwest, Brad Finegood is leading the response to the overdose crisis in Seattle, where the latest data shows a 15% drop in drug deaths this year.

BRAD FINEGOOD: A year ago, as overdose deaths continued to rise, I was really struggling with hope. But today I have so much hope.

SHAPIRO: REMEMBER THIS – we know that overdose deaths have gone down. What we don’t know is why.

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SHAPIRO: From NPR, I’m Ari Shapiro.

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SHAPIRO: It’s CONSIDER THIS FROM NPR. Addiction experts have never seen such a drop in overdose deaths as this year. The figures have fallen by at least 10% in the past twelve months. NPR addiction correspondent Brian Mann has been tracking this big improvement in overdose deaths, and he’s here to talk about what it means. Hello, Brian.

BRIAN MANN, BYLINE: Hello, Ari.

SHAPIRO: Any idea what caused this precipitous decline?

MANN: You know, one of the things that’s really fascinating about discussing this is that it’s a mystery, right? This has been a crisis that has escalated and escalated, starting in the ’90s and then getting worse during the fentanyl era of the last five years – now this turnaround, and we’re not sure why this is happening. One theory is that the United States has more or less flooded the field with naloxone. That’s this anti-overdose drug that helps people who have overdosed on fentanyl. That’s one possibility.

There is also better medical care for people, medications like Suboxone that can help people lower their risk of overdose. A darker possibility, Ari: there is a theory that many vulnerable people have just died. I talked to Keith Humphreys about this. He’s a researcher at Stanford University, and this is what he said about this theory.

KEITH HUMPHREYS: During COVID, a lot of people who otherwise would have died – let’s say this year, next year, a year later – already died. And so that’s terrible, you know, it has brought those deaths forward, but it does mean that the population is smaller. The number of people who still have to die is smaller.

MANN: That’s just one theory, and it’s controversial. So the short answer right now is that this is something that researchers are trying to understand, in part because they want to build on it. They want to keep this trend going, so they’re trying to understand why we’ve seen this very hopeful improvement.

SHAPIRO: Of course they want to know what they did right. I mean, we’ve described the dramatic decline in deaths. Once you break it down, are there certain populations that are doing better, that are more at risk?

MANN: Yeah, that’s a very good question because addiction affects the United States very differently, and that’s a pattern that we’re seeing now. Some states are currently doing better. It appears that the decline in death rates from drug overdoses is greater in the East than in the West.

Another thing that is still very disturbing is that people in the African American community are still very vulnerable to fatal overdoses, and also Native American communities across the country and also Native communities in Alaska are actually seeing an increase in drug deaths have seen. So this is again part of the pattern that researchers say they really need to understand: Why is it that this is getting better so quickly for some parts of the American community, while others still seem to be very vulnerable?

SHAPIRO: One theory is that the street supply of fentanyl has decreased, and that could be behind the drop in overdose deaths. What do you hear from people who use the drug and try to buy it on the street?

MANN: Yes, this is a big focus right now: the question of what happens to the fentanyl supply that is on the street. Remember, we always thought fentanyl was basically impossible to stop. It’s so cheap to make. It is a synthetic opioid, so you can prepare it quite cheaply and easily in a laboratory. But what we’re suddenly seeing is that in many parts of the US, the fentanyl that’s arriving at street level, this illegal drug, is weaker. Other chemicals are being heavily cut, including an industrial chemical called BTMPS.

I talked to Morgan Godvin about this. She’s a researcher from California who has taken to the streets to talk to people who buy and use fentanyl. Here’s what she had to say.

MORGAN GODVIN: People report that drugs make them sick – despite smoking fentanyl – because they use such a low percentage of fentanyl. And everyone is searching and sifting through different suppliers, and the daily amount they spend to stay healthy has skyrocketed.

MANN: So what you’re hearing there, Ari, is that street drugs have really changed. In some cases that’s very hopeful because what we’re hearing is that people who can’t find the medicine they need on the street are in some cases going to clinics and public health care facilities and saying, okay, this is the way it is. Now is the time for me to get healthcare because I can’t find the fentanyl I wanted on the street. And so there is this idea that for some people who are trapped in this life, there is a real opportunity to begin healing.

SHAPIRO: So as we work backwards in the supply chain from the dwindling supply of street fentanyl, does that suggest that the Mexican drug cartels that produce or transport the fentanyl that ends up on the streets – have been affected? Are they weaker?

MANN: You know, it’s interesting. This is the second mystery, right? The first mystery: Why are these drug deaths suddenly dropping? The second mystery: Why is fentanyl suddenly diluted in this way? Why is it harder to find? And yes, one of the theories is that the Biden administration and other countries around the world have increased their attacks on the Mexican drug cartels. Later this month, a pair of top drug lords will appear in court in New York City, where they will face sentencing and also a hearing as some really high-level arrests have been made. Also a really aggressive approach to the money supply – you know, the money launderers and the underground banks that handle the fentanyl profits. The Biden administration says they are making real progress there.

There have also been massive seizures of street fentanyl across the country. In the past, people thought the supply chain was so resilient that this probably wouldn’t have much of an impact, but now we’re starting to hear from people that these drug cartels may actually be so affected that it will become harder and more expensive to find fentanyl on the streets . If that happens, if that kind of disruption works, it could save lives.

SHAPIRO: Fentanyl has been a big issue during the campaign. Do we hear the candidates talking about it differently now that these numbers show such a dramatic change?

MANN: The short answer is no. You know, this is something that has really been a real flashpoint for politicians. And what we’re hearing from Kamala Harris, the Democratic candidate, is – you know, she was at the southern border and she promised to continue to redouble her efforts to stop fentanyl – she called it a scourge. And I think the Biden administration is being very cautious about declaring any kind of victory here because so many people are still dying, right? This is a big improvement, but tens of thousands of people still die every year from fentanyl and other drugs.

Meanwhile, Ari, Donald Trump has continued to spread misinformation and say things about fentanyl that are simply not true – claiming that it is transported across the border by undocumented migrants, when in fact it is normally transported – mostly by American citizens. This is evident from NPR’s reporting. In fact, this is still being linked by Trump’s campaign to these broader fears about immigration and the border. So for now, in the pre-election debate, this improvement and this reduction in drug deaths is not part of what voters are hearing from these candidates.

SHAPIRO: That’s NPR addiction correspondent Brian Mann. Thank you.

MANN: Thanks for having me.

SHAPIRO: This episode was produced by Marc Rivers and Vince Pearson. It was edited by Jeanette Woods and Andrea de Leon. Our executive producer is Sami Yenigun.

And one more thing before we go: you can now enjoy the CONSIDER THIS newsletter. We’ll still help you break down a big story of the day, but you’ll also get to know our producers and hosts and some moments of joy from the All Things Considered team. You can sign up at npr.org/considerthisnewsletter.

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SHAPIRO: It’s CONSIDER THIS FROM NPR. I’m Ari Shapiro.

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