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Drug use remains dangerous and debilitating for many people in the U.S. A person in addiction pleaded for help on a street corner in Burlington, Vermont.

Carol Guzy for NPR

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Carol Guzy for NPR

Drug use remains dangerous and debilitating for many people in the U.S. A person in addiction pleaded for help on a street corner in Burlington, Vermont.

Carol Guzy for NPR

Kevin Donaldson uses fentanyl mixed with a powerful and dangerous animal tranquilizer called Xylazine in Burlington, Vermont. He knows how risky this kind of drug addiction can be.

“I feel like some of us have learned how to deal with the overdoses a lot better,” Donaldson tells NPR.

But he’s still alive. And he says fewer of his friends are dying.

For a while, Donaldson said it was impossible to not hear about the Fentanyl crisis in his community every other day.

“But who was the last overdose we heard about?” he asked, consulting with a friend. “A couple of weeks ago, maybe. That’s pretty far and few between.”

The data backs up Donaldson’s experience. The Vermont Department of Health shows 22% fewer drug deaths in the first half of this year. And the drop in deaths extends beyond Vermont.

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What the data shows

Dennis Cauchon is an advocate for addiction treatment in Ohio, where fatal overdoses have dropped by nearly a third.

“The deaths were just plummeting and the data has never moved like this,” Cauchon told NPR.

In the Pacific Northwest, Brad Finegood heads the overdose crisis response in Seattle, where the latest data show a 15% drop in drug deaths this year.

“A year ago when overdose deaths continued to rise, I was really struggling with hope. But today, I have so much hope,” Finegood said.

The data has shown a national downward trend for opioid overdoses. But what many experts haven’t been able to nail down is why exactly this is happening now.

NPR’s addiction correspondent Brian Mann has been trying to piece together the story behind this promising trend.

“This has been a crisis that has escalated and escalated starting in the nineties and then getting even worse during the era of fentanyl over the last five years. Now, [there’s] this pivot and we don’t know for sure why it’s happening,”

Mann says that one theory is that the United States flooded the field with Naloxone, the overdose reversal medication that helps people who have overdosed on fentanyl.

“There’s also better medical care for people out there,” Mann explained to Consider This host Ari Shapiro.

“Medications like Suboxone [are available] that can help people lower their risk of overdose,” he added.

Another darker possibility Mann shares, is that many of the vulnerable people may have simply died already.

Stanford University researcher Keith Humphreys explained:

“During [the] COVID [years], a lot of people who would have died otherwise, say this year, the next year, the year after had died already. And so that is horrible, but it does mean the number of people left to die is smaller.”

Mann emphasizes that this is just one theory and it’s a controversial one.

“So the short answer right now is that this is something researchers are racing to try 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.”

Looking forward.

One root cause of this trend is what experts thought wouldn’t be possible: the supply has simply started to dry up.

“The fentanyl that’s arriving at the street level, this illicit drug, is weaker,” Mann said. “It’s being cut heavily with other chemicals, including an industrial chemical called BTMPS.”

Morgan Godwin is a researcher based in California who has been out on the streets talking to people who are buying and using fentanyl.

“People are reporting getting dopesick, going into withdrawal despite smoking fentanyl because what they are using is such a low percentage fentanyl,” Godwin said.

“And everyone is searching and going through different suppliers. The daily amount that they’re spending, trying to stay well, has skyrocketed.”

One of the theories as to why the supply has dwindled is that the Biden administration and other countries around the world have been stepping up their targeting of the Mexican drug cartels that have supplied it.

“Coming up later this month, a couple of top drug kingpins will be in court in New York City, facing sentencing and also a court hearing because there have been really high level arrests,” Mann explained.

The Biden administration claims they are making real progress there, in addition to huge street fentanyl seizures around the country.

“In the past, people thought that the supply chain was so resilient that this probably wouldn’t have much of an impact,” Mann said.

“But we’re now starting to hear from people that maybe, these drug cartels really are being affected to a degree, that it’s going to be harder and more expensive to find fentanyl on the street. If that happens, if that kind of disruption works, it could save lives.”