On a special episode (first released on January 23, 2024) of The Excerpt podcast: Deaths from fentanyl are falling. The promising news comes as the overdose antidote naloxone becomes more widely available. But are dropping death rates concealing other issues in the fight against this brutal form of addiction? Reuters Investigative Reporter Maurice Tamman joined The Excerpt to discuss what he’s seeing on the ground where addiction and death are still the reality.
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Taylor Wilson:
Hello and welcome to The Excerpt. I’m Taylor Wilson. Today is Thursday, January 23rd, 2025, and this is a special episode of The Excerpt.
There’s been a major change to the conversation around opioid addiction in America. Deaths from fentanyl are falling. The promising news comes as the overdose antidote naloxone becomes more widely available, but are dropping death rates concealing other issues in the fight against this brutal form of addiction? Here to help us make sense of what’s happening is Reuters investigative reporter, Mo Tamman. Mo, thank you so much for joining me today on the Excerpt.
Maurice Tamman:
Yeah, my pleasure. Glad to be here.
Taylor Wilson:
So let’s just start with this. The death toll from fentanyl and other synthetic opioids is falling. That’s obviously really good news, Mo. What story did the numbers tell us here?
Maurice Tamman:
A cursory look at the numbers does suggest that there is at least a glimmer of good news. There’s still tens of thousands of people dying every year, and I don’t want to lose sight of that fact. But in some parts of the country, we’re seeing 25, 30% reduction year over year in the number of people who are dying from synthetic overdose deaths, the vast majority of which are from fentanyl.
I think what we’re seeing here is a number of factors. The most obvious one, and the biggest one is the ubiquitous distribution of naloxone, which is that opioid overdose reversal drug that is everywhere in areas where fentanyl abuse is going on.
On the frontlines of the fentanyl crisis, is Naloxone the answer?
Deaths from synthetic opioids are falling. What’s behind the promising trend?
Taylor Wilson:
Yeah. Well, let’s talk about naloxone more commonly referred to by a brand named Narcan as well. Some have credited with these dropping numbers as you’ve said. Can we just get some basics out of the way here, Mo? I mean, what is this, for folks who may not be aware, and what does current access to naloxone look like in America?
Maurice Tamman:
So the way it works, and I’ll try not to be too technical about this, is that we all have what’s known as opioid receptors in our brains. The way that naloxone works is that it basically kicks off all opioids off those receptors and puts a blanket over those receptors. So immediately, almost instantaneously when it’s administered, the person is liberated, their body is liberated of the effects of fentanyl, and they immediately come back to life. They start breathing again. And there are other issues that are going on, but fundamentally, they’re alive again. Almost on a dime. It’s quite remarkable in its effect.
Taylor Wilson:
Well, what does access look like in America right now, Mo? Is it widespread? I mean, how does someone who wants to access this get it?
Maurice Tamman:
Basically almost anywhere you go, you can get free access. Now in places where there is a large population of people who are addicted to fentanyl, you’ll find them at recreational centers. In Ohio where we were, all the trap houses, the places where people go to buy drugs, there were piles of them in corners. People who are addicted and using drugs in these houses will administer them to fellow users and bring them back to life when if need be. It is amazing. I mean, one center we went to in Columbus, they’re distributing thousands every month. And the numbers are growing all the time. And it’s difficult not to see how that isn’t having a significant effect on the reduction of fentanyl or synthetic overdose deaths.
Taylor Wilson:
So I mean, is this really a matter of access to naloxone? I mean, it’s been around for decades. Has anything changed recently over the last year, in recent years?
Maurice Tamman:
Last year, of course it became available over the counter. So that makes a big difference. And I think there’s been a push just generally to get this stuff out there. Some of my reporting indicated, like in places in Missouri, for example, where they did an analysis of where the distribution took place, the drops in fentanyl overdoses really mirrored where the naloxone was distributed. Clearly we’ve got a very strong correlation with large distribution areas and drops in synthetic overdose deaths. That’s not to say there aren’t other reasons that might explain what’s going on, but clearly naloxone, or Narcan, has had a huge effect on the reduction.
Taylor Wilson:
Well, Mo, I want to get to some of those other factors here in a second, but is there any downside to Narcan or naloxone?
Maurice Tamman:
Downside, that’s an interesting choice of words. I mean, you’re still alive, right? That’s the ultimate downside, if you’re not alive. But if you take it, we were talking before, the way the drug works, it removes the fentanyl from the receptors instantly. And what that means is that the person, if they are addicted to opioids or fentanyl, they go into instant withdrawal. And they would tell you that not just instant withdrawal, but the worst withdrawal they’ve ever experienced.
If you or I, who aren’t addicted to fentanyl accidentally took fentanyl and somebody administered Narcan and we came back, we would feel nothing. There would be no effect. But because these people are addicted, the moment that somebody administers it, they wake up and it is intense: retching and vomiting and panicking, and it’s really brutal. And of course, that instant they realize what’s happened, what’s the first thought they have is where do I get my next fix to get rid of those feelings as quickly as possible. Because the only way to get rid of the effects of withdrawal is to have more of the drug that caused the withdrawal in the first place.
Taylor Wilson:
Mo, I want to talk about fentanyl itself for a second. Is it changing? I mean, I know you’ve written about illicit narcotics distributors increasingly adding these veterinary tranquilizers to the fentanyl they sell. Can you talk about that a little bit? Why is that happening and what might that mean for cutting down overdoses?
Maurice Tamman:
There are lots of theories out there about what’s going on with street drugs. There aren’t a lot of hard and true facts, but what is true is that especially starting on the East Coast and moving toward the west, there has been an increasing amount of xylazines, which are a tranquilizer of sorts that’s used most often in veterinary medicine, medetomidine, a version of which is routinely used in surgery. I mean, if anyone out there has had surgery, chances are you’ve had fentanyl and you’ve had medetomidine. Medetomidine is used to relax the patient so that they can have the breathing tube taken out and they don’t panic. It’s able to be left in there for a period of time, and then they don’t panic while it’s in there. They can have it withdrawn slowly and without any fuss.
There is a school of thought that these longer lasting drugs, which are not opioids or at least they’re not traditionally viewed as opioids, delay the onset or at least the perception of the onset of withdrawal. So with the introduction of this into the drug supply, it’s unclear why it started happening, but with that introduction, instead of waiting for users, regular users an hour before or two hours before they want another fix, maybe they wait three hours, maybe they wait four hours. Because the onset of that urge to have more fentanyl is delayed. At least that’s the theory.
And of course, if you can imagine, I’m going to make up some probabilities here, but let’s say you had a 1 in 50 chance of having an overdose every time you take fentanyl. You just don’t know what the supply of the strength is. Well, if you do that five times a day, each time 1 in 50, there are odds you’re going to eventually in some relatively short period of time encounter an overdose. Maybe it takes you a week, I don’t know. But if you’re only doing it three times a day because you’re delaying it, again, you’re putting off and you’re reducing the chances of an overdose on any given day, you’re extending the time between when you encounter another dose that might kill you. And if you extrapolate that over the course of an entire population, then of course there are less overdose deaths.
So there are some serious people who believe that that is an important and contributing factor to the reduction in overdoses as well.
Taylor Wilson:
So something else, Mo, that you’ve covered in your great reporting is this idea of what some people call the susceptibles: the possibility that the huge number of overdose deaths in recent years has just so sharply culled the population of potential fentanyl abusers that the number of overdoses was bound to fall. Can you talk through this idea a little bit, what do experts say here?
Maurice Tamman:
Well, I wouldn’t say that… Listen, I mean, this is kind of a macabre way of viewing the whole thing, right? But look at the numbers. Since 2015, approaching 450,000 people in this country have died of a synthetic overdose death. 450,000. That’s a lot of people. That’s more people than have died in most wars in this country. And it happened in 10 years. The population of people in this country who are inclined to take narcotics, it’s not infinite. It’s not a hundred percent of the population. It’s a percentage of the population of people who are inclined, for whatever reason, to experiment with drugs and narcotics.
Now, if you take 450,000 people and subtract that from the population of people who might be inclined to take drugs, you now just simply as a matter of basic mathematics reduce the population of people who would be vulnerable to overdoses in the first place. And it’s such a large number that some would argue that it was inevitable that at some point you would start to see severe reductions or significant reductions in the number of people who are dying of overdoses.
Taylor Wilson:
Very interesting. So when it comes to law enforcement and the courts and the prosecution level here, Mo, are prosecutions of fentanyl suppliers and the drugs ingredient makers playing any role in this drop in deaths that we’re talking about?
Maurice Tamman:
If you talk to the federal government, if you talk to the DEA, if you talk to the DOJ, if you even talk to the White House office on drug enforcement and drug policy, they would tell you that part of the reason why synthetic overdose deaths are down is precisely because of that, that there has been aggressive law enforcement attempts to arrest, indict people who are selling precursors, who are selling the drugs themselves. That they are working side by side with China to reduce the chemicals coming into this country and into Mexico that are ultimately made into fentanyl.
They would say that that has resulted in a pinching of the Mexican cartels and that as a result of that, the amount of fentanyl coming into this country is down. And they would argue it’s because, and you can see that because their tests show that the amount of fentanyl in doses that they have seized is down. And that drop mirrors the drop in synthetic overdose deaths. So there’s a lot of reasons that seem to be pointing all in the same direction, all of which can plausibly explain some or potentially all, I suppose, of the dip in overdose deaths.
Taylor Wilson:
I want to talk about just kind of the commerce world and commerce regulation for a second, Mo. There’s a loophole in 2016 trade law aimed to help commerce that has actually made things easier for fentanyl traffickers, at least ostensibly. And this is a regulation known as de minimis, individual parcels of clothing and other merchandise valued at up to $800 now enter the country duty free. Can you talk through that a little bit? What do you know about this and what does this mean?
Maurice Tamman:
The beginning of this project was of course, we wanted to tell the story of the supply chain of the precursor chemicals and how they get to Mexico, where they are turned into fentanyl, and subsequently end up on the streets in the States. We went out and we spent $3,600 and we bought perfectly, as far as we know, perfectly legally precursor chemicals from China. They were shipped to both Mexico City and to New Jersey. And we bought enough stuff, pill presses, fillers, cutting agents, dyes, you name it. We bought everything. We didn’t make fentanyl, but we did it all.
Almost all that stuff got shipped in small packages via the de minimis tariff exemption. They showed up in small boxes at a post office box. They showed up in small boxes in Mexico City, sometimes labeled as doorknobs and other assorted items. There are so many packages coming in. The cartels realized that there was a wonderful opportunity to hide in plain sight, that there is so much coming in, in this direct to consumer space from China, that it was easy enough just to simply slip in a few boxes of chemicals that could be used to make fentanyl and no one would ever suspect it or detect it. Suspect it, maybe, but detect it is a much harder thing.
Taylor Wilson:
Mo, thank you so much for your impressive reporting work on this topic and for coming on and discussing.
Maurice Tamman:
My pleasure.
Taylor Wilson:
Thanks to our senior producers, Shannon Rae Green and Kaely Monahan for their production assistance. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to [email protected]. Thanks for listening. I’m Taylor Wilson, and I’ll be back tomorrow morning with another episode of The Excerpt.
