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After record drug deaths, there have been major reforms in addiction treatment

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The opioid epidemic surged in 2022 — killing record numbers of Americans, but help may be on the way in the form of more aid to communities and major reforms in opioid addiction treatment.

A MARTíNEZ, HOST:

The Justice Department is suing AmerisourceBergen over opioids. In their civil lawsuit, federal prosecutors accuse the drug wholesale distributors of failing to notify the government about suspicious opioid orders. It's just the latest chapter in a pivotal year for the opioid crisis. More people died than ever before from drug overdoses as street fentanyl flooded communities. But there have also been major reforms in addiction treatment. This year, drug companies also agreed to pay more than $50 billion to help communities recover from the opioid epidemic. NPR's addiction correspondent Brian Mann joins us now to take stock. Brian, so many people are still dying. Why does the opioid crisis keep getting worse?

BRIAN MANN, BYLINE: You know, A, I think it's helpful to remember how the COVID pandemic kept changing - right? - as different strains of the virus emerged. Well, the opioid epidemic is kind of similar. The type of opioids keeps changing. First, we had prescription pain pills sold by drug companies and pharmacies. They ignited this public health crisis. Then people shifted to heroin, which is more dangerous. And now what we're seeing is more and more people using fentanyl, which is this deadly synthetic opioid that's so powerful, it's contributing to a drop in American life expectancy. The CDC now says overdose deaths appear to have peaked in March of this year, but at a really deadly level, 110,000 Americans dying from drugs in a single 12-month period.

MARTíNEZ: And a lot of those are under the age of 40. What are they saying about the danger of fentanyl?

MANN: Well, they're scared. I spent time in Tacoma, Wash., with Marche Osborne, who's 31. She used to use heroin, which she felt like she could maintain pretty safely, using that drug. But now these volatile fentanyl pills are the only opioid she can find on the street.

MARCHE OSBORNE: They're zombifying people. They're - anybody will do anything for a pill. It's ridiculous. Like, they're turning people - they're dehumanizing people. And it's not a good thing. And it's not going to go anywhere good if it continues.

MANN: And because of fentanyl, drug overdoses are now a leading cause of death for Americans under the age of 40.

MARTíNEZ: And it's led, though, to some major reforms this year in addiction treatment. What's changing?

MANN: Yeah. For a long time, the disease of addiction has been siloed off from the rest of the health care system because of stigma and bureaucratic red tape and the lack of insurance coverage. A lot of people, most people with addiction, still get no help of any kind, which is crazy because there are actually great medications, like methadone and buprenorphine and naloxone. These drugs help people stop using opioids. Or they help reverse overdoses before they're fatal.

And so what's happened this year is the Biden administration and Congress have pushed through a series of really major reforms, some of them actually tucked into that spending bill that President Biden just signed. And all these reforms are making it easier for doctors and medical clinics to prescribe these lifesaving medications. I spoke with Dr. Rahul Gupta, who heads the White House Office of National Drug Control Policy.

RAHUL GUPTA: We began to normalize and understand addiction as a disease. And we start to treat people who are suffering from addiction as human beings and then be able to prescribe them treatments.

MANN: And more of these medications are now being dispensed. CDC data suggests, since March, month by month, the rate of overdose deaths has started to come down. So experts I talked to are hopeful. They hope this is a real turning point.

MARTíNEZ: What about stopping fentanyl from coming into the U.S.? Any progress there?

MANN: The answer here is no. The Biden administration says border agents did seize twice as many fentanyl pills coming from Mexico in 2022 - more than 50 million pills being smuggled in, mostly through ports of entry. But that doesn't appear to really be putting a dent in the street supply. Fentanyl is just everywhere right now. And it's really cheap.

MARTíNEZ: Now, one more big development this year was a reckoning with pharmaceutical companies. They made and sold a lot of opioid pain pills. How much will corporate America pay? And will that money help?

MANN: Yeah, Big Pharma really ignited this public health crisis, aggressively marketing opioids beginning in the late '90s. 2022 was the year companies ranging from CVS and Walmart to Cardinal Health and Johnson & Johnson, they came to the table and agreed to pay more than $50 billion in settlements. Just yesterday, the Justice Department actually announced they're suing another big corporation, AmerisourceBergen, over its opioid practices. Billions of dollars more on the line there.

These companies all deny any wrongdoing. But experts I talked to say this money really could help. It'll fund a bunch of drug treatment programs, a bunch of health care, especially in rural areas and urban neighborhoods, where the need is desperate. No one believes this will be a silver bullet, A. This isn't going to cure the opioid crisis. But along with the other reforms we talked about, this development could save a lot of lives.

MARTíNEZ: That's NPR addiction correspondent Brian Mann. Brian, thanks.

MANN: Thank you.