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Staying alive

The situation is grim. But it might be improving—a little. The CDC’s preliminary data shows that between April 2023 and April 2024, overdose deaths in America declined by 10 percent. It’s the largest drop on record—and in some states, truly remarkable: In Ohio, deaths fell by 31 percent.

But this follows record-setting years when fatalities rose sharply: Between April 2018 and April 2019, nearly 69,000 people died. Between April 2022 and April 2023, that number rose to 112,000. And that, in turn, followed several decades of spreading opioid abuse across America.

Now, though, that trend is possibly turning. The drop in overdose deaths recorded this April will continue if the preliminary, tentative CDC numbers turn out to be correct. What’s behind this drop?

Magdalena Cerdá is a professor of population health at New York University’s Grossman School of Medicine, where she leads the Center for Opioid Epidemiology and Policy. Cerdá says that in recent years, American officials have implemented a whole suite of new strategies to prevent and reduce overdose deaths—and there are signs that those strategies are now working. But the U.S. is in the third decade of its opioid epidemic—and this wouldn’t be the first time public health officials thought things might be improving …

• “One of the leading strategies is the dissemination of naloxone, which is a drug that can reverse the effects of overdoses. There’s been a huge increase in the availability of naloxone across the U.S. Recently, it became possible to sell naloxone over the counter in pharmacies, whereas before—depending on state laws—someone would typically have to get a prescription from a doctor. It’s much more freely available now, partly because there’s been a lot of federal and state funding for its dissemination—community organizations, first responders, correctional facilities, and schools now carry it.”
• “Fentanyl-related deaths started on the East Coast and then spread toward the West Coast. And the recent decline also started on the East Coast and then shifted westward. That also coincided, as well, with a shift in the geography of fentanyl. As fentanyl moved west, overdose deaths started going down on the East Coast but up on the West Coast. Which suggests to me that changes in the fentanyl supply are partly what’s behind the rise and fall of fatal overdoses across the United States.”
• “We’re seeing particularly high levels of overdose deaths among black Americans, American Indians, Alaska Natives, and Hispanic Americans. And that racial and ethnic disparity is increasing. Historically, the highest rates of overdose deaths were among whites, American Indians, and Alaska Natives. But then, with the start of the Covid-19 pandemic, the rates of black Americans and Hispanic Americans—particularly Puerto Ricans—started to rise, even surpassing rates among whites. So, in my opinion, the next stage of the response should be to make sure that these disproportionately affected groups receive the best possible services and treatments.”

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Vladimir Putin calls a friend

Meanwhile, South Korean intelligence agencies have told their country’s lawmakers that the North plans to send 10,000 soldiers—and has been training a contingent of this size since September. North Korea and Russia deny the claims.

If true, however, the deployment of North Korean soldiers to Russia would be a remarkable sign of the strengthening ties among four of the world’s most powerful autocracies—North Korea and Russia, along with China and Iran. North Korea has already sent Moscow millions of artillery shells for the Ukraine war, while Iran has sent some 200 ballistic missiles—having already been working with the Russian military in Syria since 2015. As the war in the Middle East widens to include Iran, Beijing has said it stands with Tehran. What’s going on with all of this?

Recently at The Signal, Lucan Way explored the forces bringing these countries together. Way says the appearance of a tighter alliance among these autocracies is mostly driven by Moscow and its war needs. And while it’s true that the countries do share an interest in undermining U.S. power globally where they can, they otherwise have little in common—making it unclear just how close this partnership will stay after the war ends.

—Michael Bluhm

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