AYESHA RASCOE, HOST:
The U.S. addiction crisis is evolving in ways that experts say are both hopeful and incredibly dangerous. The good news is that fatal overdoses from fentanyl and other street drugs keep dropping. But there are also new waves of synthetic drugs, some more powerful than fentanyl, turning up in U.S. communities. NPR's Brian Mann reports.
BRIAN MANN, BYLINE: Let's start with the big shift that has drug policy experts feeling positive for the first time in decades. A year ago, NPR broke the story that street drug deaths in the U.S. were plummeting. Lori Ann Post, a researcher at Northwestern University, says that progress is continuing.
LORI ANN POST: This is unprecedented, historic for the longest consecutive months of decline. That is awesome.
MANN: Most experts credit a mix of factors for this recovery - less potent fentanyl on the streets, better health and addiction care. Nabarun Dasgupta, who studies overdose patterns at the University of North Carolina, says drug deaths among young people have seen especially big improvements. He points to the latest data from the state of Maine.
NABARUN DASGUPTA: It's remarkable that no one in Maine under age 25 has died in nearly 12 months. Zero is a meaningful number.
MANN: But lurking behind this hopeful trend is another reality far more grim that keeps Dasgupta and other street drug experts awake at night.
DASGUPTA: The synthetic soup that is the American drug supply.
MANN: Synthetic soup - here's what Dasgupta means. For decades, drug dealers in the U.S. mostly sold plant-based substances like cocaine and heroin. But drug gangs have pivoted more and more to cheaper drugs made using industrial chemicals. Fentanyl and methamphetamines - they're the most common and deadliest examples. Research chemist Ed Sisco, who works for a federal agency that tracks street drugs called the National Institute of Standards and Technology, says illegal drug labs are mixing new compounds into drug batches with devastating speed.
ED SISCO: Once a month or once every other month, we're encountering something that we've never seen before, and we haven't seen indications of it being seen in the United States before, either.
MANN: The list of new chemical substances is dizzying. There are dangerously powerful sedatives like medetomidine and xylazine - sometimes known as tranq. Also there are new types of synthetic opioids even more potent than fentanyl. Sisco says street drug users have no way of knowing what they're putting in their bodies.
SISCO: Almost none. Substances that are in the supply are - feel like they're constantly changing, and the other thing we see is that the amount of the substances in the supply is also constantly changing.
MANN: Even when not lethal, many of these compounds cause grave harm to the human body - everything from skin lesions to heart ailments. The chemicals are also much harder to detect. Naida Rutherford is the coroner in Richland County, South Carolina. She helped investigate what appeared to be a mysterious overdose death earlier this year.
NAIDA RUTHERFORD: Every sort of physical manifestation, like the foam coming from the mouth and the nose as if they had an overdose - and their blood tested negative for any substances, which was very odd.
MANN: Her team was stumped, so Rutherford expanded their testing, looking for new compounds.
RUTHERFORD: That's where we found the cychlorphine.
MANN: Cychlorphine is just one of the incredibly potent synthetic opioids spreading fast in the U.S. street drug supply.
RUTHERFORD: This is the first time we've seen it in South Carolina, which is very scary because none of us knew to test for it.
MANN: Some drug experts say these apparently contradictory trends - a more dangerous and unpredictable drug supply at a time when there are far fewer drug overdose deaths - may actually be linked. Here's Nabarun Dasgupta at the University of North Carolina.
DASGUPTA: People who have been using for a long time are saying, that's enough. Like, that's not what I signed up for.
MANN: Dasgupta and others say more people, especially young people, appear to be opting out of drug use or seeking treatment for addiction because the synthetic soup of street drugs in the U.S. is now so toxic and perilous. Brian Mann, NPR News. Transcript provided by NPR, Copyright NPR.
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