The Morning: Has fentanyl peaked?

Plus, Trump's trial, Iran's president and Scarlett Johansson's voice.

View in browser|nytimes.com May 21, 2024 By German Lopez Good morning. We're covering a decline in drug overdose deaths — plus Trump's trial, Iran's president and Scarlett Johansson's voice. Narcan, an overdose antidote. Amanda Lucier for The New York Times A turnaround Last week brought some rare good news on drugs: Overdose deaths declined in 2023. And while the opioid crisis has taken some surprising and terrible twists over the years, it may finally be turning around. There are two main causes. First, drug epidemics tend to follow a natural course in which the drugs enter a market, spread and then fade away, at least for some time. The opioid epidemic appears to have entered that final phase. Second, policymakers have increased access to both Narcan, a medication that reverses opioid overdoses, and addiction treatment. These changes have saved lives. Today's newsletter will explain both causes. Faddish cycle Drugs are often faddish; epidemics tend to ebb on their own. Why? Users die. People see the damage that a drug does, and they shun it. Surviving users move on to other drugs that they see as better or safer, sometimes incorrectly. Think of all the drugs that have come and gone over the past several decades, such as crack, meth and synthetic marijuana. (In the case of meth, a comeback is underway. Even the worst fads can return.) The opioid epidemic is no exception. In fact, it has arguably been a succession of three different fads — first opioid painkillers, then heroin and finally fentanyl — that have felt like one. Source: C.D.C. | Chart shows predicted provisional death counts. | By The New York Times In the 1990s, doctors started to prescribe more painkillers. The drugs proliferated not just among patients but everyone else as teenagers took them from parents' medicine cabinets and peddlers sold them on the black market. By the 2010s, many painkiller users had moved on to heroin as they lost access to the pills — because doctors stopped prescribing them — or sought a stronger high. Then, fentanyl arrived. Fentanyl has been worse than heroin and other opioids. Drug cartels make it in laboratories in Mexico, using ingredients typically imported from China. Before the current crisis, fentanyl was not widely misused in the U.S. It first spread in drug markets across the East Coast and the Midwest in the mid-2010s, consistently causing a spike in overdoses wherever it went. For a little while, its spread largely stopped at the Mississippi River. It was easier to mix with the white-powder heroin popular in the eastern U.S. than with the black tar heroin popular in the western U.S. As fentanyl's spread briefly stalled, overdose deaths declined nationally in 2018. But then the drug went westward, reaching the Pacific Coast. That new wave, coupled with the Covid pandemic, caused annual overdose deaths to exceed 100,000. So why is last year's drop different from 2018's? Opioids, including fentanyl, have already reached every corner of the country; they have few places left to spread. The Covid pandemic is over, taking with it the chaos and isolation that led to more overdoses. The drug users most likely to die have already done so. More people have rejected opioid use. And the remaining users have learned how to use fentanyl more safely. Policy's impact Some policy changes have played a role in the decline, too. In particular, federal officials have successfully pushed the use of Narcan (also known as naloxone), a medication that reverses opioid overdoses. Police officers and firefighters often administer it. Libraries and schools carry it. Pharmacies sell it over the counter. Some first aid kits include it. People who overdose are now much likelier to get Narcan quickly enough to save their lives. The federal government has also put more money toward addiction treatment, both through Medicaid and through new laws aimed at the drug crisis. The government has pushed doctors to prescribe medications that treat opioid addiction. Some states, like Vermont, have made treatment more accessible and higher quality. Training community members to test for fentanyl. Desiree Rios/The New York Times These changes have not addressed every problem. Patients can struggle to pay for treatment. And some programs continue to use practices not supported by science, such as confrontational approaches and therapies in which patients bond with horses. Still, the policy changes have helped improve the treatment system overall. More to do Even after last year's decline, annual overdose deaths remain above 100,000. That death toll is higher than all annual deaths from car crashes and guns combined. The introduction of a new drug — the next fad — could still increase that death toll again. Policymakers could speed up the drop in deaths. They could require health insurance plans to cover addiction treatment. They could fund more high-quality treatment. They could reduce the price of Narcan and similar medications. They could better coordinate with China and Mexico to reduce the flow of fentanyl into the U.S. The opioid epidemic is burning out anyway, but its decline could be steeper, saving thousands more lives. Related: A major study found that weed use among teenagers was lower in states where the drug was legal, confounding expectations. ADVERTISEMENT THE LATEST NEWS Trump on Trial Donald Trump Dave Sanders for The New York Times The prosecution rested its case in Donald Trump's Manhattan criminal trial after Michael Cohen finished testifying. The defense is likely to rest today. Prosecutors found a photo of Trump with his bodyguard from October 2016, taken shortly before Cohen said he called the bodyguard to discuss the payment to Stormy Daniels with Trump. The defense had challenged Cohen's account of the call. During cross-examination, Cohen admitted to stealing from Trump's company. He kept money that was meant to go to a tech company hired to rig polls in Trump's favor. The defense called Robert Costello, a lawyer who advised Cohen before they had a falling out. Costello testified that Cohen told him that Trump "knew nothing" about paying off Daniels. Cohen previously said that he'd lied to Costello. Trump has often sat still, his eyes closed, during the proceedings. Sometimes he's sleeping; sometimes he seems to be compartmentalizing, our colleague Maggie Haberman says. A verdict could come next week, answering the question of whether Trump will campaign for president as a convicted felon. Iranian President's Death In Tehran, Iran. Arash Khamooshi for The New York Times Iran began funeral events for Ebrahim Raisi, its former president who died in a helicopter crash. A "technical failure" caused the crash that killed Raisi and Iran's foreign minister, the state media reported. Images of the crash site show that Raisi's helicopter was a model developed for the Canadian military in the 1960s. Iran struggles to update its aviation fleet because of sanctions. Raisi was a candidate to succeed Ayatollah Ali Khamenei, 85, as Iran's supreme leader. His death complicates a difficult search for the next ruler. Israel-Hamas War Benjamin Netanyahu, left, and Yahya Sinwar. Ronen Zvulun/Reuters; Mahmud Hams/Agence France-Presse — Getty Images The International Criminal Court's chief prosecutor requested arrest warrants for Benjamin Netanyahu and the leaders of Hamas for crimes related to Oct. 7 and the war in Gaza. President Biden called the prosecutor's request outrageous: "There is no equivalence — none — between Israel and Hamas." He later said that what's happening in Gaza "is not genocide." A.I. Scarlett Johansson Paul Morigi/Getty Images OpenAI asked Scarlett Johansson, who played a seductive virtual assistant in the movie "Her," to become a voice of ChatGPT. She said no twice, but the company released an assistant that sounds like her. "I was shocked, angered and in disbelief": Johansson rebuked Sam Altman, OpenAI's chief executive. The company has suspended the voice. OpenAI designed a voice of a "lightly flirtatious, wholly attentive woman," our movie critic writes. Read more about how the voice resembled the one in "Her." More on Business In Torrance, Calif.  Patrick T. Fallon/Agence France-Presse — Getty Images The seafood chain Red Lobster has filed for bankruptcy. The company plans to close many of its restaurants. The financier Ivan Boesky, who symbolized the brash Wall Street of the 1980s — and paid a $100 million penalty for insider trading — died at 87. 2024 Election Trump and the Republican Party beat Biden and the Democrats in fund-raising for the first time this election. The Biden campaign still has far more cash on hand. Trump's Truth Social account posted a video with hypothetical newspaper articles about what his victory would mean for America that referred to "the creation of a unified Reich." His campaign said a staffer had posted it. Other Big Stories Jimmy Chérizier, also known as Barbecue, is one of Haiti's most powerful gang leaders. Matias Delacroix/Associated Press Gangs control Haiti's infrastructure, including police stations and ports. South Africa's highest court barred former President Jacob Zuma, who is attempting a political comeback, from running for Parliament next week. His new party will still put his face on ballots, complicating the election. Contaminated blood products killed about 3,000 patients of Britain's National Health Service, a long-awaited report found. The authorities hid their failings for years. Storms could bring tornadoes and damaging winds to the Midwest today. Opinions Arizona has a choice: become more like Texas or more like California. This year's U.S. Senate race will suggest where it's headed, Tom Zoellner writes. Samer Attar spent weeks documenting the struggle to save lives in Gaza's ravaged hospitals. Watch his dispatches in this Opinion Video. Here are columns by Michelle Goldberg on Trump's criminal trial and Paul Krugman on the Dow's hitting 40,000. A subscription to match the variety of your interests. News. Games. Recipes. Product reviews. Sports reporting. A New York Times All Access subscription covers all of it and more. Subscribe today. MORNING READS Emilio Parra Doiztua for The New York Times Travel: Spend 36 hours on the Spanish island of Minorca. Climate questions: Is biodegradable plastic really a thing? Yes, but it isn't a perfect solution. Health: How to soothe — and prevent — ingrown hairs. Lives Lived: Bruce Nordstrom, whose grandfather immigrated from Sweden and founded Nordstrom as a small shoe-store chain, was instrumental in turning the retailer into an international fashion giant. He died at 90. SPORTS N.H.L.: The Edmonton Oilers survived Game 7 in Vancouver despite giving up two goals in the final nine minutes. They will play the Dallas Stars in the Western Conference Final. N.B.A.: The Boston Celtics and Indiana Pacers play in Game 1 of the Eastern Conference finals tonight. Boston is a favorite. ADVERTISEMENT ARTS AND IDEAS Charlie Neibergall/Associated Press Robert F. Kennedy Jr.'s style — the skinny ties, button-downs and weather-beaten tan — is unique among this year's presidential hopefuls. It also might be an electoral advantage: His preppy look evokes, in the American mind, his father and his uncle, the Times's chief fashion critic Vanessa Friedman writes. "It matters because those unstated associations serve to moderate Mr. Kennedy's more outré positions," Vanessa adds. More on culture "Kinds of Kindness" stars Jesse Plemons, Willem Dafoe and Emma Stone. Sam Hellmann for The New York Times The Times sat down with the stars of Yorgos Lanthimos's new dark comedy, "Kinds of Kindness," which just premiered at Cannes. Penguin Random House, the largest publishing house in the U.S., dismissed two top executives; the industry faces financial challenges. The author of "Crazy Rich Asians" left Singapore's upper crust when he was 11. He's still writing about it. The Portal — a live video feed between Dublin and New York City — has reopened. It was shut off last week because of bad behavior on both sides, including a flasher. Stephen Colbert had thoughts about Justice Samuel Alito blaming his wife for the flying of an upside-down American flag. THE MORNING RECOMMENDS … Linda Xiao for The New York Times Roast a curry-rubbed half chicken with peppers, an ideal recipe for one. Celebrate love with an anniversary gift. Take a portable solar battery charger with you on a hike. GAMES Here is today's Spelling Bee. Yesterday's pangram was taxonomy. And here are today's Mini Crossword, Wordle, Sudoku, Connections and Strands. Thanks for spending part of your morning with The Times. See you tomorrow. — German P.S. We apologize: We told you yesterday that the comments section for David Leonhardt's article on "neopopulism" would still be open, and it wasn't. But it's open again now and will remain so all day. Sign up here to get this newsletter in your inbox. Reach our team at themorning@nytimes.com. Editor: David Leonhardt Deputy Editor: Adam B. Kushner News Editor: Tom Wright-Piersanti Associate Editor: Lauren Jackson News Staff: Desiree Ibekwe, Sean Kawasaki-Culligan, Brent Lewis, German Lopez, Ian Prasad Philbrick, Ashley Wu News Assistant: Lyna Bentahar Saturday Writer: Melissa Kirsch Need help? Review our newsletter help page or contact us for assistance. You received this email because you signed up for the Morning newsletter from The New York Times, or as part of your New York Times account. To stop receiving The Morning, unsubscribe. To opt out of other promotional emails from The Times, including those regarding The Athletic, manage your email settings. To opt out of updates and offers sent from The Athletic, submit a request. Subscribe to The TimesGet The New York Times app Connect with us on: Change Your EmailPrivacy PolicyContact UsCalifornia Notices The New York Times Company. 620 Eighth Avenue New York, NY 10018