MARY LOUISE KELLY, HOST:
Here is a hopeful statistic. In the U.S., deaths from overdoses of fentanyl are plummeting. They're down over 30% year over year. That's according to data from the Centers for Disease Control and Prevention. Some addiction experts believe the deadliest wave of the fentanyl crisis may finally be over. Now, that does present a new challenge. Many communities must now help the growing number of fentanyl survivors who are still deeply unwell. NPR's Brian Mann has our story from Philadelphia.
BRIAN MANN, BYLINE: On a late winter morning, Keli McLoyd with Philadelphia's Overdose Response Unit sets off on foot across Kensington, one of the most drug-scarred neighborhoods in the U.S.
KELI MCLOYD: Hey, sir. You all right? You OK?
MANN: In the first block, she kneels next to a man curled up on the sidewalk.
UNIDENTIFIED PERSON #1: He's fine.
MCLOYD: He's good. You good?
UNIDENTIFIED PERSON #1: Yes.
MCLOYD: All right. I can see him moving. He's good.
MANN: Good means still alive. But the growing number of people who survive fentanyl overdoses still face complicated health problems - many still severely addicted, often with skin wounds, bacterial infections and cardiovascular disease.
MCLOYD: It's absolutely heartbreaking to see people live in these conditions.
(SOUNDBITE OF TRAFFIC)
MANN: The city is pushing hard to clean up Kensington, but in the shadow of the elevated train track, people slump against abandoned buildings. A few blocks down the street, men and women crowd outside a warming shelter called the Sunshine House, run by Rosalind Pichardo.
(CROSSTALK)
UNIDENTIFIED PERSON #2: There's a little smoke in here. We're making some bacon.
MANN: People can get a meal here and clean clothes, and maybe a new winter coat.
ROSALIND PICHARDO: I call them my sunshines, so we serve a lot of sunshines here.
MANN: They can also get naloxone, also known as Narcan. It's the overdose reversal drug. Pichardo says she personally has brought back more than 2,000 people overdosing on fentanyl.
PICHARDO: Everyone carries naloxone. So it does save lives all over Kensington, all over the city.
MANN: This is why I'm here. Kensington often looks grim, but things are better. Thanks in part to naloxone, Pennsylvania is seeing roughly 2,000 fewer drug overdose deaths a year. It's part of a dramatic national improvement that stunned addiction experts like Nabarun Dasgupta.
NABARUN DASGUPTA: It has been a complete shock to see numbers declining in the way that they have been.
MANN: Dasgupta's new study at the University of North Carolina found the drop in drug deaths nationally is big, with all states seeing at least some improvement, and many states, like Pennsylvania, experiencing 30% fewer fatal overdoses. That's a huge public health accomplishment. But Dasgupta says the trend creates a new challenge.
DASGUPTA: Initially, it's been kind of this panic mode of preventing deaths. But now that we are - we have found some effective ways to keep people alive, it's really important to try to reach out to them and help them improve their whole lives.
MANN: That's a tall order. The distance from where the U.S. is now in places like Kensington to that kind of public health response feels vast. As Keli McLoyd heads back out on the street, she bends to check on another man huddled and unresponsive.
MCLOYD: He's not dead, but he's not OK.
MANN: The complicated reality is that more people surviving fentanyl overdoses will mean more people needing a whole network of care.
MCLOYD: When we say, you know, this person is ready to go to substance use treatment, oh, but they have an amputation. They have an open wound. They have incredibly high blood pressure.
(SOUNDBITE OF ELEVATED TRAIN)
MCLOYD: You know, historically, our system is not built for that person.
MANN: A few blocks down the street, I meet Tracy Horvath, who says she's lived in Kensington most of her life, much of that time using fentanyl.
TRACY HORVATH: I relapsed, like, a week ago, but I'm trying to stay clean.
MANN: She looks weary and cold, but she is one of the survivors. Horvath, too, says fentanyl might have killed her if Narcan weren't so widely available.
HORVATH: I only used a little bit, and I still overdosed.
MANN: I ask what she'd need to move beyond this life, beyond addiction. Horvath says her first goal is a safe place to live.
HORVATH: Stable housing.
(SOUNDBITE OF CAR HORN HONKING)
MANN: Addiction care experts say getting people off the street into homes is often a crucial step. But there are so many needs here, it can feel overwhelming. Keli McLoyd says there has been progress building a network of services and support that didn't exist a decade ago.
MCLOYD: There's one of our partners, the Kensington Hospital wound care van.
MANN: We pass a mobile health care team and a food pantry. There's a special police unit trained in addiction response and a group from a university dispensing buprenorphine, a medication that reduces fentanyl cravings. I meet Scout Gilson working at a syringe exchange run by a group called Prevention Point.
SCOUT GILSON: I was addicted to heroin, and then eventually fentanyl.
MANN: Gilson, who's in long-term recovery, said she knows firsthand how complicated the health impacts of drug use can be, from mental health challenges to lingering skin wounds.
GILSON: I'm covered in scars. Like, I am heavily scarred. I am pretty much marked forever as a drug user.
MANN: But Gilson thinks deeper healing that moves people beyond survival is possible with the right help.
GILSON: It's not just pointless suffering. There's things that are happening. There's people doing the work, and there's obvious ways we can improve and just figuring out how to do that.
(SOUNDBITE OF SIRENS)
MANN: In my time in Philadelphia, I see examples of this hopeful work, and I meet people like Gilson who've managed to rebuild their lives. But the need is clearly growing here in Kensington and around the U.S. One question is whether there will be money to pay for these services. So far, the Trump administration has focused largely on keeping fentanyl out of the U.S., not on programs that help people recover. Some Republicans in Congress are still talking about budget cuts that could affect Medicaid. That's the federal program that funds most addiction treatment in the U.S. I asked Keli McLoyd, with Philadelphia's Overdose Response Unit, if she's hopeful, despite all the desperate need and the uncertainty. After a moment, she nods a cautious yes.
MCLOYD: And so we just, you know, work our best to help people be well and keep trying.
MANN: But it took years to slow fentanyl deaths in the U.S. McLoyd says healing people in neighborhoods like Kensington will take more resources and a lot more time. Brian Mann, NPR News, Philadelphia. Transcript provided by NPR, Copyright NPR.
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