The Brief

Over the past six months, I've been tracking something really cool and mysterious happening on American streets. For the first time in 30 years, drug deaths are plunging at a rate that addiction experts say is hopeful — but also baffling.

In the past, even the most ambitious, well-funded efforts to slow drug deaths only helped a little bit. Reducing fatal overdoses by 8% or 9% was seen as a huge win.

But now, deaths nationwide plunged more than 26% from the peak in June 2023, according to the latest preliminary data gathered by the Centers for Disease Control and Prevention.

That means roughly 30,000 fewer people a year are dying. Many states are seeing even bigger improvements of 30% to 50%. In some states, progress has been sustained since 2021 and 2022, which suggests this isn't a temporary blip.

So how did the U.S. finally turn the corner on drug deaths?

What's going on? No one knows for sure, but here are eight leading theories I hear from experts.

1. Naloxone, also known as Narcan, may be the game-changer. The Biden administration raced to make this medication, a nasal spray that quickly reverses opioid and fentanyl overdoses, far more widely available. People can buy it now over the counter without a prescription. It's distributed for free in many high-risk communities, and people using drugs often carry it. It's unclear how many lives naloxone is saving each year, but many front-line public health workers tell me the impact is huge. Learn more here.

Naloxone, also known as Narcan, is much easier and more affordable than ever. People who use fentanyl now regularly revive one another after experiencing overdoses. Some public health experts and activists think this medication may be a big factor shifting the tide of America's overdose crisis.

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2. Weaker fentanyl. Street fentanyl is incredibly potent. But in many parts of the U.S., organizations that test fentanyl doses sold by drug dealers — often in pill form — have found a significant drop in purity. No one's sure why drug cartels have changed their mixtures. Some researchers believe law enforcement pressure in China, Mexico and the U.S. is disrupting the black market fentanyl supply chain. Learn more here.

3. A dangerous but less lethal street drug supply. In most of the the U.S., gangs are selling complicated "cocktails" of street drugs. The amount of fentanyl appears to be dropping (see above), while the amount of animal tranquilizers, such as medetomidine and xylazine, is rising. These chemicals are highly toxic. They cause skin wounds, severe withdrawal symptoms and other long-term health problems. But doctors and addiction experts generally agree they aren't as immediately lethal as fentanyl. That could mean more chronic illness but fewer fatal overdoses. Learn more here.

When America's opioid crisis began in the 1990s, drug addiction treatment was rare and often came shrouded in stigma. The U.S. addiction treatment system and safety net have seen huge improvements over the past decade. Better medications are available, and in many communities, more resources are available to help people using highly dangerous drugs such as fentanyl.

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4. Better public health. Thirty years after the U.S. opioid crisis began — and a decade after fentanyl spread nationwide — the U.S. has made strides developing better and more affordable services for people experiencing addiction. Medications that reduce opioid cravings, including buprenorphine and methadone, are more widely available, in part because of insurance coverage provided by Medicaid. In many states, roughly $50 billion in opioid settlement money paid out by corporations is also starting to help. Going forward, it's unclear how the Trump administration's deep cuts to public health agencies and grants will affect this new addiction safety net. Learn more here.

5. Many of the most vulnerable people have already died. This theory is discounted by some researchers I talk to, but many addiction experts think it's a factor. Over the past five years, the U.S. has been losing roughly 110,000 people to fatal drug overdoses every year. It's possible drug deaths are declining in part because a heartbreaking number of people using fentanyl and other high-risk street drugs simply didn't survive. Learn more here.

6. Waning effect of the COVID pandemic. The isolation, trauma and disruption of addiction treatment programs that followed the onset of COVID in 2020 overlap with the most devastating years of drug overdose deaths. Many public health experts believe the pandemic deepened the catastrophic impacts of fentanyl. According to this theory, as the impacts of COVID continue to fade, deadly overdoses are also declining to a more "normal" level. Learn more here.

7. People are using fentanyl (and other high risk street drugs) more skillfully. This is a common theory among people who use street drugs. They often tell me they've adapted to the risks of fentanyl by smoking rather than injecting the drug, which many addiction experts believe is safer (though still incredibly dangerous). People try to never use fentanyl alone and often carry naloxone or Narcan to reverse overdoses. Many people use test strips to identify unwanted contaminants in their drugs and use smaller fentanyl doses. Learn more here.

8. A decline in young people using drugs. Street fentanyl has emerged as a leading cause of death among young people in the U.S., age 18 to 45. But research suggests far fewer young people and teenagers are using drugs (other than cannabis). This trend matters because new users have low physical tolerance for opioids such as fentanyl, which means they're more likely to overdose and potentially die. Fewer young users means fewer people taking that risk. Learn more here.

It's important to emphasize all of these theories are just that — theories. Most researchers, doctors and front-line care providers say they need more data and more time to understand a shift this large.

But there is a growing, tentative consensus that the answer may well be "all of the above."

A big question going forward is How low will U.S. drug deaths go? We've already seen the biggest, fastest drop in U.S. history. So far, there's no sign the improvement is slowing.
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The case: In September, the city settled a lawsuit brought forward by two brothers in their 70s who said they suffered serious injuries after an LAPD officer crashed into their car. Days before the $18 million settlement was reached, lawyers for the brothers said Feldstein Soto called an expert witness testifying for the plaintiffs and “attempted to ingratiate herself with him and asked him to make a contribution to her political campaign,” according to a sworn declaration to the court by the plaintiffs’ attorney, Robert Glassman.

The response: Feldstein Soto did not respond to an interview request. Her spokesperson said the settlement “had nothing to do” with the expert witness. Her campaign manager told LAist the city attorney had been making a routine fundraising call and did not know the person had a role in the case, nor that there were pending requests for her office to pay him fees.

What Jurado says: In a statement to LAist, Jurado said she wants to “make sure that the city’s legal leadership is guided by integrity and accountability, especially when their choices affect public trust, civic rights and the city’s limited resources."

What’s next: The motion needs to go through a few committees before reaching the full City Council. If it passes, the motion calls for the city attorney to “report to council in closed session within 45 days regarding the ethics breach violation and give updates to the City Council."

Every year in Santa Ana, Luis Cantabrana turns the front of his home into an elaborate altar in honor of La Virgen de Guadalupe that draws hundreds of visitors.

Along the front of the house, the multi-colored altar is filled with lights, flowers and a stained-glass tapestry behind a sculpture of the Lady of Guadalupe. Cantabrana’s roof also is lit up with the green, white and red lights that spell out “Virgen de Guadalupe” and a cross.

Visitors are welcomed with music and the smell of roses as they celebrate the saint, but this year’s gathering comes after a dark year for immigrant communities.

Luis Cantabrana stands in front of the stunning altar he built in front of his home in honor of La Virgen de Guadalupe. Every year, his display draws hundreds of visitors.

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Why do they celebrate? 

In 1513, the Virgin Mary appeared before St. Juan Diego between Dec. 9 and Dec. 12, asking him to build a church in her honor. Her image — a brown-skinned woman wearing a green veil with her hands together in prayer and an angel at her feet — miraculously appeared on his cloak.

To celebrate in Santa Ana, worshippers gathered late-night Wednesday and in the very early hours Dec. 12 to pray the rosary, sing hymns and celebrate the saint.

Cantabrana has hosted worshippers at his home for 27 years — 17 in Santa Ana.

The altar started out small, he said, and over the years, he added a fabric background, more lights and flowers (lots and lots of flowers).

“It started with me making a promise to la Virgen de Guadalupe that while I had life and a home to build an altar, that I would do it,” Cantabrana said. “Everything you see in photos and videos is pretty, but when you come and see it live, it's more than pretty. It's beautiful.”

The Santa Ana home's elaborate altar in honor of La Virgen de Guadalupe draws hundreds of visitors each year.

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Gathering in a time of turmoil 

Many also look to the Lady of Guadalupe for protection, especially at a time when federal enforcement has rattled immigrant communities.

“People don’t want to go to work, they don’t want to take their kids to school, but the love we have for our Virgen de Guadalupe,” Cantabrana said. “We see that la Virgen de Guadalupe has a lot of power, and so we know immigration [enforcement] won’t come here.”

Margarita Lopez of Garden Grove has been visiting the altar for three years with her husband. She’s been celebrating the Virgencita since she was a young girl. Honoring the saint is as important now as ever, she said.

“We ask, and she performs miracles,” Lopez said.

Claudia Tapia, a lifelong Santa Ana resident, said the Virgin Mary represents strength.

“Right now, with everything going on, a lot of our families [have] turned and prayed to the Virgen for strength during these times,” Tapia said. “She's a very strong symbol of Mexican culture, of unity, of faith and of resilience.”

See it for yourself

The shrine will stay up into the new year on the corner of Broadway and Camile Street.

California’s unemployment agency kept paying cellphone bills for 4 1/2 years without checking whether its workers actually were using the devices.

That’s how it racked up $4.6 million in fees for mobile devices its workers were not using, according to a new state audit detailing wasteful spending at several government agencies.

The Employment Development Department’s excessive cellphone bills date to the COVID-19 pandemic, when it shifted call center employees to remote work and faced pressure to release benefits to millions of suddenly unemployed Californians.

It acquired 7,224 cellphones and wireless hotspots by December 2020. State auditors analyzed 54 months of invoices since then and found half the devices were unused for at least two years, 25% were unused for three years and 99 of them were never used at all.

The investigation, which auditors opened after receiving a tip, identified 6,285 devices that were unused for at least four consecutive months, and said the department spent $4.6 million on monthly service fees for them.

From the beginning, the department had about 2,000 more cellphones than call center employees, according to the audit. The gap widened over time after the pandemic ended and the department’s staffing returned to its normal headcount.

As of April, the audit said the department had 1,787 unemployment call center employees, but was paying monthly service fees for 5,097 mobile devices.

“Although obtaining the mobile devices during COVID-19 may have been a good idea to serve the public, continuing to pay the monthly service fees for so many unused devices, especially post-COVID-19, was wasteful,” the audit said.

Department officials told auditors they were unaware of the spending, but auditors pointed to regular invoices from Verizon that showed which phones were not being used.

“We would have expected EDD management to have reconsidered the need to pay the monthly service fees for so many devices that had no voice, message, or data usage,” the audit said.

The unemployment department began acting on the auditors’ findings in April, when it canceled service plans for 2,825 devices. It has since implemented a policy to terminate service plans for devices that go unused for 90 days.

The California state auditor highlighted the mobile devices in its regular report on “improper activities by state agencies and employees.” The audit also showed that the California Air Resources Board overpaid an employee who was on extended leave as he prepared to retire by $171,000.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.