It's the big take from Bloomberg News and I Heart Radio. I'm West Gusova today. How fentanyl caused the opioid crisis to come roaring back. Just before the COVID pandemic hit, there was some cautiously optimistic news about America's decades old opioid epidemic. After many years of rising deaths from overdoses, the numbers were starting to tick downward in some hard hit states, and it appeared like prevention and treatment methods were finally starting to work. But that all changed in when the powerful opioid fentanyl began flooding the streets right as the world shut down. Fentinyl overdoses are now a major health crisis in many places across the country, and public health officials are struggling to keep up well. If you look out the definition of an opoi, the first thing it says is that it creates a feeling of euphoria. After a while, there's no longer that sense of euphoria. It's really just I want to feel like I can function today. That's Helena Gerard. She's a health official in Volucia County, Florida, which is one of the places where fentyl overdoses are a terrible problem. We'll hear more from her in a bit, but first to explain what's happening and what's being done about it. I'm joined by Bloomberg reporters am A Court, Leonardo Nicoletti, and Linley Lynn, who have worked on a deeply reported story about the fentinyl crisis. Emma, Linley Leonardo, thanks so much for being here. Thank you glad to be here, Thanks for having us. Let me just start with the most basic question, what is fentanyl. Fentanyl is a synthetic opioid, and that means it is made in a lab. It's not a natural opioid. And when we're talking about fentanyl in this context, we're really talking about the rise of illegal fentanyl. Largely that's what's killing people. But fentanyl was originally sort of developed as a medication to manage pain, and there is a prescription version as well, but in this context, again really talking more about the illegal drug market, so that originally this was a manufactured pharmaceutical, but then it became illicitly manufactured. Yeah, and and lately especially it's really kind of um. The initial chemicals to make fentanyl are coming from China, they're going to Mexico and manufacturing fentanyl and it's getting smuggled in through the southern border. And you know, part of the reason fentanyl has really taken off is because fentanyl is extremely cheap to manufacture and it's extremely powerful, so it produces a high much more easily than with other kinds of drugs. So you've gathered in this story an enormous amount of data tracking the rise in the use of ventinyl and then along with it the explosive rise in tragic deaths. Could you give us a sense of just how large a problem this is nationwide in the US? Sure thing? Um I spent a lot of time analyzing um CDC data, that's the data from Centers for Disease Control and Prevention, and just to share one set of numbers, last year, over eighty thou Americans died from opioid overdose, and fentanel was founding octossities of at least seventy thousand of these deaths. So this include those people who knowingly or unknowingly took fentanyl, and sometimes there might be um drug cocktails that they just took they didn't know fentanel was part of it like cartail being they might have taken marijuanan and had ventanol in it or heroin another drug, exactly, multiple substances mixed up. And this year's provisional data so far show that almost a nine of Americans who have died of opio it overdose died of fentanyl. That's very gruesome numbers. And as we dove further into our reporting, I was talking to myself, I just think it is an opioid and this is part of the everlasting opiod crisis. But this exact chapter we're at right now is a real fentanyl crisis. To give you some size and scope. Um since March, the beginning of the pandemic, more than one d and sixty five thousand Americans have died from opioid overdoses. What was it about the pandemic that made people suddenly turned back to opioids and in particular fentanyl. That's a great question, and it's something we really wanted to explore in this story. In particular, I think when you think of the opioid crisis, people often think of prescription drugs, right, they think of produced pharma. You know, there's a long history the opid crisis has gone on since the you know, the mid to late nineties and the United States, but in this case, fentanyl was already sort of starting to take off in the US prior to COVID. But what we really saw it was in the last three years the deaths from fentanyl just kind of exploded, and we saw like enormous fatalities from fentanyl. And when we tried to sort of explain why that was, the answer we kept kind of coming back to was sort of mostly the ubiquity of fentanyl was a big, big factor. So it's not that people were necessarily seeking it out. It was permeating other illegal drug supplies. So people who were you know, using drugs like heroin, for instance, or meth or even something like cocaine or marijuana, which people don't typically think of as these really you know, some of these drugs don't sound like marijuana particularly dangerous, but they were getting sort of adulterated with fentanyl. Fentinel was getting kind of mixed into that drug supply. And when were they mixing fentinel into those other drugs. It's a little hard to say, you know, one of the big explanations is that fentanyl is um so cheap and so you equitous that it was a way of sort of spreading out drug supply. In some cases it might have also been you know, an accident. All the stuff being made in the same kind of space. Ventanyl so poisonous that small mistakes could really be quite devastating. But in addition to sort of the illegal drug supply getting sort of contaminated with fentanyl, another part of that story that's really important is counterfeit pills. So people buying black market out of all or xanax or other kinds of drugs, and those drugs might not actually be out of all or xanax, they might be pills with fentanyl inside. Then those might also be causing deadly overdoses. And this seems to be a pretty big trend. Now, these these two sort of factors in the sort of rise of fentanyl. Yeah, to add on that, a lot of the deaths they are actually due to accidental overdose when it comes to ventanyl. And from the CDC data, we actually saw like a growing number of deaths um when officials were doing autopsies that were ultiple narcotics were found in the same body, so many died without knowing from what substance they died from even and so this cocktail effect has definitely been a new trend that we are observing. Leonardo Linley just mentioned the CDC, the Centers for Disease Control and Prevention data. You're we're heavily involved in gathering and then analyzing the data that you used to track the rise of fentanyl in this story. What did you find in that data. One of the things that you know, we found in the data, and that we think we showed really clearly in one of the graphics is that a lot of things have been changing in the past few years. And one of the things that has been changing is that who fentanel has been killing has changed a lot. And you know, you can see that while the opioid death rate was highest for white Americans for more than fifteen years, so until six white Americans were dying at the highest death rate, but now it is highest among Americans. Um, you can see that, you know, the opiod death rate for Black Americans has more than doubled since and most of this increase has happened during the pandemic. Um Obviously, fentanyl has had a really big role in this increase, and do we know from the data why there was that switch from more white people dying from overdoses to more black people dying. The CDC has actually really tried to highlight this trend over the pandemic, and one of the potential explanations they've given is that access to medical care for opioid use disorder, which is the disease of opioid addiction, may be sort of quite unequal, and so people of color, including Black Americans also there's been a big increase in the death rate among Native Americans in the US, may not have the same kind of access to treatment um as white Americans. One of the things that really struck me in the story, uh, and you alluded to this before, is just how deadly fentyl is and the way you described it was just a few grains of salt worth is enough to overdose, and that so many of the doses of drugs that people buy in the street contained way more than that. Yeah, So this is something that really struck us as well when we were reporting this story, is that just two milligrams of fentanyl equal to a few grains of salt is enough to potentially cause a deadly overdose. UM. And you can envision a few grains of salt. That is a very small amount um And part of the reason for that is that fentanyl is up to a hundred times more powerful than morphine, you know, a prescription opioid, and fifty times more powerful than heroin. And so what we actually heard out of the county that we focused on in the story, which is Lucia County. It's in Florida, is that some people were overdosing and they had so much fentinel in their bodies that it was enough to kill thirty or four the people. That's what the Medical Examiner's office told the county council. My conversation with Emma Leo and Linley continues after the break. So, now that we have a pretty good idea of just how powerful and deadly fentanyl is, I want to talk about the focus of your story, which is in Valusia County, Florida, which has seen a huge increase in fentanyl deaths, and what's happening there and what they're trying to do about that. Linley, can you describe what's happened in Valusia County. So, when we were using a database from the CDC that tracks death causes in the US. We screened opiate death data of every single county in America and try to see which ones fitting to this exact pattern. And there were scores of counties all of the US that have gone through similar tragedies, and we looked into fifty counties and called fifteen of them. After all that work, we picked Volucia in Florida. Then we looked at Vlucia Stata more closely, and we saw fentanel induced overdose deaths tripled in from the year before. So it was very shocking to us. And it just had a lot to do with the COVID pandemic and add isolations and everything. And so in Lucia, two hundred and seventy two lives were lost that year due to fentanel and more surprisingly, that's over nine of all of the total opiate overdose deaths in that county that year. What was it about COVID in particular that would make people turn to drugs? I mean, boredom, I suppose, but that's a pretty extreme solution to boredom. The way that we have been thinking about and learning about this is really through the lens of losing support and routine and kind of structure of life, right, so all of a sudden everything has completely changed. And there's also I mean it's hard to remember now with so many COVID protocols kind of out the window, but there was a time people were extremely scared of this new virus. And so you put all that together, the fear, the boredom, the loss of support, social isolation, social distancing was one of the big tactics we used initially to keep this virus at bay. And you have kind of a recipe for people using substances, um. And there was actually back at that point in time, there was some thought, oh, you know, all this disruption will extend the drug trade too, but that doesn't seem to have happened. In fact, we've seen as a result of a lot of these disruptions, we've seen people getting cut off from many vital sources of support for addiction. For instance, in Vlusia County, we know some local support groups and like narcotics anonymous style groups actually stopped meeting for a period of time. Um. You know, even when they began meeting again, they might have only done so virtually, which you know, I think we can all recognize that there is a place for zoom meetings in life, but we were also all getting very tired of zoom meetings. And then in person treatment changed a lot to the clinic that we talked about a lot in this story, um sm A healthcare and Volucia County was meeting with patients virtually, and one of the providers said to me, you know, virtually, you don't really read people as well. We don't have them in we can't test their urine for drugs, so we don't really know if they're using drugs again, and we can ask them questions, but we don't totally know, you know, we can't read them, you know, are they telling us the truth or not? So it did really change the dynamic um And even now with things sort of resuming, it's been difficult, I think, to get some of those rhythms back. Leonard, When you were looking at all this data and trying to figure out a way to visualize it, what leaped out at you the most from these floor the numbers. For me, what leaped out the most was really the spike that you see during the pandemic, and it's it's just so clear. You can look at the graphic and you see that if you just put a ruler on, that's exactly when the spike started. Like it's almost vertical that line. It's really crazy to look at exactly like M said, it follows the vertical line all the way up to you know, the highest point of the chart. But I think what really struck me when I was looking at the numbers was just on the national data the chart was actually too tall to fit in this on the screen. So there isn't actually a mobile device or a computer that you can use to actually see the entire chart at once. You have to scroll basically through, and as you scroll you see that like you still haven't reached the peak of deaths in M. So we've outlined this enormous problem, how intractable it is. What works? What do we know actually works to bring down addiction rates and overdoses. Yeah, so we basically know that one of the most important things you can do when someone has what's known as opioid use disorder, it's you know, most people call opiate addiction, is to open up access to medication assisted treatment. That basically means treating folks with essentially opioids that have been specifically approved by the US Food and Drug Administration the FDA to treat, you know, opioid use disorder, and so it's been very well established this is the gold standard of treating opioid addiction. And these medications essentially help people sort of reduce some of the euphoria highs associated with use of these drugs, but they also help reduce the risk of relapsing. And that's kind of key. It's a controlled environment. These folks are being kind of adminis, you know, admit stared and looked after biomedical professionals, and this is supposed to help prevent them from using exactly the kinds of street drugs we're talking about and dying of an overdose. There are a lot of other things though, that can also be done to address this crisis and are being done, including making the lock zone, which is the opioid overdose reversal medication UM, much more widely available. And that's Narcan. Is that what we're talking about. Yeah, the brand name is is Narcan. The Lockson is the generic name, and there's been a big push to get this stuff, you know, available over the counter, for instance, so you don't need a prescription anymore. To get it UM, get in the pockets of people, get out into places like nightclubs where people might be, you know, using drugs and be at risk of overdosing. And the idea is that is that the person who's overdosing does it, but somebody who sees someone is overdosing, they have this on them and they can help that person so the person doesn't die right. And actually, one of the most powerful things I heard while reporting this story was COVID was a disease where isolation. Social isolation was the way you prevented it from spreading. And you're using drugs alone, there's nobody there to revive you with the loxon with nark, can you know. And I thought that was really I mean, that kind of hit me with a punch in the gut. So one thing that a place like Florida is actually starting to do as of this year is they're trying to do a better job connecting people who are at risk of overdose or who are you know, have overdosed UM with this medication assisted treatment. But in Florida and other places around the country, you know, many conservative states are not fully embracing all of the tools of what we call harm reduction, and harm reduction is basically acknowledging that you can't prevent people from using drugs and all instances, but when they do use drugs, you can try to mitigate the harm and make it, you know, safer to use drugs. Literley, at the beginning of the interview, you gave us some pretty jaunting numbers for a number of people who have died from hope we had used and in partain killer fentanel overdoses. Where are we in the numbers now when it comes to trends on the national skill, we are actually seeing, um from the total number accounts, we are seeing fewer over those deaths so far this year. But um caveat that is we are all just having provisional data for now. They are going to be updated as time goes by. We are gradually walking out of that pandemic, and I'm hopeful that without that essay major contributing factor, we should be able to see fewer drug overdose deaths. And also there is a growing awareness of what kind of role fentonel is playing in this overall opioid crisis nowadays, so I'm hoping for the best. I would also say you know, in this day and age, with fentanel creeping into so many other illegal drugs, drugs that people don't think of as sort of dangerous. Know, these are drugs that are now becoming extremely dangerous and using them can kill you. It's a very real danger now, it's not a hypothetical situation. Emma Linley Leo, thanks so much for joining me today. Thank you, Thank you so much for having us, Thanks for having us West. When we come back a close up view of the fentinyl crisis in Florida for a closer look at fentinyl's toll on people and communities, I'm joined by Helena Girard, who you heard at the beginning of the episode. She's the overdose Prevention coordinator for the Florida Department of Health Involutiona County. Helena, thanks so much for coming on the show. Thanks so much for having me. Can you first just describe what does the overdose Prevention program coordinator for Valuja County do? What is your job? So I get to work with community partners, so this would include hospital systems, um the sheriff office, the medical examiner. Most importantly, I get to work with people who have been directly impacted by substance use, whether it's themselves personally, or a family member or a friend, and we all work together. We look at the data that's provided by some of those partners and we find out who is the most impacted. You know where these overdoses are taking place, and we try really hard to get the messaging out into those areas so that people are aware that what a crisis we're experiencing. We recently now started passing out in our can um at the Department of Health in Militia County, which is huge. Last week we had one of our active participants in our work overdosed and UM her family requested that our can be distributed at her funeral. So how did you come to this line of work? I think I started this work just volunteering, being involved in my own recovery, and in two thousand and eighteen was ordered a fellowship with the Pritzkur Children's Initiative, and I focused on substance exposed newborns. I got some really great experience working in that maternal and child health world, but also with substance use. So that fellowship ended in and a position was open at the Department of Health in Blutia County. And I think it was created for me. I mean it just it feels like it's amazing to come to work every day and get to do things that I'm very passionate about. For people who use it, how does fentinel feel that makes it such a powerful drug? Well, if you look at the definition of an opioid, the first thing it says is that it creates a feeling of euphoria. And that's with a lighter dose. So when somebody uses fentanyl in in my this is my own personal experience, um that it's a feeling of euphoria, and um it's it's it's scary. It's scary because it's for somebody that experiences anxiety or depression. It could be that moment that you feel normal, like, oh this is what other people feel like, So I'm going to do it again. And then the intention is never to do it forever. But nobody wakes up every day hoping to fail. And it's progressive and deadly and after a while there's no longer that sense of euphoria. It's really just I want to feel like I can function today. And how were you able to get off of it. I was um, I was pregnant, and I was able to detox in a hospital under a physician's supervision nurses around the clock. So it took about six days of intensity talking in the hospital, and then from there I went to an intensive impatient facility where I could stay until my daughter was born, and then we stayed until she was almost a year old. So I stayed for a very long time. And how did your own experience, how does that sort of inform the work you're doing now? I think I'm able to take my personal experience and remember the feeling, so that I'm not doing the work through a lens of judgment. I'm doing it through a lens of compassion and having been there myself and understanding the pain and that it's not moral failing. It's not because people are bad, that they are struggling with substance use, and so it really creates an opportunity for me to have a really open mind with the work. Everybody's recovery is different, everybody's story is different, and how can we support everybody's recovery in a different way? Can you describe what the situation is right now in Valusia County it's not good. UM. We are second in the state capita for overdoses, so there are a lot of people dying a lot of um non fatal overdoses as well. And it's um whether they're using fentanyl because they know it UM, but we also have those who are using something else. They might think they're taking a zanex and it's pressed with fentanol, or they buy some weed and the dealer just had touched fentanyl and then it gets into the marijuana and they're exposed that way. And you know, it takes the size of two grains of salt to be fatal. So it's um pretty serious when you know a couple of crumbs get into anything else. You talked about how important our can is. Can you describe why it's so important? Simply it saves lives. But when narcan is administered, and it looks like a nasal spray, the one that is most generally in the public. But what they do it goes in and it goes to the receptors, the opioid receptors in the brain and it pushes opioids out, so it pulls the person out of an overdose. It sometimes takes a couple of tries, especially with the ventanyl. Now I have friends that I personally know that have taken six doses to revive them. And another thing that I always like to remind people if they don't go with UM the first responders once they arrive, making sure to keep an eye on them because the narcan only stays in the receptors for a certain amount of time. So if there's enough opioids in their system, then they could reattach and they can overdose again without even using any more drugs. And is narcan something that anyone can carry and if they see a person is overdose, they can administer it. Yes, there's a good Samaritan Act that that covers someone. So what we're taught is if anyone is unresponsive, assume that it's an overdose. If it is not an overdose, it won't hurt them. But it's just something that you want to tell the paramedics when they arrive. Hey, I didn't mr narcan just in case, but anybody can do it. We also often hear about needle exchanges. Is that something that you do and is that in an effective practice? We don't currently do the needle exchanges in Felicia County but they have been found to be very very effective, you know, lowering the risk of endocarditis, appetitis, C, HIV, all of those you know, all those things can ultimately lead to death. You know, you might not even have to have experience and an overdose. So having access to clean syringers is really really important. Are there things that you find, uh are part of the treatment policies that just aren't working very well that that need to be changed. Well, we you know, we talked about syringe syringe exchange. That's a huge one. Final test trips. The test trips are not legal in the state of Florida. They're considered paraphernalia. There are groups that that they go to dance parties or different venues like that concerts and they will provide this strips there. So if you are using something and you want to test it to make sure it doesn't have Fenton All in it, they can do it without you getting in trouble. I think that should be everywhere. I think that you know that that's something that should be easily accessible, just like narcan is. Now, are you starting to see results from your work? Can you see that you're making a dent in overdose numbers. I would like to think. I hope that. UM. I know that our community partners from since the beginning of the year have been tracking the amount of narcan that they're distributing, and they also track how many reversals are reported. So a reversal would be if someone had to use their narcan and they revived someone and they come back and say, I need some more because I had to use it. So they're reporting that they were able to save a life with that narcan. But at the beginning, there wasn't that trust, so no one was reporting. And now people are reporting, and we have had over with just one of our community partners, over one reversals reported. And have you found the public is more receptive now to taking and carrying our ken in the event that they come across someone who's overdosed. I think we have work to do, but UM, I think so. I think, UM, if you're able to have that real conversation, people are becoming more open to it. Helena Gerard, thanks so much for taking the time to talk to me today. Thank you. You can read the Fentel story by Ema Court, Leonardo Nicoletti, Linley Lynn, and Madeline Campbell at Bloomberg dot com. Thanks for listening to us here at the Big Tag. It's the daily podcast from Bloomberg and I Heart Radio. For more shows from my Heart Radio, visit the i Heart Radio app podcast or wherever you listen. Read Today's story and subscribe to our daily newsletter at Bloomberg dot com slash Big Tag, and we'd love to hear from you. Email us with questions or comments to Big Take at Bloomberg dot net. The supervising producer of The Big Take is Vicky Burgalina. Our senior producer is Katherine Fink. Our producer is Rebecca Shasson. Our associate producer is Sam Gobauer. Raphael M. Seeley is our engineer. Original music by Leo Sidrin. I'm west Kasova. We'll be back tomorrow with another Big Take

It's the big take from Bloomberg News and I Heart Radio. I'm West Gusova today. How fentanyl caused the opioid crisis to come roaring back. Just before the COVID pandemic hit, there was some cautiously optimistic news about America's decades old opioid epidemic. After many years of rising deaths from overdoses, the numbers were starting to tick downward in some hard hit states, and it appeared like prevention and treatment methods were finally starting to work. But that all changed in when the powerful opioid fentanyl began flooding the streets right as the world shut down. Fentinyl overdoses are now a major health crisis in many places across the country, and public health officials are struggling to keep up well. If you look out the definition of an opoi, the first thing it says is that it creates a feeling of euphoria. After a while, there's no longer that sense of euphoria. It's really just I want to feel like I can function today. That's Helena Gerard. She's a health official in Volucia County, Florida, which is one of the places where fentyl overdoses are a terrible problem. We'll hear more from her in a bit, but first to explain what's happening and what's being done about it. I'm joined by Bloomberg reporters am A Court, Leonardo Nicoletti, and Linley Lynn, who have worked on a deeply reported story about the fentinyl crisis. Emma, Linley Leonardo, thanks so much for being here. Thank you glad to be here, Thanks for having us. Let me just start with the most basic question, what is fentanyl. Fentanyl is a synthetic opioid, and that means it is made in a lab. It's not a natural opioid. And when we're talking about fentanyl in this context, we're really talking about the rise of illegal fentanyl. Largely that's what's killing people. But fentanyl was originally sort of developed as a medication to manage pain, and there is a prescription version as well, but in this context, again really talking more about the illegal drug market, so that originally this was a manufactured pharmaceutical, but then it became illicitly manufactured. Yeah, and and lately especially it's really kind of um. The initial chemicals to make fentanyl are coming from China, they're going to Mexico and manufacturing fentanyl and it's getting smuggled in through the southern border. And you know, part of the reason fentanyl has really taken off is because fentanyl is extremely cheap to manufacture and it's extremely powerful, so it produces a high much more easily than with other kinds of drugs. So you've gathered in this story an enormous amount of data tracking the rise in the use of ventinyl and then along with it the explosive rise in tragic deaths. Could you give us a sense of just how large a problem this is nationwide in the US? Sure thing? Um I spent a lot of time analyzing um CDC data, that's the data from Centers for Disease Control and Prevention, and just to share one set of numbers, last year, over eighty thou Americans died from opioid overdose, and fentanel was founding octossities of at least seventy thousand of these deaths. So this include those people who knowingly or unknowingly took fentanyl, and sometimes there might be um drug cocktails that they just took they didn't know fentanel was part of it like cartail being they might have taken marijuanan and had ventanol in it or heroin another drug, exactly, multiple substances mixed up. And this year's provisional data so far show that almost a nine of Americans who have died of opio it overdose died of fentanyl. That's very gruesome numbers. And as we dove further into our reporting, I was talking to myself, I just think it is an opioid and this is part of the everlasting opiod crisis. But this exact chapter we're at right now is a real fentanyl crisis. To give you some size and scope. Um since March, the beginning of the pandemic, more than one d and sixty five thousand Americans have died from opioid overdoses. What was it about the pandemic that made people suddenly turned back to opioids and in particular fentanyl. That's a great question, and it's something we really wanted to explore in this story. In particular, I think when you think of the opioid crisis, people often think of prescription drugs, right, they think of produced pharma. You know, there's a long history the opid crisis has gone on since the you know, the mid to late nineties and the United States, but in this case, fentanyl was already sort of starting to take off in the US prior to COVID. But what we really saw it was in the last three years the deaths from fentanyl just kind of exploded, and we saw like enormous fatalities from fentanyl. And when we tried to sort of explain why that was, the answer we kept kind of coming back to was sort of mostly the ubiquity of fentanyl was a big, big factor. So it's not that people were necessarily seeking it out. It was permeating other illegal drug supplies. So people who were you know, using drugs like heroin, for instance, or meth or even something like cocaine or marijuana, which people don't typically think of as these really you know, some of these drugs don't sound like marijuana particularly dangerous, but they were getting sort of adulterated with fentanyl. Fentinel was getting kind of mixed into that drug supply. And when were they mixing fentinel into those other drugs. It's a little hard to say, you know, one of the big explanations is that fentanyl is um so cheap and so you equitous that it was a way of sort of spreading out drug supply. In some cases it might have also been you know, an accident. All the stuff being made in the same kind of space. Ventanyl so poisonous that small mistakes could really be quite devastating. But in addition to sort of the illegal drug supply getting sort of contaminated with fentanyl, another part of that story that's really important is counterfeit pills. So people buying black market out of all or xanax or other kinds of drugs, and those drugs might not actually be out of all or xanax, they might be pills with fentanyl inside. Then those might also be causing deadly overdoses. And this seems to be a pretty big trend. Now, these these two sort of factors in the sort of rise of fentanyl. Yeah, to add on that, a lot of the deaths they are actually due to accidental overdose when it comes to ventanyl. And from the CDC data, we actually saw like a growing number of deaths um when officials were doing autopsies that were ultiple narcotics were found in the same body, so many died without knowing from what substance they died from even and so this cocktail effect has definitely been a new trend that we are observing. Leonardo Linley just mentioned the CDC, the Centers for Disease Control and Prevention data. You're we're heavily involved in gathering and then analyzing the data that you used to track the rise of fentanyl in this story. What did you find in that data. One of the things that you know, we found in the data, and that we think we showed really clearly in one of the graphics is that a lot of things have been changing in the past few years. And one of the things that has been changing is that who fentanel has been killing has changed a lot. And you know, you can see that while the opioid death rate was highest for white Americans for more than fifteen years, so until six white Americans were dying at the highest death rate, but now it is highest among Americans. Um, you can see that, you know, the opiod death rate for Black Americans has more than doubled since and most of this increase has happened during the pandemic. Um Obviously, fentanyl has had a really big role in this increase, and do we know from the data why there was that switch from more white people dying from overdoses to more black people dying. The CDC has actually really tried to highlight this trend over the pandemic, and one of the potential explanations they've given is that access to medical care for opioid use disorder, which is the disease of opioid addiction, may be sort of quite unequal, and so people of color, including Black Americans also there's been a big increase in the death rate among Native Americans in the US, may not have the same kind of access to treatment um as white Americans. One of the things that really struck me in the story, uh, and you alluded to this before, is just how deadly fentyl is and the way you described it was just a few grains of salt worth is enough to overdose, and that so many of the doses of drugs that people buy in the street contained way more than that. Yeah, So this is something that really struck us as well when we were reporting this story, is that just two milligrams of fentanyl equal to a few grains of salt is enough to potentially cause a deadly overdose. UM. And you can envision a few grains of salt. That is a very small amount um And part of the reason for that is that fentanyl is up to a hundred times more powerful than morphine, you know, a prescription opioid, and fifty times more powerful than heroin. And so what we actually heard out of the county that we focused on in the story, which is Lucia County. It's in Florida, is that some people were overdosing and they had so much fentinel in their bodies that it was enough to kill thirty or four the people. That's what the Medical Examiner's office told the county council. My conversation with Emma Leo and Linley continues after the break. So, now that we have a pretty good idea of just how powerful and deadly fentanyl is, I want to talk about the focus of your story, which is in Valusia County, Florida, which has seen a huge increase in fentanyl deaths, and what's happening there and what they're trying to do about that. Linley, can you describe what's happened in Valusia County. So, when we were using a database from the CDC that tracks death causes in the US. We screened opiate death data of every single county in America and try to see which ones fitting to this exact pattern. And there were scores of counties all of the US that have gone through similar tragedies, and we looked into fifty counties and called fifteen of them. After all that work, we picked Volucia in Florida. Then we looked at Vlucia Stata more closely, and we saw fentanel induced overdose deaths tripled in from the year before. So it was very shocking to us. And it just had a lot to do with the COVID pandemic and add isolations and everything. And so in Lucia, two hundred and seventy two lives were lost that year due to fentanel and more surprisingly, that's over nine of all of the total opiate overdose deaths in that county that year. What was it about COVID in particular that would make people turn to drugs? I mean, boredom, I suppose, but that's a pretty extreme solution to boredom. The way that we have been thinking about and learning about this is really through the lens of losing support and routine and kind of structure of life, right, so all of a sudden everything has completely changed. And there's also I mean it's hard to remember now with so many COVID protocols kind of out the window, but there was a time people were extremely scared of this new virus. And so you put all that together, the fear, the boredom, the loss of support, social isolation, social distancing was one of the big tactics we used initially to keep this virus at bay. And you have kind of a recipe for people using substances, um. And there was actually back at that point in time, there was some thought, oh, you know, all this disruption will extend the drug trade too, but that doesn't seem to have happened. In fact, we've seen as a result of a lot of these disruptions, we've seen people getting cut off from many vital sources of support for addiction. For instance, in Vlusia County, we know some local support groups and like narcotics anonymous style groups actually stopped meeting for a period of time. Um. You know, even when they began meeting again, they might have only done so virtually, which you know, I think we can all recognize that there is a place for zoom meetings in life, but we were also all getting very tired of zoom meetings. And then in person treatment changed a lot to the clinic that we talked about a lot in this story, um sm A healthcare and Volucia County was meeting with patients virtually, and one of the providers said to me, you know, virtually, you don't really read people as well. We don't have them in we can't test their urine for drugs, so we don't really know if they're using drugs again, and we can ask them questions, but we don't totally know, you know, we can't read them, you know, are they telling us the truth or not? So it did really change the dynamic um And even now with things sort of resuming, it's been difficult, I think, to get some of those rhythms back. Leonard, When you were looking at all this data and trying to figure out a way to visualize it, what leaped out at you the most from these floor the numbers. For me, what leaped out the most was really the spike that you see during the pandemic, and it's it's just so clear. You can look at the graphic and you see that if you just put a ruler on, that's exactly when the spike started. Like it's almost vertical that line. It's really crazy to look at exactly like M said, it follows the vertical line all the way up to you know, the highest point of the chart. But I think what really struck me when I was looking at the numbers was just on the national data the chart was actually too tall to fit in this on the screen. So there isn't actually a mobile device or a computer that you can use to actually see the entire chart at once. You have to scroll basically through, and as you scroll you see that like you still haven't reached the peak of deaths in M. So we've outlined this enormous problem, how intractable it is. What works? What do we know actually works to bring down addiction rates and overdoses. Yeah, so we basically know that one of the most important things you can do when someone has what's known as opioid use disorder, it's you know, most people call opiate addiction, is to open up access to medication assisted treatment. That basically means treating folks with essentially opioids that have been specifically approved by the US Food and Drug Administration the FDA to treat, you know, opioid use disorder, and so it's been very well established this is the gold standard of treating opioid addiction. And these medications essentially help people sort of reduce some of the euphoria highs associated with use of these drugs, but they also help reduce the risk of relapsing. And that's kind of key. It's a controlled environment. These folks are being kind of adminis, you know, admit stared and looked after biomedical professionals, and this is supposed to help prevent them from using exactly the kinds of street drugs we're talking about and dying of an overdose. There are a lot of other things though, that can also be done to address this crisis and are being done, including making the lock zone, which is the opioid overdose reversal medication UM, much more widely available. And that's Narcan. Is that what we're talking about. Yeah, the brand name is is Narcan. The Lockson is the generic name, and there's been a big push to get this stuff, you know, available over the counter, for instance, so you don't need a prescription anymore. To get it UM, get in the pockets of people, get out into places like nightclubs where people might be, you know, using drugs and be at risk of overdosing. And the idea is that is that the person who's overdosing does it, but somebody who sees someone is overdosing, they have this on them and they can help that person so the person doesn't die right. And actually, one of the most powerful things I heard while reporting this story was COVID was a disease where isolation. Social isolation was the way you prevented it from spreading. And you're using drugs alone, there's nobody there to revive you with the loxon with nark, can you know. And I thought that was really I mean, that kind of hit me with a punch in the gut. So one thing that a place like Florida is actually starting to do as of this year is they're trying to do a better job connecting people who are at risk of overdose or who are you know, have overdosed UM with this medication assisted treatment. But in Florida and other places around the country, you know, many conservative states are not fully embracing all of the tools of what we call harm reduction, and harm reduction is basically acknowledging that you can't prevent people from using drugs and all instances, but when they do use drugs, you can try to mitigate the harm and make it, you know, safer to use drugs. Literley, at the beginning of the interview, you gave us some pretty jaunting numbers for a number of people who have died from hope we had used and in partain killer fentanel overdoses. Where are we in the numbers now when it comes to trends on the national skill, we are actually seeing, um from the total number accounts, we are seeing fewer over those deaths so far this year. But um caveat that is we are all just having provisional data for now. They are going to be updated as time goes by. We are gradually walking out of that pandemic, and I'm hopeful that without that essay major contributing factor, we should be able to see fewer drug overdose deaths. And also there is a growing awareness of what kind of role fentonel is playing in this overall opioid crisis nowadays, so I'm hoping for the best. I would also say you know, in this day and age, with fentanel creeping into so many other illegal drugs, drugs that people don't think of as sort of dangerous. Know, these are drugs that are now becoming extremely dangerous and using them can kill you. It's a very real danger now, it's not a hypothetical situation. Emma Linley Leo, thanks so much for joining me today. Thank you, Thank you so much for having us, Thanks for having us West. When we come back a close up view of the fentinyl crisis in Florida for a closer look at fentinyl's toll on people and communities, I'm joined by Helena Girard, who you heard at the beginning of the episode. She's the overdose Prevention coordinator for the Florida Department of Health Involutiona County. Helena, thanks so much for coming on the show. Thanks so much for having me. Can you first just describe what does the overdose Prevention program coordinator for Valuja County do? What is your job? So I get to work with community partners, so this would include hospital systems, um the sheriff office, the medical examiner. Most importantly, I get to work with people who have been directly impacted by substance use, whether it's themselves personally, or a family member or a friend, and we all work together. We look at the data that's provided by some of those partners and we find out who is the most impacted. You know where these overdoses are taking place, and we try really hard to get the messaging out into those areas so that people are aware that what a crisis we're experiencing. We recently now started passing out in our can um at the Department of Health in Militia County, which is huge. Last week we had one of our active participants in our work overdosed and UM her family requested that our can be distributed at her funeral. So how did you come to this line of work? I think I started this work just volunteering, being involved in my own recovery, and in two thousand and eighteen was ordered a fellowship with the Pritzkur Children's Initiative, and I focused on substance exposed newborns. I got some really great experience working in that maternal and child health world, but also with substance use. So that fellowship ended in and a position was open at the Department of Health in Blutia County. And I think it was created for me. I mean it just it feels like it's amazing to come to work every day and get to do things that I'm very passionate about. For people who use it, how does fentinel feel that makes it such a powerful drug? Well, if you look at the definition of an opioid, the first thing it says is that it creates a feeling of euphoria. And that's with a lighter dose. So when somebody uses fentanyl in in my this is my own personal experience, um that it's a feeling of euphoria, and um it's it's it's scary. It's scary because it's for somebody that experiences anxiety or depression. It could be that moment that you feel normal, like, oh this is what other people feel like, So I'm going to do it again. And then the intention is never to do it forever. But nobody wakes up every day hoping to fail. And it's progressive and deadly and after a while there's no longer that sense of euphoria. It's really just I want to feel like I can function today. And how were you able to get off of it. I was um, I was pregnant, and I was able to detox in a hospital under a physician's supervision nurses around the clock. So it took about six days of intensity talking in the hospital, and then from there I went to an intensive impatient facility where I could stay until my daughter was born, and then we stayed until she was almost a year old. So I stayed for a very long time. And how did your own experience, how does that sort of inform the work you're doing now? I think I'm able to take my personal experience and remember the feeling, so that I'm not doing the work through a lens of judgment. I'm doing it through a lens of compassion and having been there myself and understanding the pain and that it's not moral failing. It's not because people are bad, that they are struggling with substance use, and so it really creates an opportunity for me to have a really open mind with the work. Everybody's recovery is different, everybody's story is different, and how can we support everybody's recovery in a different way? Can you describe what the situation is right now in Valusia County it's not good. UM. We are second in the state capita for overdoses, so there are a lot of people dying a lot of um non fatal overdoses as well. And it's um whether they're using fentanyl because they know it UM, but we also have those who are using something else. They might think they're taking a zanex and it's pressed with fentanol, or they buy some weed and the dealer just had touched fentanyl and then it gets into the marijuana and they're exposed that way. And you know, it takes the size of two grains of salt to be fatal. So it's um pretty serious when you know a couple of crumbs get into anything else. You talked about how important our can is. Can you describe why it's so important? Simply it saves lives. But when narcan is administered, and it looks like a nasal spray, the one that is most generally in the public. But what they do it goes in and it goes to the receptors, the opioid receptors in the brain and it pushes opioids out, so it pulls the person out of an overdose. It sometimes takes a couple of tries, especially with the ventanyl. Now I have friends that I personally know that have taken six doses to revive them. And another thing that I always like to remind people if they don't go with UM the first responders once they arrive, making sure to keep an eye on them because the narcan only stays in the receptors for a certain amount of time. So if there's enough opioids in their system, then they could reattach and they can overdose again without even using any more drugs. And is narcan something that anyone can carry and if they see a person is overdose, they can administer it. Yes, there's a good Samaritan Act that that covers someone. So what we're taught is if anyone is unresponsive, assume that it's an overdose. If it is not an overdose, it won't hurt them. But it's just something that you want to tell the paramedics when they arrive. Hey, I didn't mr narcan just in case, but anybody can do it. We also often hear about needle exchanges. Is that something that you do and is that in an effective practice? We don't currently do the needle exchanges in Felicia County but they have been found to be very very effective, you know, lowering the risk of endocarditis, appetitis, C, HIV, all of those you know, all those things can ultimately lead to death. You know, you might not even have to have experience and an overdose. So having access to clean syringers is really really important. Are there things that you find, uh are part of the treatment policies that just aren't working very well that that need to be changed. Well, we you know, we talked about syringe syringe exchange. That's a huge one. Final test trips. The test trips are not legal in the state of Florida. They're considered paraphernalia. There are groups that that they go to dance parties or different venues like that concerts and they will provide this strips there. So if you are using something and you want to test it to make sure it doesn't have Fenton All in it, they can do it without you getting in trouble. I think that should be everywhere. I think that you know that that's something that should be easily accessible, just like narcan is. Now, are you starting to see results from your work? Can you see that you're making a dent in overdose numbers. I would like to think. I hope that. UM. I know that our community partners from since the beginning of the year have been tracking the amount of narcan that they're distributing, and they also track how many reversals are reported. So a reversal would be if someone had to use their narcan and they revived someone and they come back and say, I need some more because I had to use it. So they're reporting that they were able to save a life with that narcan. But at the beginning, there wasn't that trust, so no one was reporting. And now people are reporting, and we have had over with just one of our community partners, over one reversals reported. And have you found the public is more receptive now to taking and carrying our ken in the event that they come across someone who's overdosed. I think we have work to do, but UM, I think so. I think, UM, if you're able to have that real conversation, people are becoming more open to it. Helena Gerard, thanks so much for taking the time to talk to me today. Thank you. You can read the Fentel story by Ema Court, Leonardo Nicoletti, Linley Lynn, and Madeline Campbell at Bloomberg dot com. Thanks for listening to us here at the Big Tag. It's the daily podcast from Bloomberg and I Heart Radio. For more shows from my Heart Radio, visit the i Heart Radio app podcast or wherever you listen. Read Today's story and subscribe to our daily newsletter at Bloomberg dot com slash Big Tag, and we'd love to hear from you. Email us with questions or comments to Big Take at Bloomberg dot net. The supervising producer of The Big Take is Vicky Burgalina. Our senior producer is Katherine Fink. Our producer is Rebecca Shasson. Our associate producer is Sam Gobauer. Raphael M. Seeley is our engineer. Original music by Leo Sidrin. I'm west Kasova. We'll be back tomorrow with another Big Take