In 2022, the US reached [a grim peak](https://nida.nih.gov/sites/default/files/images/fig1-2024.jpg) in drug overdose deaths: Nearly 108,000 people died that year, more than twice the number who died in 2015, and more than four times the number in 2002. Now, in what experts hope is more than a blip, the overdose epidemic that has affected every state in the nation might be showing some signs of abating. The Centers for Disease Control and Prevention’s preliminary data on the [12-month period ending in June](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) showed that [overdoses dropped about 15 percentage points](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) from the previous period. There were still roughly 94,000 overdose deaths, signaling that the public health crisis is far from over, though a positive change could be on the horizon. Understand the world with a daily explainer plus the most compelling stories of the day. Sign up [here](https://www.vox.com/pages/today-explained-newsletter-signup). America’s overdose crisis was exacerbated decades ago by the increasing use of and addiction to synthetic opioids, such as fentanyl, that have proliferated through the nation’s drug supply. Fentanyl was first produced in the 1960s and prescribed by doctors to people seeking relief from severe pain, such as cancer patients. A cheaper, more potent cousin of heroin, the drug soon became a favored commodity of traffickers, who began cutting other drugs with fentanyl and drawing people addicted to prescription painkillers such as oxycodone that have become increasingly more difficult to access. [As my colleague German Lopez wrote in 2017](https://www.vox.com/science-and-health/2017/5/8/15454832/fentanyl-carfentanil-opioid-epidemic-overdose), fentanyl made America’s opioid crisis — already the deadliest drug crisis in US history — even deadlier. So what might have turned the trend around? In the latest episode of Vox’s _Today, Explained_ podcast, we asked Lev Facher, a reporter covering addiction at STAT News. “There’s no one event that happened about a year and a half ago that would explain this sudden significant decrease in drug overdose deaths,” says Facher. “While there’s a lot of optimism in the harm reduction and addiction medicine and recovery world, it’s cautious optimism because people don’t really know what’s happening.” Despite that, Facher says, experts and advocates do have a few potential explanations: The simplest explanation for the drop in overdoses could be the nature of the drugs themselves; they simply may have become less toxic and less potent. Last month, DEA administrator Anne Milgram suggested [that the agency’s crackdowns](https://www.dea.gov/press-releases/2024/11/15/deas-third-annual-national-family-summit-fentanyl-highlights-progress) were having a direct impact on the drug supply. “The cartels have reduced the amount of fentanyl they put into pills because of the pressure we are putting on them,” she said at the National Family Summit on Fentanyl, which gathers people who’ve had loved ones die from drug use. Customs and Border Protection (CBP) data can’t give us the full picture of the effectiveness of cartel crackdowns, but it shows that the [rate of fentanyl confiscation at the border](https://www.cbp.gov/newsroom/stats/cbp-drugs-dosage-value-and-weight) is hardly consistent. In January, CBP confiscated 1.3 million doses of the drug. The number of confiscations dropped significantly in June before rising back to about 1.3 million doses again in August. And data on the potency of illicit drugs is limited, given that drug-tracking systems vary from one community to another, Facher told Vox. “The places that do have really good drug checking, there have been some changes detected in terms of the drugs people are using, but nothing that would explain this sudden drop,” he said. Another explanation could be that harm-reduction efforts are working. Access to [naloxone](https://www.vox.com/even-better/353129/you-can-help-reverse-the-overdose-epidemic), the lifesaving, overdose-reversing drug, expanded significantly in cities across the United States in the last few years. Local governments such as [Los Angeles County](https://laist.com/news/health/los-angeles-naloxone-overdose-deaths) made the drug available at schools, churches, libraries, and jails, and [everyday](https://health.ucdavis.edu/blog/cultivating-health/why-you-should-carry-naloxone-narcan-to-combat-opioid-overdoses/2023/08) Americans are increasingly encouraged to carry naloxone. Harm-reduction campaigns may have also had an impact on those who use recreational “party” drugs, who might favor stimulants but could find themselves unknowingly ingesting fentanyl if a dealer has mixed it into cocaine or MDMA. [Drug testing kits like Overdrive](https://www.amazon.com/Fentanyl-Overdrive-Substances-Detection-Sensitive/dp/B0D936KTKM) are available for less than $15 from retailers like Amazon and provide people with step-by-step directions on testing drugs for fentanyl. Data also suggests that the way people consume drugs might reduce the likelihood of death by overdose. Smoking fentanyl is becoming increasingly more popular than injecting it, and the former is linked to [fewer fatal overdoses and blood-borne infections](https://www.sciencedirect.com/science/article/abs/pii/S0376871623012917?via%3Dihub). The third explanation, floated by some epidemiologists, is the most bleak, and suggests that after hundreds of thousands of people were killed by drug overdoses in a relatively short time span, the [epidemic is essentially burning itself out](https://www.nejm.org/doi/full/10.1056/NEJMe2406359). “It’s a concept called the ‘depletion of susceptibles,’” Facher said. “And that’s just to say that so many people have already died of drug overdoses that there aren’t as many drug users left to die. That’s not necessarily a mainstream theory. And even if it were accepted, it probably wouldn’t explain the full significant sudden decrease in drug deaths.” The staggering number of deaths from the opioid epidemic, however, could be a contributing factor to declining youth drug misuse. [An analysis from KFF](https://www.kff.org/mental-health/issue-brief/teens-drugs-and-overdose-contrasting-pre-pandemic-and-current-trends/#:~:text=In%202023%2C%2010%25%20of%20high,alcohol%20use%20(30%25%20vs.) showed a small drop in opioid misuse among high school students from 2017 to 2023. As [Maia Szalavitz writes for the New York Times](https://www.nytimes.com/2024/12/02/opinion/drug-overdose-deaths-decline.html), “Drug epidemics are often cyclical. Younger generations witness the harm specific drugs have caused their older siblings or parents, leading them to avoid those substances.” The latest data on overdose deaths comes amid a pivotal presidential transition. While the addiction crisis is a marquee issue for both Republicans and Democrats, the incoming Trump administration includes high-level officials who’ve been intimately impacted by it. The vice president-elect, JD Vance, has spoken extensively about how opioid addiction affected his mother and his community of Middletown, Ohio. Trump’s nominee for secretary of the Department of Health and Human Services, Robert F. Kennedy Jr., is in addiction recovery himself and his policy proposals include a network of “[wellness farms](https://www.youtube.com/watch?v=liZq31HLnyA&t=1778s)” to serve [as treatment facilities.](https://www.statnews.com/2024/12/11/rfk-jr-opioid-epidemic-addiction-policy-tough-love/) It remains to be seen whether the administration will focus its efforts on addiction recovery or if it will devote more attention [to law enforcement](https://www.youtube.com/watch?v=NUClE1P8ApI) and [the US-Mexico border](https://www.npr.org/2024/11/18/nx-s1-5187973/fentanyl-trump-cartels-addiction). “There is trepidation about a potential shift toward law enforcement and away from treatment,” Facher said. “Most of my sources talk about harm reduction, treatment prevention, and really just keeping people alive \[by\] meeting them where they are and getting them the services they need to live healthier lives as the cornerstone of ending this drug crisis.” You’ve read 1 article in the last month Here at Vox, we're unwavering in our commitment to covering the issues that matter most to you — threats to democracy, immigration, reproductive rights, the environment, and the rising polarization across this country. Our mission is to provide clear, accessible journalism that empowers you to stay informed and engaged in shaping our world. By becoming a Vox Member, you directly strengthen our ability to deliver in-depth, independent reporting that drives meaningful change. We rely on readers like you — join us.  Swati Sharma Vox Editor-in-Chief See More: * [Criminal Justice](https://www.vox.com/criminal-justice) * [Health](https://www.vox.com/health) * [Policy](https://www.vox.com/policy) * [War on Drugs](https://www.vox.com/drug-war)

Vivian Qu is the Chinese film-maker who has directed three features and also produced the [noir drama Black Coal, Thin Ice](https://www.theguardian.com/film/2015/jun/04/black-coal-thin-ice-review-diverting-downbeat-noir) which in 2014 won Berlin’s Golden Bear. Now she brings this crime melodrama to Berlin, an engaging if tonally uncertain high-wire adventure that satirises China’s hopeless addiction to gangster capitalism. It is also acidly unsentimental about the bread-and-circuses escapism of the country’s booming film and TV industry with all its period-costume wuxia nostalgia. It’s an appealing film, though it contains some strangely broad comedy and is also, in a couple of violent moments, a bit naive about exactly how easy it is for a young woman physically to fight off a big strong guy. Above all, Qu gives us a rather amazing set-piece scene on the set of a wire-fu action movie, a scene that feels real in a way that the rest of the film really doesn’t, for all that it is watchable. Fang Di (Wen Qi) is a tough woman employed as a stunt double on a movie set, playing the black clad, sword-wielding ninja bouncing over terracotta rooftops and whizzing through the air in long shot. For the closeup, the preening star in the same outfit steps in while Fang Di staggers over to get a coffee at the craft table. The work is exhausting and dangerous and Fang Di is doing it to pay off her family debts to mob matriarch Madame Wang. Desperate for more cash, she takes on a gruelling night shoot in which, attached to a wire harness, she has to be submerged under murky water to fly up into the air. The callous director demands this shot to be repeated endlessly, despite Fang Di’s obvious distress – and seeing that there are too many ripples from the last take, he commands she stay under the water for 15 seconds before the camera rolls, instead of the almost-safe three. Just at this unimaginably low point in Fang Di’s life, her long estranged cousin Tian Tian (Liu Haocun) appears; she is being pursued by the mob, having fallen into debt and drug addiction at the hands of the same criminals who supplied drugs to Tian Tian’s notoriously parasitic and waster dad, the source of all the family’s despair. Now Fang Di and Tian Tian have to evade the same duo of hatchet-faced tough guys, as well as a local cafe owner from their home town who the mobsters have bullied into joining them. There are entertaining, incidental scenes mocking the craziness of show business; looking to graduate away from stunt work, Fang Di auditions for a drama, doing an absurdly written scene, and bursts out laughing in the middle of the dialogue, to the director’s outrage. And there is a moment of pure (and implausible) farce when the gangster tough guys, taking a wrong turn in the movie studio, are inveigled into taking part in a hospital drama and a war epic. It’s amusing, but the silliness doesn’t entirely work. All this is interspersed with flashbacks showing the two young women’s former intimacy and the painful anguish of their family dysfunction, establishing a mood of sadness that is underscored by the final, desolate scene of their early childhood. A flawed, but involving spectacle. Girls on Wire screened at the [Berlin film festival](https://www.theguardian.com/film/berlinfilmfestival).

At Guinea’s only private drug rehabilitation clinic, Dr Marie Koumbassa and her 15-person team are so convinced that drug use is a national emergency that they work for no pay. Every week, SAJED-Guinée (Service for Helping Young People in Difficult Situations due to Drugs) receives dozens of distress calls from relatives of addicts who are then taken to the facility in the working-class Conakry neighbourhood of Dabompa. In richer areas of the city, cocaine is the drug of choice. Elsewhere, the prevalent substances are tramadol, crack and – in a recent trend – kush, [a deadly mix](https://theconversation.com/kush-what-is-this-dangerous-new-west-african-drug-that-supposedly-contains-human-bones-220608) of cannabis, fentanyl, tramadol, formaldehyde and [reportedly human bones](https://www.theguardian.com/global-development/2023/sep/13/its-like-smoking-poison-sierra-leones-youth-battle-addiction-to-a-mystery-drug). People who smoke it have been known to collapse, cause themselves bodily harm or even die. “People come here from the madrasa \[Islamic schools\] and tell us that scholars told them: ‘Take this, you will read well and quickly learn’,” Koumbassa said, referring to kush. “It actually destroys them.” The team first encountered kush in Conakry last March. Its use has now spread so much that patrons of nightclubs and lounges are known to be mixing it into shisha pots. [](https://www.theguardian.com/world/2025/apr/20/kush-guinea-rehab-clinic-drug-epidemic#img-2) Dr Marie Koumbassa. Photograph: Eromo Egbejule/The Guardian Unlike its neighbours Guinea Bissau – seen as a “narco-state” – and Sierra Leone, which is the regional hub for kush, drug abuse and trafficking are not readily associated with the more culturally conservative Guinea. But experts say a crisis is under way, fuelled by a growing market operated by cross-border trafficking syndicates. “The gangs in Sierra Leone have always moved to Guinea \[when necessary\], said Kars de Bruijne, senior research fellow with Dutch thinktank Clingendael’s conflict research unit. “If a gang member committed a crime in Sierra Leone or was otherwise being looked for they would go to Guinea and hide out. “Similarly, we are aware of boats that sometimes move materials including drugs from Guinea to Sierra Leone. There’s really a lively cross-border informal trade.” Data about the drug abuse and trafficking situation is hard to come by, but according to [a UNODC report](https://www.unodc.org/westandcentralafrica/en/westandcentralafrica/press/world_drug_report_2024.html), at least 5.6 tonnes of cocaine were seized off the coast of Guinea between January 2019 and June 2024. Earlier this year, Guinean authorities said they [found seven suitcases](https://www.bbc.co.uk/news/articles/cn4zzq1vk87o) containing suspected cocaine in a car belonging to the Sierra Leonean embassy.  Inside the war on kush: The drug ‘mixed with human bones’ taking over Sierra Leone – video Staff at SAJED say there is a serious lack of awareness about remedies and therapy. Still, the nonprofit has handled more than 500 cases since 2019, when Koumbassa opened the centre after returning inspired from workshops for psychologists in Abuja and Accra. “We have patients who come from everywhere, from within the country, as well as students returning from places like America and France,” said Yamoussa Bangoura, the centre’s head of psychotherapy. “We want to extend our operations to Boké \[a city near Guinea-Bissau\], and all the regions. But we don’t have the means.” Many factors are to blame for the drug epidemic, including poverty and porous borders. Some social workers think demonstrators against the junta that seized power in a coup in 2020 began taking drugs to give themselves the confidence to take to the streets. Some say the junta’s all-encompassing focus on holding on to power has distracted it from daily affairs of the state. The scale of the problem has overwhelmed Guinea’s meagre capacity for treating addicts. The country only has two known state-run centres catering to substance abuse. During the Covid-19 pandemic, one was closed for a time, overcrowding the other. SAJED’s own resources are extremely limited. It can only take around a dozen patients at a time. The facility is mostly funded by the people who worked there, but it also receives small grants from private donors and the sale of fruits within the compound that patients help water daily to keep them engaged. Sales of medication for treatment provides another source of revenue, but most of the patients are poor, so the clinic gives the medication to them for nothing. [](https://www.theguardian.com/world/2025/apr/20/kush-guinea-rehab-clinic-drug-epidemic#img-3) Staff at SAJED say there is a serious lack of awareness about remedies and therapy. Photograph: Eromo Egbejule/The Guardian Rented from a member of the Guinean diaspora at a heavily discounted rate, the compound consists of a single-storey building with cubicles inside that serve as kitchen, laboratory and pharmacy. There is also a small emergency room and one bedroom each for men and women, as well as a common room with a TV. “People fear to come in sometimes because of the look of the building,” said Bangoura. People suffering from depression and alcohol addiction are also welcome at the clinic. One of those currently at the facility is Diallo Mahmoud, a 32-year-old whose alcohol addiction began as a teenager drinking with elders. Over the last three years, he moved to Abidjan and Brazzaville in search of work, drowning his failures in alcohol. After breaking a bottle on someone’s head in a fight at a Conakry nightclub, his siblings called SAJED. These days, he and other patients at the clinic discuss life together, anticipating a different direction when they are discharged. “After I leave here, I’ll not drink again and I’ll preach that to people,” Mahmoud said. Stories like his keep the clinic staff going, even when the road seems rough. “We have come to understand that drug consumption is recurrent in our homes, and the layer it consumes the most is the youth, the future of the nation,” said Koumbassa. “If we don’t help them get out of it, it will be a problem for the nation.”

Just two years ago, the US was suffering through the worst stretch of its long-running drug overdose crisis. More than 110,000 Americans had [died](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) in the previous 12 months from an overdose — almost twice the number of people who died in all of the Vietnam War. But late last year, the country got some unexpected good news: Overdose fatalities had [fallen](https://www.dea.gov/press-releases/2024/12/16/overdose-deaths-decline-fentanyl-threat-looms) by 10 percent. It was the first drop of any kind since 2018, but here’s the really good news: While in 2018, deaths only plateaued for a few months before rising again, the current decline appears to be sustaining and even accelerating. According to the most recent national data from the Centers for Disease Control and Prevention, deaths in 2024 were [down](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) a whopping 26 percent, to less than 81,000 over the preceding 12 months. New county-level CDC data [reveal](https://www.cdc.gov/nchs/nvss/vsrr/prov-county-drug-overdose.htm) some communities in the states hit hardest by the opioid epidemic — such as West Virginia, New Hampshire, and Ohio — have seen deaths fall by 40 percent to 50 percent over the past year. Too many people are still dying preventable deaths, but the decline nonetheless represents a significant improvement in a problem that has bedeviled public health officials since [the opioid epidemic](https://www.vox.com/the-highlight/2024/1/16/24033590/treatment-opioid-addiction-crisis-2024) began to take off in the 2000s. [Nobody is quite sure](https://www.npr.org/2025/03/24/nx-s1-5328157/fentanyl-overdose-death-drugs) — and several of the experts I spoke to fear the downturn could be temporary. But there are a few plausible explanations. First, the pandemic is over. Overdose deaths [rose sharply](https://pmc.ncbi.nlm.nih.gov/articles/PMC8856931/) during 2020 and 2021, likely for a combination of reasons. People were more isolated, for one, and health care providers were overwhelmed. That’s no longer the case. People who use opioids and other deadly drugs also now know about the particular risks of [fentanyl](https://www.vox.com/science-and-health/2017/5/8/15454832/fentanyl-carfentanil-opioid-epidemic-overdose) and other synthetic opioids and are being more cautious. There is [the contentious theory](https://opioiddatalab.ghost.io/are-overdoses-down-and-why/#5-depletion-of-susceptibles) that the pool of potential victims has shrunk: More than 1.5 million Americans have died from overdoses since 2000, and many of the people who were most vulnerable to becoming dependent on opioids and overdosing may have, sadly, been among that group. It is also possible that people are shifting away from opioids like heroin and fentanyl and toward other drugs that are less deadly. More people are [taking](https://nida.nih.gov/news-events/news-releases/2024/08/cannabis-and-hallucinogen-use-among-adults-remained-at-historic-highs-in-2023#:~:text=Cannabis%20and%20hallucinogen%20use%20among%20adults%20remained%20at%20historic%20highs%20in%202023,-Vaping%20among%20younger&text=Past%2Dyear%20use%20of%20cannabis,the%20Monitoring%20the%20Future%20survey%20.) nonlethal drugs such as cannabis and psychedelics, and the use of cocaine and other illicit stimulants has also been [growing](https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2024/08/stimulant-use-is-contributing-to-rising-fatal-drug-overdoses); they still present a public health risk, especially with [reports](https://www.uclahealth.org/news/release/overdose-deaths-fentanyl-laced-stimulants-have-risen-50-fold) of cocaine laced with fentanyl, but these substances lead to fewer deaths on average. The US has also invested billions of dollars into public health campaigns to reduce overdose deaths. We are not only increasing users’ awareness about fentanyl, for example, but some public health departments have also provided millions of free testing strips so people who use opioids can easily check whether what they are using could quickly and unexpectedly kill them. Access to opioid addiction treatments like methadone and buprenorphine, too, has been greatly expanded through government and philanthropic investments. And perhaps most importantly in the prevention of unnecessary overdose deaths, [naloxone](https://www.vox.com/policy/2023/3/30/23663064/narcan-overdose-fentanyl-drug-where-to-get) — Narcan, the nasal spray that rapidly reverses opioid overdoses — is [omnipresent](https://www.vox.com/even-better/353129/you-can-help-reverse-the-overdose-epidemic). You can find it in vending machines in police stations, libraries, and public schools around the country. Nearly 70,000 lifesaving doses were [administered](https://momentousrecoverygroup.com/rehab-blog/what-is-narcan-the-life-saving-tool-in-the-fight-against-the-opioid-crisis/) in 2021 by emergency responders. “Increased naloxone distribution has saved countless lives by reversing opioid overdoses in real time,” Jessica Hulsey, founder of the Addiction Policy Forum, told Vox. This was a hard-fought public health victory: While some people have at times [objected](https://pmc.ncbi.nlm.nih.gov/articles/PMC7153573/) to placing a drug overdose treatment in a public health setting, the harm-reduction argument that we should make these interventions widely available to save as many lives as possible has largely won out. Even as the good news rolls in, President Donald Trump’s health department is currently working on plans to reduce federal spending on opioid treatments by millions of dollars. A draft budget, recently obtained by [several news organizations](https://www.washingtonpost.com/health/2025/04/16/hhs-budget-cut-trump/), including Vox, would specifically terminate programs that supply Narcan to health centers, doctors, and first responders, as well as programs to train first responders on how to use the drug during an overdose emergency. Other programs focused on drug abuse treatment and support would also be eliminated, according to the document. To be clear, this is only a draft document, and the president’s budget, even when finalized, is rarely adopted exactly as it is written. Congress will have its say, and lawmakers have shown support for substance abuse treatment in recent years. But the proposal nonetheless raises the risk that the US will take a step backward after finally making progress in reducing the toll of opioids. If the programs were to ultimately be eliminated, some day, a health center might not have Narcan on hand when a patient comes through the front door experiencing an overdose. Or an EMT might find their supply runs out, and they don’t have any naloxone spray available when an overdose call comes in. The move by the Trump administration to cut these successful programs would seem to undermine their own goals to curb the opioid crisis. HHS Secretary Robert F. Kennedy Jr., who has spoken openly about his own heroin addiction, [said](https://wpln.org/post/rfk-stumps-for-overdose-prevention-in-nashville-as-tennessees-death-rate-declines/) just days ago that “we need Narcan” — even as his department drafts plans to cut it. In his first term, Trump [promised](https://www.nytimes.com/2017/10/26/us/politics/trump-opioid-crisis.html) to end the opioid epidemic, and he [signed](https://www.pewtrusts.org/en/research-and-analysis/articles/2018/10/24/president-trump-signs-bipartisan-bill-to-fight-opioid-crisis) some of the first significant legislation to provide federal funding to combat it before the pandemic sent overdose deaths soaring. Now, within the early days of his second term, Trump [framed](https://www.vox.com/politics/402530/trump-tariffs-canada-mexico-explanation) his tariff policy around the goal of stopping fentanyl or its ingredients from being smuggled into the US. “The recent drop in overdose deaths is extremely welcome news, yet there is still a colossal amount of work to be done,” Andrew Kessler, the founder of Slingshot Solutions, a consulting firm focused on mental health and substance abuse, told Vox. “Just as with HIV, Covid, or any other public health emergency, the keys are investments in research, practicing prevention, and evidence-based treatment. It is a tried-and-true formula that should not be deviated from.” See More: * [Health](https://www.vox.com/health) * [Health Care](https://www.vox.com/health-care) * [Policy](https://www.vox.com/policy) * [Politics](https://www.vox.com/politics) * [Public Health](https://www.vox.com/public-health) * [Trump Administration](https://www.vox.com/trump-administration)

The state of Oregon, which has long struggled with one of the [worst drug-addiction crises in the US](https://www.theguardian.com/us-news/2025/apr/01/oregon-drug-recovery-programs), last year announced $20m in [grants](https://www.theguardian.com/us-news/article/2024/aug/31/oregon-drug-recriminalization-law) to help connect people to substance-use services. The funds, the governor and lawmakers said, would go to counties to support a “treatment first” approach, encouraging jurisdictions to get drug users into recovery programs, instead of arresting and jailing them. Some local governments, however, have spent the taxpayer-funded grants to beef up law enforcement. Budget documents obtained by the Guardian through public records requests reveal that several counties have put the money toward hiring prosecutors, acquiring police gadgets and police vehicles, and covering sheriff costs. Washington county, the state’s second-largest jurisdiction, budgeted twice as much of its funds for police and district attorney salaries as it did on community programs, while two other counties used the money for laser devices that are meant to detect drugs but have been criticized as useless. Counties have said their law enforcement investments are geared toward getting people treatment. But some recovery organizations and advocates for people with addiction said the spending was a misuse of funds meant to help people in need, and an example of governments prioritizing policing over investing in services to address an urgent public health crisis. The state has [ranked](https://www.kgw.com/article/news/health/oregon-worst-in-nation-for-addiction-treatments-locals-rally-in-salem/283-b2e5b42b-218e-4b2c-9ec5-f3ce9fca8c74) last in the nation for treatment access while overdoses have surged to [five deaths a day](https://www.opb.org/article/2024/12/13/deaths-from-drug-overdoses-surged-nearly-33-in-oregon-last-year/). The counties’ spending choices also come as addiction service providers across the state are [grappling](https://www.salemreporter.com/2025/04/07/bridgeway-ends-plan-for-recovery-home-as-local-treatment-providers-brace-for-state-funding-cuts/) with significant [budget cuts](https://www.klcc.org/health-medicine/2025-03-27/walk-in-addiction-recovery-service-in-eugene-risks-shutting-after-drastic-state-funding-cuts), with some non-profits [forced](https://www.kgw.com/article/news/health/oregon-measure-110-drug-treatment-detox-inpatient-withdrawal/283-5c570fd2-c7ff-4d55-98f9-5eb29829e4d9) to put would-be patients and clients on long [waitlists](https://www.oregonlive.com/politics/2025/01/oregon-lawmaker-wants-to-expand-emergency-housing-program-for-people-navigating-drug-addiction.html) before they can get help. The funding controversy stems from the state’s high-profile flip-flop on drug policy. In 2020, Oregon voters passed a first-in-the-nation ballot measure to decriminalize possession of small amounts of drugs, aimed at treating addiction as a disease instead of a crime. But the radical initiative [faced a fierce backlash](https://www.theguardian.com/us-news/2024/feb/21/oregon-drug-law-measure-110-backlash) and was blamed for rising rates of fentanyl overdoses, public drug use and homelessness – even though studies [show](https://www.opb.org/article/2023/09/27/oregon-drug-decriminalization-measure-110-overdose-deaths/) there were a [range](https://www.opb.org/article/2023/09/27/oregon-drug-decriminalization-measure-110-overdose-deaths/) of [factors](https://www.pdx.edu/criminology-criminal-justice/measure-110-research) contributing to these problems. [Lawmakers reversed course](https://www.theguardian.com/us-news/2025/mar/31/oregon-new-drug-law-arrests) with a bill enacted last fall that recriminalized drugs, allowing police to again arrest people for carrying small quantities. However, legislators [promised](https://www.oregon.gov/gov/Documents/2024_4_01_Signing_Letter_HB_4002.pdf) the law would not be a return to “business as usual” of the war on drugs and instead set up a $20m program called “deflection”, which would allow police to refer people facing possession charges to services rather than enter the criminal legal system. Legislators gave the state’s 36 counties wide discretion on how to implement the new law, or whether to create deflection programs at all, and the decentralized approach has allowed for significant variations in spending. Washington county, located west of Portland, got a $1.5m deflection budget approved last year. Nearly $700,000 of it was allocated to salaries for new law enforcement positions: $283,487 for a high-level deputy district attorney; $116,664 for a legal specialist in the district attorney’s office; and $257,335 for a sheriff’s lieutenant. It also included $40,000 for overtime for the sheriff’s office. The county, meanwhile, allotted $360,000 total for community peer mentor services meant to directly help people get services and treatment. “These funds are limited. It’s a zero-sum game,” said Grant Hartley, a public defender. Hartley is the metropolitan public defenders director for Multnomah county, the region that includes Portland, and he sat on a committee that reviewed the deflection grants, though he didn’t have a vote. “When you spend money on a district attorney position, that might be two or three case managers you can’t hire, or a contract of services you can’t make.” Washington county’s new law enforcement positions would be focused on implementing deflection, officials said in budget documents. However, data shows that few people have been successfully directed to treatment. From September through early May, the county filed more than 1,000 drug-possession misdemeanor cases now allowed under recriminalization, the highest number in the state. Only roughly 75 people have been referred to deflection, as of April, the latest available records. [](https://www.theguardian.com/us-news/2025/may/19/oregon-addiction-spending#img-2) Roberto Paredes of El Jardín, a non-profit that serves people with substance-use disorders, does outreach in Hillsboro, Oregon, on 27 February. Photograph: Amanda Lucier/Guardian County officials, including the district attorney, Kevin Barton, set up [strict eligibility requirements](https://www.washingtoncountyor.gov/addictions/deflection-program#toc-who-is-eligible-and-not-eligible-for-the-program-) for deflection, disqualifying people who had any other charges pending or were on any supervision, such as probation. Since people targeted for possession arrests are often unhoused with criminal records, the program has been inaccessible to many who would benefit, advocates said. “The district attorney wants to think we can still arrest our way out of the problem,” said Fernando Peña, director of El Jardín, a non-profit that serves people with substance-use disorders and operates Oregon’s only recovery drop-in centers dedicated to Latinos, including one in Washington county. “Substance-use disorder is a public health issue. We need services to deflect people to.” Representatives for Washington county’s deflection program and the district attorney’s office did not respond to inquiries. Other counties that prioritized law enforcement salaries to institute deflection included: Clackamas, with $259,200 for a senior district attorney; Harney, which budgeted $83,052 for the district attorney’s office and sheriff, making up 55% of its grant; Yamhill, which allotted $124,304 for a district attorney whose job included “pursuing criminal charges” against people who weren’t successful at deflection, and $4,267 for a district attorney office “remodel”; Union, which allocated $70,000, nearly half its budget, for a district attorney job; and Crook, which allocated $129,000, or 86% of its budget, for a sheriff’s position. The budgeting decisions were approved by the state grant review committee for deflection. The interim director of the Oregon Criminal Justice Commission, which convenes the committee, declined to comment. Gadgets and vehicles -------------------- Budget line items in other counties have raised eyebrows. Clatsop county budgeted $71,000 of its deflection funds for two TruNarc “spectrometers”, handheld devices that are marketed for detecting narcotics. The county said TruNarc would allow law enforcement to “scan directly through plastic bags or glass containers” to “reduce exposure”, “increase officer safety … and protect first responders”. It’s unclear how the devices would be used to connect people to services through deflection. The devices were scrutinized in a [segment](https://www.youtube.com/watch?v=Io0yuH1CiA0) on the [Last Week Tonight with John Oliver](https://www.theguardian.com/tv-and-radio/series/john-oliver-recap), which investigated misuse of funds meant to stem the opioid crisis. The episode spotlighted a Wisconsin county that argued the devices protected officers from overdosing in the field, a claim rooted in the [pervasive falsehood](https://www.nytimes.com/2022/07/13/magazine/police-fentanyl-exposure-videos.html) within [law enforcement](https://www.argusleader.com/story/news/politics/2024/01/21/south-dakota-house-passes-bill-on-exposure-to-fentanyl-but-how-often-does-that-happen-cdc/72247000007/) that mere exposure to fentanyl can be dangerous or fatal. “This is the epitome of the funds being used to supplement law enforcement dollars. When you put out a grant without any meaningful restrictions, saying it can be spent on anything related to deflection, this is what you end up with,” said Hartley. “TruNarc was requested because of a myth about the dangers of fentanyl exposure. And by paying for it, you’re endorsing the myth.” Polk county also spent $76,000, or 32% of its budget, on TruNarc. Kristen Hanthorn, a Clatsop corrections lieutenant, said in an email that TruNarc was “not about officer safety”, but used to “fast-track decisions about referrals, services, and charging, if any”. The devices can be used to rule out charges, when illegal substances aren’t detected, and can yield information that can be shared with treatment providers: “We view TruNarc not as a tool of criminalization, but as one of harm reduction and service connection.” Marion county allocated $81,000 for a new sheriff’s patrol vehicle, which it said would be used to support the “addiction population”, but also “safety of our citizens beyond … the deflection program”. Danielle Bethell, a Marion county commissioner, said in an interview the vehicle had been assigned to a deputy who works in unhoused communities and is focused on getting people help: “We’d rather people go into treatment than jail … We really believe in connecting people to services,” Bethell said. Marion has one of the [highest number](https://olis.oregonlegislature.gov/liz/2025R1/Downloads/CommitteeMeetingDocument/303226) of deflection referrals in Oregon. Bill Stewart, a Clackamas county prosecutor funded by the grants, said the majority of his job was overseeing deflection and other efforts to get people in the criminal system into treatment, but he also continued to prosecute crimes, often tied to homelessness. The district attorney’s office has relationships with community groups and police agencies and was in the best position to oversee the new program, he said. “The most cost-effective thing we can do is get people housed and treated,” he said. Clackamas county, which has logged 900 drug-possession arrests since last year, has had 47 people enter deflection, with two completions so far, he said. More people are entering treatment after they have been charged, he said. Brandi Johnson, director of LoveOne, a non-profit that partners with Clackamas county on deflection, said she was initially skeptical of funds going to the district attorney, but said it had worked well: “We have open communication. We’re able to say: ‘What is actually going to help this person move forward?’” Representatives for the other county deflection programs did not respond to inquiries. Andy Ko, director of Partnership for Safety and Justice, an Oregon criminal justice reform group, said he was concerned that using the grants to fund additional prosecutors and other law enforcement investments encourages the same punitive responses to the drug crisis that have long failed. “To keep more people alive, we have to act differently,” he said. “This is supposed to be about helping people through a crisis. That’s what the public wants. If we keep doing the same thing we’ve been doing for 60, 70 years, we’re going to get the same result.” Since recriminalization and deflection began in September, through early May, police across Oregon have carried out nearly 7,000 arrests for possession. Only 723 people have enrolled in deflection as of mid-April, the latest available data, and only 88 people have completed the program. ‘We need more treatment’ ------------------------ Some counties have prioritized treatment services and community programs over law enforcement investments and seen more progress getting people help, advocates said. Lane county budgeted ​​$377,304 for low-barrier emergency housing focused on treatment, and $700,000 for a services provider to handle case management, a contract that went to Ideal Option, a firm that provides addiction medication. A team of navigators supports people entering deflection, getting them housing, clothing and food, then assessing their treatment needs, signing them up for healthcare and creating a plan for their recovery, said Chris Parosa, the Lane county district attorney. [](https://www.theguardian.com/us-news/2025/may/19/oregon-addiction-spending#img-3) A drug treatment center in Medford, Oregon, on 24 February. Photograph: Amanda Lucier/Guardian “If we were going to do a program deflecting people away from the criminal justice system, it didn’t make a lot of sense to house it in the sheriff’s office or DA’s office,” said Parosa. “We wanted to get people to our peer navigators and from there to programming they need to address their personalized issues.” He said he did not see any need to hire more district attorneys, adding: “If this worked well, we wouldn’t do any prosecutions.” He budgeted for a paralegal in his office to track data and progress of the program. State representative Jason Kropf said he was pursuing legislation meant to increase accountability for deflection budgets, including by tying funding allotments to how effectively counties were deflecting people out of the criminal system. Paul Solomon served on the deflection grant review committee and is chair of the Criminal Justice Commission, which has tracked data on the program. He said he hoped to see more guardrails on how the funds are spent moving forward. The state, he said in an email, was making progress toward prioritizing services over the criminal justice system, but should invest more in treatment. “While law enforcement plays an important role in public safety and community engagement, I believe we are not yet investing enough in the treatment side of the deflection equation,” he said. “Deflection only works if people have somewhere safe to go and someone they trust to walk with them. That means funding community-based providers and peer navigators who understand the lived experience of recovery. It also means ensuring people have housing and access to consistent care – not just in urban centers, but across all regions of Oregon.”

A gaggle of former US Navy Seals open up about their post-traumatic stress in this absorbing if somewhat formulaic documentary by Jon Shenk and Bonni Cohen. Ultimately, it is something of an advertisement for a new therapeutic protocol that involves the veterans taking the hallucinogens [ibogaine](https://www.theguardian.com/society/2023/jan/23/ibogaine-iboga-drug-addiction-psychedelic-gabon) (derived from an African shrub) and [5-MeO-DMT](https://www.theguardian.com/lifeandstyle/2022/sep/10/celebrity-shoe-designer-patrick-cox-on-his-psychedelic-toad-awakening) (derived, like something out of a William S Burroughs novel, from a river toad); a treatment that, to hear the subjects here describe it, can work miracles on the battle-scarred, suicidal minds of its users. Currently, the treatment is only available at a Mexican clinic because the drugs have not been cleared by the US Food and Drug Administration, but a bunch of boffins connected to [Stanford University’s Brain Stimulation Lab](https://bsl.stanford.edu/) are studying its clinical effects and the film works hard to make everything look as legit as possible. To be clear, we’re not necessarily questioning the drugs’ efficacy, but this particular film seems barely interested in the cognitive science and lets interviews with scientists with interesting glasses and fancy vocabularies stand in as guarantors that it all actually works. More persuasive is the testimony from the half dozen men we meet, who bravely discuss their pain and distress while the cameras roll. What the former soldiers experienced in the theatre of war, especially in Afghanistan in the early 2000s, has left many feeling like husks of their former selves and bedevilled by constant thoughts of suicide. One soldier testifies that the abuse he experienced as a child, which significantly contributed to his decision to become a soldier in the first place, was an even bigger component of the trauma he carried and something he could only face while under the influence of these psychedelics. Since few things are duller than watching someone else having an experience on drugs, the film opts to illustrate the trips with tasteful animation featuring images of our subjects spinning in space, surrounded by the memories that assault their senses. At one point, we get to see a soldier’s vision of spending hours on a couch watching the sitcom Malcolm in the Middle, a detail that seems deliciously amusing and against the mostly sombre grain of the film. That solemnity is underscored by the music, which seems mostly comprised of plangent Philip Glass-style chords played on violins repeated ad infinitum, a style of musical shorthand that immediately signals tragic cycles of pain. In Waves and War is on Netflix from 3 November. _In the UK and Ireland, [Samaritans](https://www.samaritans.org/) can be contacted on freephone 116 123, or email [[email protected]](mailto:[email protected]) or [[email protected]](mailto:[email protected]). In the US, you can call or text the [988 Suicide & Crisis Lifeline](https://988lifeline.org/) at 988 or chat at [988lifeline.org](https://988lifeline.org/). In Australia, the crisis support service [Lifeline](https://www.lifeline.org.au/) is 13 11 14. Other international helplines can be found at [befrienders.org](http://www.befrienders.org/)_