For the first time in 25 years of America's opioid crisis, we're witnessing a significant decline in overdose deaths. Dr. Andrew Kolodny, Medical Director at the Opioid Policy Research Collaborative at Brandeis University, joins us to unpack this promising trend while emphasizing that the numbers remain unacceptably high.

The conversation reveals shocking new statistics: approximately 10 million Americans currently suffer from opioid use disorder—roughly 5% of all adults—a dramatic increase from previous federal estimates of just 2 million. Despite reduced death rates, Dr. Kolodny stresses we're still failing those who need help most.

We dive deep into the settlement money flowing from pharmaceutical companies to states and localities, exploring the concerning lack of guardrails protecting these funds from being diverted away from addiction services. Without proper oversight, history may repeat itself as we saw with tobacco settlement funds that often went to unrelated expenses rather than addressing the health crisis.

Dr. Kolodny outlines what real progress would look like: dramatically improved access to outpatient treatment with medications like buprenorphine, available on demand regardless of ability to pay. He shares several compelling theories behind the declining death rates—from improved treatment access to changes in the drug supply itself—while emphasizing how crucial it is to understand which interventions are actually working.

This eye-opening discussion challenges conventional wisdom about border security, fentanyl trafficking, and addiction treatment while offering a roadmap for continuing positive trends. If you're concerned about America's opioid crisis or work in healthcare, addiction services, or policy, this episode provides essential context for understanding where we stand and what must happen next.

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