When the history of America's long, devastating opioid crisis is finally written, 2022 may be remembered as both a low point and a turning point.
Data from the Centers for Disease Control and Prevention suggests the avalanche of overdose deaths — driven largely by the spread of illicit fentanyl --may have crested in March.
Researchers found a staggering 110,236 people died in a single 12-month period, a stunning new record.
But there are signs help may finally be on the way.
The avalanche of drug deaths spurred a series of major reforms in 2022 to the way drug addiction is treated in the U.S., changes designed to reduce stigma and improve access to care.
2022 was also a year of corporate accountability.
Major drug companies, distributors and pharmacy chains reached settlements of opioid lawsuits filed by state and local governments totaling more than $50 billion.
Experts say that money, paid out over the next two decades, will fund treatment programs and other services that are desperately needed, especially in poor rural towns and urban neighborhoods.
Here are the major developments in 2022 that made it a pivotal year for the overdose epidemic.
Fentanyl got worse in 2022. Probably a lot worse.
Let's start with the grim news.
Street drugs in America got even more toxic in 2022 with the spread of the synthetic opioid fentanyl. Many of those dying are young, under the age of 40.
"They're zombifying people," said Marche Osborne who lives on the streets in Tacoma, Wash.
She's been addicted to opioids for 18 years and prefers heroin, but says fentanyl is now the only drug street dealers are offering.
"Anybody will do anything for a pill, it's ridiculous. They're dehumanizing people. It's not a good thing. It's not going to go anywhere good if [the spread of fentanyl] continues," Osborne told NPR.
Using data from 2021, the Centers for Disease Control and Prevention announced in late 2022 that life expectancy in the U.S. has dropped to its lowest point in two decades, in part because of street drugs.
"Overdose deaths are increasing," said Kenneth Kochanek, a statistician with the CDC. "The majority of those deaths are to younger people, deaths to younger people affect the overall life-expectancy more than deaths to elderly."
The Drug Enforcement Administration said in December it seized far greater quantities of illicit fentanyl than ever before in 2022.
But drug policy experts say Mexican cartels are still able to smuggle the deadly synthetic opioid into the U.S. with relative impunity.
Republicans made fentanyl a major part of their midterm election message, attempting to link drug smuggling to undocumented immigration.
But NPR found the overwhelming majority of opioids being smuggled across the border came through legal points of entry.
What to look for in 2023: Because drug death data is gathered slowly in the U.S., it won't be known for many months exactly how many people died from fatal overdoses in 2022, but the toll is expected to be grim.
Look for fentanyl to continue to be a hot-button political issue. Republicans have promised to focus attention on Southern border security and smuggling. The question is whether the GOP can come up with policy solutions that will have a real impact on the Mexican cartels.
2022 brought major reforms to addiction treatment
For decades, recovery treatment has been shaped by drug war-era policies that tend to be punitive, bureaucratic and so confusing many doctors simply refuse to treat people with opioid use disorder.
As a result, studies show roughly 90 percent of people with addiction get no healthcare at all.
Driven in part by the carnage of fentanyl deaths, 2022 was the year that changed that.
Congress and the Biden administration pushed through major reforms to the way people with addiction get healthcare.
The Biden administration announced new rules that will make it easier for many patients to access methadone and buprenorphine, medications proven to help patients avoid opioid relapses.
Congress also eliminated a bureaucratic hurdle known as the "x-waiver" that prevented many physicians from prescribing buprenorphine.
Lawmakers and federal officials also worked successfully to help at least one drug manufacturer prepare to sell the opioid-overdose reversal drug naloxone over the counter in pharmacies, without the need for a prescription.
"We begin to normalize and understand addiction as a disease," said Dr. Rahul Gupta, head of the White House Office of National Drug Control Policy. "And we start to treat people suffering from addiction as human beings and then prescribe them treatments."
Drug policy experts say this mainstreaming of addiction care, including modern medical treatments for opioid use disorder, could save tens of thousands of lives.
What to look for in 2023: Will the mainstream healthcare industry buy in and begin treating more patients with addiction now that red tape is being eliminated? Studies show deep stigma among care providers toward patients suffering from substance use disorder. It's not clear how many doctors will begin prescribing opioid-treatment medications.
"It is actually the most painful part for me as a physician that this stigma exists in the healthcare community," Dr. Gupta said. "If it remains easier for people to get illicit drugs than to get treatment, we're not going to be able to bend the curve."
In 2022 corporations agreed to pay for the opioid crisis
Drug policy experts agree Big Pharma ignited this public health crisis by aggressively marketing and selling opioids.
2022 was the year some of America's biggest companies, including AmerisourceBergen, Cardinal Health, CVS, Johnson & Johnson and Walmart, came to the table to cut deals.
While admitting no wrongdoing, corporate America agreed to pay more than $50 billion dollars in settlements.
"It is important – and long overdue – that we hold opioid companies accountable," said Sen. Maggie Hassan (D-N.H.).
While experts believe these payouts represent a tiny fraction of the public cost of the opioid crisis, the settlement money could be a game-changer.
Most of the opioid money is lock-boxed by court agreements in a way that ensures it will go to fund addiction treatment and healthcare over the next two decades.
"No amount of money will ever make up for the lives lost and families destroyed," Hassan told NPR. "The funding supports opioid prevention, treatment, and recovery services."
Along with big increases in state and federal funding for addiction care over the last year, corporate cash could make addiction treatment far more accessible and affordable — especially for people in poor rural areas and urban neighborhoods.
What to look for in 2023: While most corporations involved in the opioid business have reached settlements with state and local governments, they still face scrutiny from the U.S. Department of Justice.
The DOJ has already sued two of America's top-10 biggest corporations over opioids, AmerisourceBergen and Walmart, and more civil complaints against other companies are expected to follow. Here again, the corporations insist they did nothing wrong. Billions of dollars in fines and penalties hang in the balance.
What about the Sacklers in 2022?
In recent years, members of the Sackler family who own Purdue Pharma, have emerged as the public face of the opioid crisis.
While they admit no personal wrongdoing, their company has pleaded guilty twice to federal crimes related to opioid marketing, in 2007 and again in 2020.
Their flagship product, Oxycontin, became one of the most widely abused pain pills.
In March 2022, the Sacklers reached a $6 billion dollar settlement with state attorneys general, a deal that's still under review by the federal courts.
Key members of the Sackler family were also confronted for the first time by victims of their company's wrongdoing during an emotional court proceeding that was held via videoconference.
In a process agreed to as part of the settlement, survivors of addiction and those who lost family members to opioid overdoses spoke directly to the Sacklers, describing the agony caused after Oxycontin flooded communities.
"You created so much loss for so many people," said Kay Scarpone, whose son Joe Scarpone, a retired Marine, died of an opioid overdose.
"I'm not sure how you live every day. I hope you ask for God's forgiveness for your actions. May God have mercy on your souls."
The Sacklers didn't speak during the proceeding and offered no apology. (During a congressional hearing in 2020, David Sackler told lawmakers the "family and the board acted legally and ethically.")
Members of the family faced another high-profile public reckoning in 2022 in the form of an award-winning documentary about the life of Nan Goldin.
The celebrated photographer lost years of her life to Oxycontin addiction.
"All The Beauty And the Bloodshed," which won the Golden Lion award at the Venice Film Festival, follows Goldin as she campaigned to force museums and galleries around the world to break ties with the Sacklers.
"All the museums and institutions need to stop taking money from these corrupt evil bastards," Goldin says in the documentary, as she helps organize one of the opioid protests that rocked the art world.
It worked. Major arts, education and medical institutions around the world have removed the Sackler name from buildings and programs.
What to look for in 2023: The $6 billion Purdue Pharma settlement — which could grant members of the Sackler family immunity from future opioid lawsuits — is still being reviewed by the U.S. Court of Appeals for the 2nd Circuit in Manhattan. A ruling is expected in 2023. If the deal is finalized, the money would go to fund drug treatment programs across the country.
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