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A MARTÍNEZ, HOST:

The Justice Department is suing AmerisourceBergen over opioids. In their civil lawsuit, federal prosecutors accuse the drug wholesale distributors of failing to notify the government about suspicious opioid orders. It's just the latest chapter in a pivotal year for the opioid crisis. More people died than ever before from drug overdoses, as street fentanyl flooded communities. But there have also been major reforms in addiction treatment. This year, drug companies also agreed to pay more than $50 billion to help communities recover from the opioid epidemic. NPR's addiction correspondent Brian Mann joins us now to take stock. Brian, so many people are still dying. Why does the opioid crisis keep getting worse?

BRIAN MANN, BYLINE: Yeah, the big culprit now, A, is street fentanyl, this powerful, deadly synthetic opioid. It's so deadly it's contributing to a drop in American life expectancy. The CDC says overdose deaths appeared to have peaked in March of this year at 110,000 Americans dying from these drugs in a single 12-month period.

MARTÍNEZ: And you found that a lot of Americans dying of overdoses are young, under the age of 40. What are they saying about the danger of fentanyl?

MANN: Yeah, I've spent a lot of time talking with young people, and they're scared. I spent time in Tacoma, Wash., with Marche Osborne, who's 31 years old. She used to use heroin, but now these fentanyl pills are the only opioid she can find on the street.

MARCHE OSBORNE: They're zombifying people. They're - anybody will do anything for a pill. It's ridiculous. Like, they're turning people - they're dehumanizing people. And it's not a good thing, and it's not going to go anywhere good if it continues.

MANN: And because of fentanyl, drug overdoses are now a leading cause of death for Americans under the age of 40.

MARTÍNEZ: But it's led to some major reforms this year in addiction treatment. What is changing?

MANN: Yeah. For a long time, the disease of addiction has been sort of siloed off from the rest of the health care system. And because of stigma and red tape and lack of insurance coverage, a lot of people, like Marche Osborne, with addiction get no help of any kind. And what's crazy about that, A, is that there are actually great medications, like methadone, buprenorphine, naloxone. These drugs can help people stop using opioids. They can help reverse overdoses before they're fatal.

So what happened this year is the Biden administration and Congress pushed through a series of really major reforms, some of them tucked into that big spending bill that was signed by President Biden yesterday. These reforms are already making it much easier for doctors and medical clinics to prescribe these medications. And the CDC data, as grim as it is, suggests that things may be improving. Since March, month by month, the rate of overdose deaths have started to come down. Experts I talked to say they hope this is a real turning point.

MARTÍNEZ: What about this - any progress in stopping fentanyl from coming into the U.S.?

MANN: There's really no good news there. The Biden administration says border agents seized twice as many fentanyl pills coming from Mexico in 2022, more than 50 million pills that they captured, most coming through ports of entry. That doesn't appear, though, to be putting a dent in the street supply. Fentanyl right now is everywhere, and it's just super cheap.

MARTÍNEZ: Yeah. One more big development this year was a reckoning with pharmaceutical companies. They made and sold a lot of opioid pain pills. How much will corporate America pay? And will that money help?

MANN: Yeah, this was a big game-changer in 2022. Big Pharma ignited this public health crisis, aggressively marketing opioids, and now companies ranging from CVS and Walmart to Cardinal Health and Johnson & Johnson, this year they came to the table. They agreed to pay more than $50 billion in settlements. And experts I talked to say this money will help, funding a bunch of drug treatment programs and health care, especially in rural areas and urban neighborhoods where the need is desperate. No one believes this will be a silver bullet for the opioid crisis, but along with the other reforms we talked about, this development in 2022 could save a lot of lives.

MARTÍNEZ: That's NPR addiction correspondent Brian Mann. Brian, thanks.

MANN: Thank you.

(SOUNDBITE OF MUSIC)

MARTÍNEZ: Brazilian soccer legend Pelé has died at the age of 82.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED SPORTSCASTER: Watch Pelénow. What a beautiful goal from Pelé. El Rey Pelé- 100 goals for Brazil.

MARTÍNEZ: He's often called the greatest of all time and is the only player to lead their country to three World Cup titles, the first when he was just 17 in 1958. He made the No. 10 shirt an iconic image in world soccer. Peléended his career helping to popularize soccer here in the U.S. when he joined the New York Cosmos in 1975. And later in life, he served as an ambassador for the sport and witnessed its worldwide expansion. Andrew Downie has written two books about Brazilian soccer, and he joins us now from Sao Paulo. Andrew, in his own words, I mean, Pelésaid that when he started, he just wanted to be as good as his dad, who was also a soccer player in Brazil. He ended up, I think, being a lot more. What made him a legend?

ANDREW DOWNIE: Well, as you said in your intro there, he was the first player to - and the only player to win the World Cup three times. And I think by that, he alone - that puts him above many of the others that played the game. He was also (inaudible) who took a small-time club, Santos, to the top of the world. They became the champions of South America and the champions of the world. And after that, he had - he was comparable to, I think, Muhammad Ali in the U.S. He was the only guy, along with Ali, who was recognizable in the whole world. And I think he did this at a time when football was becoming a business as well as a sport, and that gave him this projection all over the world. And it projected Brazil all over the world because, before Pelé, before that team of the 1960s and 1970s, people - a lot of people did not know Brazil. And he really put Brazil on the map, and it made him a true legend.

MARTÍNEZ: Yeah, a one-named superstar - that's how you know you're big. What's the mood in Brazil today? What's the country going to do?

DOWNIE: Well, the period between Christmas and New Year is always quite quiet in Brazil because there's always a lot of people who go on holiday and, you know, works are off. It's always - there's not the usual hustle and bustle that you have the rest of the year. So things have been a little bit quieter. But there has definitely been a huge outpouring of grief over the last 24 hours because everyone recognizes, you know, the greatness of Pelé, the legend of Pelé. People were, I think, expecting his death. He's been in and out of hospital for more than a year. And the last month, his family have been posting pictures and, I think, preparing people for the worst because they knew things - that he was not getting much better. So there is this grief, and people have taken it with a kind of naturalness because they knew that it was about to come.

MARTÍNEZ: Yeah. You know, many big Brazilian superstars that came after Pelé- like Zico, Ronaldinho, Neymar - they consider him an inspiration, but I don't think any of them really ever eclipsed Peléin the hearts of Brazilians.

DOWNIE: No, I don't think so. They all - I mean, Peléwas this - was a curious guy in the sense that he would often refer to himself in the third, and he would say, you know, Pelé is the football player, the public face, and Edson - his name was Edson Arantes Nascimento - Edson is just the private man. And he had this curious relationship with Brazilians. They realized how great he was, how brilliant he was and how important he was for the country, but there was a lot of questions about whether he stood up for Black Brazilians, you know, enough during the racism that he suffered in the - particularly in the '60s and '70s. There was a lot of questions about whether he should have done more to stand up to the military dictatorship in the 1960s and '70s. And he also had a very - a private life, shall we say. He was married three times. He had several children...

MARTÍNEZ: Yeah, yeah.

DOWNIE: ...Some out of wedlock. And I think these were all issues that really complicate his legacy for some Brazilians.

MARTÍNEZ: Yeah. Andrew Downie joining us from Sao Paulo, Brazil. Andrew, thanks.

DOWNIE: Thank you.

(SOUNDBITE OF MUSIC)

MARTÍNEZ: One of the takeaways from the midterm elections last month - a majority of young voters, millennials and members of Generation Z, cast their ballots for Democratic candidates. Now young Republicans are demanding change from their party in order to keep up with their generation. Here to tell us all about it is NPR's Elena Moore. So what are young Republicans telling their party?

ELENA MOORE, BYLINE: First and foremost, they're paying attention to this exit polling. Nationally, over 60% of voters under 30 cast their ballots for Democrats this midterms, which is the second-highest youth turnout for Democrats after the 2018 midterms. And that's pretty notable. One of the conservatives I talked to about this was former congressional candidate Karoline Leavitt, who's 25. Leavitt lost her race in November, but as a member of Gen Z herself, she takes this all very seriously, calling it, you know, the greatest challenge for the Republican Party today.

KAROLINE LEAVITT: It's more than one candidate or one campaign can handle. It needs to be a colossal shift in the messaging and the mediums utilized by the GOP and the establishment. And it's discouraging to see, you know, the Republican establishment not even acknowledge that this problem exists.

MOORE: Leavitt's arguing that Republicans need to both improve their online outreach strategy and actively highlight issues that young people care about, like protecting the environment and reducing the cost of housing and even going to college.

MARTÍNEZ: I couldn't help notice that abortion was not on that list. That was a big issue, a big one, for Democrats in the midterms. How does that play into young Republicans' strategy here?

MOORE: Right, right. A, it's a big challenge. Pollsters and voter data experts tell me that protecting abortion access is key to maintaining support among these younger voters, since it was such a big issue this past election. So I asked another young conservative about this, 25-year-old Iowa House Representative Joe Mitchell, and he told me Republicans really can't shy away from discussing divisive issues like abortion. And Mitchell himself, by the way, voted to restrict abortion access in the state Legislature. But he made a similar point on addressing climate change and gun violence, too.

JOE MITCHELL: Coming front and center on these issues to say, no, we believe in, you know, reasonable exceptions for these sorts of things. We believe in having a more renewable energy future when that works and when that's appropriate. And obviously, we want to make sure that kids are safe in school. And we just have different ideas of how to protect them.

MOORE: And Mitchell went on to tell me that taking these social issues head-on is important when they're asked about, instead of having Republican stances oversimplified by Democrats, opponents, the like.

MARTÍNEZ: Now, thing is, though, political parties are drenched and entrenched in tradition. They wear it like a coat of molasses. All right, so how can younger conservative influencers shake up institutions that maybe aren't easily changed?

MOORE: Well, that's what they're trying to figure out. We did reach out to the Republican National Committee. They did not respond to NPR's request for comment on this story. But, you know, long story short, A, it's going to be a difficult balance. You see from Leavitt and Mitchell that social issues seem to, you know, at least be part of the way in to getting this younger generation engaged. But as one Republican pollster put to me, social issues don't hand victories to Republican candidates the same way economic issues do, and that means it's a limited pool of resources. It's about where the money gets spent. Why spend money on engaging with a new age group, young voters, who aren't reliably conservative and historically aren't even reliable voters when older voters consistently vote Republican and turn out at higher rates?

MARTÍNEZ: That's NPR's Elena Moore. Elena, thanks.

MOORE: Thanks, A. Transcript provided by NPR, Copyright NPR.

A Martínez
A Martínez is one of the hosts of Morning Edition and Up First. He came to NPR in 2021 and is based out of NPR West.

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