NCSL Podcasts

States, Feds Work Together to Prevent Overdoses | OAS Episode 205

Episode Summary

Two experts on the nation’s drug overdose crisis join the podcast to discuss how state and federal governments are tackling the problem that has led to more than 110,000 deaths in the 12-month period that ended last September. The vast majority of those deaths, near 80%, involved fentanyl and other synthetic opioids.

Episode Notes

Overdose deaths from all drugs, including opioids, have risen to more than 110,000 in the 12-month period that ended last September. The vast majority of those deaths near 80% involved fentanyl and other synthetic opioids.

State legislatures have been active in passing legislation to address the crisis and enacting more than 180 bills in 2022 and 2023, most of them focusing on harm reduction strategies such as medication-assisted treatment. However, the number of deaths remain stubbornly high.

On this podcast, we sat down with Michelle Putnam from the Division of Overdose Prevention at the Federal Centers for Disease Control and Prevention, and Charlie Severance-Medaris, who tracks state policy related to drug overdose prevention for NCSL.

Putnam discussed the steps her office is taking to understand the patterns of drug use and overdoses and working with local public health departments to better equip them to deal with the situation. She also talked about the frustration faced by state and local officials, families, law enforcement, and others at the ongoing death toll despite decades of efforts to control illegal drugs.

Severance-Medaris discussed the trends in legislation aimed at addressing the drug overdose problem and whether states may change their approach. 


Episode Transcription

Ed:     Hello and welcome to “Our American States,” a podcast from the National Conference of State Legislatures. I’m your host, Ed Smith. 


MP:   We are losing about 300 Americans a day to a drug overdose. That’s losing someone every 5 minutes to an injury that is preventable. 


Ed:     That was Michelle Putnam from the Division of Overdose Prevention at the Federal Centers for Disease Control and Prevention. Michelle is my guest on the podcast along with Charlie Severance-Medaris, who tracks state policy related to drug overdose prevention for NCSL. 


           Overdose deaths from all drugs including opioids have risen to more than 110,000 in the 12-month period that ended last September. The vast majority of those deaths, near 80%, involved fentanyl and other synthetic opioids. State legislatures have been active in passing legislation to address the crisis enacting more than 180 bills in 2022 and 2023. Most of them focusing on harm reduction strategies such as medication-assisted treatment. However, the number of deaths remains stubbornly high. 


           Putnam discussed the steps her office is taking to understand the patterns of drug use in overdoses in working with local public health departments to better equip them to deal with the situation. She also talked about the frustration faced by state and local officials, families, law enforcement and others at the ongoing death toll despite decades of efforts to control illegal drugs. Charlie discussed the trends in legislation aimed at addressing the drug overdose problem and whether states may change their approach. Here is our discussion starting with Michelle Putnam. 


           Michelle, welcome to the podcast.


MP:   Thank you, Ed. It is a pleasure to be here.


Ed:     Well great to have you here. This issue of drug overdoses in the country I know is one that is of great concern to an awful lot of people including a lot of legislators. I wanted to start why don’t you tell us a little bit about the Division of Overdose Prevention and its mission.


MP:   CDC’s Division of Overdose Prevention sits within the section of an agency that focuses on injury prevention. So, where we sit is called the National Center for Injury Prevention and Control. And our overdose prevention work happens alongside other priority areas. Things like preventing suicide, preventing adverse childhood events and really other events that can negatively impact someone’s life. What gets us out of bed every morning here at the Division of Overdose Prevention is our North Star, which is to prevent drug overdoses right now. We are losing about 300 Americans a day to a drug overdose. That’s losing someone every five minutes to an injury that is preventable. You may ask well what are we doing about it. And, I will say that we are monitoring emerging drug trends that tell us more about fatal and nonfatal overdoses. For example, data can tell us what substances were involved in an overdose, what circumstances surrounded an overdose death. For example, whether a person had recently been in treatment or whether naloxone was administered. And we are funding state and local health departments to collect this data and to use it to get the right saving or the right lifesaving strategies to the right person at the right time. So, supporting better data, but that’s only helpful if we use it to inform where we might need more linkage to care and treatment or more peer navigators in emergency departments or more naloxone. So, what we are looking at closely is what works, what may not work so that long term, we can prevent substance misuse and addition that may lead to drug overdoses. 


Ed:     Everyone knows we are in a crisis with drug overdose deaths though the numbers that you just put to it make that pretty stark. Where do things stand now and to what degree can you sort of trace how we’ve gotten to the point we’ve gotten more than 100,000 overdose deaths a year? 


MP:   The statistics are absolutely tragic. Preliminary data tells us that we lost 110,000 people to a drug overdose during the 12 months ending in September of 2023. So that’s the latest preliminary data that we have. What we know is that two-thirds of these deaths and that’s a pattern that has withstood the stand of time over the past couple of years. Two-thirds of those deaths are driven by illegally made fentanyl. I may slip into my you know government land and use the acronym IMF and that’s what I mean to refer to illegally made fentanyl. But we are seeing illegal fentanyl co-involved with other drugs. So, drugs like cocaine and methamphetamine, we’re seeing illegal fentanyl in counterfeit prescription pills where the person buying the pill may not even know it is there. 


           The illegal drug supply is increasingly dangerous and that has drastically changed a person’s risk for a drug overdose. Even if the intent was not to ingest fentanyl or even an opioid. So, to put this in perspective and why that 110,000 deaths kind of gives you a picture of why it is occurring, back in 2010 there was roughly one fatal overdose for every 20 non-fatal overdoses treated in emergency departments. In 2020, two out of every three overdoses involving fentanyl in 2020 were fatal and that is due to illegally made fentanyl. Because what I like to point out for people and is a sign of promise and you know potentially where the statistics aren’t necessarily showing up promise. But one area where we are seeing some positive signs is that we are seeing rates of substance use remain leveled and in some groups like youth, drug use is decreasing, but the risk of drug use has drastically increased in light of illegal fentanyl. So, it’s an everybody problem. But we do have public health strategies that can help make sure that we are preventing overdose deaths in all different type of communities and different groups of people.


Ed:     I want to drill down into the fentanyl issue in just a second, but first let me take the privilege of being an old guy and ask you from a somewhat longer timespan, I remember when Richard Nixon announced the war on drugs or what came to be called the war on drugs back in 1971. I just wonder what do you think the key lessons that have been learned through the ups and downs of that period that can kind of help, experiences that can help us now.


           TM:  6:50


MP:   Let me focus on two key lessons if I may. You know one, the first lesson is that this is incredibly hard work and that’s not an excuse. It is just a fact. It relies on human connection and human behavior and we cannot expect a one sector approach to work. One of the biggest lessons that I would say we have learned over the past 50 years is that law enforcement and public health have to work hand in hand. So, we are both involved in this epidemic and we all have a role to play. We are both at the table here so let’s you know curate a menu of strategies together rather than having kind of a potluck. So, a lot of times, public safety and first responders they are the first people on the scene of an overdose and that’s an opportunity to provide lifesaving resources. It’s also an opportunity to link people to care, but they cannot do it alone. Compassion fatigue is real. I completely understand that and we can learn from each other. 


           You know public health has data that can inform proven public health strategies that can link people to care, get them into treatment and supportive services when they are ready. And we’ve seen things like diversion programs and drug courts that are becoming more and more common in states and local communities. And some programs offer on-site infectious disease testing or substance use and mental health screenings and then can directly link people to care and other risk reduction. So, we are working with public safety in a completely unprecedented way to evaluate the impact of working together. And no strategy is perfect and no strategy will ever be perfect. But we can save a life. We can save a family. We can save a community because I think what’s more and more apparent is that one drug overdose death impacts so many people beyond that individual. We talked about 110,000 people that died of an overdose and that number is by the millions if you look at the people who are impacted by that death. So, we want to work with public safety to support healthy and safe communities where people are really thriving and we really can’t get to that goal if we are not working together.


           Another lesson really quickly is that we can’t ignore what is working. We know that naloxone saves lives. We know that the more people that have it, the more lives we can save. More people need to know what naloxone is. They need to know where to get it. That’s become even easier as it’s gone over the counter. They need to know how to use it. We know naloxone works. We know things like using fentanyl test strips can alert an individual and it can alert public health if there is illegal fentanyl in the drug supply. And public health can work with others in the community to get these tools to the people who need them. So, I point to some of the success that states have seen around increasing access to naloxone and probably some listeners I would imagine had a hand in this when we are talking about things like expanded access to naloxone like good Samaritan laws so that a person who administers naloxone won’t be punished if there are drugs found on the scene. So that type of leading into what we know works now can really help make a difference. We might not have every answer yet, but while we work on getting those answers, we can use the tools that we have.


Ed:     Well, let’s drill down on the fentanyl issue. From what I understand, something like 70% of overdose deaths seem to be related to fentanyl. Just talk a little bit about why it has become such a prominent part of the drug supply and what we can do about it.


MP:   That is such a complex question and I’m going to take it in a couple of different ways here. One is really drilling down on the data. Fentanyl is everywhere. What do we know about it. And we look at different data sources to understand all that we can about this substance. So, for example, we partner with health departments to review medical examiner and coroner reports following an overdose death to see what substances were onboard. Was it just fentanyl. Was there another substance like Xylazine. We also look at data from emergency departments. We look at discharge data. We even look at emergency medical services data so where was the overdose. How many times was naloxone administered and that kind of data and our partnerships with public safety allow us to pull in that data as well as things like supply data so drug seizure data so that we can see where is it coming from. Where is there an influx in a community and that’s incredibly helpful for us to understand how these drugs make their way around the country and we really do kind of see differences in regions. We saw this early on with heroin and we saw it with fentanyl that really kicked off in the northeast. And then we always see things spread west. So, we know more and more about how these things are happening and that allows us to know which sections of the country to work in to maybe find new emerging drugs or to put out public health alerts. Because for example, if we see an increase in the types of drugs seized, public health can alert communities and partners so we can make sure people on the ground have naloxone and fentanyl test strips. Again, those are both key ways we save lives right now when we do see these types of drugs in communities.


           You know fentanyl is very cheap to make. When we were talking about illegally made fentanyl is a synthetic fentanyl that you know you people can make in the labs. The ingredients are very cheap. And I know you know others are working on addressing that economics of the drug supply chain. Really in public health, we are focused on making sure that people know that the illegal drug supply is dangerous. And it may be unknowingly in the drug supply so you may not know what you are taking. One fact that actually stays with me, it keeps me up at night, is that a large portion of drug overdose deaths that occur if they had someone nearby at the time of death and if that person knew that the person they were with was taking a substance or if they had naloxone or how to use it, that could have been a life saved. And I think just honing in on that is incredibly important when we are talking about fentanyl. 


           When I said earlier, it was an everybody problem, that really is true because one thing that we are learning is that there are just different on routes to some of the substance use right now and so we want to meet everyone where they are.


Ed:     Yeah, I think one thing you mentioned to me when we discussed this before we went on air was the notion that people can and they have no idea what they are getting. They could think they are getting Adderall or something of that nature and it could actually have fentanyl in it and that’s a pretty frightening notion. I wonder if you could talk a little bit, you had mentioned Xylazine so called Tranq as well as people mixing stimulants. Can you talk a little bit about that trend and why it is so dangerous.


           TM:  14:08


MP:   I think what is different now and why it’s incredibly dangerous now, it goes back to the complexity of the illegal drug supply, more so even than the increase of people mixing drugs because I do know anecdotally that has occurred for you know for some time, for decades. What we are seeing now is that people don’t actually know what’s in the drug that they are taking and that’s the key difference sometimes people would mix in things to elongate an effect or counterbalance an effect with a stimulant and opioid. For example, fentanyl is very potent, but it has a short time period in which you feel its effects so a very short shelf life. So, anecdotally we heard that xylazine is sometimes mixed in to lengthen the effect of the fentanyl. And again, in this illegal market, it’s hard to determine where the mixing is occurring and at what levels of the supply chain. 


           We have a program called the Overdose Response Strategy where we have our public health analyst working with a drug intelligence officer in every state and they are sharing information and knowledge about kind of the supply chain. And that does allow us to somewhat start to understand where is this mixing occurring, why is it occurring. And that’s been incredibly fruitful for us to know that. But that’s another key reason why public health alerts and having people in the community know what is driving the supply and what substances are emerging is critically important.


           To give you an example of how fast the supply can change, we looked at data in 2023. We were looking at backwards to see you know when did we really start to see increases in xylazine so we looked across a subset of states and saw that the monthly percentage of fentanyl involved deaths with xylazine detected increased 276% from January of 2019 to June of 2022. So that just gives you a sense of what these adulterants are mixed in. We are seeing that they are scaled more rapidly now and we just start it creep into other parts of the country more quickly. You know another thing that’s new, Ed, that I would be remiss not to mention in this landscape is social media which is a platform where you know a lot of things occur on social media platforms. But people can also access drugs in a new market so they can buy drugs on some of these social media platforms. That’s a completely new market right if you are talking about drug supply and economics. And this market is particularly risky to teenagers, young adults and older Americans who may think that they are buying a real prescription but are instead buying a counterfeit pill that has illegal fentanyl in it. So that’s new in the reach of those platforms. It really requires public health to be out there raising awareness around the risk of illegal fentanyl. 


Ed:     Let me ask you for our audience with legislators, legislative staff and other people interested in state policy, how is the CDC working with states. What’s the state role here and I know it’s a significant one in trying to address this situation?


MP:   CDC supports state and local health departments primarily. We fund 49 states and Washington, D.C., through a program called Overdose Data to Action. That’s really how we get the bulk of our federal funding out the door to advance opioid prevention in states. We also have a program that funds 40 local and city health departments, which just kicked off this year as well. And that program allows us to again improve the data that we are getting on fatal and nonfatal overdose, but the key component of it is that states and localities are using that data to then inform where do we need to be. What communities need more linkage to care. What communities don’t have enough naloxone. What communities are schools seeing potential overdoses near their campuses. So, again the point is to use that data for state and local action and that’s our main way that we get federal funding out the door.


Ed:     Both the federal and state governments have tried now as we were discussing for decades to get a handle on this and as we discussed, the death toll remains very high. I’ve got to think a lot of state and local officials are very frustrated by this and how would you address that. What would you tell them?


MP:   First, I would say I hear you. I think a lot about everyone involved in this epidemic. That includes first responders, family members, harm reduction organizations that have been working on the ground for decades, public health, public safety who may be experiencing you know compassion fatigue or dealing with their own tragedies in their own families. I think about people who are abstracting some of this data day after day. Just abstracting data, reading medical examiner/coroner reports and death scene investigations. And I hold compassion for all of us because that is incredibly heavy to take and deal with every day. And when I think about meeting people where they are which is a very important component in drug overdose prevention for me that means everybody. So, I would say one thing to think about at you know the state level is that the beauty of a multi sectoral approach and having public health at the table with all of these other partners what it really means is that someone is there to back you up. We all need a safety net because we all feel tired and frustrated and helpless at times. But if we need to pause to regain our strength or reevaluate a program, we know that someone is going to be there. We know that housing programs will know what to do. We know that schools are equipped with naloxone. They will know what to do. And that kind of approach keeps me optimistic. And the idea that everyone does have a role to play here. So small wins are really big wins when we are talking about preventing a drug overdose. And a lot of it relies on human behavior change and that’s hard no matter what kind of habit you are looking to change or improve and there is no quick fix. And sometimes that is hard for us especially if we are looking you know everyone has time constraints whether it’s a term limit or whether it’s a project funding period. We are all dealing with we want to get the answer now. But I think we are on the road to getting there and if we just work together and we make sure we keep all the doors open for people to get treatment and recovery in the form that works for them that will get us where we need to be. Because a closed door may keep someone from sharing that they are using drugs. It may keep you or me or anyone near someone from saving a life so I always think about it as are the doors open. Are we open to working together and to meeting people where they are.


Ed:     Well, Michelle, let me ask this as we wrap up here. Is there anything else that you would like to share with our audience?


MP:   I would like to thank your listeners, Ed and thank you and NCSL for doing this podcast. A number one, thanks to the listeners for listening because that shows that you have some good curiosity. You are either already playing a role here or you want to play a larger role and we desperately need you on the ground. And I would encourage listeners to reach out to their state or local health departments. State health departments in this case and learn what they are doing and what kind of resources state health departments might need. Sometimes it’s you know a policy change right like good Samaritan laws or access to test strips. Other times, it’s a really broad change like we want to be able to hire people to do some of this work so reach out to them and learn a little bit about their programs. And also, I’ll make sure that we share these links, but look at our fatal and non-fatal drug overdose dashboards. If you scroll through that, you can immediately see some areas where you can start making a difference like having the lock zone or linking people to care and that can be really, really helpful. And lastly and this is probably the most important, I would love for people to reach out to me if they see something working in their state. It doesn’t have to be a large program. It could be a personal interaction that they witnessed. To me, that’s all the same and that’s all-good news that I like to hear so definitely reach out if you have things to share with us here at CDC. And thank you for having me, Ed.


Ed:     Well Michelle, thank you for your optimism and your persistence in dealing with this just incredibly challenging public health crisis and take care.


MP:   Thank you, Ed.


Ed:     I’ll be back right after this with Charlie Severance-Medaris from NCSL to talk about the legislative landscape and how legislators are responding to the drug overdose crisis.


           TM:  23:44


Ed:     Charlie, welcome back to the podcast.


CM:   Yeah. Thanks so much for having me again, Ed.


Ed:     So, Charlie, I was talking earlier on the podcast with Michelle Putnam from the CDC about the overdose prevention efforts that that organization is making and I wanted to turn now to what state legislatures can do and what can states do to try to stop this rise in overdose deaths?


CM:   So, I like to visualize the actions we’ve seen states take by segmenting their approaches into four different buckets. Bucket one is really upstream and that’s taking action to prevent opioid misuse and opioid addiction to begin with. This can look like educating health care providers on safe opioid prescribing or on the benefits of using your state’s prescription drug monitoring program. Essentially that’s a database where prescriptions for narcotics are logged to help identify people who may be at risk of opioid misuse. The second bucket is to treat opioid overdoses which really means increasing access to naloxone, which is the opioid overdose reversal drug. All 50 states, D.C. and Puerto Rico have some sort of naloxone access law either through legislation or through what we call a standing order, which is essentially a community prescription for naloxone. Right now, the challenge states are facing is making sure that naloxone is reaching the people who need it most. Bucket three is sort of increasing access to treatment for opioid use disorder. Specifically increasing access to medication-assisted treatment or MAT. You might also hear this referred to under the acronym MOUD or medications for opioid use disorder. To elaborate a little more on that that is, there are three primary medications associated with MAT:methadone, buprenorphine and naltrexone. Methadone and buprenorphine can help control withdrawal symptoms and cravings for other opioids without causing a euphoric effect or that high. Essentially it can just help patients manage their cravings. Meltrexone, on the other hand, will block the euphoric effects of opioids and alcohol. There is a wealth of evidence demonstrating that MAT can help prevent relapse and facilitate longer periods of abstinence when used with integrated treatment plans that take other health considerations into account. And the final bucket is to support people in various stages of recovering. Think of this as expanding access to recovery housing where people in recovery can live in safe, stable communities that support healthy habits and help them abstain from illicit drug use. This can also be expanding access to what we call the peer support workforce which is essentially people with lived experience so people who are in recovery themselves and peer support specialists can help others in recovery in a number of ways ranging from sort of moral support to acting as health care system navigators to help folks find the right care providers or the right programs that they need for their recovery.


Ed:     So that’s what states can do and I wonder if you can tell us what are the trends?  What are they doing?  What kind of legislative trends are you seeing out there?


CM:   Ed, I think by far the biggest trend we’ve seen in states is trying to increase access to that lifesaving overdose reversal drug naloxone. And I once heard an advocate talk about this in really stark terms. If someone has an overdose that it is fatal, there are no more chances to get that person into recovery, to get them back with their family, to get them back integrated with their community. Right now, with the really terrifying amount of fentanyl that is in everything having access to naloxone is so critical. To be more specific, one trend we are seeing is requiring college campuses and other education settings to carry naloxone. This might not be where we are seeing the most opioid use, but we are seeing fentanyl in things like counterfeit Adderall that students might be taking to try to get an edge in studying. Arkansas, California, Texas are examples of states taking that approach. 


           On the subject of fentanyl specifically, states are also taking action to increase access to fentanyl test strips which is equipment you can use to determine whether or not whatever substance you are about to use contains fentanyl. In many states, these strips are considered drug paraphernalia and are illegal to possess or distribute, but since 2017 we’ve tracked at least 15 states that have exempted fentanyl test strips from their drug paraphernalia laws. Ohio and Missouri being examples from 2023. 


           Both of these are part of a broader approach that states have been taking for the last few years called harm reduction which is essentially an approach to minimizing the harms associated with drug use and helping people to reduce their usage. Most familiar aspect of this approach are probably needle exchanges or syringe service programs where people can access sterile equipment. These programs have a lot of evidence to support their effectiveness at reducing transmission of bloodborne diseases as well as being access points for MAT and other recover services. Speaking of MAT, states are really taking a look at their laws that relate to access for MAT. For many states, that has meant examining their telehealth laws and allowing providers to make MAT prescriptions remotely or allowing for more take home doses so patients don’t have to visit a clinic every day to get their medicine.


           States are also examining what we call parody laws essentially making sure that insurers are providing equal access to therapy and MAT as they would for physical health services. Of course, right now, states are in the initial stages of spending down the money that has been allocated through these opioid settlements with opioid manufacturers, opioid distributors. We could probably have a whole other podcast just on that subject. But for now, just know that if your state participated in the national settlement which most states did, you have a state plan to spend that money and usually about 15 to 20% of that money is being allocated directly by state legislatures. 


Ed:     So, we’ve seen what you’ve just explained is there are a number of approaches. Are some of them more successful than others or is this more of there’s no silver bullet. It’s sort of an amalgam of approaches that are chipping away at the problem?


           TM:  29:56


CM:   Yeah, so this is tough to answer because nationally we just keep seeing these overdose numbers go up. That said some states saw decreases in their overdose deaths last year. Notably South Dakota’s overdose death declined by 17%. A diverse range of states from Florida, Colorado, West Virginia, Alaska I think a total of 23 states saw decreases. In certain states, programs have reported successes. For instance, a program backed by funding from Colorado’s legislature has expanded MAT’s access to more than 4,000 people in most rural parts of the state. A state backed program in Rhode Island called Anger ED has been connecting overdose survivors to peer support specialists while they are in the emergency department. They report over 80% of more than 1400 survivors voluntarily chose to discuss treatment options with a recovery specialist. Kentucky service programs have demonstrated consistent and significant reductions in bloodborne infections like viral hepatitis and HIV. So, I think the takeaway here is that we have programs in place and we have evidence that they do work. The challenge states are facing is to scale these programs and adapt what might be working in other states to the unique needs of their communities and certainly to fill their role as being the labs of democracy and really innovate on some of the challenges we are seeing in regards to fentanyl. 


Ed:     Well as we wrap up, Charlie, one question I’ve had has to do with over the long course of this so-called war on drugs that we’ve been engaged in for many decades we’ve kind of gone back and forth between punitive measures and what you had referred to earlier as harm reduction solutions and I wonder if you could just kind of explain for listeners without getting into a lot of detail just what those basic approaches are.


CM:   This is definitely something that every community is grappling with right now. I think there is sort of a burgeoning consensus that law enforcement, the criminal justice system cannot fix this problem on its own, but also that the harm reduction approach is falling short. There is a really tough balancing act that states and local governments are having to do right now where for instance we know that syringe service programs can help get people into treatment and approve other health outcomes, but we need to be responsive to communities who are concerned about the impact of opening these services basically next door. Where I certainly think we are seeing a lot of bipartisan work is in leveraging law enforcement and the criminal justice system broadly as partners in public health approaches and partners in getting people who need care for a substance abuse disorder into treatment. One really exciting development from the last 12 months or so is that the Centers for Medicare and Medicaid services, CMS for short, which is the federal agency that oversees state Medicaid programs, greenlit first of their kind plans to provide MAT treatment through Medicaid for people in carceral settings in California and Washington. There are I believe 15 other states who are awaiting approval for similar programs. 


           There are a disproportionate number of people with SUDs who are currently incarcerated and so giving these folks treatment is a big deal. State legislatures obviously have a hand in this approval process and are also supporting programs to make sure that on release there’s a continuity of care for these folks so they are being released from a setting where they are receiving MAT and they are being released into another environment where they can still get that care and that they have access to things like naloxone. So, there has kind of been this push/pull relationship between law enforcement and public health or these competing narratives about what the best approach is, but we are seeing some consensus on a bipartisan basis that these two state systems can achieve a lot more as partners than they can as adversaries.


Ed:     Yeah, I think that was also the message from the CDC that if there was a lesson learned over the last decades that working together rather than at odds is probably going to be more productive. Well Charlie, thanks so much for walking through this legislative landscape and I appreciate your time. Take care.


CM:   Absolutely. Thanks, Ed. 


Ed:     I’ve been talking with Michelle Putnam from the CDC’s division of Overdose Prevention and Charlie Severance-Medaris with NCSL about the drug overdose crisis in the U.S. and state and federal efforts to combat. Thanks for listening.


You can check out all the podcasts from the National Conference of State Legislatures by searching for NCSL podcasts wherever you get your podcasts. This podcast “Our American States” dives into some of the most challenging public policy issues facing legislators. On “Across the Aisle” host Kelley Griffin tells stories of bipartisanship. Also check out our special series “Building Democracy” on the history of legislatures.