Used needles sit in a container inside the Baltimore City Health Department's Needle Exchange Team van in Baltimore.
In 2020, fatal opioid overdoses in the D.C. area surged dramatically — in some cases, to the highest levels ever recorded.
Based on the most recently available data, 2021 is set to be an even deadlier year for much of the region — a trend that experts attribute to a myriad of factors, including pandemic-induced isolation, the omnipresence of the powerful synthetic opioid fentanyl, and a lack of addiction support resources.
"Overdoses are occurring in dwellings and they are occurring alone....and now, there are reports of even stronger fentanyl that is out there," says Ambrose Lane Jr., the founder of Health Alliance Network, a D.C.-based health equity group. "There's contributing factors as well — there's really not a sound robust effort of outreach to get people into treatment."
By the end of August 2021, the most recent month for which data is available, D.C. recorded 288 fatal opioid overdoses — one more than the number of deaths recorded at the end of August 2020. In Virginia, drug-related fatal overdoses in the first half of 2021 were 22% higher than the first half of 2020 — which was the commonwealth's deadliest year for fatal drug overdoses. A report from the state's medical examiner projects that about 2,600 Virginians will die of a fatal overdose in 2021, a 13% increase from 2020.
Maryland is on track to surpass last year's record as well, although only by about 1% currently, according to the most recent statewide data. Montgomery County is recording a roughly 11% increase from last year. But in Prince George's County, overdose deaths have actually gone down by around 14% in the first two quarters of 2021.
The trends mirror those of the nation; from April 2020 to April 2021, more than 100,000 people died of drug overdoses, a 30% increase from the previous year. Many experts have attributed the spike in overdoses, at least in part, to the stress and isolation of the pandemic: stay-at-home orders cut off access to vital in-person recovery treatment, unemployment rates soared, and social distancing or travel restrictions may have separated people from their support systems.
While 2021 has been less isolated for many people, the fallout from last year's lockdowns is continuing to affect opioid usage and overdose rates, says Emily Bentley, Alexandria's opioid response coordinator.
"If a person's use increased, or they began using a year ago, when the stress of the pandemic was at its worst, that physical dependence on opioids, it doesn't stop just because a pandemic is wrapping up," she says. "Even with the return of some of [their] support system, somebody's use may have increased so dramatically in the time that they were home that they now face a much larger problem on the other end."
As of Dec. 1, Alexandria has recorded 13 fatal overdoses over the course of 2021, with seven still under investigation by the medical examiner. That means the jurisdiction could record as many as 20 fatal opioid overdoses this year, up from 11 in 2020, according to Bentley.
The impacts of the pandemic coupled with a continuing boom of fentanyl created "the perfect storm," according to Lane, whose organization runs an opioid crisis solutions working group. Out of the 288 fatal overdoses recorded in D.C. through Aug. 2021, 94% have been related to fentanyl – a powerful synthetic opioid that's between 50 to 100 times stronger than morphine.
"There's a real crisis," says Lane. "The number of opioid deaths is pretty much double the homicide rate, and the homicide rate is the highest it's been since 2003."
Due to its cheap production cost and high potency, fentanyl is being added or mixed into almost every purchasable drug, according to Bentley, including non-opioids like cocaine or PCP.
"We are now sort of fighting this new crisis of fentanyl related overdoses for people who never intended to ingest an opioid," she says. "The nature of this crisis has really shifted over the last 10 years. All people in all communities are 100% at risk for being in contact with an opioid problem."
But demographic data show who is — and has been — most impacted by the opioid overdoses in the region, even before it was labeled an "epidemic." As national discussions regarding the crisis in the past decade primarily centered on white Americans in rural and suburban towns, Black residents in urban areas died of opioid fatalities at higher rates. Over the past six years, Black D.C. residents made up around 84% of all opioid fatalities, according to the D.C. medical examiner's office.
Dr. Edwin Chapman, a D.C. physician, treats about 240 patients with substance use disorders every month at his office in Northeast — a majority of them Black men over the age of 50.
For Chapman and his patients, he says the opioid epidemic has always been "a little different" than the one that's led to lawsuits against large pharmaceutical companies, condemned for pushing the highly addictive opioids onto patients trying to manage physical pain. Unlike users who first were introduced to opioids through a prescription, Chapman says many of his patients are decades-long users.
"So many of our patients were introduced to whatever drugs they were using, not because they got it from the doctor's office, [but because] they were self medicating oppression and depression related to underlying racism," Chapman says. "Addiction in the African American community, whether it was opioids, or cocaine, or marijuana, or PCP, was always viewed as a moral problem....we had to make the community and our patients understand that they were not dealing with a moral problem, they were dealing with a social-economic problem that resulted in their addiction."
The ubiquity of fentanyl has also had heightened impacts on patients like those Chapman sees.
"Patients who had been stable on, let's say, their usual heroin supply, suddenly, were being exposed to these more potent additives that they were not aware existed in the drugs," he says.
Solutions and strapped resources
In 2018, a Washington Post investigation revealed that D.C.'s response to a then-surging numbers of overdoses had failed disastrously — millions of grant dollars were going unused, and D.C. agencies failed to implement life-saving measures even as they were adopted by other large cities.
In response, D.C. Mayor Muriel Bowser announced a plan to cut fatal opioid overdoses in half by 2020. The program, LIVE LONG D.C., laid out several strategies towards reducing drug overdoses – like improving prevention measures, bringing more education programs into schools, and increasing the availability of naloxone, or Narcan, a medication that reverses the effects of an overdose.
According to the city, from October 2020 through July 2021, 40,057 naloxone kits have been distributed compared to 31,917 kits in the previous reporting period. On International Overdose Awareness Day this past August, Bowser's administration touted its expansion of naloxone supply and opioid use disorder treatment facilities as steps to improvement — but Lane says it's not enough.
"They're spending lots of money...and we've even gone over the budget for LIVE LONG D.C., and we're wondering 'Where the hell is this money going?'" he says. "They're putting up ads in Metro, but that's not outreach."
He says the city needs more 24-hour treatment and sobering centers in wards 7 and 8, where residents can receive safe, low-barrier care and avoid interactions with police. He also says the city could hire and pay more peer support specialists, individuals who help residents currently receiving treatment from D.C.'s Department of Behavioral Health.
"We need something east of the river, where the problem is," he says.
Across the region, fentanyl test strips have become a highly sought after mitigation measure for overdoses. A user can test whatever drug they have before taking it to identify any traces of fentanyl. In August, Arlington County began distributing test strips through a pilot program, and ran out in a week. The county also began giving people released from incarceration free fentanyl test strips. (Alexandria does this as well.)
Bentley says that the test strips, while they may not always stop someone from using a drug, have been shown to alter their behavior in using. For example, they may only use it around others, or if they have Narcan available.
"We can only really help people in recovery if they're still alive," she says. "A large part of our work is just getting people to the front door. And if that means that we have to provide tools to keep them safe until they can get there, then that's where a large part of focus regionally is."
According to Dr. Chapman, who has navigated treating his patients throughout the coinciding health crises of opioid-use disorder and the coronavirus pandemic, solving the epidemic expands far beyond substance-use treatment, to improving healthcare access, affordable housing, job opportunities, and support for residents exiting incarceration.
"Hopefully the pandemic has leveled the playing field, so that we are able to see individuals as human beings rather than prejudging them and putting them in categories and pushing them aside," Chapman says. "Every time we lose a patient, we're losing a parent, a brother, a sister. And each one of these patients has a ripple effect on the community and impacts us all."
This story is from DCist.com, the local news website of WAMU.