D.C. opioid deaths surge past 500 in worst year on record

The overwhelming majority of overdose victims were older Black men, according to the medical examiner. Since 2017, more than 8 in 10 deaths due to opioid use were among Black residents, city data shows.

The increase is in keeping with trends in other large metropolitan areas around the country, where African Americans are succumbing to powerful synthetic opioids in disproportionate numbers as deaths of White users in rural areas level off, experts say.

Despite an infusion of tens of millions of federal dollars annually, observers say the District’s strategy of paying nonprofits and community groups to engage users and distribute fentanyl test strips and the overdose antidote naloxone is not making a dent in the crisis.

“The numbers speak the loudest truth, and our numbers are still going up,” said Beverlyn Settles-Reaves, a program manager who arranges treatment for patients with substance use disorder at Howard University. “This situation is spiraling out of control.”

Experts say overdose rates continue to rise nationally because of barriers to accessing medication-assisted treatment, such as buprenorphine; social barriers such as unstable housing; inadequate infrastructure to distribute resources; and the stigma facing users.

Compared with states, the District had the fourth-highest opioid overdose death rate behind West Virginia, Delaware and Maine, 2022 provisional data from the Centers for Disease Control and Prevention shows, while Maryland ranked 12th and Virginia 29th. Only West Virginia outpaced the District in the rate of fatal overdoses from all drugs, the data shows.

But experts warn that comparing D.C. with states can be misleading because the capital city is entirely urban, lacking a state’s mix of urban, suburban and rural areas.

“D.C. sadly seeing an increase doesn’t make it an outlier compared to other urban areas in this part of the country,” said Sheila P. Vakharia, deputy director of research and academic engagement at the Drug Policy Alliance and author of “The Harm Reduction Gap.”

Locally, opioid overdoses have claimed more lives than homicides, but other cities in the region are grappling with even higher rates of drug overdoses. The District ranks 10th among 66 large metropolitan counties with the highest drug overdose death rates, according to an analysis by the research nonprofit KFF of provisional CDC data from 2022, the most recent year from which national data is available.

Baltimore had the highest fatal overdose rate, followed by Richmond in the fourth position, ahead of Philadelphia, Nashville and Louisville. (The analysis omitted Alexandria because of insufficient data.)

Data is not available at the county level for opioid deaths specifically, but opioids drove drug-related deaths, accounting for three-quarters of such fatalities in the District and nationally, said Heather Saunders, a health policy expert at KFF.

The District has struggled with opioid overdoses for years, yet as tens of millions of federal dollars have rolled in, the death rate has continued to rise. Advocates and victims’ loved ones are frustrated with the pace of change, asking why leaders have not studied current programs for results.

Barbara J. Bazron, director of the D.C. Department of Behavioral Health, the lead agency combating opioids, said the city is doubling down on strategies that have been in place for several years, noting that the District has been a leader in free distribution of naloxone.

The District and community groups have distributed 300,000 doses of naloxone, also known by the brand name Narcan, and expect to give out 50,000 more this year, in part to those who text the number 888-811 seeking free cartridges, Bazron said. But she acknowledged that naloxone has limitations.

“Naloxone is no good if you’re using alone, and we know more people are overdosing in their own homes or homes of family or friends,” Bazron said.

The city’s first stabilization and sobering center opened last year but has mostly catered to alcohol users. Of the 1,340 patients the D.C. Fire and EMS Department has transported to the center since it opened five months ago, about half had primarily used alcohol; 13 percent had used drugs other than opioids; and about 10 percent were experiencing an opioid overdose or withdrawal, a Department of Behavioral Health spokeswoman said, citing fire department data.

The District formed a panel, the Opioid Abatement Advisory Commission, to recommend how government agencies should channel approximately $80 million from multistate opioid settlements into solutions to the crisis. Of the $23 million the attorney general’s office said the city has received so far, the Department of Behavioral Health has earmarked grants of up to $500,000 to expand existing programs, such as naloxone distribution, and pilot a new program through the fire department.

The agency received a grant to initiate buprenorphine, a medication used to opioid use disorder, in the field, joining a handful of cites that have similar programs, in hopes of keeping users in treatment longer.

Chad Jackson, chairman of the advisory commission, said the city’s latest plan, known as Live.Long.DC. 3.0, continues to give money to community groups without a comprehensive strategy for how to use health, behavioral health and housing resources to make change.

“We have a siloed approach in Washington, D.C., where individual groups receive money and do their particular job really well,” he said. “The problem is there’s no … way to move from one silo to another, so everything falls out of the system.”

Settles-Reaves of Howard, who also sits on the commission, said it’s difficult to hold a fragmented system accountable.

“We cannot let this keep happening,” she said. “This is a public crisis. People are dying in the street. People are seeing their family and friends die of this.”