Every now and then, the newsroom at The New York Times drops an amazingly detailed article about drug addiction in America. This time, the paper of record has focused on Baltimore, Maryland. In conjunction with The Baltimore Banner and the Stanford Computational Journalism Lab, the Times looked at every single drug overdose death in the city for two generations.

Some of the disturbing statistics unearthed by the journalists include:

• One-third of the city blocks that make up Baltimore have been the scene of a fatal drug overdose.

• From 2018 to 2024, more than 6,000 individuals — 1,000 a year, three every day — died from fatal drug overdoses in Baltimore.

• From 2018 to 2022, Baltimore had a fatality rate from drug overdoses nearly double that of any other major U.S. city.

• Baltimore’s overdose fatality rate is higher than Appalachia’s during the prescription pill crisis, higher than the Midwest’s during the meth lab crisis, and higher than New York City’s during the crack epidemic.

• Baltimore’s fatal overdose rate quadrupled from 2013 to 2020, from 40 deaths per 100,000 population to more than 180.

• Three times as many people die in Baltimore each year from drug overdose vs. homicide.

• Despite the perception that addiction is a young person’s disease, the journalists report that the highest death rates were Black men aged 50-70 years. 

The journalists confronted public officials with their findings, and the result was shock, outrage, and disbelief. The system for tallying drug overdose deaths was opaque even to the head of Maryland’s health department. The Baltimore Banner had to take the state’s Office of the Chief Medical Examiner to court to get data on causes of death which most jurisdictions disclose routinely.

Baltimore’s overdose fatality rate has always been higher than the national rate, hovering at about 40 deaths per 100,000 population for 20 years from 1993 to 2013, while the national rate slowly rose from less than five to 15 deaths per 100,000. Then, in 2013, fentanyl and synthetic opioids such as xylazine sent Baltimore’s fatality rate skyrocketing much faster than any other major metropolitan area. Why Baltimore?

Back in 1994, Baltimore was the first major city to start a legal syringe exchange. After a 2006 statewide effort to distribute buprenorphine (Naloxone), drug overdose deaths decreased. Then came a flood of oxycodone, which trickled down to the streets from legal prescriptions. When the oxycodone spigot was turned off, many addicted people went underground to buy drugs such as fentanyl. The Times journalists report:

Frequent drug users describe being high on fentanyl as a carefree, sometimes euphoric stupor, followed by a painful withdrawal — nausea, anxiety, sweat and flu-like symptoms — that drives them to use again.

Baltimore pursued a policy of driving down drug deaths until Catherine Pugh became mayor and the spread of community treatment centers stopped. She was replaced by Brandon Scott in 2020, and he focused Baltimore’s resources on driving down the city’s very high homicide rate. Since then, the number of Medicaid patients getting buprenorphine has declined, the number of overdose revivals has dropped, and the number of deaths has ballooned.

The efforts Baltimore is now making to reduce its overdose deaths include:

• A special “Narcan crew” EMS time that rushes to the scene when an overdose is called in. They revive thousands of people every year.

• Johns Hopkins Medical Center runs a mobile medical clinic from a van in collaboration with the city.

• Emergency rooms offer connection to care and resources, but there is no requirement to enter a treatment program and little followup.

Many communities struggle with these problems and some have found solutions that work better than others. One is harm reduction, a policy of pursuing non-law-enforcement strategies for treating overdose victims. Portland, Oregon, and San Francisco, California, have scaled back their harm reduction programs after bringing the scourge of addiction out into the open.

Contingency management, the practice of offering rewards to addicts for entering treatment programs and meeting recovery goals, is something that works, as does community reinforcement, which enlists support from family members or friends. There’s no excuse for not knowing what works when you stay tuned to AddictionNews.

Written by Steve O’Keefe. First published May 30, 2024.

Sources:

“Almost 6,000 Dead in 6 Years: How Baltimore Became the U.S. Overdose Capital,” The New York Times, May 23, 2024.

“Almost 6,000 dead in 6 years: How Baltimore became the U.S. overdose capital,” The Baltimore Banner, May 23, 2024.

Image Copyright: Nick Youngson, used under CC BY-SA 3.0 courtesy Pix4free.