In the pandemic's shadow, the opioid overdose epidemic in Washington rages on
Opioid deaths rose by 46 per cent in Washington, D.C., in 2020, with most deaths among older Black men
Terrence Cooper nodded his head to people walking by on the sidewalk next to a beige Winnebago parked in the Benning Heights neighbourhood of Washington, D.C.
"Hey, how's it going?" he asked.
Occasionally, he popped into the side door of the RV, returning with a small box of clean syringes, a container of food or a pre-made safe injection kit in a brown bag for one of those passing by.
His job: to keep people alive in this northeast Washington neighbourhood where drug use is prevalent — something that's been a challenge over the past year.
"People were using drugs even more in the pandemic — and we had a lot of overdoses," said Cooper. "So we were passing out more Narcan if anything, and got a lot of new clients."
While daily new COVID-19 cases are now averaging in the single digits in Washington and more than 50 per cent of residents are fully vaccinated, the opioid crisis is showing no sign of letting up, making services like these increasingly vital.
The mobile clinic is run by Washington's Family and Medical Counselling Services Inc., which has clinics in D.C. and Maryland.
The RV offers needle exchange services — where clients can exchange used needles for sterile ones — and outreach for those looking for help managing their addiction or information about treatment. Cooper and his colleague Tyrone Pinkney drive from neighbourhood to neighbourhood daily.
"There's a lot of people out here talking that they want help, but they don't know how to get to the help — so that's where we come in," said Cooper.
Data from the D.C. medical examiner's office shows opioid overdose deaths rose by 46 per cent from 2019 to 2020. Of the 411 deaths last year, 351 were in the Black community. The majority of those were men aged 50 to 69.
In neighbouring Maryland, health officials noted a similar trend: while overdose deaths in the white community plateaued, they continued to increase in the Black community.
Experts say the increasing prevalence of fentanyl and a lack of accessible and affordable treatment options in communities of colour and culturally appropriate care for Black communities could explain the disparities.
"This is an active issue within the Black community. And if we don't do something about it, then more people are going to unnecessarily die," said Dr. Aliya Jones, deputy secretary for the behavioural health in Maryland's Department of Health.
'Giving you something positive'
One of the clinic's regular clients goes by the name Melo (he would only share his first name). He comes by for a meal and sterile tools.
"I just turned 64 on the 18th of this month and I've been using since I was 12," said Melo, who uses heroin but not intravenously.
"They will try to help you if you want to stop using. They give you an opportunity not to use by giving you something positive."
Long before COVID-19, the opioid crisis was raging on the streets of D.C, with the rise of fentanyl in 2017, and the number of deaths increasing between 2018 and 2019.
Last year "was the advent of something that we had never seen before," said Mark Robinson, regional syringe service program co-ordinator for Family and Medical Counselling Services Inc.
"It was a pandemic that layered itself on top of an opioid epidemic that was already prevalent within many of our communities. It highlighted a level of desperation that was already brewing beneath the surface."
Robinson said his team was forced to pivot in the approaches to outreach to follow COVID safety protocols — not just for their own safety but also for the safety of clients.
"We now have to keep ourselves safe because we're dealing with a high-risk population that has a tremendous amount of vulnerabilities and other comorbidities that would put them directly in harm's way," said Robinson.
Much of Robinson's job is being a regular presence — and getting to those who want to get help at the right time.
"The window [of time] is often very small," he said. "And it closes very rapidly because of the desperation — because of the trauma. Because of the pain. Because of the mental health status of a lot of people."
Task force launched
Some of the patterns in D.C. are mirrored in neighbouring Maryland, where the state has launched a task force that looks specifically at why the opioid crisis has disproportionately affected the Black community.
"When we looked more closely at the numbers, we saw that there was a plateauing, if anything, in the white community, but a significant escalation in opiate overdose deaths in the Black community," said Jones, who co-chairs a task force with the Maryland Department of Health.
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The task force is trying to understand why the Black community is disproportionately impacted when the state is predominantly white.
"There are challenges with regards to awareness about treatment options and having access to treatment in the Black community," said Jones.
"There's the stigma that we continue to deal with in the Black community around having substance use disorders … because of the historical war on drugs and the consequences that that has had and how Black people interact with the treatment environments."
Racial disparities in treatment
Barbara Andraka-Christou has studied racial and ethnic disparities in the U.S. in the use of opioid use disorder treatments such as methadone and buprenorphine (the active ingredient in suboxone) and identified several barriers in a recent journal paper — including accessibility.
"We know that buprenorphine providers tend to accept commercial insurance and not so much Medicaid. People of colour in the U.S. are more likely to have Medicaid if they are people with opioid-use disorder," said Andraka-Christou, an assistant professor in the department of health management and informatics at the University of Central Florida.
Andraka-Christou said that buprenorphine is often viewed as easier to access, in that it can be prescribed and taken at home, versus methadone, which requires an individual to physically go to a clinic and take their dose. However, she said there are fewer clinics offering buprenorphine in communities of colour. And there are historical stigmas with use of methadone.
"It's very stigmatized. It's very visible," said Andraka-Christou
"You might be waiting outside in line with the whole community seeing you as opposed to buprenorphine, which tends to be provided on a monthly basis with someone picking it up from their community pharmacy. "
Andraka-Christou is calling for the expansion of Medicaid to cover opioid use disorder drugs, and government grants and incentives for more clinics in communities of colour to offer opioid-use disorder treatments like buprenorphine.
In April, U.S. President Joe Biden released new federal guidelines that will make it easier for doctors to be able to prescribe buprenorphine.
Work 'in the trenches'
In the meantime, those fighting the crisis on the front lines say they'll continue their work building connections in communities. Much of their job, according to Robinson, is empathy and not being afraid to be close to the problem.
"The purpose is to help save a life. And you know sometimes people don't believe their lives are worth saving," said Robinson.
"The process is to engage folks in an effort to build those relationships with people right there in the trenches on the front lines."
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