For those struggling with drug abuse, Baltimore is the deadliest city in America.
In fact, it surpasses every other city in the nation for its overdose death rate by a long shot, according to an analysis by the San Francisco Chronicle. The newspaper cites data covering the 12-month period ending in June 2023, when Baltimore saw 183.2 deaths per 100,000 people.
About 87% of the deaths were attributed to fentanyl, a synthetic opioid significantly more potent than heroin. But that’s not the only factor driving a surge in fatalities.
“There has been an increase in demand for street drugs in recent years due to the COVID pandemic’s impact on access to treatment, social isolation, and the increased cost of living,” said Jennifer Martin, deputy director for Baltimore City Health Department’s Division of Population Health and Disease Prevention.
The pandemic created a myriad of challenges for Americans. People lost work, crimes such as domestic violence increased and isolation exacerbated mental health conditions.
In addition, housing costs went up, and access to social services decreased. As COVID-related aid expired, some were forced into homelessness.
All of these challenges dealing with what experts call social determinants of health have repeatedly been proven to increase fatal overdose rates.
The Chronicle’s list ranking overdose death rates is composed of counties and independent cities with 500,000 or more people. Behind Baltimore, Philadelphia had the second-highest fatal overdose rate, with 90 deaths per 100,000 people.
The newspaper also compared all jurisdictions that saw at least 10 overdose deaths. In that list, Baltimore fell only behind McDowell County, West Virginia, a small area of just more than 18,000 people that reported 207.3 deaths per 100,000 people.
The data used by the newspaper isn’t, however, the most recent that’s available — at least concerning Baltimore. Since that data was published, Baltimore saw a modest decrease in its overdose death rate.
Baltimore had 174.1 deaths per 100,000 people in the 12-month period ending September 2023, according to an analysis by The Long Haul using data from Maryland’s Office of Overdose Response.
With 1,020 total deaths during that period, the number marked a 5.6% increase over the year prior. The city’s death toll comprises about half of all overdose fatalities in Maryland, but it accounts for only 9.5% of its population.
For many, opioid addiction began with opioids that were once prescribed by a doctor for pain relief, Martin said.
As they became too costly, though, a significant number of people eventually opted for cheaper — and stronger — drugs such as heroin, studies have shown.
Enter fentanyl, which is generally considered to have cemented its role in the overdose crisis in 2013. The powerful drug, often sold in gel capsules for just a few dollars, prompted the most significant spike in overdose deaths around 2020.
The flow of fentanyl into the U.S. increased and more countries began trafficking it around that same time, the U.S. Drug Enforcement Administration noted in a report titled “Fentanyl Flow to the United States.”
Paired with the devastating impact of the pandemic, the increased fentanyl supply led the death rate to swell. With resources already strained, the stigma surrounding addiction further hindered efforts to help those in need.
In a vacuum, all of these variables create an environment that fosters drug abuse. But they also may be compounded by Baltimore’s lengthy history of racial inequality, said Emily Keller, special secretary of the Maryland Office of Overdose Response.
“I don’t think that Baltimore got over it,” Keller said. “They put certain populations in certain places in the city. And now the government is having to undo 100 years of disparities. I do think they’re making great strides.”
Baltimore to this day is reckoning with its history of segregation and redlining, which began in the 1930s. Both have created conditions that increase the likelihood of drug abuse among disadvantaged populations.
Through acts such as redlining, Black Baltimoreans were denied services available to the white population. This not only prevented them from obtaining loans and finding housing, but it also led to poor health outcomes.
To this day, the effects of those policies still linger — and the number of consequences are seemingly endless.
The most recent data from the city health department shows that, between 1999 and 2021, Black males aged 45 years and older accounted for a majority of overdose deaths.
The Chronicle’s data, however, shows that the demographics may have shifted in more recent years.
In the 12-month period ending June 2023, white individuals had a slightly higher death rate than Black individuals, with 201 per 100,000 compared to 192.9 per 100,000, respectively.
Even so, concentrations of overdose deaths in Baltimore have been found largely in impoverished, majority-Black neighborhoods located in what’s known as the “Black Butterfly.”
“Based on EMS data related to nonfatal overdose calls BCHD obtains through a data use agreement, we know that we see clusters of nonfatal overdoses routinely in the Penn North/Reservoir Hill, Upton/Druid Heights, Sandtown-Winchester, and Southwest Baltimore neighborhoods,” Martin said.
Addressing these inequalities takes money — and lots of it. Both city and state officials have agreed that funding remains one of the largest roadblocks in solving the overdose crisis.
“I think the roadblock is always money,” Keller said. “While there have been significant increases in access to funding and significant increases that Gov. Moore has put into place, is there ever enough? Can you put a price on a human life?”
With all of this being said, the data and history of how Baltimore became the epicenter of the country’s overdose crisis may portray a grim picture.
Baltimore is “easy to point to” when looking for evidence of the overdose crisis, and the numbers accurately portray just that, Keller said.
However, those statistics tend to overshadow the work being done at the state and local level, which have focused on harm reduction, she added.
At least due in part to these efforts, the state as a whole has made progress in saving lives. That’s particularly true between mid-2021 and late 2022, when the state saw a notable decrease in its death rate.
The most recent data also shows that a majority of counties in Maryland saw a decrease in overdose deaths.
In total, there were 2,053 overdose deaths in Maryland in the year-long period ending in September 2023, with 81% of those being fentanyl-related.
Meanwhile, state and city officials haven’t rested on their laurels.
Gov. Wes Moore last month unveiled a proposed budget with a record-high $1.4 billion in state aid for mental health and substance abuse services. He also created the Office of Overdose Response in December to collaborate with agencies throughout the state to address the overdose crisis.
Most recently, the governor has been traveling the state to tout the ENOUGH Act which, if passed, would provide millions of dollars for communities that can demonstrate they have viable pathways to combat poverty.
Mayor Brandon Scott said in a statement that such legislation could be a game changer in Baltimore, where about one in five residents live in poverty.
“We know that, while (addiction) can impact people of any socioeconomic background, addiction often disproportionately impacts communities that have been historically disinvested in,” Scott said. “We will continue our work in this area to address addiction as a public health issue, and hopefully soon will have the added support of the ENOUGH Act to help.”
There are other reasons to be hopeful, officials say.
For example, Scott last month signed legislation to create more affordable housing. Baltimore has also implemented harm reduction strategies such as needle exchange programs, vaccine clinics and naloxone training.
Test strips for fentanyl and xylazine, a tranquilizer that’s resistant to naloxone and often mixed with the synthetic opioid, are provided by the city.
In addition, the city has increased access to buprenorphine treatment, opened stabilization centers and created a peer support program at local libraries to connect addicts with resources.
“I think there’s a lot to be hopeful for,” Keller said. “Obviously, the numbers have been devastating to all of us. And I know Baltimore has really struggled. But the pieces are starting to come together.”
For those interested in addiction resources and treatment options, visit the Baltimore City Health Department website here.
Comments