Young black men in cities across America died of drug overdoses at high rates in the 1980s and 1990s. During the recent fentanyl crisis, older black men in many cities have died at unusually high rates.
They are all from the same generation.
An examination of millions of death records — a collaboration between The New York Times, The Baltimore Banner, Big Local News and nine newsrooms across the country — reveals the extent to which drug overdose deaths have affected a group of black men in dozens of cities across America at almost every stage of their adult lives.
In recent years, the opioid epidemic has brought dangerous drugs to every corner of the country, and overdoses have increased among younger, whiter and more rural populations.
The huge wave is now showing to ebb out — but not for this group of black men. In the 10 cities surveyed in this partnership, including Baltimore, Chicago, San Francisco, Newark, Washington, Milwaukee and Philadelphia, black men ages 54 to 73 have died of overdoses at more than four times the rate of men of other races .
“They were resilient enough to live through a bunch of other epidemics — HIV, crack, COVID, multidrug-resistant tuberculosis — only to be killed by fentanyl,” said Tracie M. Gardnerthe executive director of the National Black Harm Reduction Network and a former New York State health official.
Overall, the analysis identified dozens of cities, mostly in the Northeast and Midwest, where a generation of black men were at higher risk of lifetime overdose deaths. In many of these places, cities have done little to allocate resources to this population.
The details vary from city to city.
- In Chicago, there is no focused effort in nearly $1.3 billion in state opioid settlement money to help older black men, despite a high death rate for this group, The Chicago Sun-Times found.
- In Pittsburgh, black men in prison with opioid use disorders have been less likely to receive medication to combat their addiction than white men, a PublicSource investigation has found, even as local officials work to close the gap.
- In San Francisco, many of the men who overdose are using both opioids and cocaine, a combination that can make treating their addiction more complex, according to an analysis of mortality data by San Francisco Standard.
- In Newark, NJ.com/The Star-Ledger also found that overdose victims used both opioids and cocaine.
- In Baltimore, hundreds of men have died in nursing homes, The Baltimore banner was found.
- In Philadelphia, older black men were actually less likely to die than their white peers — until recently. Since 2018, their mortality has increased, according to a Philadelphia Inquirer analysis.
- In Washington DC, local regulations and insurance companies have prevented doctors from giving long-term opioid users effective doses of drugs meant to curb their cravings. The 51st found.
“Dead for Decades”
Black men of this generation, born from 1951 to 1970, came of age at a time of great economic disparity between black and white people in their cities. Some of them served in Vietnam, where they were first exposed to heroin. In cities where heroin was available, others started using the drug closer to home in the 1970s and 80s and became addicted.
Many have continued to use drugs on and off for decades. Although some managed their addiction safely, the risk of overdose was always there.
Mark Robinson, 66, grew up in Washington, DC, and now runs a syringe exchange program in the city. He estimates he knows 50 people who have died of overdoses over the years, including one of his best friends.
“Black men didn’t just start dying,” he said. “We’ve been dying for decades as a direct result of opioid use disorder.”
The cities with this pattern of drug deaths tend to be places with large black populations, intense residential segregation and heroin markets that were active in the 1970s, when the oldest of these men were young and first exposed to illegal drugs, according to Dr. Dan Ciccarone, professor of family and community medicine at the University of California, San Francisco.
“Heroin has become an endemic problem,” he said. “It never went away.”
In addition to the risk of overdose, men of this generation lived through convulsions in public health and criminal justice issues. In the 1980s, some were exposed to HIV through injecting drugs. In the 1990s, more aggressive penalties for drug offenses meant that many of them spent time in prisons or jails.
Several public health researchers said widespread incarceration may have reduced these men’s chances of staying clean. “You basically disarm them from having a good life,” said Ricky Bluthenthal, a professor of public health at the University of Southern California, who has studied injection drug users for decades. “They lose girlfriends, they lose houses, they lose touch with their children.”
They have lived through the social upheavals of covid, a period of isolation that coincided with an increase in the overdose for almost all groups.
They will also benefit from the recent embrace of more medical approaches to drug addiction. Drugs that can reverse an overdose are widely distributed in many cities now. And more doctors are willing to prescribe drugs that can curb drug cravings for people who want to quit.
But in many of the cities where older black men die at high rates, these innovations may not reach this group.
Decades of drug use, criminal risks and stigma have made some hesitant to discuss their addiction. Philadelphia Councilwoman Kendra Brooks said she recently learned of nine overdoses among elderly black residents in her neighborhood. The overdoses had happened quietly, in private homes.
“In this generation, you don’t get high in public,” Brooks said. “It is something very private and personal. Among people I know, it’s like a secret disease.”
Older black drug users have been less likely than whites to receive prescription drugs that are now the gold standard for addiction treatment.
Medicare, the public program that insures older Americans, tends to cover fewer addiction services than insurance for younger people.
And more generally, many outreach programs are aimed at younger populations.
“If you go to a harm reduction program, it’s usually not set up with older people in mind,” said Brendan Saloner, a professor of health policy at Johns Hopkins in Baltimore, who studies access to health care among people who use drugs. “They are by no means unwelcome, but they are generally not the target.”
In Chicago, Fanya Burford-Berry, who heads the West Side Heroin and Opioid Task Force, pleaded with state officials to devote more resources to the city’s older black drug users at a recent meeting.
“There seems to be a blind spot in prioritizing black men, older black men and drug use,” she said.
“Not some real heroin”
This generation’s experience also shows how much more dangerous the drug supply has become. Despite better treatment and more resources to combat addiction, overdose deaths among older black men in these cities have increased in recent years, as heroin has been replaced of the more potent fentanyl.
“There’s no real heroin being sold on the streets, period,” said Joe Henery, 77. Henery, who lives in Washington, DC, used heroin for 30 years before getting clean. He said his friends who are still alive were “lucky enough to survive epidemics of all kinds,” but he worries about the risk of overdose for those still using. What was once heroin in Washington is now almost all either replaced by or mixed with fentanyl.
Fentanyl is easier for cartels to manufacture in labs and smuggle into the country. But the high doesn’t last as long as heroin, which often means drug users take more doses a day to avoid withdrawal symptoms. And its varying strength makes it more likely for even experienced users to accidentally take a fatal dose.
Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, said the pattern of deaths in Baltimore reported by The Times and The Banner has caused her to seek new research into why these men die and how to prevent it.
Volkow acknowledged that their drug addiction has long put them at risk, but she said fentanyl has greatly intensified that risk.
“If you used heroin in the past, your chances of dying were much, much lower than your chances of dying now,” she said. “The key element now is the dangerousness of the drugs.”
Josh Katz and Margot Sanger-Katz reported for The New York Times. Nick Thieme reported for The Baltimore Banner.
Reporting was contributed by Cheryl Phillips, Eric Sagara, Sarah Cohen and Justin Mayo of Big Local News; Frank Main, Elvia Malagón and Erica Thompson of The Chicago Sun-Times; Aubrey Whelan and Joe Yerardi of The Philadelphia Inquirer; Venuri Siriwardane and Jamie Wiggan of PublicSource; Abigail Higgins and Colleen Grablick of The 51st; Ryan Little of The Baltimore Banner; David Sjostedt, Noah Baustin and George Kelly of The San Francisco Standard; and Steve Strunsky and Riley Yates of NJ.com/The Star-Ledger.
About this project
The data and methodology behind this project can be downloaded from Stanford Digital Repository. This article was published in partnership with The New York Times, Stanford’s Big Local News and other local news outlets: The Chicago Sun-Times, The Philadelphia Inquirer, PublicSource, The 51st, The San Francisco Standard and NJ.com/The Star-Ledger. Others with ongoing work on this project include The Boston Globe, Free Press Indiana and Wisconsin Watch.
