The Washington PostDemocracy Dies in Darkness

The rising homicide rate in D.C. is nothing compared with what fentanyl is doing

Edwin Chapman, who specializes in treating addiction in D.C., counsels patient Charlie LeSane, 60, who has been using 27 years and seeing Chapman for seven years. (André Chung for The Washington Post)
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The deaths aren’t always loud or public. There’s no web of screaming yellow crime-scene tape, and sirens are rare. But in 2020, opioids claimed more than twice the 198 lives that gunfire did in the nation’s capital.

“It’s a silent killer,” Nura Green Lane, program manager for D.C. Opioid Response in Wards 7 and 8, said in one of several meetings in the city on Monday about the epidemic, 10 days after an alarming rash of overdoses that left three people dead burst the silence.

It’s the sixth year that drugs have killed more people than guns. City records show the trend began in 2014 and held steady even as gun violence surged; so, too, did the age of those dying of an overdose.

Ten opioid overdoses in one day, with three deaths: 'There's a lethal batch'

“We’ve had a significant increase in age,” said Edwin Chapman, 75, who specializes in treating addiction in the nation’s capital.

Most of the older folks dying in this epidemic are Black — the community that also struggles hardest to access treatment. These facts fuel Chapman’s tireless work, writing memos and emails, hopping into meetings and testifying about the gaping inequity in between seeing hundreds of patients every month.

“When we looked at the average six years ago, it was 52,” Chapman said. “Now the average age is 60.”

That became even clearer on that Friday afternoon of 10 overdoses last month, when the three people who died were all senior citizens.

“I’ll never forget that image I have in my head of Gloria,” said the Rev. Ruth Hamilton, pastor at Westminster Presbyterian Church in Southwest Washington. “She was like the neighborhood pied piper, always a joy to be with, chaperoning this large group of children, coming up on the sidewalks, all of them following her.”

Gloria Hamilton, 72, was the oldest person to die of an overdose that day. An Army veteran and longtime volunteer at the church, she clearly “had some pain” that others didn’t know about, Pastor Hamilton — no relation — said in a tribute to her last Sunday.

Another victim that day was 69, and the third was an elderly woman who hasn’t been identified, Pastor Hamilton said.

The graying of overdose victims is happening across the nation, not just in D.C.

In 1999, 518 Americans 55 and older died in opioid-related overdoses. That number rocketed to 10,292 deaths in 2019, according to a Northwestern Medicine study published last month in the Journal of the American Medical Association. That’s roughly the same number that die in drunken-driving deaths in the United States each year.

Ageism is a contributing factor, Lori Post, the Buehler professor of geriatric medicine and professor of emergency medicine and medical social sciences at the Feinberg School of Medicine at Northwestern, told Northwestern Now.

“They’re invisible,” Post said. “We’re talking grandmas and grandpas doing drugs, and to the point of overdosing. We don’t think of them seriously. Not as potential victims of domestic abuse, physical or sexual assault or drug addiction. That needs to change.”

Most of the senior citizens dying of an overdose in D.C. are Black men, said Chapman, who cited evidence of medical racism in the exploding epidemic.

“Last year, we had more than 400 [overdose] deaths,” he said. “And we haven’t had the commensurate increase in treatment.”

Chapman said that in his experience, the most effective treatment for opioid addiction is buprenorphine, a drug that partially fills the opioid receptors in a user’s brain, softening withdrawal and the cravings. And “only 2.7 percent of buprenorphine prescriptions are written in the Black community,” Chapman said. Methadone, which is less effective, is more common in Black communities.

A report last year by the federal Substance Abuse and Mental Health Services Administration supported Chapman’s observations.

“Unequal treatment is common in many Black/African American communities, where access to treatment options is more dependent on race, income, geography, and insurance status, rather than individual preferences, or medical or psychiatric indicators,” the report states. “One study based in New York City found that the residential area with the highest proportion of Black/African American and Latino low-income individuals also had the highest methadone treatment rate, while buprenorphine and naloxone were most accessible in residential areas with the greatest proportion of White high-income patients.”

On Monday, Chapman jumped from call to call, one on a radio station, another with a health alliance, to talk about the crisis, to advocate better treatment options for the patients he keeps losing.

Opioid deaths surged during the pandemic

“We have three major universities, three medical schools in this city; we should not be in this situation,” Chapman said during a Health Alliance Network opioid working group Zoom meeting on Monday.

D.C. has one 24-hour intake center for drug treatment. It’s in Tenleytown, on the opposite side of the city from where most of the drug overdoses are happening, said Ambrose Lane Jr., founder of the Health Alliance Network.

In a resolution he sent to Advisory Neighborhood Commissions across the city, Lane asked for sobering centers in Wards 7 and 8 and for 24-hour health-care providers for when overdoses occur.

Most of the opioid overdose deaths in D.C. last year — 94 percent — involved fentanyl. And most of the users never meant to get near it.

It’s showing up in heroin, in cocaine, in counterfeit pills, in marijuana “and even in cigarettes,” Rosalind Parker, director at the Ward 7 and 8 Prevention Center, said at the Health Alliance Network forum.

And that makes a moral referendum out of treatment, withheld because the addicts aren’t seen as victims the way White addicts who came to fentanyl via prescription pills are, Chapman said.

“Many of our patients were introduced to whatever drugs they were using, not because they got it from the doctor’s office, but they had a disease of despair, they were self-medicating,” Chapman said. “And addiction in the African American community is viewed as a moral problem.”

The folks where Gloria Hamilton used to go to church refuse that kind of moral judgment.

“[Access to] treatment is the crux of the problem,” Ruth Hamilton said.

There’s grace in action. So they provide training on overdose revival drugs, and are working to stock up on test strips people in addiction can use to check their supply for fentanyl.

As the city grapples with its response to the crisis, the church traces its harm-reduction blueprint to John 16:33: “I have told you these things, so that in me you may have peace. In this world, you will have trouble. But take heart! I have overcome the world.”