Heroin and drug paraphernalia at a home in Southeast Washington. The number of fatal opioid overdoses in the District rose quickly between 2014 and 2017. (Andre Chung/for The Washington Post)

More than two months after D.C. Mayor Muriel E. Bowser (D) released a far-reaching plan to cut opioid overdose deaths in half by late 2020, key programs described in the plan have not been launched, according to city officials and service providers.

The anti-opioid initiatives include a dramatic expansion of the availability of the overdose antidote naloxone and new treatment programs for overdose survivors in hospital emergency rooms. They were laid out by the mayor in response to one of the nation’s most severe increases in fatal overdoses over the past several years, most caused by heroin laced with the synthetic opioid fentanyl.

But both the naloxone expansion and hospital programs remain in the planning stages, city officials and others involved with the efforts acknowledged last week. Meanwhile, the D.C. Department of Behavioral Health — the District’s lead agency in combating the opioid epidemic — remains without a permanent director, about three months after the removal of Tanya Royster as director.

City officials said Friday that the mayor’s plans for reducing overdose deaths are on track. Within two weeks, the Bowser administration will be issuing a revised, more detailed plan that lays out specific goals and timelines, said Department of Health Director LaQuandra Nesbitt.

“The city has been acting with a sense of urgency for quite some time,” said Nesbitt, who is now serving as interim director of the Department of Behavioral Health in addition to her role leading the health department.

But the pace troubles some critics, who say the city has already wasted years in its response to rising heroin and fentanyl deaths.

“Every month that goes by . . . you still have overdoses and folks dying,” said Edwin Chapman, a longtime addiction medicine doctor who practices in Northeast Washington.

Chapman said that the initiatives the city plans have been widely adopted elsewhere and should not be hard to get up and running. “This is not rocket science,” he said.

D.C. Council member Vincent C. Gray (D-Ward 7), chairman of the council’s health committee, said he did not see much progress.

“I don’t think anybody can truthfully tell you that a lot has occurred,” Gray said.

Gray said he was concerned that the city might not act quickly enough to spend about $21 million in anti-opioid grant money it has been awarded by the federal government. How­ever, he said he would reserve judgment until he receives and reviews the new, more detailed plan that Nesbitt has promised.

In December, The Washington Post published a series on shortcomings in the District’s response to surging opioid overdoses.

Between 2014 and 2017, the city’s rate of fatal drug overdoses rose by 209.9 percent — an increase higher than that in any state and the ninth highest among all U.S. counties, federal data show.

In 2017, there were 279 fatal opioid overdoses in the District, surpassing the city’s homicides. More than four in five victims were African American — often older, longtime heroin users — belying the conventional narrative of the opioid epidemic as a problem afflicting white users in rural and suburban areas.

In 2018, opioid overdoses declined moderately, with 192 deaths through the end of November, according to the chief medical examiner’s office.

Yet city officials repeatedly fell short in their efforts to curb drug-related deaths, distributing naloxone at a far lower rate than comparable cities and mismanaging federal grant dollars.

After The Post published its series, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) launched an audit of the city’s use of its grant money, and D.C. Council members called a public hearing to examine the city’s opioid response.

A SAMHSA spokesman said Friday he could not provide an update on the audit, which is ongoing.

On Jan. 18, Bowser announced that the city would buy and make available 50,000 new naloxone kits. Many of those kits would be distributed directly to District residents or to service providers, the mayor said, and police officers would also be equipped with the medication. Police officials had previously resisted carrying naloxone, as law enforcement officers already do in thousands of other jurisdictions.

Nesbitt said Friday that 15,000 kits would go to D.C. police, with the rest going to residents and community organizations. Nesbitt said the city does not “have a finite timeline” for getting the kits out the door and didn’t know the police department’s plans.

Police officials did not respond to a request for comment. Council member Charles Allen (D-Ward 6), chairman of the committee on the judiciary and public safety, said that at a recent oversight hearing, Police Chief Peter Newsham “wasn’t able to provide specific timelines” for the agency’s naloxone rollout, “but he did say they were actively working on the deployment plans.”

Another key initiative is the city’s plan to begin outreach and treatment programs for recent overdose victims at three hospitals — United Medical Center, MedStar Washington Hospital Center and Howard University Hospital. Those programs will offer patients buprenorphine, a medicine that reduces opioid cravings and is frequently used for long-term addiction treatment.

However, those programs are still months away from treating patients, hospital officials said last week.

The UMC and MedStar programs are scheduled to start by the end of April, said Jennifer Hirt, senior director of communications and member engagement at the D.C. Hospital Association, which is partnering with the city on the effort. The Howard program is expected to launch in July, hospital spokesman Anthony Blue said.

Wayne Turnage, acting deputy mayor for health and human services, said Friday that the Bowser administration has begun interviewing candidates to lead the Department of Behavioral Health. Turnage said the mayor wants to hire a director “as soon as possible,” but was taking time to find a candidate with the right qualifications, including experience in public health efforts to address the opioid epidemic.

“We don’t want to rush and end up with a candidate who is not a good fit,” Turnage said, “so that process is ongoing.”