D.C. has one of the highest opioid overdose death rates in the country. But in recent months, opioid deaths have decreased in the District for the first time since 2018, according to a report by the D.C. Office of the Chief Medical Examiner—and based on data from the first half of this year, it’s likely that 2024 as a whole will have significantly fewer opioid-related deaths than prior years.
From 2018 to 2023, opioid-related fatalities per year almost doubled in D.C., increasing from 213 to 523. However this year, there were only 196 deaths reported between January and June. If this half of the year is indicative of the second half of the year, D.C. may have around 400 opioid-related fatalities in 2024. While this is still a large number, it is a significant decrease from 2023.
So, what has led to this change? In part, it’s because of local organizations’ initiatives to address the opioid problem head-on.
The work of community organizations and government programs
Community organizations have looked for ways to make care more accessible and personalized for residents of D.C., and their efforts are beginning to pay off.
“This [the decrease in opioid deaths] is something that seems to be happening because we are making better policy choices and we are having more success with treatment intervention,” Mark LeVota, executive director of the D.C. Behavioral Health Association, said.
The Behavioral Health Association manages 34 member organizations in D.C. that address issues related to mental illness and substance use. Recently, the Association has spent a lot of time evaluating the role their member organizations play in behavioral health services and improving their responses, according to LeVota. Some of their focus areas include increasing capacity for jobs around behavioral health services as well as implementing new health information technology like telehealth.
“Our work at the association is really to help our member organizations with policy advocacy, with training and technical assistance, and with kind of a general community engagement presence,” Levota said.
LeVota also credited D.C.’s emergency services like D.C. EMS and Fire Services for helping to make Naloxone, a life-saving medicine that reverses the effects of opioid overdoses, readily available for those who need it. He added that law enforcement has also worked to limit the spread of drugs in the city.
The Behavioral Health Association is just one of many community organizations that have worked to reverse the trend in opioid deaths. Bridge to Treatment is a program that aims to provide evidence-based substance use care in communities across the country. Ariana Campbell, the organization’s co-founder and senior director, said she began noticing problems with the way patients with substance use disorders were treated during her work as a physician assistant in rural California.
“I asked a very simple question that we should all be asking,” Campbell said. “‘What are we doing when we identify opioid use disorder?’ And it was crickets, nobody had an answer.”
Campbell began looking at scientific research and working with emergency centers to implement specific medications and treatments that would best serve those suffering from substance use disorders. Since then, Campbell’s work has helped to redesign the standard of care for people in California, and those initiatives have spread from coast to coast, impacting a number of cities—including D.C.
“We knew that if we implemented a change in emergency departments in hospitals, it could provide immediate access to treatment for people, it’s identifiable, open 24/7, and can also influence healthcare in communities and change what people are comfortable with doing,” Campbell said.
Campbell and her team trained physician’s assistants and medical professionals in prescribing withdrawal medications and created the position of “substance use navigator” in more than 250 hospitals across California, according to Campbell. These navigators identified people with substance use disorders, advocated for those patients, and connected them with recovery options.
“Just the work of the substance use navigators decreases readmissions by almost 60% in my hospital,” Campbell said.
While California has some of the biggest bridge programs for substance use recovery, treating over 100,000 patients, these programs have been scaled nationally and have also made their way to D.C., providing a similar standard of care to patients in the District.
Campbell explained that people with substance use disorders who are in need of care don’t always know how to find the services they need. Organizations like Bridge to Treatment can connect patients with treatment options so that they can decide what works best for them.
Campbell also mentioned that a lot of her work centers around creating a safe space for patients to have an open dialogue with medical professionals to encourage people to explore possible treatment options.
“We had to communicate to our community that they can talk to us about drugs,” Campbell said.
Campbell has seen her efforts make a real difference.
“I’ve had people cry because they say I’m the first medical professional that they’ve ever been able to have an honest conversation about drug use with and get real answers,” she said.
Beyond nonprofit organizations, local government programs have also worked tirelessly to address the opioid crisis. Over the past five years, the D.C. Department of Behavioral Health (DBH) has expanded initiatives and practices to better serve those who may be suffering from addiction.
One such program, LiveLongDC, focuses on prevention, harm reduction, treatment, and recovery support for those with opioid use disorder. It encompasses about 85 community partners, including service providers, local organizations, and faith leaders, who help to implement community programs and carry out initiatives from the DBH.
“[LiveLongDC is] driven by a growing public understanding that opioid addiction is a disease that can be treated, and people can recover,” a DBH spokesperson wrote in a statement to the Voice.
Through the DBH, D.C. has increased treatment options in community health clinics and has opened a Stabilization Center in Northeast D.C., which runs around the clock with free emergency support and connections to treatment for substance use. The center offers easy and immediate access to approved medications and connects those who come in with other resources they may need, including transportation and social services. In the last year, the Stabilization Center has had 5,381 total admissions, according to data the DBH shared with the Voice.
The DBH also employs peer specialists who have had experiences with substance use disorder to try to encourage patients to pursue options that are best for their recovery.
Above all, the DBH is continuing to create new programs and initiatives that could further expand their outreach in the D.C. community.
“We are keeping our foot on the gas—doubling down on what’s working and developing new strategies to address new challenges” the spokesperson wrote.
The DBH also runs four Prevention Centers and manages public awareness campaigns such as “One Pill Can Kill” aimed at preventing youth drug use. These initiatives are run in both English and Spanish, in hopes of making educational resources accessible and reaching as many communities across D.C. as possible.
One of the dangers of the illicit drug supply is that drugs may be laced with fentanyl, a powerful opioid that can be fatal even in trace amounts. Thus, organizations have been working to expand access to Naloxone.
Seeing the introduction of fentanyl into many opioids and how this had affected overdose deaths, the DBH has made Naloxone available for free at about 30 pickup sites across D.C, including pharmacies, public schools, vending machines, and even places of worship. The increased accessibility of this life saving medication has made it much easier for people to intervene when witnessing an overdose. According to the DBH spokesperson, about 370,000 Naloxone kits have been distributed through LiveLongDC, reversing 16,000 suspected overdoses.
Racial, economic, and social factors contribute to disparities in substance use and access to care
There are large disparities in substance use among different demographics, and many experts say that government policies do not effectively address these inequalities.
On a national level, studies have shown that Black and Latino communities have higher rates of illicit drug use than white communities. Many factors may contribute to these disparities, including that people with substance use disorder in these communities are less likely to receive treatment.
Disparities in substance use are also evident locally, including in statistics from the DBH’s Stabilization Center. Of the more than 5,000 individuals admitted to the Center over the last year, 80% were African American and 10% were white, according to data the DBH shared with the Voice. D.C. as a whole is 44% Black and 36% white.
Shelly Weizman is the senior project director of the Center on Addiction and Public Policy at the O’Neill Institute for National and Global Health Law, a Georgetown University institute that aims to train global health students and conduct research on global and national health concerns. Weizman conducts research focusing on the opioid epidemic and how the law can better improve access to treatment.
Weizman said that racial inequities are a major factor behind vulnerability to drug usage and subsequent insufficient treatment for those with drug use disorders, but this is often overlooked by current drug policies.
“Unfortunately, our laws are often not rooted in science and evidence. Instead, they are often based on stigma, discrimination, criminalization, and racism,” she said.
Laws around drug use and the way these laws are enforced have produced disparate impacts on different demographic groups. For example, people of color are more likely to be arrested or incarcerated for drug-related offenses. While Black people constitute only 5% of people who use drugs, they constitute 29% of those arrested and 33% of those incarcerated in state prisons for drug offenses.
In her research, Weizman found that the majority of overdose deaths in D.C. occured in predominantly Black neighborhoods, particularly in Wards 7 and 8. She also found that while the number of opioid-related deaths decreased for white individuals in D.C. over the past year, Black and Indigenous populations did not see the same shift. In some neighborhoods, overdose deaths are still increasing among these populations.
Weizman said that future government policies and practices around substance use and recovery must consider racial inequities and differences among individuals.
“Addressing substance use disorders requires a multi-faceted approach. Different people need different things, and every community can benefit from policies that help people get the right services at the right time,” she said.
LeVota also emphasized that other social and economic factors are potential factors behind vulnerability to substance use.
“Homelessness and lack of housing security is a tremendous contributing factor to substance use, and we have to take that seriously,” LeVota said. “When people don’t feel safe, sometimes they choose to self-medicate through the use of inappropriate substances.”
Campbell said that in addressing substance use, she always acknowledges that “everybody has a story.” She considers events that have influenced her patients’ drug use, which may include adverse family events, sustained trauma, or other factors, and comes up with recovery strategies accordingly. She also emphasized that it is important to “work upstream” to prevent drug use, such as educating teachers to look for signs of substance use in parents or students and to take preventative action early on.
Campbell has pushed her team to identify people who care providers may not always realize are at risk for drug use.
“We’ve realized that people at risk are often invisible. And the only way to create visibility is to look at who you’re missing,” Campbell said.
Going forward
While advocacy groups and government programs have made many strides that have contributed to the decrease in opioid-related deaths, Weizman and others believe that this is only the beginning.
“There has been an effort to increase access to prevention, harm reduction, treatment, and recovery support in D.C., but there is much work left to be done,” Weizman said.
Weizman hopes to see drug use recovery programs account for individuals’ other needs in addition to their recovery efforts, such as child care, food security, and housing, as economic pressures and family responsibilities can make it difficult for people to enter treatment.
“A lot of people struggle to get their basic needs met, which can make it really hard to engage in services in the first place,” Weizman said.
Campbell shared a similar sentiment about the need for continued work in addressing the opioid crisis.
“I’m glad we’re seeing a decrease in overdose deaths, it’s certainly not enough for me to rest,” Campbell said. “We saw a doubling of overdose deaths over the last seven to eight years, we should be able to halve these deaths over the next five years.”
Campbell looked to interventions in previous public health crises for guidance.
“When we were facing the HIV/AIDS epidemic, we created a system of care to get people into treatment. I still think we need a system of care,” she said.
Campbell believes a system of care, or a network of community-based services providing support for an issue, can help to better individualize modes of treatment for each patient by providing them with a variety of options. She also believes it would be beneficial to have decreased regulations on the substance use disorder treatment medications and a higher number of care workers who are trained to prescribe these medications.
LeVota said that while the recent decrease in opioid deaths is promising, D.C. and its residents have already had to grieve for too many.
“We still are going to have to mourn that people have died because we didn’t get the resources to them in time,” LeVota said.
Still, LeVota still sees hope for the future.
“The majority of people who use inappropriate substances are able to recover. That is a really important message that people sometimes need to hear repeated before they believe it themselves,” he said.
D.C. will see real changes, LeVota said, as long as policymakers and treatment providers “keep our foot on the gas.”
