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 been dying at unusually high rates.
They're all from the same generation.
An investigation of millions of death records -- in a partnership 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 one group of Black men in dozens of cities across America at nearly 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 risen among younger, whiter and more rural populations.
That huge tide now appears to be ebbing -- but not for this group of Black men. In the 10 cities examined in this partnership, including Baltimore, Chicago, San Francisco, Newark, Washington, Milwaukee and Philadelphia, Black men ages 54 to 73 have been dying from 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 -- H.I.V., crack, Covid, multi-drug-resistant tuberculosis -- only to be killed by fentanyl," said Tracie M. Gardner, the executive director of the National Black Harm Reduction Network and a former New York State health official.
In all, the analysis identified dozens of cities, mostly in the Northeast and Midwest, where a generation of Black men were at higher risk of overdose deaths throughout their lives. In many of those places, cities have done little to distribute resources to this population.
The details vary from city to city.
In Chicago, there is no focused effort in nearly $1.3 billion of state opioid settlement money to help older Black men, despite a heavy death toll for this group, The Chicago Sun-Times found.
In Pittsburgh, Black men in jail with opioid use disorders have been less likely to receive medications to combat their addictions than white men, a PublicSource investigation has found, though local officials are working to close the gap.
In San Francisco, many of the men vulnerable to overdoses use both opioids and cocaine, a combination that may make treating their addictions more complex, according to an analysis of mortality data by The San Francisco Standard.
In Newark, NJ.com/The Star-Ledger also found that overdose victims were using both opioids and cocaine.
In Baltimore, hundreds of men have been dying in senior housing, The Baltimore Banner found.
In Philadelphia, older Black men were actually less likely to die than their white peers -- until recently. Since 2018, their death rate has shot up, according to a Philadelphia Inquirer analysis.
In Washington, local regulations and insurers have prevented doctors from giving longtime opioid users effective doses of drugs meant to curb their cravings, reporters for The 51st found.
'Dying for decades'
Black men of this generation, born from 1951 to 1970, came of age at a time of wide economic disparities 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. Though some managed their addictions safely, the risk of overdose was always there.
Mark Robinson, 66, grew up in Washington and now runs a syringe exchange program in the city. He estimates he knows 50 people who have died over the years from overdoses, 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 became exposed to illicit drugs, according to Dr. Dan Ciccarone, a 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. In the 1980s, some became exposed to H.I.V. through drug injections. In the 1990s, more aggressive sentences for drug crimes meant many of them spent time in jails or prisons.
Several public health researchers said widespread incarceration may have reduced these men's chances of staying clean. "You're basically disarming 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 connections to their children."
They have lived through the social upheavals of Covid, a period of isolation that coincided with an increase in the overdose rate for nearly all groups.
They also stand to 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 medications that can curb drug cravings for people who want to quit.
But in many of the cities where older Black men are dying at high rates, those innovations may not be reaching this group.
Decades of drug use, criminal risk and stigma have made some reluctant to discuss their addictions. The Philadelphia council member Kendra Brooks said she recently learned about nine overdoses among older Black residents in her neighborhood. The overdoses had happened quietly, in private homes.
"In this generation, you don't get high in public," Ms. Brooks said. "It's something very private and personal. Amongst folks that I know, it's like a secret disease."
Older Black drug users have been less likely than white ones to receive prescription medicines 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 not typically set up with older folks 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're not in any way unwelcome, but they're not generally the target."
In Chicago, Fanya Burford-Berry, who directs 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.
"It seems like there's a blind spot when it comes to prioritizing Black men, older Black men and drug usage," she said.
'Not any real heroin'
This generation's experience also highlights how much more dangerous the drug supply has become. Despite better treatment and more resources to combat addiction, the overdose death rate among older Black men in these cities has risen in recent years, as heroin has been replaced by the more potent fentanyl.
"There is not any real heroin being sold in the streets, period," said Joe Henery, 77. Mr. Henery, who lives in Washington, used heroin for 30 years before getting clean. He said his friends who are still alive were "fortunate enough to survive the epidemics of all sorts," but he worries about the risk of overdose for those who are 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's, which often means drug users take more doses a day to avoid withdrawal symptoms. And its variable strength makes it more likely for even experienced users to take a fatal dose accidentally.
Nora Volkow, the 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 on why these men are dying and how to prevent it.
Dr. Volkow acknowledged that their drug addiction has long placed them at risk, but she said that fentanyl has greatly intensified that risk.
"If you were, in the past, using heroin, 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."
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 the Stanford Digital Repository. This article was published in partnership with The Baltimore Banner, 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 pending work in this project are The Boston Globe, Free Press Indiana and Wisconsin Watch.