In the shadows of Washington's government office buildings, Gary Hayes searches for another dose of heroin, chasing a high that will last only a few hours before he wants more.
"It's hard to stop using when you are living on the streets and there's no treatment help," Hayes told VOA. The 28-year-old Black man, who lives in a homeless tent encampment in the nation's capital, has struggled with substance abuse disorder for a decade.
"I overdosed twice in the last year, but I know several people who died," Hayes said, reflecting on the deadly opioid epidemic playing out during another health tragedy, the coronavirus pandemic.
More than 93,000 Americans died from drug overdoses in 2020, the highest number on record, according to Centers for Disease Control and Prevention (CDC) statistics released in July. U.S. health officials attribute the rise in deaths to powerful synthetic opioids such as fentanyl, which can be up to 100 times more potent than morphine.
Overdose deaths: Black vs. white
In the District of Columbia, more than 400 people died from opioid overdoses last year, and most were African American. The medical examiner's office reported that fentanyl or fentanyl analogs were present in many cases.
"In some communities, we've seen deaths among African Americans eclipse the death rates among whites over the past several years," said Dr. Caleb Alexander, a professor of epidemiology and medicine at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. "Many people who have died from the opioid epidemic or otherwise developed addiction are African American or other people of color living in urban areas."
Opioid overdose deaths among African Americans have been on the rise since 2013, according to a study published in the journal Addiction. Simultaneously, opioid use among white Americans leveled off for the first time since the 1990s, when doctors began overprescribing the opioid painkiller that sparked the health crisis.
"Historically, the opioid epidemic has at times been painted as an epidemic of rural white working-class families, but opioids don't discriminate," Alexander told VOA. "The addiction that one develops looks just the same, regardless of the color of your skin."
According to the CDC, between 1999 and 2019, nearly 500,000 lives in the U.S. were lost to overdoses involving opioids, both prescription and illicit types. The epidemic has impacted many communities, and U.S. health officials believe the crisis has worsened since the pandemic started.
While overdose deaths were already increasing in the months preceding the COVID-19 outbreak, the latest data show a sharp rise in overdoses during the pandemic.
"It's gone from being called the opioid crisis to the overdose crisis," said harm reduction activist Britt Carpenter, director of the Philly Unknown Project, a group that advocates for the homeless. He says the pandemic has reversed progress made in reducing opioid addiction in recent years.
Carpenter walks the streets of the Kensington neighborhood in Philadelphia, Pennsylvania, trying to help the homeless people he sees using opioids. "It's been a younger demographic of users from the suburbs in their 20s, coming into the city to live on the streets and use drugs," Carpenter told VOA. "In the last 18 months, some of the neighborhood streets have become overwhelmingly filled again with people."
In August, Philadelphia city workers and police cleared out two large homeless encampments in Kensington, where, according to officials, hundreds of people had been living and several drug overdoses had been reported. "The outreach and recovery world have their hands full now," Carpenter said.
In Philadelphia County, illicit fentanyl was present in more than 80% of drug overdose deaths in 2020, according to the U.S. Drug Enforcement Administration (DEA). In September, the DEA issued a public safety alert warning Americans of an alarming increase in the lethality and availability of fake prescription pills containing fentanyl and methamphetamine.
"Drug traffickers, both here and abroad, are increasingly using counterfeit pills to package and distribute the poison that illicit fentanyl is," said Thomas Hodnett, acting special agent in charge of the DEA's Philadelphia Division. Law enforcement officials say most of the counterfeit pills coming into the United States are produced in Mexico and China.
U.S. health officials believe the pandemic lockdowns and the availability of potent drugs last year dramatically increased overdoses and addiction rates.
"I know a lot of people who had made progress in their recovery, then relapsed," Arman Maddela, a recovering addict, told Reuters. Maddala, who lives in San Diego, California, lost his sobriety and began using heroin and fentanyl last year. "Being alone and isolated in your living space without any reason to leave the house is enough for someone struggling with addiction to relapse and dig themselves into a hole," he said.
Harm reduction advocate Carpenter agrees. "One trait of addiction is isolation. The pandemic lockdowns made it hard for people to attend support group meetings in person or visit their therapists."
With the easing of many pandemic restrictions this year, more drug counseling programs reopened in-person services. At the same time, U.S. medical researchers are working to develop new treatments for opioid addiction with further hopes of reducing fatal drug overdoses.
Clinical trials are under way for the first vaccine to be tested in the U.S. for opioid abuse disorder. The vaccine would create antibodies that prevent opioids such as oxycodone from reaching the brain and later impairing a person's breathing. The serum could be given in combination with other opioid-based medications used to treat addiction.
"A vaccine that lasts for several months could help many more people beat their addiction and potentially protect them from an overdose death if a patient relapses," said Sandra Comer, a professor of neurobiology at Columbia University Vagelos College of Physicians and Surgeons, where the research is being conducted.
With billions of dollars being spent on the coronavirus pandemic, some health care specialists are calling on the government to allocate more money for comprehensive addiction prevention and treatment programs.
"We need to be sure these treatments are available and that individuals with addiction have unfettered access because it can reduce the risk of dying by as much as 50%," said Alexander. "We know this can be done because there are millions of Americans living healthy successful lives in recovery today."