Terrence Cooper nodded to people walking on the sidewalk next to a beige Winnebago parked in the Benning Heights neighborhood of Washington, DC
“Hey how are you?” he asked.
Occasionally he would appear through the side door of the RV and return with a small box of clean syringes, a container of groceries, or a pre-made safe injection kit in a brown bag for one of the passers-by.
His job: to keep the people alive in this northeastern Washington neighborhood, where drug use is widespread – something that has been a challenge over the past year.
“People used even more drugs during the pandemic – and we had a lot of overdoses,” said Cooper. “So we spent more, if any, Narcan and got a lot of new customers.”
While Washington is seeing new single-digit COVID-19 cases on average every day and more than 50 percent of residents are fully vaccinated, the opioid crisis is showing no sign of subsiding, making services like this increasingly important.
The mobile clinic is operated by Washington’s Family and Medical Counseling Services Inc., which has clinics in DC and Maryland.
The RV offers needle exchange services – where customers can swap used needles for sterile ones – and contacting those looking for help with their addiction or information about treatment. Cooper and colleague Tyrone Pinkney drive from neighborhood to neighborhood every day.
“There are a lot of people out here who say they want help, but they don’t know how to get help – so we come in,” Cooper said.
Data from the coronerâs DC in DC shows deaths from opioid overdoses rose 46 percent from 2019 to 2020. Of the 411 deaths last year, 351 were in the black community. Most of them were men between the ages of 50 and 69.
In neighboring Maryland, health officials noted a similar trend: while overdose deaths plateaued in the white community, they continued to rise in the black community.
Experts say the increasing prevalence of fentanyl and a lack of accessible and affordable treatment options in communities of color and culturally appropriate care for black communities could explain the differences.
âThis is an active issue within the black community. And if we don’t do anything about it, more people will die unnecessarily, âsaid Dr. Aliya Jones, Assistant Secretary of Behavioral Health, Maryland Department of Health.
“Give you something positive”
One of the clinic’s regular customers is called Melo (he only shared his first name). He comes by for food and sterile tools.
“I just turned 64 on the 18th of this month and have been using heroin since I was 12,” said Melo, who uses heroin but not intravenously.
âThey will try to help you if you want to stop consuming. They give you the opportunity not to consume by giving you something positive. “
Long before COVID-19, the opioid crisis raged on the streets of DC, with the rise in fentanyl in 2017 and the death toll between 2018 and 2019.
Last year “was the emergence of something we had never seen before,” said Mark Robinson, regional syringe service program coordinator for Family and Medical Counseling Services Inc.
âIt was a pandemic that laid over an opioid epidemic that was already prevalent in many of our communities. It showed a level of despair that is already brewing under the surface. “
Robinson said his team had been forced to participate in the outreach approaches to follow COVID security protocols – not only for their own safety, but also for the safety of customers.
“We need to protect ourselves now because we are dealing with a high-risk population with an enormous number of vulnerabilities and other comorbidities that would put them directly at risk,” said Robinson.
A large part of Robinson’s job is to be there on a regular basis – and reach out to those who need help at the right time.
“The window [of time] is often very small, âhe said. âAnd it closes very quickly because of the desperation – because of the trauma. Because of the pain. Because of the mental health of many people. “
Some of the patterns in DC are mirrored in neighboring Maryland, where the state has created a task force specifically looking at why the opioid crisis has disproportionately affected the black community.
“When we looked at the numbers, we found that there was a plateau, if any, in the white community, but a significant escalation in opiate overdose deaths in the black community,” said Jones, a task co-chair Force with the Maryland Department of Health.
CLOCK | An outreach worker talks about fighting two crises at the same time:
The task force tries to understand why the black community is disproportionately affected when the state is predominantly white.
“There are challenges in terms of awareness of treatment options and access to treatment in the black community,” said Jones.
“There is the stigma that we in the black community continue to grapple with when it comes to substance use disorders … because of the historic war on drugs and the aftermath of it and how black people interact with the treatment environment.”
Racial Differences in Treatment
Barbara Andraka-Christou researched racial and ethnic differences in the treatment of opioid use disorders such as methadone and buprenorphine (the active ingredient in suboxone) in the United States and identified several barriers – including accessibility – in a recent journal article.
“We know that buprenorphine providers tend to accept commercial insurance and not as much Medicaid. People of color in the US are more likely to be Medicaid when they are people with opioid use disorder,” said Andraka-Christou, assistant professor at the institute in Health Management and Computer Science from the University of Central Florida.
Andraka-Christou said that buprenorphine is often viewed as more accessible because it can be prescribed and taken at home, unlike methadone, which requires a person to physically go to a clinic and take their dose. However, she said there are fewer clinics offering buprenorphine in color communities. And there are historical stigmas about methadone use.
“It’s very stigmatized. It’s very visible,” said Andraka-Christou
“You may be waiting in line for the whole community to see, unlike buprenorphine, which is usually given monthly when someone picks it up from their community pharmacy.”
Andraka-Christou calls for Medicaid to expand to include anti-opioid drugs, as well as government grants and incentives for more clinics in colored communities to offer treatments for opioid use disorders such as buprenorphine.
In April, US President Joe Biden released new federal guidelines to make it easier for doctors to prescribe buprenorphine.
Work ‘in the trenches’
In the meantime, those on the front lines fighting the crisis say they will continue their work to build connections in the communities. Much of their work, Robinson says, is empathy and not being afraid to get close to the problem.
“The purpose is to save a life. And you know, sometimes people don’t think their lives are worth saving,” Robinson said.
“The process is to engage the people in an effort to build those relationships with the people right in the trenches at the frontlines.”