Last week, 27 people in the Penn North neighborhood of West Baltimore overdosed on drugs nearly simultaneously. The incident is one of the largest mass overdoses in recent memory and a sobering reminder of the toll the opioid epidemic is still taking on the city as hundreds of people continue to die every year.
Now Penn North and the city at large are working to help the area recover and get to the bottom of what happened.
“We’ve never seen anything like it”
Bill Brooks, the CEO of Penn North Recovery Center, was sitting in his office around 9:20 a.m. last Thursday when he started hearing about people overdosing just blocks away.
“Every single person had started overdosing at the same time,” Brooks said. “We've never seen anything like it, so it was kind of an all-hands-on-deck type situation. We started going up in the alleys and in the back of abandoned houses. We were calling in there. ‘You guys need any Narcan. Did you hear what happened?’”
Narcan is the brand name of the drug Naloxone which reverses opioid overdoses by blocking the receptors in the body.
The overdoses left at least five people in critical condition.
The drugs, distributed by dealers as “testers,” are free samples of new products.
“The reason it's a test or sample is because the folks who are going to distribute the drug product want to see how it affects the people that consume it,” said Alex Krotulski, the director at the Center of Forensic Science Research and Education. “The people who use drugs become sort of the guinea pigs and that is just really not a great scenario.”
Joe Carlini, the co-founder of Chrysler Counselor, an overdose prevention nonprofit in Baltimore, was one of the people on the scene helping those who were overdosing.
“People were being worked on all over the place,” Carlini said. “It was insane, because you get all these different emotions. You’ve got to remember, Penn North is an open air drug market. Neighbors are used to people going out and just walk right by. But last week, you have EMS and the police and us trying to do reversals, and it's almost like people will just sit there and stare.”
First responders and volunteers searched through 177 abandoned buildings to find the 27 people who ranged in age from 25 to 55 and transport them to eight local hospitals.
Penn North and the surrounding area have seen 73 overdose deaths over the last year. So far, everyone who overdosed last week has survived.
A potent investigation
Finding out what exactly was in the drugs is falling to the National Institutes of Science and Technology.
Edward Sisco, a research chemist for NIST’s Rapid Drug Analysis and Research program said as soon as they get the sample they can send out a full analysis within 24 to 48 hours.
Sisco said his lab often sees synthetic opioids as the culprit behind overdoses.
“Fentanyl is obviously a big one, and is usually the number one or number two drug we see in terms of prevalence, and you see a couple other fentanyl analogs that pop up, things like Fluorofentanyl and Carfentanil,” he told WYPR.
However, the drugs that are used to cut opioids can be dangerous as well. Dealers use various drugs to limit how much opioids are actually in what they sell to make profit while still trying to create a high. They will use other drugs like Xylazine or Medetomidine, which are used to sedate animals, benzodiazepines like Valium or other things like sugar or caffeine.
Krotulski said there have even been reports of antifreeze or Freon in the drugs, however, Scisco said his lab has not come across any instances.
Whatever was in the drugs that caused Thursday’s mass overdose was potent, Brooks said.
Brooks said he saw people overdosing again after the Narcan wore off because the drug was still so built up in their system.
“They wouldn't actually even need to take any more drugs,” he said. “They would just start going into overdose again, based on what they had taken earlier.”
Rebuilding and skepticism
The city of Baltimore responded quickly to the overdoses, working with local harm reduction organizations to hand out thousands of doses of Narcan and fentanyl test strips.
On Saturday morning Narcan spray was laid out on street corners and test strips were fluttering in the wind.
Baltimore officials opened up an outreach center in the Pennsylvania Avenue Library where dozens of people had stopped in to get information and take home harm reduction kits. Community organizations are also offering acupuncture and other stress relieving measures.
Sara Whaley, the city’s director of overdose response, sat in the library with staff.
“Our concentration the first two days was to educate the community, let them know about the event, what happened, and to spread harm reduction messaging around,” she said. “The rest of the weekend we're going to continue to do canvassing, putting out information, spreading harm reduction supplies, Naloxone and test strips and continue to connect folks to resources.”
Jessica Magidson, director of the Center for Substance Use, Addiction & Health Research at the University of Maryland, said outreach is critical after an event like last week’s.
“What stood out to me is the local police departments working with community organizations, the health department, various state agencies, and just so quickly and swiftly being able to move to address this together,” Magidson said.
Going forward, she said peers who are in recovery will be key to helping the community heal.
“Peers are a voice in the community to be able to point people to other hotspots and locations where people may be at risk, to hand out harm reduction supplies, and really be so pivotal in coordinating all these efforts. So much of it is about people coming together. And I think peers really playing such an important, important role,” Magidson said.
However, the community is still reeling and feeling distrustful of officials. Many feel the city has already forgotten them and will use the mass overdose as an excuse to closely monitor the neighborhood.
Andre Taylor, a resident of Penn North, calls the overdoses an effect of criminalizing poverty, and fears that the incident will give police more of an excuse to crack down on people and push them out of the neighborhood.
“The bottom line is, they're changing this area. Go down a little bit further, towards 83 on left hand side, has brand new housing starting at $300,000,” Taylor said. He added that a few years ago that area was called Murder Mall because of the amount of violence.
“Now in that area you go up and spit wrong, and the cops looking at you crazy,” Taylor said. “They're working their way up this area. They're taking, these urban areas like this, clean them up and turn them back over to the more to the richer people. That's what it is. Baltimore's been doing this for years.”
Tara Bracey, another Penn North resident, was also skeptical of the city’s presence.
“I don't believe that none of this is by happenstance, like I don't think that a drug dealer woke up and said, ‘Let me make a bad batch of drugs.’ I just don't believe that,” Bracey said. “I think that happened to bring about a change in this area.”
Scisco and Krotulski, both chemists, said they believe the bad batches usually come from people who are inexperienced in mixing drugs who make mistakes.
A possible opportunity
All of this is happening as Baltimore is seeing an influx of at least $400 million, if not more, from settlements with opioid companies.
The city decided to sue the companies on its own because of the disproportionate impact on its residents and, so far, has seen more money than if it signed on to the global settlement.
Baltimore is just beginning to decide how those funds will be spent, at least $87 million will go to about two dozen addiction and opioid prevention services in the city.
The city held its first of four listening sessions with communities most impacted by opioids the night before the mass overdose.
Additionally, the city council is holding a series of hearings on how the money will be spent.
The city put out a revised plan earlier this month, honing in on specific items that will reduce overdoses and addiction.
Those include increasing access to harm reduction services and mental health services like naloxone and mobile vans that offer care.
Other parts of the strategy aim to dismantle silos in the continuum of care by coordinating with state and federal efforts to reduce illegal drugs and enhancing access to data to allow the most precise work possible.
The plan also works to reduce stigma and barriers to care, improve substance abuse treatment and develop effective non-emergency response systems that reduce contact with law enforcement and increase interactions with mental health professionals.
The strategy is based on cutting edge research and best practices from throughout the globe.
