How Baltimore became the US overdose capital

Some cities send teams of trained professionals, such as recovery specialists, paramedics and sometimes police officers, to knock on patients’ doors 24 to 72 hours after the overdose to offer treatment options and other assistance. These initiatives in Houston, Louisville, Kentucky and Montgomery County, Ohio, reach hundreds of people each year.

Studies show the efforts can work. One study followed the people the Houston team contacted for three months and found that more than half stayed in treatment and none overdosed again. In Baltimore, the city’s emergency rooms provide connections to care and resources. But the only team that contacts those who refuse to go to the hospital after an overdose received the names of only 50 people from emergency responders last year, says Gabby Knighton, executive director of People Encouraging People, which runs the group.

People in Baltimore who struggle with addiction often have to seek help themselves.

Vernon Hudson Jr., 54, first took opioids when he was given painkillers after a knee injury as a defensive end on the Virginia Tech football team. He returned to Baltimore from college with a growing addiction and no football career. For more than two decades, he struggled between relapse and recovery.

In December 2021, he sniffed a powdered drug and then overdosed while driving, crashing his Mustang into the front steps of a church. He regained consciousness in the back of an ambulance after being administered naloxone. Tormented by shame, he refused to go to a hospital.

With the help of a support group, he has since been able to quit using drugs. But in the ambulance when he overdosed, no one offered to connect him with treatment or social services, he said. After he asked to get out of the vehicle, no one from the city checked on him, he said.

Cheryl Phillips, Eric Sagara and Emily Sullivan contributed reporting. Susan C. Beachy And Kirsten Noyes contributed to the research. This article was written in collaboration with Big Local News at Stanford University.

About the analysis

The Times and The Banner analyzed anonymized data from the Centers for Disease Control and Prevention on every death in the U.S. between 1989 and 2022. The data, obtained by reporter Nick Thieme through his connection to Columbia University under an academic license, shows demographics and causes of death. Deaths between 1968 and 1989 were collected from a separate dataset published by the CDC.

Death rates in this article The number of deaths that occurred in Baltimore is measured, not deaths of Baltimore residents. The numbers are calculated for the entire country by dividing the total number of overdose deaths in each jurisdiction by the population. For this reason, the totals differ from those in the CDC’s online database, CDC Wonder, which measures deaths by place of residence and also excludes deaths of people living in U.S. territories or outside the United States.

The CDC reports data by county, and the analysis identified large U.S. cities based on counties with at least 400,000 residents. Baltimore City is reported as a separate county. Overdose deaths are those in which drug poisoning is reported as the underlying cause of death.

In addition, The Banner sued Maryland’s Office of the Chief Medical Examiner for autopsy data that allowed reporters to examine detailed geographic patterns of overdoses within the city.

No death rates are calculated for the US territories and Washington, but they are significantly lower for both areas than for Baltimore.