Monday, June 3, 2024

LET ME START ........................

 

Let ne start by saying  Baltimore Maryland....... is  a fucking  cold .....repugnant.....dirty....crime ridden .....shithole,....................................

In Baltimore’s Senior Homes, Overdoses Plague a Forgotten Generation

BALTIMORE — Larnell Robinson sat at a desk in his cluttered office last September, between a bookshelf full of Bibles and a table stacked with the overdose antidote Narcan. He slid out a list of residents of the West Baltimore high-rise where he was tenant council president — one of dozens of subsidized complexes that house the city’s poor seniors. One by one, he began scratching through names, conducting a grim accounting of the dead.

William, 63, killed by fentanyl and found in his ninth-floor unit in February 2023. Richard, 61, discovered in an apartment with multiple drugs in his system 2 1/2 weeks later. David, 68, three days after that, also dead from fentanyl.

And then 59-year-old Glenn, who had lived on Robinson’s floor for years. Known for his willingness to run errands for others, he often biked to the store to get Robinson cigarettes. But after not seeing Glenn for a day, Robinson stuck a flyer in his door. When it was still there the next morning, he summoned security.

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This was one death, Robinson said later, that he couldn’t bear to witness. “I feel like I work at the morgue sometimes,” he said in an interview.

Over the past six years, as Baltimore has endured one of America’s deadliest drug epidemics, overdoses have fallen surprisingly hard on one group: Black men currently in their mid-50s to early 70s. While just 7% of the city’s population, they account for nearly 30% of drug fatalities — a death rate 20 times that of the rest of the country.

Black men of that age in the city are more likely to die of overdoses than cancer or COVID-19 at the height of the pandemic; drugs are essentially tied with heart disease for their top killer. “I can’t think of another situation like this,” said Robert Anderson, chief of statistical analysis and surveillance at the Centers for Disease Control and Prevention.

Those men were part of a little-recognized lost generation, their lives shaped by forces that have animated the city’s drug crisis for decades, according to an examination by The New York Times and The Baltimore Banner.

Half a century ago, manufacturing jobs began to disappear in an industrial city where Black families had few other opportunities to build wealth. By 1980, nearly half of Baltimore’s Black men under the age of 30 were out of work — a level similar to Black unemployment during the Great Depression.

At the same time, an influx of highly addictive illegal drugs created a lucrative but corrosive shadow economy. Some young people turned to dealing drugs and then using them. Many were arrested and incarcerated, never finding jobs that let them move ahead.

Baltimore’s Black men of this generation have been dying of overdoses at some of the highest rates in the country ever since, a Times/Banner analysis found. More than 4,000 have been killed since 1993 amid waves of drugs: first heroin and crack cocaine, then prescription opioids and now fentanyl — the deadliest drug threat America has ever seen.

Though startling numbers of older white men and Black women have been killed as well, it is deaths among this group — Black men born between 1951 and 1970 — that have elevated Baltimore’s fatal overdose rate far above other cities’.

Many of those men can now afford only subsidized apartments in complexes for older adults that residents say are often awash in drugs. Lonely grandparents and retirees who have been fighting their addiction for decades are suddenly surrounded by illicit temptations, in buildings where buying narcotics can be as easy as walking down the hall.

At least 31 of the 50 addresses where people have fatally overdosed in Baltimore most often since 2018 are advertised as senior housing complexes, according to previously undisclosed autopsy records that the Banner obtained after suing the state’s Chief Medical Examiner’s Office. More than 340 people over 50 have died in those buildings, including 15 in Robinson’s, Rosemont Tower.

Nonetheless, there has been little targeted outreach to older people by health officials, the Times and the Banner found. The city has concentrated its drug education efforts on the young, and the battle against overdoses in senior buildings has largely been left to people with little expertise — a nonprofit program coordinator here, an apartment manager there.

City health officials told Times/Banner reporters they had taken steps to address the issue, including training residents at some senior apartments to use naloxone, the generic name for Narcan.

In an interview, Mayor Brandon Scott said that while the city’s overdose prevention efforts — which include groups that go into neighborhoods to provide medical care, Narcan and clean syringes — did not target any particular demographic group, they served large numbers of older Black people because they were most affected by addiction.

He said he did not need to consult data for the racial disparities in overdoses to be apparent to him. “As a Black man who lives in Baltimore, I know, because we’ve seen it our whole lives,” he said.

Joseph Saunders, 62, stopped using drugs two years ago; recently, after his wife died of a heart attack stemming from long-term opioid use, he became a single father to his 13-year-old son. He said he had seen people selling drugs in hallways and on elevators in the senior building where he lives, MonteVerde Apartments. Thirteen people over 50 have died from overdoses there since 2018, the autopsy records show.

“It’s supposed to be a safe haven,” Saunders said. Instead it is “just like being out in the streets.”

Al Baker vs. His Worst Instincts

In Southwest Baltimore, down the road from a cemetery, is a brick apartment complex named Irvington Place where women in wheelchairs and on walkers greet nearly everyone who walks in. Wellness checks on Nov. 3 turned up three dead tenants with evidence of fentanyl in their bodies.

In the days after, the maintenance man recalled hearing quiet weeping as he walked the hallways. Somber relatives sorted through possessions.

And William Baker, 65, known as Al, took stock of his life. He had moved to the building a few months earlier and was friendly with those who died. One was a 74-year-old woman he joked with about needing a girlfriend. Another was a 69-year-old man on Baker’s floor who was always trying to sell things to make extra money. The third was a 65-year-old woman who had shared macaroni and cheese casserole with Baker.

He added them to his growing tally of people lost to addiction. Not long before, his life had almost ended the same way, he said in an interview.

When Baker was growing up, his stepfather was a Bethlehem Steel ship welder, and his mother worked at a state-run institution for people with developmental disabilities. But Baker was separated from his family when he was 12 after repeated arrests for shoplifting and stealing cars. Judges sent him first to a juvenile detention center, then to a foster home. There, he met a drug dealer who taught him how to make a living. He began injecting heroin in his late teens.

He spent much of the next few decades in prison, but he also got married, had two children and did odd jobs like washing cars, paving roads and cooking fast food. The best-paying work, though, was riding the Greyhound bus from New York City to Baltimore, ferrying duffel bags stuffed with marijuana, heroin and cocaine several times a week, he said. It was not until his 50s that Baker enrolled in college online, got a psychology degree and worked as an addiction counselor in Philadelphia. After years of sobriety, he relapsed, then suffered a stroke. His family moved him back to Baltimore five years ago, and he went through cycles of recovery and drug use, always trying to hide the problem from his grandchildren. “The last thing I wanted: for my granddaughter to come in that room and see her grandfather dead,” he said. “All over something he did to himself.”

But last August, Baker collapsed at his dining room table after sniffing some drugs he had bought on a nearby street corner, he said. He would have died if not for a surprise visit from his family. His teenage grandson forced his way into the one-bedroom apartment. Afterward, Baker enrolled in a treatment program, where he participated in group therapy and got monthly shots of naltrexone, a medication to control drug cravings, he said.

These days, Baker spends almost all of his time at home with a pencil or paintbrush. He draws commissioned portraits for friends and acquaintances, as well as cartoon greeting cards and vibrant scenes awash in color. One day he hopes to make enough money to help his grandchildren build a better life.

He holds on to one artwork for himself. It depicts a man in a prisoner’s orange jumpsuit staring at a chess board and grasping a Bible. His opponent: a thickly muscled Satan. It is Baker versus his worst instincts, he explained, locked in a match that will not end until he is dead.

Outside his window, the streets came alive at dusk one day last fall. A police cruiser parked on a side street earlier had left, and a drive-through drug market replaced it. Young men leaned into car windows, baggies in one hand and bills in the other. Four cars were waiting in line.

‘A Lot of It Was Desperation’

In 1960, when Baker was 1 year old, Baltimore was a booming city of 939,000, the sixth largest in the United States. The city’s Black population had grown by hundreds of thousands during the Great Migration, many moving in search of jobs and a better life away from the racial violence of the Deep South.

Bethlehem Steel, where Baker’s stepfather worked, was right outside the city. Its steel mill and shipyard employed at their peak more than 30,000 people, building ships for the World Wars and churning out steel used in the construction of the Golden Gate Bridge. The mill was once the largest steel producer in the world.

If Baltimore’s prosperity hinged on manufacturing, its decline did, too. The region lost more than 100,000 manufacturing jobs from 1950 to 1995, or about three-quarters of all industrial employment. Large manufacturers of cars, planes, phone cords, bottle caps, beer and ink closed their Baltimore plants. The storied steel mill laid off workers by thousands before shuttering in 2012.

When Sylvester Brown was growing up, his father worked at Domino Sugar, and seven of his aunts and uncles worked at the Bethlehem Steel shipyard. It felt like his extended family was rich, said Brown, 63. They owned two-story row houses and Cadillacs.

Brown dropped out of high school in the ninth grade, never thinking he would have trouble finding a good job. His relatives told him they would bring him “into the industry” when he turned 18.

But by the late 1970s, the shipyard was not hiring. Some of his family eventually lost their jobs in mass layoffs.

The only work he could find paid little. At 17, working as a part-time cook at a fast-food restaurant, he said, he did not earn enough to cover rent and utilities. Under pressure from his mother to move out, he said, he became a drug dealer, selling heroin and cocaine. He later began using them, too.

“I felt like that was the only thing I could do at the time,” said Brown, who got sober nearly 20 years ago and mentors others trying to recover from drug use. “A lot of it was desperation.”

Derrick Wright, 60, grew up a few blocks west of Pennsylvania Avenue, once among the country’s premier Black art and entertainment districts, attracting the likes of Louis Armstrong, Duke Ellington, the Supremes and Ella Fitzgerald.

He recalls the neighborhood as blue-collar and proud; in his youth, neighbors paid him to clean their marble steps with a scrub brush and Ajax.

Today, it is near one of Baltimore’s most notorious drug markets. “It’s like they dropped a bomb in that area,” he said.

Sidewalks are littered with empty drug vials and used syringes. People get high in public and in the boarded-up vacant buildings that line the streets. There are more 911 calls for overdoses here than anywhere else in the city.

A Generation Falls Behind

Baltimore was not the only city to suffer during the manufacturing exodus. Philadelphia, Detroit, Chicago and parts of New York had equal or greater rates of joblessness in 1980 among Black men of this generation. In those cities, and others that rapidly lost industrial work, this group also died from overdoses in elevated numbers, although that was not true across the nation as a whole, the Times/Banner analysis showed.

But Baltimore stood out, with these men dying at a higher rate over the last three decades here than anywhere else.

Sudden and widespread unemployment can create lifelong disadvantages, decades of research has shown, associated with early deaths from overdose, alcohol and smoking.

The setbacks are often strongest for the people coming of age when the downturn occurs. The prior generation is more likely to keep their jobs, and workers born later have new options, said Hannes Schwandt, a Northwestern professor who studies the effects of such economic shifts. Young people entering the job market during recessions go on to die from drugs and alcohol more often than others, with the most pronounced effects emerging in their 50s, Schwandt’s research found.

This result is what public health researchers call a cohort effect: a disease or disparity that is especially common among people born at the same time. Using a statistical model, Times/Banner reporters found such an effect among overdoses for Black people in Baltimore, but not for white people, or older or younger Black people.

Racial tensions — and, at times, overtly racist policies — also made it harder for Black people of this generation to recover, according to historians and interviews with dozens of people alive in that era.

As better-paying jobs moved to the suburbs, benefiting white families who had fled the city in large numbers since at least the 1960s, some Baltimore County leaders used discriminatory zoning practices to discourage Black families from following. The city became increasingly poor.

City redevelopment projects destroyed certain Black communities, uprooting more than 10% of the city’s population. By the early 1980s, Baltimore’s young adults had some of the lowest high-school graduation rates in America. In 2001, Maryland imprisoned the third-highest percentage of drug offenders in the United States — the vast majority of them Black. Nearly all the seniors interviewed for this article had been incarcerated.

Lonely Days and Dangerous Samples

Today, many poor seniors have little choice but to live in privately run, publicly subsidized homes. Some also include younger residents with disabilities. Several of the buildings are former public housing projects.

Drugs in recent years have become more deadly for the elderly all over the country. Aging bodies may have a harder time processing narcotics, and doctors often fail to diagnose their addiction.

In Baltimore, fentanyl began to enter the city’s drug supply in the mid-2010s, and the pace of overdose deaths in the senior homes quickened. Then the pandemic hit. Residents were isolated, with nowhere to go and nothing to do, and illicit drugs were readily available.

The number of deaths shot up. Seventy-seven people died from overdoses in senior homes in 2023, more than double the number from 2019, the autopsy records show.

Ambulances rushed to some complexes multiple times a day. At MonteVerde, a manager recalled, emergency workers revived five people in a single weekend. While visiting Rosemont Tower in August, Times/Banner reporters saw a woman collapse outside the building in what appeared to be an overdose; she was carted away in an ambulance.

In November, after Baker’s three neighbors died at Irvington Place, a rumor spread in the building that they had taken bad “testers,” or free samples given out by dealers — both a risky marketing ploy and a way to gauge the potency of freshly mixed batches of drugs. A spokesperson for the Baltimore Police Department said the investigations into the deaths were open.

Dealers “target” senior apartments like Irvington Place because they know residents are vulnerable, said Cherese Rogers, who leads group counseling sessions at a treatment program down the street from the building. “At least once a month they get some money,” she said, referring to government benefits.

Relatives of two of the people who died said they were surprised to learn that fentanyl had been involved. They knew the women had used drugs when young, they said, but thought they had stopped decades ago.

One of the women had complained about the drug trade in the building.

“She told me it was something that disgusted her, to see that kind of stuff going on among seniors,” her daughter recalled.

Her family celebrated her birthday by attending a play with her about Billie Holiday. One month later, they were packing up her apartment.

Few Efforts to Target Seniors

In Baltimore’s poor neighborhoods, it is common knowledge that fentanyl is exacting a steep toll on seniors who have long wrestled with addiction. Even so, the cumulative impact of drugs on this generation has not drawn wider attention from government officials, health experts or social scientists.

In a 2022 report, a state task force looking into racial disparities identified Black people 55 and older as the fastest-rising demographic in overdose deaths. In another report that year, state health officials pledged to work together to “further understand these trends” and find solutions. They made the same promise again a year later.

The task force’s recommendations — steps like additional training and expanding efforts to help Black people access opioid addiction medication — have been largely untouched, said Dr. Aliya Jones, who led the group as a deputy secretary of the state’s Behavioral Health Administration from 2020 to 2022.

Jones said understanding the history of addiction among a generation had important public health implications, such as helping health care providers screen the right people.

In an interview, Dr. Laura Herrera Scott, Maryland’s health secretary since 2023, said the state had not studied the larger pattern of deaths among this generation.

“Our data or our funding is not targeted to those individuals,” she said, adding that the state was beginning to use data to focus its efforts, and would examine this group more closely to determine what kinds of services it needs.

The state Health Department subsequently said it had awarded a $30,000 grant to hire recovery specialists for one of the city’s hardest-hit senior buildings, would consider other recommendations and planned to publish progress reports.

Last week, the Times and the Banner reported that Baltimore’s initial public health response to rising overdoses was hailed as a national model, but efforts began to stall as other crises preoccupied leaders. Even as spending on addiction treatment for poor patients in the city’s sprawling behavioral health system skyrocketed, the number of people getting treatment dropped. The death rate rose to the highest level ever seen in a major American city.

In a statement, the city said the Health Department had been examining deaths in senior buildings and overdose data related to older adults for a year and a half, “with a large focus on identifying exactly who is overdosing at those locations.” It also said it had held naloxone trainings at 13 senior buildings in 2023 and six buildings so far this year.

Last year, a city Health Department spokesperson declined repeated requests for an interview, calling overdoses among seniors a “niche topic.” The health commissioner, Dr. Ihuoma Emenuga, who took office in March, also declined to speak to Times/Banner reporters.

In a more recent interview, Scott, the mayor, rejected the spokesperson’s characterization. “Overdose is not a niche topic for me,” he said.

He said the city needed to focus on factors that contribute to addiction by investing in stable housing and providing employment and educational opportunities.

When Black men are “denied jobs, denied good education, denied the opportunity to be trained in any of the places that other folks are working, this is what you get,” he said.

Going It Alone

As early as 2019, ambulances were coming to City View at McCulloh Homes multiple times a day, said Shanda Brown, a regional director at the Community Builders, the nonprofit that owns the building, a 350-unit former public housing project.

She recalls sitting in her ground-floor office and crying as she watched bodies being carried out past her window. Brown pored over security reports and discovered that fatal overdoses were shockingly frequent.

Three miles away, at MonteVerde Apartments, more of the building’s tenants turned to drugs and fell behind on rent in the isolation and stress of the pandemic, said Cindy Rozón, senior director of residents services for Affordable Homes and Communities, the nonprofit that owns the apartments.

For years, Rozón thought overdoses were a problem unique to the building until learning otherwise from Times/Banner reporters. She wondered why she had never heard from health officials.

“It’s alarming,” she said, “and shows more work needs to happen.”

At both buildings, managers took matters into their own hands. They came up with plans and searched for money, each receiving $250,000 in grants from an affordable housing nonprofit. At MonteVerde, managers used that money to start regular group therapy sessions and convert a game room into offices for full-time addiction treatment specialists. At City View, residents now have peer recovery coaches, transportation to drug treatment appointments and group outings to help them feel connected to the community. Ambulances have been coming less often, Brown said.

Ryan Carter, 58, quit heroin last year by enrolling in a methadone program a few blocks away and filled his days with watching action movies in his spartan one-bedroom apartment. But the boredom got to him one day in March and he used drugs again. As he has continued in treatment, the fashion shows for seniors and cookouts hosted by City View help. “It gives me other things to do instead of just lying around,” he said.

But the grants are for a limited time, the managers said, and they will have to find new ways to help their residents.

At Rosemont Tower, Robinson, the tenant council president, has not heard of any suspected drug deaths in the last few months. He wonders if a recent change has helped: The building’s managers arranged for a treatment program to hold group sessions there a few days a week and take residents on outings.

Between overdoses and other deaths in the building, he figures he has seen well over a dozen bodies. Some he watched being wheeled through the halls, but others he discovered while accompanying the maintenance staff on wellness checks. They found one neighbor sitting up on his couch, a small cap used for cooking drugs laid out in front of him. Others were long dead. The memories weigh on him.

He himself had once been addicted to heroin, slept at bus stops and been pistol-whipped by drug dealers. When he feels overwhelmed, he sits alone in his living room beside a few boxes of Narcan, underneath a sign he lettered with words of encouragement to himself: “We do recover.”

______

About the analysis

The New York Times and The Baltimore Banner analyzed anonymized data about every death in the United States between 1989 and 2022 from the Centers for Disease Control and Prevention. The data, obtained under an academic license through the reporter Nick Thieme’s affiliation with Columbia University, shows demographics and causes of death. Fatalities from 1968 through 1989 were collected from a separate data set the CDC publishes. Fatality rates in this article measure deaths that occurred in Baltimore, not deaths of Baltimore residents. For that reason, totals will differ from those in the CDC’s online database, CDC Wonder, which measures deaths by place of residence and also excludes deaths of people who live in U.S. territories or outside the United States. Baltimore’s older Black men were compared with demographic groups across the country by year of death, race, sex and county. The analysis grouped people born between 1931 and 1950, 1951 and 1970, 1971 and 1990, and after 1990 into buckets. To reveal the effect a birth cohort had on overdose mortality, the Times and the Banner used a statistical model to separate the impact of age, death year and birth year from other demographic factors. This technique, known as age-period-cohort modeling, is commonly used in epidemiology, and the modeling methods were reviewed by four experts in this type of analysis. The model showed that Baltimore’s cohort of Black men born between 1951 and 1970 overdosed at significantly higher rates than other generations of Black men. Using age-adjusted death rates did not change the results. Reporters identified deaths in senior homes using autopsy data from the Maryland Office of the Chief Medical Examiner, which was obtained by the Banner in a lawsuit. Senior homes were identified from the Baltimore City Department of Aging’s list of public housing options; those in the federal Rental Assistance Demonstration program, which also accept younger people with disabilities; or those that are advertised as senior-only buildings.

c.2024 T


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