More older Black men in Philadelphia are dying of overdoses than many other places in the U.S.: ‘It’s like a secret disease’

The year he turned 50, Ricky Austin nearly died of drug overdoses three times.

He had started using heroin as a teenager in East Baltimore. Four decades later, a move to Philadelphia introduced him to a new and deadly synthetic opioid, fentanyl, which had replaced heroin in the city’s drug markets.

Soon he had infections in his colon and in his blood. His sturdy frame shrank to 110 pounds. And though he craved the drug’s effects, he had no way to gauge the dosages sold on the street.

Austin’s life may have been saved by chance. He was homeless and sleeping behind a Walgreens on a cardboard mattress in Kensington, the epicenter of the city’s drug crisis. There, bystanders had ready access to a medication used to reverse opioid overdoses, naloxone. This helped, again and again, to bring him back from the brink of death.

The third overdose was Austin’s wake-up call. He sought help at a local hospital, then entered long-term addiction treatment. Now almost three years in recovery, the 52-year-old feels grateful for a chance that many of his friends never lived to see.

In Philadelphia, Black men like Austin from their 50s to their 70s have been dying of overdoses at staggering rates. The overdose crisis for Black men in American cities began decades ago, along with economic dislocation and a new abundance of heroin, yet the disproportionate suffering of this older generation was long unrecognized.

The toll continues to rise for this population, even as overdoses are ebbing for others who are younger, whiter, and more rural, a new national data analysis shows. In Philadelphia, 942 Black men born from 1951 through 1970 died of overdoses over a five-year span ending in 2022. That group represented 15% of Philadelphia’s overdose deaths in that period but makes up only 4% of its population.

» READ MORE: How drug overdose deaths have plagued one generation of Black men across the U.S. for decades

That disparity — more than 11 percentage points — is one of the largest in the country, the analysis by the Baltimore Banner, the New York Times and Stanford University’s Big Local News found, using data from the Centers for Disease Control and Prevention not available to the general public.

This group died of overdoses at a rate more than 40% higher than their similarly aged Hispanic and white peers.

“All the guys I got high with — they’re all gone. They’re all dead,” said Austin, who was born in 1972, just shy of the worst-hit demographic.

Philadelphia’s age and racial disparities are different from those seen in other big cities. In Baltimore, Washington, San Francisco, and Chicago, deaths among this group of older Black men have been higher than for any other group for much of the last 30 years.

In Philadelphia, the new analysis shows it was not until more recently that this group of older Black men started dying at the highest rates of all.

Philadelphia health officials are still learning about the causes. It’s likely that no one factor is behind these deaths, but rather a combination of issues.

To start, there are the drugs themselves: The rise of fentanyl has spurred skyrocketing overdose rates across the city.

Age is also a factor as more Black Philadelphians are dying with stimulants like cocaine and methamphetamine in their systems, either alone or in combination with opioids like fentanyl. In particular, people who have used stimulants for years risk heart damage that puts them at higher risk of an overdose.

Concerted outreach to Black communities with rising overdose rates has only recently gotten off the ground, and is complicated by the legacy of racist drug policing.

The men who are now dying at the highest rates in Philadelphia were children, or entering adulthood, when the federal War on Drugs began in the 1970s. Their experiences were shaped by the crack epidemic, racist rhetoric about “crack babies” and “super-predators,” intense police surveillance, and harshly punitive jail sentences.

Now, many are wary of drawing attention to their drug use.

City Councilmember Kendra Brooks saw this spring the extent of the problem surfacing in Nicetown, the majority-Black neighborhood where she was raised and still lives. It started with a social media post about a neighbor who had recently died of an overdose.

A few days later, there was another overdose. A few days after that, a neighbor confided in her about another death.

Within just a few weeks, she learned about nine people who had died of overdoses in about five square blocks. All were Black. Most were in their 50s or older.

Brooks thought about how many people may be using in basements and living rooms, without anyone around to intervene in an emergency. People like her father, who is now in his late 70s and was addicted to crack for most of her life. Until he entered recovery, he kept going to work, hiding his addiction.

“In this generation, you don’t get high in public. It’s something very private and personal,” Brooks said. “Amongst folks that I know, it’s like a secret disease.”

By 2022, the number of fatal overdoses in the Nicetown area was second only to the community encompassing Kensington, nationally known for one of the country’s largest open-air drug markets.

The soaring deaths among Black residents of all ages have offset the progress made in reducing overdose deaths overall in Philadelphia, city and state data show.

In 2023, fatal overdoses in the city declined slightly to 1,316 deaths, according to state data. It was still the second-highest death toll ever recorded in the city, through an improvement from a record-breaking 1,413 fatal overdoses the year before.

While fentanyl is involved in the overwhelming majority of overdose deaths in Philadelphia, that doesn’t tell the whole story. Since 2017, about half of the overdose deaths in the city have involved both an opioid like fentanyl and a stimulant like cocaine or methamphetamine.

Such deaths have increased by 146% among Black residents from 2018 through 2022, and by 81% among Hispanic residents.

By contrast, deaths among white residents involving opioids and stimulants rose by only 7%.

It’s unclear whether this rise is occurring because people are mixing drugs intentionally, or unintentionally using stimulants contaminated with fentanyl.

Efforts to warn people with addiction about dangerous drug combinations, and the rise of fentanyl, vary wildly between neighborhoods.

In places like Kensington, outreach workers have flooded the area with naloxone and test strips that detect the presence of fentanyl in illicit drugs.

But the city has only recently stepped up similar efforts in majority-Black neighborhoods in North Philadelphia and West Philadelphia, where drug use is less visible.

After the cluster of overdoses in Nicetown this year, Brooks and her City Council office helped to organize a health fair aimed at getting residents health assessments, addiction treatment, and overdose prevention tools like naloxone and testing strips.

City health workers say in the zip code that includes Nicetown, they’re inching closer to having given out enough naloxone to reach a “saturation point,” meaning that whenever someone overdoses, it’s likely that someone else nearby will have a dose.

For Germantown resident Albert Knight Jr., that kind of outreach is crucial. Knight had used cocaine since his 20s with a group of mostly older friends in his Northwest Philadelphia neighborhood.

A few years ago, when he first began “blacking out” occasionally after using cocaine, he had no access to test strips and no idea how to use them. He did not even suspect that fentanyl had contaminated his drugs.

“I was clueless,” said Knight, 47.

Knight reached out to Brooks’ office for help seeking treatment earlier this year after his girlfriend died of an overdose. His mother found her dead on the living room couch.

“It was devastating,” he said. “And it could have been me.”

This year, working his way through addiction treatment, Knight has lost eight friends to overdoses, including several in the cohort of older Black men dying at the highest rates.

City outreach workers have knocked on more than 100,000 doors in predominantly Black and Hispanic neighborhoods seeing rising overdose rates in the last year.

About one in 11 residents answered the door, and most of those who did were both aware of the overdoses in their community and eager to accept naloxone and fentanyl testing strips: In some zip codes, up to 88% of neighbors took them.

But outreach workers found the acceptance of prevention tools was lowest in the neighborhood where overdoses were highest: Nicetown.

Rudolph Looney, a longtime West Philadelphia resident, regularly hands out naloxone and testing strips around the neighborhood as part of his role on a community advisory board run by Penn Medicine.

In each interaction with Black men of his generation, he sees the consequences of systemic racism and poverty, the long specter of the War on Drugs, the more recent stress of the COVID-19 pandemic, and the struggle of living in gentrifying West Philadelphia while trying to make ends meet.

“People are trying to find ways to make themselves feel better — or not even to feel better, but to forget,” Looney said.

The racial disparities extend to addiction treatment.

In 2023, state officials looked into cases of overdose deaths to see whether the deceased person had ever been treated for addiction. They found that 24% of white Philadelphians who died of overdoses that year had gotten some form of treatment at least once in their lives, and about 14% were in treatment at the time they died.

Just 14% of Black Philadelphians who died of overdoses, by contrast, had ever received addiction treatment before their deaths, and 7% were in treatment when they died.

Ricky Austin feels lucky he was able to get into a treatment program that helped him start methadone, a medication used to curb the cravings of opioid addiction. But he has learned that recovery goes beyond medicine.

“You have to teach people to look for resources — you feel defeated, as a grown man, not knowing how to balance a checkbook or fill out a job application,” he said.

Now, Austin lives at a South Philadelphia recovery house and works in food services at the University of Pennsylvania. He thinks often of his childhood friends and the help that didn’t reach them in time.

“It was only through God’s grace,” he said, “that somebody was there for me.”