For the past six years, Baltimore has endured one of the deadliest drug epidemics in America, with fatal overdoses hitting one group disproportionately hard: black men, now in their mid-50s to early 70s.
They make up just 7% of the city's population but account for about 30% of drug deaths, a death rate 20 times higher than the rest of the country.
An investigation by The New York Times and The Baltimore Banner, based on previously unreleased autopsy records, more than 100 interviews and novel data analysis, sheds light on the impact on these men, who were part of a little-known lost generation.
In Baltimore, black men born between 1951 and 1970 have a disproportionately high rate of drug overdose deaths, and this has continued for decades.
Since 1993, more than 4,000 people have been killed in a drug wave — first heroin and crack cocaine, then prescription opioids and now fentanyl — that is the deadliest drug threat in American history.
Elderly white men and black women have also died at alarming rates, but fatal overdoses among these groups make Baltimore's death rate far higher than other cities..
Now, with fentanyl being introduced into the city's drug supply, deaths are at an all-time high. This generation of Black people is more likely to die from an overdose during the pandemic than from cancer or COVID-19. The drugs have become the leading cause of death, along with heart disease. “We can't think of any other situation like this,” said Robert Anderson, director of statistical analysis and surveillance at the Centers for Disease Control.
Many of these men now live in subsidized apartments for seniors that residents say are overrun with drugs.
Lonely grandparents and retirees who have struggled with drug addiction for decades suddenly find themselves surrounded by illicit temptations in buildings where drugs are easily available by walking down a hallway. Deaths have soared during the pandemic.
At least 31 of Baltimore's 50 most common locations for drug overdose deaths since 2018 are advertised as senior housing complexes. More than 340 people over the age of 50 have died in those buildings.
The information comes from previously undisclosed autopsy records and was only made public after The Banner won a lawsuit against the state's chief medical examiner's office.
“Sometimes I feel like I work in a morgue,” said Larnell Robinson, president of the Rosemont Towers Residents Council, where 15 people over the age of 50 have died of drug overdoses since 2018.
Their lives have been shaped by the forces that have driven the city's drug crisis for decades.
A half-century ago, manufacturing jobs began to disappear in an industrial city where black families had few opportunities to build wealth. By 1980, nearly half of Baltimore's black men under 30 were unemployed, the same level of black unemployment as during the Great Depression.
At the same time, the influx of highly addictive illegal drugs created a lucrative but corrupt underground economy in which some young people turned to selling and using drugs, many of whom were arrested, imprisoned and never found positive employment.
Mayor Brandon Scott said in an interview that the cause of the overdose disparity is clear: “When black men are denied jobs, when they are denied a good education, when they are denied the opportunity to get training in places where other people are working, this is what happens,” he said.
“As a Black person living in Baltimore, I know because we've seen it our whole lives,” he added.
There are few targeted efforts to support older black men.
The city has focused its drug education efforts on young people, leaving the fight against overdoses in senior care facilities to people with little expertise, like nonprofit program coordinators and apartment managers.
City health officials said they have taken steps to address the issue, including training residents of more than a dozen senior apartment complexes on how to use naloxone, the generic name for Narcan. Scott said in an interview that the city's efforts are not targeting any particular demographic group, but rather targeting many black seniors because they are the ones most affected by addiction.
The city also said it has been studying data on nursing home deaths and elderly overdoses for a year and a half, and the state health department said it will provide a $30,000 grant to hire a recovery specialist at one of the city's hardest-hit nursing homes and will support more related research and programs.
Some building managers are raising their own funds to try new approaches to stem overdoses, such as converting game rooms into full-time offices for addiction specialists.
This comes amid an overdose crisis of unprecedented scale in Baltimore.
Last week, The Times and Banner reported that Baltimore has become the epicenter of the worst opioid crisis ever seen in a major American city. Baltimore's death rate from 2018 to 2022 was nearly double that of any other major city, yet several top leaders, including the mayor and deputy mayor who formerly ran the city's health department, were unaware of this fact.
The city once had an aggressive strategy for overdose prevention, but many of the efforts stalled as officials became distracted by other crises.