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Mary's Center, a community health center with locations in Washington, D.C., and Maryland, started its addiction services program in 2015, offering medication-assisted treatment, naloxone training, counseling and a weekly recovery support group. Over the next five years, just four of their 600 patients overdosed and died. But that figure more than doubled in 2020, to 10 fatalities, a change the clinic attributes to the challenges of isolating during the coronavirus pandemic and the still-growing prevalence of the deadly synthetic fentanyl.

"It's awful to see. Because most of it has actually been in patients that were really stable, and they've been stable for long periods of time, sober for over a year," said Daniel Smith, director of addiction services at Mary's Center. "I can think of four people specifically that had been sober for over a year, and then relapsed and died within two weeks of their relapse."

The center's experience is just a slice of what providers in the D.C. area, and the country at large, saw last year. Fatal opioid overdoses increased 46 percent in the District of Columbia in 2020, according to city data, despite a pre-pandemic pledge by D.C. Mayor Muriel Bowser to cut opioid deaths in half between late 2018 and the fall of last year. Virginia recorded 2020 as its deadliest year ever for opioid-related fatalities, according to preliminary data, with a 47 percent increase compared to 2019. Maryland saw a nearly 19 percent jump in fatal overdoses involving opioids, according to preliminary data, with increases of 54.9 percent in Prince George's County and 25.6 percent in Montgomery County.

Although nationwide 2020 data won't be available until later this year, health researchers predict at least a 27 percent jump in fatal overdoses compared to 2019, which would be the largest single-year percentage increase in the past two decades. Experts say a major factor was the pandemic, which left many isolated from treatment as well as family and friends even as jobs dried up and schooling went online.

"This whole pandemic has been routine breaking and taking away the connections people once had," which are vital for people who are in recovery, said Osazee Imadojemu, an attorney focused on health law who worked for the D.C. Council's health committee last year. "The isolation and not being able to be around people just wears down that ability of a person to connect."

Federal authorities tried to ensure people had access to opioid-use disorder treatment during pandemic-related lockdowns — waiving some in-person medical evaluations, for example. Health experts, and the American Medical Association, hope those changes stay in place once the public health emergency ends.

"I'm an advocate for less barriers to care," said Smith, of Mary's Center. "So I think that all of the regulation relaxation that happened during the pandemic ... I think all of that is positive."

D.C. health officials say they are evaluating which changes put in place during the pandemic ought to be permanent, noting the importance of medical check-ins before people can get access to medication-assisted treatment.

"We have to be very careful, obviously, when you're distributing powerful drugs to counteract the effect of opioid use. And so the Department of Behavioral Health is examining that question," said Wayne Turnage, deputy mayor for health and human services.

There were 411 fatal opioid overdoses in the District in 2020, compared to 281 in 2019, according to an April report from the D.C. Chief Medical Examiner's Office. The majority of people dying from drug overdoses were between the ages of 50 and 69, Black and male. Ward 8, the city's poorest, saw the highest number of overdoses, with 74 in 2020 compared to 59 in 2019.

The data illustrates the failure of a key component of the District's "Live Long DC" program, launched in late 2018 after a Washington Post investigation found the city was slow to respond to an overdose crisis that primarily affected Black men. In announcing the program, Bowser said the District would use a federal grant and other resources to significantly expand treatment, tracking and education in the hopes of cutting overdose deaths in half within 21 months.

Turnage said data shows the city has had some success — emergency crews and outreach workers successfully used naloxone to reverse more than four out of five overdoses they were called to, for example. But in many other cases, they were never summoned in part because people were less likely to be with others while using opioids during the pandemic. The city distributed more than 43,000 naloxone kits in 2020, Turnage said, compared to about 15,000 in 2019 and just 3,500 in 2018.

"We do all these things, and yet we see this precipitous increase in the number of people who are dying, and it creates a certain sense initially of hopelessness," Turnage said. "But then you see data that says you reverse 82 percent of the overdoses that you were able to identify ... and it makes you realize that number, of 411 overdoses, would have been a lot worse had we not had the programs and initiatives in place to try to deal with a very, very, very challenging problem."

In the District, Virginia and Maryland, the impact of the powerful synthetic drug fentanyl continued to increase in 2020. Fentanyl was linked to 94 percent of opioid-related deaths in the District, compared to 91 percent of deaths in 2019. In Virginia, fentanyl was involved in 72.1 percent of all drug overdose deaths, a 71.7 percent increase from 2019; in Maryland, the number of deaths involving fentanyl was 93.1 percent, a 20.7 percent increase.

"The metric is astronomical," said Kathrin Rosie Hobron, the statewide forensic epidemiologist for the Virginia Department of Health Office of the Chief Medical Examiner.

The number of fatal cocaine overdoses increased by 33 percent in Virginia in 2020, although they are still far outnumbered by deaths attributed to opioids. Fatal overdoses attributed to heroin decreased 6.8 percent from 2019 to 2020, according to the state's latest report.

In Maryland, the Capital Region, which includes Montgomery, Prince George's and Frederick counties, reported a 32 percent increase in opioid-related fatalities in 2020 compared to 2019. Prince George's had the highest growth, with 158 opioid-related fatal overdoses in 2020 compared to 102 in 2019 — an increase of 54.9 percent. Montgomery County saw a 25.6 percent increase in opioid overdose deaths, from 86 to 108.

Opioid-related fatalities increased the most for people over 55 and for Hispanic people in Maryland, according to state data. Baltimore City continued to have the highest number of overdose fatalities in the state — 954 in 2020, up from 851 in 2019.

"Continued deaths from opioid misuse are heartbreaking, and clearly the coronavirus emergency has made it more difficult for people to access support systems," said Charles Gischlar, a spokesman for the Maryland Department of Health, who credited a statewide response program led by the Opioid Operational Command Center and its partner agencies with keeping the increase in Maryland below that seen in Virginia and D.C.

He said the state's Racial Disparities in Overdose Task Force "is currently examining the factors influencing the increase in deaths in Prince George's, Baltimore, and Anne Arundel counties and Baltimore City."

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