Lisa Freeman knows the relief that comes when addiction releases its grip on a loved one.
Her late husband Wallace was, by her account, a prominent drug dealer in Manchester until a dramatic religious experience led him to kick his crack habit overnight. He spent the rest of his years mentoring youth and died in 2021 as a revered community leader.
“He was very, very proud of where he ended his life,” she said.
Freeman also knows the trauma and anguish that settles on caregivers when addiction doesn’t let up. She has another relative whose substance abuse disorder frequently makes him unrecognizable. As a former caregiver, she’s learned to put up boundaries for her own protection, and for her children’s.
“If I talk to him today, he is a mere shadow of what I remember as an uncle,” said Freeman, one of the grassroots leaders consulted for a new campaign to reduce overdose deaths.
Providing support to caregivers is a key objective of the campaign headed by the Allegheny County Department of Human Services. Launched earlier this month, Connect Protect Recover emerged as the county’s response to an alarming uptick in overdose deaths in Black communities, where rates have roughly tripled since 2018. During that time, overdose deaths for white residents have plateaued. Black residents in the county are now three times as likely to die of overdoses as are white residents.
The program is geared toward supporting loved ones and caregivers because, health officials say, they’re best poised to help people battling substance use and because they are also suffering.
“Caregivers are really struggling, stressed out, in some cases wanting to give up … and they need support, too,” said Pamela Weddington, vice president of communications for MEE Productions, which helped develop the campaign. “As part of the campaign, we want them to know that we see them.”
The campaign’s other main focus is changing the culture around addiction care. Hand in hand with the disproportionate death rate, Black residents’ use of existing addiction care services has been notably low, said Jessica Ruffin, who heads the department’s Office of Equity and Engagement.
The exact reasons are unclear, Ruffin said, but factors including historic mistrust of medical providers and stigma felt by older people — an increasing share of substance use patients — likely rank among them.
“Our analysts have been looking to identify root causes so we can make sure our interventions match,” Ruffin said. “The Connect Protect Recover campaign is completely community driven. Folks spent close to a year talking to community members — folks with lived experience.”
Local knowledge for local needs
The county department has invested $400,000 in Connect Protect Recover, which aims to:
- Help family members of substance users to find services
- Improve the depth of culturally competent services by promoting smaller community agencies and encouraging larger support organizations to expand
- Stress already-available harm-reduction tools and programs.
Many smaller organizations in the addiction space, such as Sojourner House in East Liberty, are led by community members like De’Netta Benjamin-Miller whose work has grown out of their experience as caregivers. They have stores of trust in the community, but, Weddington said, their reach is limited.
“You’ll see a ton of promotion for these providers” through the campaign, Weddington said.
Larger regional providers have signed on to the initiative and recognize gaps between what they offer and what vulnerable communities feel comfortable accepting, according to Ruffin. Changing this requires robust community engagement to build trust and understanding of local needs.
“It’s important for providers to be culturally curious about what’s going on with that community,” Benjamin-Miller said. “The culture in Homewood is different from the culture in the Hill District. It’s important for our providers to look at how you serve one community.”
Ruffin said the campaign includes a big push to encourage larger providers to take on this kind of work, and they’re willing to try.
“They recognize this is a population they’re not reaching and they want to do that work,” Ruffin said.
Rising disparities
Last year, 665 people died in Allegheny County as a result of overdosing. Of them, more than one in three was Black, while fewer than one in six county residents is Black.
The county’s age-adjusted fatal overdose rate — 56.5 per 100,000 for 2022 — was substantially higher than those of Pennsylvania (40.9) and the United States (32.6) when factoring all races. And while the state and country are also seeing proportional increases among Black communities, the disparities remain far less stark than here in Allegheny County.
Erin Dalton, the county’s human services director, said the causes aren’t entirely clear, but points to “an access to care issue that we can’t ignore.”
Another factor, Dalton said, is age. Overdose rates are “incredibly high” for older Black men, a population already vulnerable to sundry health and social afflictions.
Freeman, a social worker and urban farmer, cited the broader structural forces that result in elevated poverty and incarceration rates along with poorer health and educational outcomes for Black communities in Allegheny County and across the country.
“It affects every domain of our life — employment, education, economic status,” she said.
Other factors, such as prevalence of fentanyl in street opioid sales, that don’t exclusively target Black communities also help to explain the overall uptick in overdoses since 2020.
“Street drugs continue to change and continue to be more dangerous. It was not the case that everything was adulterated with fentanyl in the past,” Dalton said.
Benjamin-Miller said the pandemic and the grief, trauma and social upheaval it brought has been another contributor.
“If, during the pandemic, you weren’t connected to a family system or friend system … isolation created depression, which led to substance issues,” she said.
‘We can help now’
One of the campaign’s key messages is that help is available to those who want it. Unlike alcoholic recovery, Dalton said, those with opioid addictions can often benefit from immediate treatment even as the recovery process is long and uncertain.
“We can help now,” Dalton said, pointing to detox, medication-assisted treatment and other support programs. “With the opioid-related addictions and dependencies, we’re not constrained by beds and that is one helpful thing in the world and I think we can meet people’s care and needs more easily.”
Drawing on her personal experiences as a caregiver, Benjamin-Miller said it’s important for providers to spread hope amid the challenges.
“When it comes to recovery, people focus on the negative numbers. I like to focus on the positive — that 75% of people do recover. It might take them three or four times to enter into treatment. However, once they get it, they get it, and they end up doing beautiful things.”
Jamie Wiggan is deputy editor at PublicSource. He can be reached at jamie@publicsource.org.
This story was fact-checked by Rich Lord.
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