To stop fentanyl deaths in Philadelphia, we're knocking on doors and distributing overdose kits

To stop fentanyl deaths in Philadelphia, we're knocking on doors and distributing overdose kits

On a narrow street lined with row houses and an auto repair shop in the Kensington neighborhood of North Philadelphia, Marsella Elie climbs the front steps of a house and knocks violently on the door.

A middle-aged man appears with a suspicious expression on his face.

“Hello sir, how are you today?” asked Elie, wearing a royal blue jacket embroidered with the city government's Liberty Bell logo. "My name is Marsella. I work with the city. You've heard about the overdoses going around the neighborhood, right?"

The man nods cautiously.

Elie gestures to the pamphlets she is holding about drug overdoses and addiction treatment programs. She holds up a box of Narcan, a brand of naloxone that can reverse an opioid overdose.

"We're trying to bring this into every home. Have you ever heard of it?" Elie asked before handing the man a shopping bag full of more pamphlets, fentanyl test strips and the box of Narcan.

Elie and other city part-time workers and volunteers are part of a large-scale, citywide door-to-door campaign in Philadelphia aimed at providing households with naloxone and other drug overdose prevention tools.

City officials hope this proactive approach will normalize naloxone as an everyday item in the medicine cabinet and prevent people, particularly Black residents, from dying from overdoses.

A record 1,413 people died of drug overdoses in Philadelphia in 2022, according to the city. Deaths among black residents rose 20% compared to the previous year, many of which occurred in private homes.

“The best thing we can do to make these things more accessible is just give them to people,” said Keli McLoyd, deputy director of the city’s Opioid Response Unit, talking about the tote bag containing naloxone and other supplies. "We're not asking you if you're on drugs. The goal here is really to build some kind of collective responsibility. As black and brown people, as we've seen during the Covid epidemic, no one is coming to save us. For us, this is a tool to save ourselves.

The outreach initiative aims to bring prevention materials directly to people who might not otherwise seek them out and raise awareness of overdoses beyond Kensington, the epicenter of the city's addiction epidemic. Canvassers plan to knock on more than 100,000 doors in Philadelphia's "hot spots" - ZIP codes with rising rates of opioid overdoses, many in minority communities.

The widening racial disparities in overdose deaths are among the long-term consequences of the war on drugs, McLoyd said. The actions of this national anti-drug campaign led to decades of aggressive policing, racial profiling, and lengthy prison sentences that disproportionately affected people of color and their communities.

Research shows that Black Americans still account for a disproportionate number of drug arrests and child protective services arrests.

"For that reason, it's very clear why black or brown people might be hesitant to raise their hand and say, 'I'm someone who uses drugs, I need these resources,'" McLoyd said.

Other communities have distributed naloxone and other supplies, although on a smaller scale than Philadelphia.

What Philadelphia is doing could become a model for other densely populated places, said Daliah Heller, vice president of drug use initiatives at Vital Strategies, a public health organization that works with local governments in seven states to combat the opioid epidemic.

“There is something very personal about human engagement,” Heller said. "And when someone knocks on your door to talk about drug use and the risk of overdose and that there's something you can do, I think that's really powerful."

Over the years, naloxone has become more accessible than ever before, Heller emphasized. It can now be ordered online and by mail, it is available in dedicated vending machines, and some drugstores now sell Narcan nasal spray over the counter.

But every year tens of thousands of Americans die from opioid overdoses. That means prevention efforts and messages about the crisis are still not reaching some people, Heller said. And for her, reaching people means meeting them where they are. “That means physical, that means what they know about something, how they perceive something and what beliefs they have,” she said. “That’s how we need to think when we think about naloxone distribution.”

The Philadelphia advertising project is being funded in part by the city's share of settlement payments from nationwide lawsuits against opioid manufacturers and distributors. The city is set to receive about $200 million over about 18 years from settlements with AmerisourceBergen, Cardinal Health, McKesson and Johnson & Johnson.

The initiative is comprised of many of the same individuals who originally began recruiting as part of the 2020 Census.

Not everyone opens the door to advertisers. Some aren't home when they come over. In these cases, workers post a flyer on the doorknob that provides information about overdose risks and contacts for additional resources. The canvassing teams, often with language interpreters, later make a second search of a neighborhood to reach people they missed the first time.

On a recent Thursday, Philadelphia canvassers knocked on doors in the Franklinville and Hunting Park neighborhoods. About 85 people died of drug overdoses in this ZIP code in 2022, according to the city. That's fewer than the 193 people who died from overdoses in Kensington in 2022, but far more than the few deaths in the city's wealthiest neighborhoods.

The canvassers approached a resident, Katherine Camacho, on the sidewalk as she emerged from her garage. Camacho told teams she was aware of the overdose problem in her community and then eagerly accepted a box of Narcan.

"I'm going to carry this with me because like I said, sometimes you're driving somewhere on the road and you can save a life," Camacho told them. “And if you don’t have those things, it’s harder to do that, right?”

Camacho said she has seen how the opioid crisis has caused suffering in her neighborhood and across the city. As for Philadelphia's canvassing efforts, she said she believes "God is calling these people to help."

As she walked into her home with the box of Narcan, Camacho said she also wanted to do her part to help.

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