She screamed and cried, banged on the dashboard, begging her husband to drive faster, faster, faster toward her brother lying face-down on his bedroom floor.
Craig Elazer had struggled all his life with anxiety so bad his whole body would shake. But because he was black, he was seen as unruly, she said, not as a person who needed help. Elazer, 56, had started taking drugs to numb his nerves before he was old enough to drive a car.
Now his sister, Michelle Branch, was speeding toward his apartment in an impoverished, predominantly Black neighborhood in north St. Louis. His family had dreaded the day he would die of an overdose for so long that his mother had paid for his funeral in monthly installments.
It was September, and as the COVID-19 pandemic intensified America’s opioid addiction crisis in nearly every corner of the country, many black neighborhoods like this one suffered most acutely. The portrait of the opioid epidemic has long been painted as a rural white affliction, but the demographics have been shifting for years as deaths surged among black Americans. The pandemic hastened the trend by further flooding the streets with fentanyl, a potent synthetic opioid, in communities with scant resources to deal with addiction.
In the city of St. Louis, deaths among black people increased last year at three times the rate of white people, skyrocketing more than 33%. Black men in Missouri are now four times more likely than a white person to die of an overdose.
Dr. Kanika Turner, a local physician leading the charge to contain the crisis, describes the soaring death rate as a civil rights issue as pressing and profound as any other. The communities now being hit hardest are those already devastated by the war on drugs that demonized black drug users, tore families apart and hollowed out neighborhoods by sending black men to prison instead of treatment, she said. Even today, black people in the United States are more likely to be in jail for drug crimes and less likely to access treatment.
Last year, George Floyd died in Minneapolis under a police officer’s knee. He had fentanyl in his system and some of the officer’s defenders tried to blame the drugs for his death. The world exploded in rage.
“That incident on top of the pandemic rocked the boat and shook all of us. It ripped the Band-Aid off a wound that has always been there,” said Turner, who grew in the same neighborhoods where Elazer lived, beset by addiction, poverty and one of the highest murder rates in America. “We’re undoing history of damage, history of trauma, history of racism.”
Pastor Marsha Hawkins-Hourd smiled at Brooks from the sidewalk.
“You make me so happy,” called Hawkins-Hourd, who runs the Child and Family Empowerment Center that helped Brooks find treatment and housing. “A lot of people fail. And it hurts when they fail. But you wipe all that away.”
She is part of a network of faith leaders and grassroots activists trying to overcome the distrust people have for the systems that typically address addiction but are infested with systemic racism, she said.
She looks at block after block of falling-down buildings in the north side of the city. She sees them as a symbol of her neighbors who were deeply traumatized, then abandoned with limited access to treatment.
At some point, these houses were filled with hope and life, she said. Then society left them to crumble as men were sent to prison and families buckled. Now the windows are broken out, their roofs caving in, weeds choking their insides.
“Mass incarceration and the war on drugs are the roots and all of this is the thorns,” she said. “It is a set-up for failure, a set-up to continue in the same cycle of poverty and death.”
Jerry Simmons sometimes imagines himself lying in one of those vacant houses where he sleeps, dead for days from an overdose before anyone discovers him.
He arrived in a church parking lot before dawn to be first in line for a mobile treatment van scheduled to arrive as part of a new state-funded effort to reach people like him.
“I just want to be a normal person back in society, working, living, loving, playing with my grandkids, making my kids be proud of me,” said Simmons, 49, who’s been addicted for 30 years, homeless and in and out of prisons.
When he climbed into the van, it had been about eight hours since he last snorted fentanyl, at 1:37 a.m. The crippling withdrawal symptoms would set in soon, he knew: aches down to the bone, diarrhea, shakes, insomnia.
To give himself strength, he wore a T-shirt printed with the face of his friend, killed in a hail of bullets 30 years ago. Simmons grew up near this church on the most murderous mile of road in one of America’s most dangerous cities.
“There’s death all around here,” he said. Three friends have died in the last month, two to gun violence and one to overdose. The drugs, at first, helped him escape.
He sat down across from a recovery coach from Hawkins-Hourd’s organization, which partnered with a treatment provider to usher people here.
“In the past 30 days, have you experienced serious depression?” she asked him.
“Have you neglected family because of your use of drugs?”
“Have you lost a job because of drug use?”
“Yes,” he said again. Addiction has taken everything from him.
He was there to enroll in a treatment program that includes a prescription for the medication buprenorphine, which has been found to greatly reduce the likelihood of overdose death. But researchers have found that white patients are far more likely than black patients to receive it. Black people instead tend to be steered toward methadone, which is distributed in highly regulated programs that often require standing in line daily before dawn.
“That is the worst form of segregation: one for the white, well-to-do people, one for the rest,” said Dr. Percy Menzies, president of Assisted Recovery Centers of America, the company stationing mobile units on street corners and church parking lots. “The tsunami of fentanyl is absolutely frightening, and they have virtually no safety net.”
Addiction is treatable with medication and therapy, he said. But he knows they can’t expect to show up in white lab coats and ask people to trust them right away.
He started going to black churches to bring pastors on board.
Minister Lacha Hughes heard him speak at her church on a Saturday, and the next day her niece, Natisha Stansberry, called her hysterical. Most of her life, Stansberry, 30, used drugs to self-medicate her mental distress. She was raped as a child and attempted suicide. In 2016, her 23-year-old brother was murdered. Stansberry wished it would have been her instead.
“I wanted to be the best I could be, but I went down the drain,” she said. “I want to get myself together.”
She was weeping into the phone that she was scared of dying; two of her friends had overdosed, one was dead and one in the hospital. Hughes ushered Stansberry into Menzies’ clinic. Until now, all she ever knew to do for her was pray.
It had felt to her like they’d had no help. In a crisis, many here are even hesitant to call 911 because they fear the police.
Now all over town, people walk around wearing little red backpacks, passed out by activists like Jerome Anderson, trying to saturate the streets with the overdose reversal medication Narcan so they can save each other.
He calls at passers-by: “Hey, take some Narcan. Save a life. I’m tired of going to family funerals.”
Anderson, in recovery for 26 years, sang at three cousins’ funerals in the last six months, all dead from overdose. He works for a grassroots public health group called Williams and Associates and his mission is to keep people alive so that one day they can find their way to recovery.
He carries around a cover letter that lets people know he’s not a cop. Sometimes drug dealers let him stand next to them, to hand their customers his kits.
Jamilia Allen has used Narcan to revive her friends, more than once. She’s terrified of fentanyl, but she’s tried and tried to shake her heroin and crack addiction.
“It’s designed to kill us, and that’s what it’s going to do. It takes your soul. If it don’t kill you physically, it’s going to kill you emotionally, kill all your dreams,” she said. “I really want my life back, but I can’t grasp it.”
Allen, 31, was once an honor roll student and the captain of her high school cheerleading squad, and back then she judged people desperate for drugs.
She went to Walmart recently and was jealous of a woman buying a shower curtain. She wants a life that simple, and she fantasizes about someone sending her to a place like Malibu, where the rich white people go to kick addiction.
She was for a long time ashamed of her life: prostitution, being raped, beaten, thrown out naked in the snow. But now, she said, she wants people to know.
“I’m not going to let this kill me, and if I can help anyone else,” she said, “then that’s one less person like me.”
All Michelle Branch has left of her brother fits into a little green shopping bag.
The Bible she bought him one time when he got sober and wrote “One Day at a Time” on the title page.
There’s the baby book her mother put together, with so much hope when she taped a lock of his hair to the pages. There are report cards chronicling a bright child, loved by teachers but struggling to focus.
By third grade, he could read as well as a sixth-grader. He and his mother, a teacher, would read the newspaper cover to cover. He liked cowboy stories.
But he was anxious and jittery. Had he been diagnosed and treated, Branch believes he would be alive today.
“But they didn’t catch hyperactivity or bipolar back then, especially not in little Black kids. We were just unruly, undisciplined, this much removed from being an animal,” Branch said, pinching her fingers so there was little space between them.
Branch worked in the school system when the opioid epidemic began, white people were dying and pundits on TV said they needed to be saved from this public health tragedy. She wondered where they’d been when her brother was swirling into addiction.
Their mother raised them alone and they didn’t have a lot of money. He told Branch he started drinking when he was 12, and soon progressed to drugs. He lived transiently, sleeping under overpasses, on dirty mattresses in dark alleys.
She can’t count the number of times he tried to get sober.
Their mother always worried he would die. She wrote on little slips of paper and left them all over the house: pinned to her bedroom lampshade, taped to the kitchen wall. “God is working this problem out for me,” they said.
She got sick with cancer, but lingered for years. Her family believed she was holding on out of fear of what would happen to her son.
She died worried about him.
He was in and out of jail, mostly for petty offenses. But several years ago, an acquaintance alleged he sexually assaulted her while using drugs. His lawyer told them the odds were against him as a black man accused of assaulting a white woman, Branch said. He pleaded guilty and spent three years in prison.
He was released in May 2020, as the pandemic bore down.
He couldn’t find a job. There were no recovery meetings in-person and he’d been so transient all his life he didn’t know how to use a smartphone. He was alone most of the time, with his 10-pound dog, Rico.
One night they couldn’t reach him. His cousin, Carleton Smith, looked through the mail slot and saw him lying there.
The first responders gathered over his body pointed to a paper plate on his bed with a pile of white powder. “Fentanyl,” they said.
When Branch sat down to write his obituary, she decided to tell his truth.
She wrote that he was a gentle soul but addiction destroyed him.
“It would devastate his family, make him homeless, cause him to beg for money on the street, take his freedom, his sparkle and smile,” she wrote.
“It would take and take and take until it took his life.”
AP reporter Mark Stevenson contributed from Mexico City and Jim Salter from St. Louis.