Aaron King, 56, homeless and addicted to cocaine, leaned against the wall of a building in Newark near a drug-use harm reduction center opened this fall as New Jersey battles an epidemic that quietly claims the lives of thousands each year.
A blue T-shirt hung from his rail-thin frame reading “Occasional Adult.”
King said he was aware of the deadly risks he faces daily of overdosing on fentanyl, the powerful opioid often added to low-grade heroin, cocaine and other street drugs to strengthen their effect, sometimes to the point of killing the user.
“I’ve seen it happen,” King said. Even so, he added, “I never think it’s me.”
It may only be a matter of luck that it hasn’t been.
The drug crisis has swept across America’s cities and towns, killing more than 100,000 people annually. But few groups have been more vulnerable to its wrath in recent years than late-middle age and elderly Black men like King, who are overdosing at rates dramatically higher than anyone else in dozens of communities across the country, data from the Centers for Disease Control and Prevention shows.
Nationally, Essex County and several other New Jersey counties were among the hardest hit by that disparity, with older Black men dying at a pace that far exceeds their share of the population, according to deaths reported to the CDC from 2018 to 2022 that were analyzed by The Baltimore Banner, The New York Times and Stanford University’s Big Local News.
In that time, 480 Black men born from 1951 through 1970 died of overdoses in the county. That represented 26% of Essex’s overdose deaths, though they make up just 4% of the population.
It was the second largest disparity in the United States, behind only Washington D.C., the media groups’ analysis found.
The divide devastated a generation of Black men now ages 54 to 73 buffeted by poverty, lack of economic opportunity, high unemployment and systemic racism, experts say.
Despite those hurdles, many of them survived decades-long struggles with addiction only to be felled by the rise of fentanyl, a powerful synthetic now found in a host of street drugs, presenting new dangers longtime drug users.
“Some may not even know they’re taking it, or at least how much they’re taking even if they’re aware illicit drugs like heroin and cocaine are laced with it,” said Angela Conover, director of opioid response and prevention at the Partnership for a Drug-Free New Jersey.
Adding to that, Conover and others said, are limited access to drug treatment due to a lack of insurance or facilities, and the isolation imposed by the coronavirus pandemic, which kept older drug users from family or friends who might have kept them from overdosing.
Experts said another factor might have been military service in the Vietnam War, a conflict that exposed many U.S. troops to drugs and one in which Black draftees were over-represented among enlisted men.
“My view is that it’s all tied to a whole lot of issues,” Dr. Robert L. Johnson, dean of the New Jersey Medical School in Newark, told NJ Advance Media. “Those social determinants of health that have an impact on how you experience healthcare are worse for that cohort, whether it’s racism, homelessness, unemployment, bad environment, lack of insurance and so on.”
Older Black men in Essex County overdosed at rates six times the rate of the county’s overall population, and nearly 12 times the rate nationally.
They died at 2½ times the rate of Essex’s second most likely group to fatally OD — older Hispanic men. Disparities were even wider with other age groups, races and women.
“When I read that I said, ‘Hey, that’s no huge surprise,’ because I know what these outcomes are like,” Johnson said.
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The data was obtained from the CDC by The Baltimore Banner under an academic exemption for a reporter affiliated with Columbia University. For a project in conjunction with The New York Times and Big Local News, The Banner shared the CDC data with NJ Advance Media and other news outlets around the country for stories focused on urban areas they cover.
The analysis detailed what epidemiologists call a cohort effect: a disease or disparity that is especially common among people born at the same time. It focused on 408 counties across the United States, each of which had more than 200 overdoses over the five years. That captured 17 of New Jersey’s 21 counties, including six that saw some of the nation’s more dramatic racial disparities among older Black men.
Like Essex, each of the other five New Jersey counties has a dominant city with a substantial Black population, pockets of poverty and other adverse conditions. They were Union County, which includes Elizabeth, ranked 15th in disparity among the counties examined; Hudson, with Jersey City, ranked 18th; and Passaic, with Paterson, ranked 22nd. Tied for 25th were Camden County, with the city of Camden, and Mercer County, with Trenton.
Essex is a widely diverse county racially, economically, in terms of density, and in other ways, with 22 cities and towns and a total population of 850,000. It is roughly divided into an eastern port dominated by Newark, the state’s largest city, and western one, made up of wealthier, whiter suburbs.
The CDC data did not break down the overdoses by municipality. But the New Jersey Department of Health said the vast majority of the deaths occurred in Newark, a city with a population of 305,000 that is 47% Black, according to 2023 Census estimates.
Newark’s levels of income and education, home ownership, health outcomes and other barometers of well-being lag below statewide averages, hurdles that addiction professionals say often accompany high rates of drug use.
“You can’t lump all of Essex County together,” said Robert Budsock, CEO of the Newark-based non-profit Integrity House, one of the state’s leading providers of residential and outpatient drug use treatment programs.
The health department called Newark “the epicenter” of drug-related deaths in the county, and acknowledged they have disproportionately impacted older Black men.
Fentanyl is a leading cause, the department said in a statement released by spokesperson Dalya Ewais. In 2021, for instance, 88% of fatal overdoses among Black men in the county involved fentanyl, usually combined with other drugs.
To curb overdoses, the department has Overdose Fatality Review Teams in every county and some larger cities, which meet monthly to review data and discuss solutions, she said. Other measures include a hot spot initiative targeting problem areas with enhanced outreach efforts.
Separate data on admissions to residential drug treatment programs in Essex also point to Newark as a hub of the county’s drug activity. According to the New Jersey Department of Human Services, Newark accounted for 61% of Essex County’s 8,194 admissions to residential treatment programs in 2022, with the neighboring municipalities of East Orange, Irvington and Bloomfield accounting for an additional 20% of cases.
Robert Budsock is CEO of Integrity House, one of New Jersey’s largest providers of residential and outpatient drug addiction treatment services. Ed Murray| For NJ Advance Media
To be sure, drug use and fatal overdose transcend race and class, with just under a third of overdoses nationwide occurring among whites, according to the CDC.
Still, Essex County’s over-representation was consistent with other large urban areas around the country, including Baltimore, Chicago and Washington D.C.
Budsock said the data obtained by The Banner confirms that policy makers, public agencies and non-profits have been targeting their limited resources at the populations and locations that need them most.
“Our mobile vehicle is an example,” he said, referring to a large RV that Integrity house staffers drive into neighborhoods to provide residents with fentanyl test kits and clean needles.
Newark officials pointed to progress New Jersey has made recently in bringing down overdose deaths.
Luis Ulerio, director of the Mayor’s Office of Homeless Services in Newark, cited statewide data released this fall by the CDC indicating a 21.5% decline in the number of fatal overdoses in New Jersey for the 12-month period ending in June. That represented 2,354 deaths, down from 2,997 deaths in the previous 12 months.
Ulerio, an appointee of Newark Mayor Ras J. Baraka, didn’t provide figures for Newark, but said the city shared in the state’s overdose decline, thanks in part to “a full spectrum of social services that includes deploying medical and clinical professionals on the ground, to providing direct access to substance abuse treatment, medications, and direct access to facilities, and housing.”
Those services have been expanded, he said, using settlement funds the state received stemming from litigation charging that pharmaceutical companies, including New Jersey-based Johnson & Johnson, were liable for opioid addiction.
“Reflecting back on that period,” Ulerio said of 2018-2022, “we see that the cohort of older black men who comprised the tragic spike in overdoses in Newark became addicted at the beginning of America’s opioid epidemic in the 1970s, in large part because of the Vietnam War.”
“Economic issues exacerbated the epidemic among the marginalized population of older black men who were unemployed and underemployed, without a sufficient support system to manage their substance use disorders co-occurring with the physical decline of aging in poverty,” Ulerio said.
Referring to fentanyl, he added, “At the same time, the quality of opioids became much more lethal during the five-year study period.”
New Jersey public health officials have sounded alarms for several years over drugs’ rising toll in the Black community. In 2015, Black New Jerseyans accounted for 13% of the state’s fatal overdose victims and 12% of the population, an almost-even representation. But that number has been rising since, with Black overdose victims making up 27% of the total this year through Dec. 14, state data shows.
“The reality is not everyone is sharing in the progress that we’ve made,” Budsock said.
Experts said drugs tend to isolate users from friends and family who otherwise might serve as a support network to keep them alive, whether by attending to everyday needs and unrelated medical issues that typically increase with age, or being available in case of an overdose to call an ambulance or administer naloxone, the opioid blocker that has saved countless lives.
Aaron King cleaned up his spot outside Integrity House’s new Harm Reduction Center opened in Newark this fall. Ed Murray| For NJ Advance
Aaron King, for example, said he lost his last supply of naloxone, along with his phone, when his backpack went missing.
King said he moved to Newark from his native Paterson in Passaic County six years ago because the larger city offered more drug treatment facilities and services. He was describing precisely what drug addiction workers said was a kind of magnet effect that may draw addicts to Essex County, inflating the area’s addicted population — and its overdoses.
For example, in addition to Integrity House and other non-profit treatment facilities, Essex is home to the massive East Orange VA Medical Center, one of only two U.S. Veterans Administration hospitals in New Jersey, which treats substance use disorder common among former service members.
Johnson cited research tracing racial imbalances in drug treatment and addiction back to the Civil War, when the country experienced its first opioid epidemic. However, biases at that time didn’t lead to disproportionate levels of addiction and fatal overdose among Black men, according to research. Just the opposite, in fact.
A February 2021 article in the journal Psychatric Times, reported that doctors declined to prescribe morphine, opium and other opioids to Black soldiers despite the drugs’ increasing popularity as painkillers, including among white soldiers. It was a reluctance rooted in the overwhelmingly white medical establishment’s racist belief that African Americans were impervious to pain even from the most horrific wounds.
The short-term effect — apart from the pain suffered by countless Black soldiers — was that opioid addiction was far less common among African Americans than white people, at least in terms of prescription-related drugs. But in the long run, Johnson said, the bias may have contributed to a lack of anti-addiction messaging and treatment geared specifically to the Black community, even as opioid addiction among the Black population became more common via illicit sources.
And particularly in the fentanyl era, Johnson and others say, the risk of overdoes is greater among those who get their drugs on the street, without the precise dosage and purity levels of prescription medication available to addicts with doctors and insurance.
“They do not want to take a risk with fentanyl and they make an effort to take drugs that are free of fentanyl,” Budsock said of aging users. “But you never know what kind of batch that you get.”
So, he added, “That’s where harm reduction comes in.”
Integrity House operates a “mobile community center” in Newark that provides fentanyl test kits and clean needles to reduce the risk of overdose and disease resulting from drug addiction. Ed Murray| For NJ Advance Media
This fall, Integrity House opened a harm reduction center on Broad Street in Newark, near its headquarters by Lincoln Park. Staffers on-site and in the mobile unit try to help addicts reduce the risk of accidental overdose and drug-related illnesses such as HIV, by distributing fentanyl test kits — “WiseBatch LLC” is the apt name of one California manufacturer — and clean needles.
A spokesman for Essex County Executive Joseph DeVincenzo said the data’s findings were “not a surprise.”
“We confront this problem on a daily basis,” the spokesman, Anthony Pugliesi, said in a written statement.
Pugliesi said the county has partnered with the federal Drug Enforcement Agency on a “Drug Take Back Day” encouraging residents to rid themselves of leftover prescription drugs; and waged a “Reach to Recovery” outreach campaign providing referral information at community events, libraries, supermarkets and other high traffic areas.
Pugliesi said treatment programs are available to prisoners at the county jail in Newark, while Drug Court initiatives include on-site counselors “to intervene during arrests and legal proceedings to help break the cycle of illegal activity by connecting defendants or those being arrested with recovery programs instead of incarceration.”
This year, he said, the county has trained 283 law enforcement officers and others how to administer naloxone.
“My view is that it’s all tied to a whole lot of issues.”
Dr. Robert L. Johnson, dean of the New Jersey Medical School, on why older Black men are overdosing at high rates.
A few miles from the Newark street corner where Aaron King talked about his addiction, 58-year-old Elijah Berry stood outside a small supermarket on Frelinghuysen Avenue, a patch of Newark’s South Ward shared by scrap metal yards, warehouses and high-rise apartments for the elderly and people with disabilities. It was just up the block from a short dead-end street that serves as an open-air drug market, according to drug counselors, users and others.
Berry wore a Nike hoody that hung loosely from his gaunt frame, with a graying beard beneath his reddened eyes. Like King, Berry said he was addicted to cocaine. Also like King, he was a Black man at the age most likely to die of a drug overdose, and said some of his fellow addicts had done just that in recent years.
Berry said some of those men had been released from prison and then resumed taking the same drugs they used before going in. Others, he said, had been through detox only to relapse one last time. He blamed a combination of fentanyl and his friends’ willingness to risk taking drugs laced with it.
“You can’t go to rehab for three, four months and come back out here and relapse, because you got a 50-percent chance you’re playing with your life,” said Berry. “I lost a lot of friends of mine doing that.”
Elijah Berry of Newark, 58, homeless and addicted to cocaine, said he was aware of the potentially fatal impact of fentanyl that is commonly added to street drugs. But the time wasn’t right to quit, he said. Steve Strunsky | NJ Advance Media For NJ.com
Berry was born and raised in Newark, where he grew up in the now-demolished Seth Boyden Court public housing complex, and played guard for the East Side High School basketball team.
An auto-body mechanic by trade, Berry said he started doing drugs in the early 2000s at age 37, smoking cocaine because his friends were doing it. He got hooked and eventually wound up on the street, where he’s lived on and off for the past 16 years.
He said he “hustles” for drug money, panhandling, sweeping floors and doing odd jobs for local businesses, and occasionally body work.
He could move back into his mother’s house in Newark, he said, instead of “being out here running around like a chicken without a head.” But that would mean having to get sober.
“I could go home,” Berry said. But, he added, “I don’t bring home what I do on the street. What I do out here on the street, I’d rather stay out here on the street and do it, because my mom doesn’t allow it. She don’t want no smoke, she don’t want no cigarettes, she don’t want none of that in her home.”
He said he tries to be careful about where he gets his drugs. But he was aware that even his regular dealers may not know what is in the drugs they’re selling.
“The reality is not everyone is sharing in the progress that we’ve made.”
Robert Budsock, CEO of Integrity House
With that knowledge, and a desire to regain control of his life, Berry said he and the woman he’s been with for the past 11 years were thinking of entering a residential program at Summit Oaks Hospital, a well-known mental health and substance use treatment center in Union County. But he wasn’t ready to quit just yet.
“I’m having a lot of pain, a lot of frustration, anger,” he said, referring to drivers of his drug use.
Berry has six grown children who occasionally see him on the street and plead with him to get straight. Like the professionals at Integrity House, his kids try not to be judgmental.
“‘Get some help, Dad,’” he recalled one of his daughters telling him recently. “‘We would love to see you clean before anything happens to you.’”
