PITTSBURGH — Every spring, when the Allegheny County Health Department released its final count of drug overdose deaths, Alice Bell used to weep.
She always knew what was coming. Bell runs the overdose prevention program for Prevention Point Pittsburgh, one of the few needle exchanges in Pennsylvania. For nearly a decade, she has watched what the opioid crisis has done to her community as the deaths continued to mount.
This year, though, the tears gave way to a sigh of relief.
After a record-breaking high of 737 overdose deaths in the county in 2017, fatal overdoses in Allegheny County dropped by more than 40% in 2018. They are expected to drop or to hold steady again this year.
“It’s like being in a war. It’s like battle fatigue. Year after year, you work so hard. And to think that these efforts have had some tangible effect,” she said, still marveling all these months later.
Experts in Pittsburgh and the surrounding communities of Allegheny County say there’s no one reason for this startling success. Flooding the county with naloxone, the overdose-reversing drug — Bell’s primary task for more than a decade — has clearly saved lives, officials say. So has getting more people into medication-assisted drug treatment. Getting doctors to prescribe fewer opioid painkillers gets some credit.
So does targeting the city’s hardest-hit areas with such public health measures as Prevention Point’s needle-exchange van, which also dispenses naloxone and offers medical care for people who use drugs.
In many ways, the plan is similar to Philadelphia’s less successful attempts to cut its catastrophically high overdose rate. Though Allegheny County is just slightly less populated than Pennsylvania’s largest city, Philadelphia weathered 1,217 overdose deaths in 2017. The following year, overdose deaths declined by 8% — encouraging, but not dramatic.
Pittsburgh, with its proximity to the Appalachian region’s infamous opioid woes, has long struggled with drug use. But the efficacy of Allegheny County’s response to the overdose crisis underlines just how entrenched the problem is in Philadelphia — and how the scope of the crisis makes its challenges that much more unique.
“We are having a targeted strategy in the same way that Allegheny County has,” said Thomas Farley, Philadelphia’s health commissioner, adding that his colleagues pay more attention to the nation’s biggest cities than to Pittsburgh.
“But we, for decades, have become this big heroin market. We’re a distribution site for a very broad area. That drug availability is going to make it harder for us.”
Pittsburgh doesn’t have a Kensington — the long-neglected section of Philadelphia’s river wards plagued by open-air drug use and sales.
But there are hot spots around Allegheny County, and using data to identify them and focus harm-reduction efforts has been key to preventing deaths, officials said.
For instance, data showing that the Pittsburghers at the highest risk of overdose were those leaving the county jail led jail officials to offer naloxone to anyone being released. (Philadelphia’s jails offer naloxone and even go a step further, treating addicted inmates with buprenorphine, proven to offer a better chance of lasting recovery.)
In 2017, staffers at the Allegheny County Department of Human Services drew up a list of the 10 communities with the highest overdose rates, and hit them hard with outreach services and lots of naloxone.
They also discovered that in some towns, police officers still weren’t carrying the reversal drug in their cruisers. That meant an officer might respond to a call for help, yet be powerless to stop an overdose from becoming fatal.
“We had to do a lot of selling to the police departments,” said Latika Davis-Jones, who runs the county’s Bureau of Drug and Alcohol Services. “But the fact that we as a county had great data, we were able to get out into the community to really talk about this. It had a significant impact on people being willing to do something about it. We were well-prepared because of the information we had as a community.”
Farley says Philadelphia officials have also targeted aid to hot spots, sending needle-exchange vans to South Philadelphia and West Philadelphia. But Kensington remains the epicenter of drug deaths — and the city’s attention. Harm-reduction services are still scarce outside the neighborhood.