White and Black people are now dying of overdoses at roughly equal rates in Philadelphia — marking a grim inflection point as the rising death toll from the opioid crisis continues to break all previous records.

The Inquirer analyzed data from the Centers for Disease Control and Prevention on deadly overdoses since 2018 in Pennsylvania and New Jersey — deaths largely driven by illicit fentanyl, the powerful synthetic opioid that has replaced much of the heroin supply.

Philadelphia joins other parts of Pennsylvania in seeing sharp increases in the number of Black residents dying of overdoses, a trend playing out nationally. Overdose deaths among Black Philadelphians have risen by 70% since 2018, and deaths among white residents have declined slightly by 9%.

The rest of Pennsylvania saw the rate of Black deaths double over the same period. Black Pennsylvanians outside Philly have been far likelier to die of overdoses than their white counterparts for about three years.

Philadelphia — home to 45% of Pennsylvania’s Black population — may soon contribute to that disparity. The crisis is also most pronounced here, where 1,276 deaths in 2021 accounted for about a quarter of all Pennsylvania overdose deaths, according to the state’s data. (City health officials have yet to finalize their exact data on overdoses in 2021 but said state numbers were in line with their expected final total.)

Outside of the region’s most populous metropolitan county, the trend was mixed: Bucks, Delaware, Montgomery, Chester, and Gloucester Counties all saw slight decreases in the rate of overdose deaths in 2021 when compared with 2020; Camden and Burlington saw increases.

Decades into the opioid epidemic, many communities, especially Black ones, are not receiving the attention needed to reduce the harms of addiction. From North Philadelphia to the suburbs, resources such as the overdose-reversing drug naloxone and testing strips that can serve as a warning when fentanyl is detected remain scarce.

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During the first two years of the COVID-19 pandemic, Philadelphia’s overdose death toll rose. The isolation necessary to contain the virus also went against one of the most basic tenets of reducing harm: Never use drugs alone — so a friend or relative can be nearby to prevent an overdose.

In Philadelphia, city officials say 77% of overdoses in 2021 happened in a home.

That was the case with Tyreek Lewis, a truck driver who died of an overdose last year after seeking relief for his back pain.

The 35-year-old from North Philadelphia had no experience with drugs. But he couldn’t afford to take time off work for an MRI and assessment at a pain clinic. At a friend’s urging, he bought two pills from a dealer who assured him they were the same drugs a doctor would prescribe, said his mother, Antoinette Hornsby.

The pills were, in fact, illicit fentanyl pressed to look like a prescription pill. Lewis took them alone in a bathroom at home one afternoon in May 2021. Shortly afterward, his girlfriend found him unconscious.

» READ MORE: Tyreek Lewis, 35, died after seeking relief from back pain — and unknowingly buying a fentanyl pill

Hornsby knew nothing about fentanyl before Lewis’ death connected her with other grieving parents around the country. She now advocates for overdose awareness and prevention, pushing for police in her rural town in Georgia to carry naloxone.

“I can’t have my child back,” she said. “But I’m fighting to save others.”

Every year for the last three years, overdoses among non-Hispanic Black residents in Philadelphia have spiked higher — 312 people died in 2018, followed by 372 deaths in 2019, a rise of nearly 20% in a year.

By 2021, the number of deaths among Black residents had soared to 532 people in a year.

In the local Black community, most of the deaths are occurring in an older population between the ages of 45 and 64.

By contrast, most of the 452 overdose deaths among non-Hispanic white city residents in 2021 involved people younger than 45.

The rate of deaths among Hispanic Philadelphians has also been rising over the years, according to state data. It’s unclear what’s driving those increases from the way the state data report race and ethnicity — for example, whether the rise among Latinos generally is due to increasing overdose deaths among Black Latinos specifically.

The Inquirer’s analysis uses CDC data that do show race and ethnicity in more detail, but the numbers for Philly were not robust enough for all groups, including residents who are both Black and Hispanic or Latino, to examine the pattern of Latino overdose death rates over time. “Black” and “white” throughout this article refer to non-Hispanic people in those groups.

While fentanyl is driving the vast majority of Philadelphia’s overdoses, more Philadelphians are dying with stimulants like cocaine and methamphetamine in their systems, said Zoe Soslow, the central administrator for OD Stat, a health department program that monitors overdoses in the city.

Black Philadelphians, historically, have been at a higher risk of dying from stimulant-related overdoses: In reviewing overdoses among older Black Philadelphians, Soslow said, analysts see “a lot of stimulant use.”

Fentanyl, an opioid with the opposite effect of a stimulant, is now contaminating drugs other than the heroin it was initially mixed with when it emerged onto the drug scene in Philadelphia in the mid-2010s.

It’s not clear whether the rise in deaths attributed to fentanyl and cocaine over the last several years is the result of unintentional contamination, people mixing multiple drugs, or both. The city health department has identified samples of cocaine with fentanyl mixed in in recent years.

But people who primarily use stimulants might not realize that fentanyl contamination may have spread to their drugs, and experts say they might not be accustomed to carrying and using naloxone like residents of other communities where opioid use has been more prevalent.

Black residents are also less likely to access addiction treatment than are white residents, said Jennifer Smith, the state’s secretary of drug and alcohol programs. Those using stimulants have even fewer treatment options: There are no FDA-approved medications to treat stimulant addiction.

In Philadelphia, many stimulant-only deaths are compounded by other health problems, such as cardiovascular issues, hypertension, and kidney failure.

“For people who use stimulants, harm reduction is often preventative health care,” Soslow said.

Philadelphia has long prioritized outreach to opioid users in the city. But outreach efforts have historically not reached Black communities in North, Southwest, and West Philadelphia, where overdose rates are rising, health officials say.

Suburban communities are also behind their counterparts in Philadelphia when it comes to harm reduction — a philosophy that promotes safety and overdose prevention for drug users who aren’t ready to stop using. These include measures like syringe exchanges, which limit infection and the spread of bloodborne illnesses among people who inject drugs.

These are currently available only within city borders, since the practice is technically banned statewide and can operate only as directed by local governments. In New Jersey, syringe exchanges are legal but scarce.

Matthew McGahren, a Bucks County resident who lost his son to an overdose in 2020, implored state officials at a recent forum in Doylestown to push for the legalization of both syringe exchanges and fentanyl testing strips.

“These are obvious things that should have been in place multiple years ago,” he told the panel of legislators, prosecutors, and addiction-treatment providers. “They would have stabilized and saved my son’s life.”

As deaths rise in the Black community, many people who have lost loved ones to overdoses are channeling their grief into outreach and education efforts.

Hazel Rollerson’s son, Elwood Porter, had struggled with opioid addiction for years. The 36-year-old Navy veteran had been prescribed opioid painkillers as early as seventh grade, when he was a passenger in a traumatic car crash that killed his grandmother, Rollerson said.

Porter cycled in and out of rehabs and stints of homelessness, but he found purpose and pride in harm reduction. He worked at Prevention Point, the city’s only brick-and-mortar syringe exchange, and often handed out naloxone, personally saving lives in dozens of overdoses.

When he was found dead of a fentanyl overdose in his apartment last summer, his mother was devastated. Her son, who used to keep others from dying by staying with victims as they were treated and woke up, had passed away alone.

“For me to think he passed the way that he did — that hurts,” she said.

» READ MORE: Elwood Porter, 36, cared for others in addiction even as he battled his own

Many Black parents of overdose victims feel that deaths in their community haven’t received the same kind of attention that white overdose victims have. The associated stigma and shame take a particular toll, Rollerson said.

In the wake of a year of unimaginable losses, grieving parents see advocacy as a vehicle to help others — and to honor their children’s memories.

Hornsby, whose son had had no experience with drugs when he died, corresponds regularly with other mothers who have lost children. She’s still shocked by the breadth of experiences she hears about. “It’s a disease for some people. For some, it’s just recreational. For some, it’s just a one-time thing,” she said.

“But we got to get this message out that it’s OK to speak up — and say enough is enough.”