LULU GARCIA-NAVARRO, HOST:
The Centers for Disease Control and Prevention reported this week that life expectancy in the U.S. is lower now, in part, because of the opioid epidemic. The crisis is often portrayed as largely affecting the white, rural, working class. But one of the places with the highest rates of overdose deaths is right here in Washington, D.C. Here to talk about this is Dr. Tanya Royster. She is director of Washington, D.C.,'s Department of Behavioral Health. Thank you so much for being here.
TANYA ROYSTER: Thank you for having me, Lulu.
GARCIA-NAVARRO: Washington, D.C., is behind only West Virginia, Ohio and Pennsylvania in its rate of overdose deaths. Those are very rural states, whereas D.C. is urban. It's diverse. It's doing very well economically, relatively - or, at least, certain parts of it are doing well. What's going on here?
ROYSTER: We have a unique situation here in the District of Columbia that might mimic some of the rural areas. We have a chronic, long-term heroin user who, with the introduction of the synthetic opioids like fentanyl into the drug supply, are having a higher death rate.
GARCIA-NAVARRO: Who is being affected by this?
ROYSTER: Our typical death from an opioid overdose is an older, African-American male between the age of 40 and 60. So as you see, that's quite different than what's being described around the country.
GARCIA-NAVARRO: So can you put that into context for us? Why is that particular community being affected?
ROYSTER: Well, because here in the district, we have not seen the excessive opioid prescribing and the conversion from misuse of opioid prescriptions to heroin on the street, which is the modality of addiction that has been described in other places. So...
GARCIA-NAVARRO: So like a doctor prescribing a painkiller and then those people becoming addicted to the painkillers and then moving on to heroin.
ROYSTER: Exactly. What we see here is our chronic user, who has been using heroin for 20, 30, 40 years, now being affected because of the introduction of fentanyl and other adulterants into the heroin supply.
GARCIA-NAVARRO: Yeah. You know, doing some reading into this, heroin's been a big problem here in D.C. for decades. It's affected black men the most. But there really hasn't been a big focus on it by either the media or the government. What does that tell you?
ROYSTER: Well, nationally, there hasn't been a focus. But certainly, here in the district...
GARCIA-NAVARRO: Sure.
ROYSTER: We have been focusing, some people would say, too much on that population. So I think that - you know, the way that I've described it is what's happening here is probably what's happening around the country in smaller pockets. But because 80 percent of the deaths have been the young, white population, everybody else is focusing on their 80 percent. Well, our 80 percent here in the district is the older African-American male. So I think when the rest of the country gets around to looking at that 20 percent that they're going to find a lot of different, diverse populations in there.
GARCIA-NAVARRO: What do you do with this population of chronic drug users that's being affected? I mean, how do you help them?
ROYSTER: So we're reaching out and providing them information and making sure they know that treatment is available and effective. And so we're really providing them direct education about this. We call that approach harm reduction, where we'd like to keep them alive long enough to get them in treatment. We're working with emergency rooms to offer treatment right in the emergency room.
If someone has an overdose and survives, that's an opportunity. We're also using peers - people who have survived and are in recovery from opioids and other addictions that are going out and speaking, really, in a direct, kind of raw way to current users and saying, it's time to make a different choice.
GARCIA-NAVARRO: Dr. Tanya Royster is the director of the Department of Behavioral Health here in Washington, D.C. Thank you so very much.
ROYSTER: Thank you. Transcript provided by NPR, Copyright NPR.