Drug overdose deaths among Black Bostonians fell by nearly 60% in 2024, halting a years-long rise in mortality.

A broader adoption of harm reduction strategies and outreach workers striving to reach the unreachable were the reasons behind the lifesaving turnaround, Shanna Person-Johnson recounted on a recent morning at Dorchester’s Codman Square Health Center, where she works as the substance use community engagement coordinator.

“Boots on the ground,” she said. “People that are going into the trenches behind Walgreens, opening the broken fences because they know there is an encampment back there. Having conversations with people and letting them give you a hug.”

The numbers show a significant reversal from the last several years. Massachusetts and the country as a whole have lauded drops in overdose deaths of white people — some long-awaited relief in a decades-long, evolving opioid crisis. A different story has unfolded for Black communities, however.

In 2023, Black men and women in Massachusetts had the highest rates of opioid-related deaths, compared to a 16% drop in the death rate of white men.

Older Black men have been hit particularly hard by the epidemic in recent years. According to a Boston Globe analysis of death records, the rate of deadly overdoses among Black men over 55 soared 242% between 2017 and 2023 statewide.

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But the numbers for 2024, released last month by the Boston Public Health Commission, were different. They showed a 59% decrease in opioid-related mortality for Black men and a 58% decrease for Black residents overall.

In 2023, 104 Black Bostonians died of a drug overdose. Last year, the number was 44.

The one-year downturn certainly deserves recognition, Person-Johnson said, but “our Black, Indigenous and Latino populations are still struggling.”

No one knows that more than Lois Frazier. In 2022, one of her sons died of a drug overdose — the combination of cocaine and fentanyl that is increasingly taking lives. A second son is living on the streets of Boston, sleeping in MBTA stations or parking garages, addicted to drugs.

Frazier, who is in recovery herself, actively checks up on him to make sure he’s “still breathing.” She’s tried countless ways to get him help over the years.

The disproportionate impacts of the drug crisis have centuries-long roots traced through the United States’ oppression of Black people, Frazier said, through slavery, segregation and other policies.

“The system has led us to this,” she said.

The approach in Black communities

The dramatic plunge in numbers over a one-year period, community health workers said, means the city and its partners are heading in the right direction with a harm reduction approach.

Harm reduction is a public health lens aimed at empowering people who use drugs to minimize negative impacts. Harm reduction tools include the opioid antidote naloxone, test strips that detect the presence of fentanyl in other substances, and syringe exchange programs that reduce the spread of bloodborne diseases such as HIV and hepatitis C.

Simultaneously, the decline in deaths is just one year’s worth of data — much work remains to stop the disproportionate harm of opioids and other drugs in Black communities.

Because of historical and structural racism, someone’s neighborhood and race can mean they’re predisposed to drugs and have greater difficulty accessing services, said Michael Curry, president of the Massachusetts League of Community Health Centers.

And because stigma can be more prevalent among certain populations, culturally competent and empathetic care is required to build trust, he said.

“We can do it, but it can’t be done in isolation,” Curry said. “It has to be done with intentionality and a sense of urgency with those most impacted forming the strategy.”

Addiction can become generational — a learned behavior — if a person grows up among it, Person-Johnson said. Compounding that in Black communities is what she sees as a hesitancy to “ask for help” with personal struggles.

“The Black population doesn’t look at mental health as mental health,” Person-Johnson said. “We just deal with it, and it’s definitely a trickling effect. That’s what we have to undo, to say it’s OK for our Black men to go see a therapist. It’s OK for Black men to cry. It’s OK for Black men to say, ‘I need help.’”

Dr. Devin Cromartie Bodrick, a psychiatrist at Boston Medical Center and First Lady of Twelfth Baptist Church in Roxbury, said simply “medicalizing (addiction)” is not enough when working with Black communities.

Outreach work needs encompass social determinants of health, she said, and be holistic — things as simple as basic hygiene needs and as complex as housing.

“We’re way more likely to get people into care and to get people to stay in care when they know you are caring for the totality of their personhood,” Cromartie Bodrick said.

What is working in Boston?

The Boston Public Health Commission attributes the decline in overdose deaths last year to “distributing naloxone, expanding access to treatment, partnering with medical services, providing harm reduction services, offering housing navigation and stabilization, and engaging with the community.”

In practice, that looked like:

• Over 23,000 doses of naloxone distributed through street outreach, public health vending machines, kiosks and community grants
• The Public Health Commission’s street outreach team conducted over 25,000 engagements with people and made over 2,000 treatment placements
• Boston Healthcare for the Homeless set up a medical clinic inside the Public Health Commission’s recovery services building, recording over 2,700 patient visits since June 2024
• Federal funds were used to put substance use navigators inside the city’s community health centers

Curry said 90% of community health centers across Massachusetts now have office-based addiction treatment, which he described as “comprehensive models that really help to guide patients along the continuum of care,” including behavioral health services, recovery coaching, street outreach, harm reduction and linkages to detox centers and supportive housing.

There are 27 community health centers in Boston, some of which have multiple locations.

“Boston really pulled in health centers to be on the tip of the spear for responding to this crisis,” Curry said.

The city used funding from the Centers for Disease Control and Prevention to connect more community health center patients with addiction treatment by implementing substance use navigators.

“The community health centers have shown tremendous progress in that people have providers and employees there who can meet their needs and plug them into services,” Curry said. “The outcome is fewer deaths.”

Dr. Marjorie Janvier, chief medical officer of Upham’s Community Care in Dorchester, said in a statement that adding a substance use navigator and dedicated nurse “has been a game changer.”

The city has also integrated housing supports into its substance use planning.

Over the last three years, new programs designed to stabilize and house people who are experiencing substance use disorder have served nearly 850 individuals. More than 270 have been placed into long-term permanent housing.

“That’s the wraparound we know saves lives,” Curry said.

Boston Medical Center is currently working on a pilot program with two churches in Roxbury and Milton to help Black churchgoers navigate mental health, with a specific focus on race-based trauma.

Cromartie Bodrick said the program is an example of meeting people where they’re at and integrating partners who have already built a foundation of trust within the Black community.

“Whenever you pull spiritual aspects into this, it really can illuminate it for people,” she said. “There have already been studies that integrating spirituality, if it’s relevant to the population we’re talking about, can really increase the effectiveness. It can really supercharge the results.”

‘Meeting you where you are’

Person-Johnson cited the persistent “fight” of street outreach workers as something that is breaking down barriers in the city — people who are representing harm reduction on the frontlines in a respectful and nonjudgmental way.

As part of her work at Codman Square Health Center, she walks Dorchester nearly every day, from Washington Street to Ashmont Station to Fields Corner, making personal connections with people in need.

She recently had a major breakthrough when the small washcloths she handed out to homeless individuals and sex workers were met with overwhelming appreciation.

“Being able to hold a person’s hand and say, ‘Hey, I’m not judging you. What can I help you with?’ I’m meeting you where you are,” Person-Johnson said.

Leading the way in this outreach work, she added, are “many minorities who did not have the support of harm reduction” when they were at their lowest decades ago.

And yet, many of them now have master’s degrees, Ph.D.s and are licensed in their respective careers.

“These are the people that I feel really need to be recognized, not for recovery, but the fact that this is what recovery can look like for our people,” Person-Johnson said. “People memorize the numbers of those in addiction, but what about our people who came out? That’s what people need to see.”