ST. LOUIS (AP) -- She screamed and cried, banged on the dashboard, begging her husband to drive faster, faster, faster toward her brother lying face-down on his bedroom floor.
Craig Elazer had struggled all his life with anxiety so bad his whole body would shake. But because he was Black, he was seen as unruly, she said, not as a person who needed help. Elazer, 56, had started taking drugs to numb his nerves before he was old enough to drive a car.
Now his sister, Michelle Branch, was speeding toward his apartment in an impoverished, predominantly Black neighborhood in north St. Louis. His family had dreaded the day he would die of an overdose for so long that his mother had paid for his funeral in monthly installments.
It was September, and as the COVID-19 pandemic intensified America's opioid addiction crisis in nearly every corner of the country, many Black neighborhoods like this one suffered most acutely. The portrait of the opioid epidemic has long been painted as a rural white affliction, but the demographics have been shifting for years as deaths surged among Black Americans. The pandemic hastened the trend by further flooding the streets with fentanyl, a potent synthetic opioid, in communities with scant resources to deal with addiction.
In the city of St. Louis, deaths among Black people increased last year at three times the rate of white people, skyrocketing more than 33%. Black men in Missouri are now four times more likely than a white person to die of an overdose.
Dr. Kanika Turner, a local physician leading the charge to contain the crisis, describes the soaring death rate as a civil rights issue as pressing and profound as any other. The communities now being hit hardest are those already devastated by the war on drugs that demonized Black drug users, tore families apart and hollowed out neighborhoods by sending Black men to prison instead of treatment, she said. Even today, Black people in the United States are more likely to be in jail for drug crimes and less likely to access treatment.
Last year, George Floyd died in Minneapolis under a police officer's knee. He had fentanyl in his system and some of the officer's defenders tried to blame the drugs for his death. The world exploded in rage.
"That incident on top of the pandemic rocked the boat and shook all of us. It ripped the Band-Aid off a wound that has always been there," said Turner, who grew in the same neighborhoods where Elazer lived, beset by addiction, poverty and one of the highest murder rates in America. "We're undoing history of damage, history of trauma, history of racism."
Pastors are now marching into the city jail to train inmates how to survive once they get outside. They host mobile treatment centers in their parking lots. They make an appeal to their congregations: Do not numb the pain of violence and racism with drugs. Don't let the next funeral be for you.
Branch for decades begged God to deliver her brother from addiction. She would lie awake at night imagining him dead in a ditch or dark alley, with nothing in the world but the clothes on his back.
She was hysterical by the time she arrived at his apartment.
The cousin who found him said he was sorry; Elazer had been alone and dead for hours. They tried to convince her not to go inside, but she wanted to see him.
As Branch looked down at his body, she felt calm come over her.
"Society failed him," she said. "And I had a sense that he'd finally been set free."
When the Rev. Burton Barr drives to the city jail, he passes a corner store with a sign painted on its side: "Drugs ... the new slavery!"
"That's true," Barr said.
He calls himself "the hoodlum preacher" and he goes to the jail twice a week to try to save people from the addiction that consumed his life for 22 years.
He was swept up when heroin inundated Black communities in the 1960s and transitioned to cocaine in the 1980s. The face of addiction then was inner-city Black people like him, and they were criminalized. Barr once tried to tally the number of times he went to jail, and he stopped counting at 30.
"It was not a war on drugs. It was a war on us," said Barr, in recovery since 1991. "It devastated our communities."
Harsh sentencing laws passed in the 1980s were far more brutal on crack cocaine users, who were more likely to be Black, than they were for powder cocaine users, who were more likely to be white. A person convicted of possessing five grams of crack got the same sentence as someone with 100 times more powder. Black men went to prison by the tens of thousands.
Addiction was not widely accepted as a public health crisis -- with a focus on treatment instead of incarceration -- until recent years, only once it started killing white teens in the suburbs, Barr said.
The timeline of the current opioid epidemic begins in the late 1990s, and unfolds in three waves. The first arrived when pharmaceutical companies campaigned to expand prescribing painkillers and addiction spread through struggling, predominantly-white communities like Appalachia.
The second came when the government cracked down on prescriptions and many turned to heroin; then the third when fentanyl, 50 times more potent than heroin, was laced into opioids sold on the street.
Some researchers believe the nation is entering a fourth wave. The drug supply is so messy and unpredictable that people overdosing have multiple drugs in their system: dangerous cocktails of fentanyl, a depressant, and stimulants like cocaine and methamphetamine.
A lot of illicit fentanyl is manufactured in Wuhan, China, where COVID-19 was first unleashed. Lockdowns initially disrupted the supply, said Vanda Felbab-Brown, a Brookings Institute fellow who studies trafficking.
In St. Louis, the drug trade became even more chaotic: People who used to know where their drugs were coming from no longer did. Fentanyl for a time was hard to find, and some turned to less-potent heroin.
But the Chinese laboratories rebounded and resumed shipping the chemicals to Mexico, where cartels process them, Felbab-Brown said. Pandemic border closures presented cartels with added incentive to traffic fentanyl: It is incredibly potent and profitable. The equivalent of a trunkful of heroin or cocaine can be carried across the border in a small suitcase.
Mexican soldiers are finding people at checkpoints ferrying tens of thousands of fentanyl pills. Navy personnel caught two men on a boat on the Sea of Cortez trying to smuggle 100,000. Mexican authorities raided a fentanyl factory in Chalco, a slum on the outskirts of Mexico City, where the drug was processed by the tons, so much they needed a forklift to move it.
In St. Louis, fentanyl flooded back to the streets. The death count exploded early last summer, said Rachel Winograd, a professor at the University of Missouri-St. Louis who tracks the state's overdose data. In the first six months of 2020, deaths increased 64% among Black people from the same period the year before, and 40% among white people.
Other cities saw a similar pattern. Doctors in Philadelphia found that in the first few months of the pandemic, overdoses increased more than 50% for Black people while decreasing for whites. In Massachusetts, health officials announced that overdose deaths among Black men soared in 2020 by nearly 70%.
The Centers for Disease Control and Prevention estimates that more than 92,000 Americans died of overdose in the 12 months ending in November, the highest number ever recorded. That data is not broken down by race.
But researchers at the University of California, Los Angeles, analyzed emergency medical calls nationwide and found an overall increase of 42% in overdose deaths in 2020. The largest increase was for Black people, with a spike of more than 50%.
One day last summer in St. Louis, Lynda Brooks went into a bathroom to smoke what she thought was crack. She felt strange, sat down and remembers only darkness. Once she was revived from a fentanyl overdose, she wondered if she'd been in hell.
She was so scared that for days she kept the lights on to try to resist going to sleep.
Brooks, a 55-year-old grandmother, had been addicted to crack for decades. She was often homeless and life out there was hard. She was assaulted, spit on, her husband died. So she took more drugs to escape feeling sad or scared or worthless.
Soon after she overdosed, she went to a community center. She told them if she didn't get help she knew she would die.
Brooks has been in recovery now for seven months, and she prays to remain scared of the drugs. She got a job and an apartment, and proudly keeps her new keys dangling from a shoelace around her neck. Her family told her they are proud of her. She said that feels like heaven.
Pastor Marsha Hawkins-Hourd smiled at Brooks from the sidewalk.
"You make me so happy," called Hawkins-Hourd, who runs the Child and Family Empowerment Center that helped Brooks find treatment and housing. "A lot of people fail. And it hurts when they fail. But you wipe all that away."
She is part of a network of faith leaders and grassroots activists trying to overcome the distrust people have for the systems that typically address addiction but are infested with systemic racism, she said.
She looks at block after block of falling-down buildings in the north side of the city. She sees them as a symbol of her neighbors who were deeply traumatized, then abandoned with limited access to treatment.
At some point, these houses were filled with hope and life, she said. Then society left them to crumble as men were sent to prison and families buckled. Now the windows are broken out, their roofs caving in, weeds choking their insides.
"Mass incarceration and the war on drugs are the roots and all of this is the thorns," she said. "It is a set-up for failure, a set-up to continue in the same cycle of poverty and death."
Jerry Simmons sometimes imagines himself lying in one of those vacant houses where he sleeps, dead for days from an overdose before anyone discovers him.
He arrived in a church parking lot before dawn to be first in line for a mobile treatment van scheduled to arrive as part of a new state-funded effort to reach people like him.
"I just want to be a normal person back in society, working, living, loving, playing with my grandkids, making my kids be proud of me," said Simmons, 49, who's been addicted for 30 years, homeless and in and out of prisons.
When he climbed into the van, it had been about eight hours since he last snorted fentanyl, at 1:37 a.m. The crippling withdrawal symptoms would set in soon, he knew: aches down to the bone, diarrhea, shakes, insomnia.
To give himself strength, he wore a T-shirt printed with the face of his friend, killed in a hail of bullets 30 years ago. Simmons grew up near this church on the most murderous mile of road in one of America's most dangerous cities.
"There's death all around here," he said. Three friends have died in the last month, two to gun violence and one to overdose. The drugs, at first, helped him escape.
He sat down across from a recovery coach from Hawkins-Hourd's organization, which partnered with a treatment provider to usher people here.
"In the past 30 days, have you experienced serious depression?" she asked him.
"Have you neglected family because of your use of drugs?"
"Have you lost a job because of drug use?"
"Yes," he said again. Addiction has taken everything from him.
He was there to enroll in a treatment program that includes a prescription for the medication buprenorphine, which has been found to greatly reduce the likelihood of overdose death. But researchers have found that white patients are far more likely than Black patients to receive it. Black people instead tend to be steered toward methadone, which is distributed in highly regulated programs that often require standing in line daily before dawn.
"That is the worst form of segregation: one for the white, well-to-do people, one for the rest," said Dr. Percy Menzies, president of Assisted Recovery Centers of America, the company stationing mobile units on street corners and church parking lots. "The tsunami of fentanyl is absolutely frightening, and they have virtually no safety net."
Addiction is treatable with medication and therapy, he said. But he knows they can't expect to show up in white lab coats and ask people to trust them right away.
He started going to Black churches to bring pastors on board.
Minister Lacha Hughes heard him speak at her church on a Saturday, and the next day her niece, Natisha Stansberry, called her hysterical. Most of her life, Stansberry, 30, used drugs to self-medicate her mental distress. She was raped as a child and attempted suicide. In 2016, her 23-year-old brother was murdered. Stansberry wished it would have been her instead.
"I wanted to be the best I could be, but I went down the drain," she said. "I want to get myself together."
She was weeping into the phone that she was scared of dying; two of her friends had overdosed, one was dead and one in the hospital. Hughes ushered Stansberry into Menzies' clinic. Until now, all she ever knew to do for her was pray.
It had felt to her like they'd had no help. In a crisis, many here are even hesitant to call 911 because they fear the police.
Now all over town, people walk around wearing little red backpacks, passed out by activists like Jerome Anderson, trying to saturate the streets with the overdose reversal medication Narcan so they can save each other.
He calls at passers-by: "Hey, take some Narcan. Save a life. I'm tired of going to family funerals."
Anderson, in recovery for 26 years, sang at three cousins' funerals in the last six months, all dead from overdose. He works for a grassroots public health group called Williams and Associates and his mission is to keep people alive so that one day they can find their way to recovery.
He carries around a cover letter that lets people know he's not a cop. Sometimes drug dealers let him stand next to them, to hand their customers his kits.
Jamilia Allen has used Narcan to revive her friends, more than once. She's terrified of fentanyl, but she's tried and tried to shake her heroin and crack addiction.
"It's designed to kill us, and that's what it's going to do. It takes your soul. If it don't kill you physically, it's going to kill you emotionally, kill all your dreams," she said. "I really want my life back, but I can't grasp it."
Allen, 31, was once an honor roll student and the captain of her high school cheerleading squad, and back then she judged people desperate for drugs.
She went to Walmart recently and was jealous of a woman buying a shower curtain. She wants a life that simple, and she fantasizes about someone sending her to a place like Malibu, where the rich white people go to kick addiction.
She was for a long time ashamed of her life: prostitution, being raped, beaten, thrown out naked in the snow. But now, she said, she wants people to know.
"I'm not going to let this kill me, and if I can help anyone else," she said, "then that's one less person like me."
All Michelle Branch has left of her brother fits into a little green shopping bag.
The Bible she bought him one time when he got sober and wrote "One Day at a Time" on the title page.
There's the baby book her mother put together, with so much hope when she taped a lock of his hair to the pages. There are report cards chronicling a bright child, loved by teachers but struggling to focus.
By third grade, he could read as well as a sixth-grader. He and his mother, a teacher, would read the newspaper cover to cover. He liked cowboy stories.
But he was anxious and jittery. Had he been diagnosed and treated, Branch believes he would be alive today.
"But they didn't catch hyperactivity or bipolar back then, especially not in little Black kids. We were just unruly, undisciplined, this much removed from being an animal," Branch said, pinching her fingers so there was little space between them.
Branch worked in the school system when the opioid epidemic began, white people were dying and pundits on TV said they needed to be saved from this public health tragedy. She wondered where they'd been when her brother was swirling into addiction.
Their mother raised them alone and they didn't have a lot of money. He told Branch he started drinking when he was 12, and soon progressed to drugs. He lived transiently, sleeping under overpasses, on dirty mattresses in dark alleys.
She can't count the number of times he tried to get sober.
Their mother always worried he would die. She wrote on little slips of paper and left them all over the house: pinned to her bedroom lampshade, taped to the kitchen wall. "God is working this problem out for me," they said.
She got sick with cancer, but lingered for years. Her family believed she was holding on out of fear of what would happen to her son.
She died worried about him.
He was in and out of jail, mostly for petty offenses. But several years ago, an acquaintance alleged he sexually assaulted her while using drugs. His lawyer told them the odds were against him as a Black man accused of assaulting a white woman, Branch said. He pleaded guilty and spent three years in prison.
He was released in May 2020, as the pandemic bore down.
He couldn't find a job. There were no recovery meetings in-person and he'd been so transient all his life he didn't know how to use a smartphone. He was alone most of the time, with his 10-pound dog, Rico.
One night they couldn't reach him. His cousin, Carleton Smith, looked through the mail slot and saw him lying there.
The first responders gathered over his body pointed to a paper plate on his bed with a pile of white powder. "Fentanyl," they said.
When Branch sat down to write his obituary, she decided to tell his truth.
She wrote that he was a gentle soul but addiction destroyed him.
"It would devastate his family, make him homeless, cause him to beg for money on the street, take his freedom, his sparkle and smile," she wrote.
"It would take and take and take until it took his life."