Skid Row, often referred to as the epicenter of L.A.’s homeless crisis, is gaining a new reputation as the city’s overdose capital as an increase in fentanyl use drives record-setting fatalities.

Fatal overdoses in the three zip codes surrounding the area increased by 1,038% over the past six years — from 13 deaths in 2017 to 248 deaths in 2022, according to data recently obtained from the L.A. County medical examiner by a group of service providers, academics and activists.

“I took one hit and blacked out, the next thing I know there were four firefighters standing over me asking me how long I had been messing with fentanyl,” said Jacquies Manson in Skid Row on Wednesday, referring to an incident about a month ago.

Manson initially thought he was smoking methamphetamine, but now believes the drug was laced with the synthetic opioid fentanyl. Firefighter EMTs were able to revive him with the use of naloxone, a drug that reverses opioid overdoses.

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Others are not as lucky.

Two-hundred and forty of Skid Row’s 2022 overdose deaths took place in the 90013 and 90014 zip codes. Fentanyl was identified as a primary cause of death in three out of four of these incidents.

“These are not just numbers and statistics, these are friends, family and loved ones,” said Charles Porter, program director for United Coalition East Prevention Project, an organization focused on addressing substance use issues in Skid Row.

“We must stop the rise in overdose deaths,” he said.

In response to these alarming numbers, Porter and other advocates have created a series of demands for elected officials.

They include making naloxone accessible in all Skid Row hotels, increasing the number of substance use treatment beds available in the area, and mandating overdose crisis response plans be made for every housing development in Skid Row.

“We are facing a crisis, not only here on Skid Row, but countywide and nationwide when it comes to the fentanyl overdose epidemic,” said Nyabingi Kuti, director of the LA Harm Reduction Network. “The county for decades has been failing at substance abuse treatment and what we’re seeing now is a continuation of that.”

The city and county have funneled millions into initiatives to address the interconnected crises of homelessness, mental health and substance use over the past several years. But these resources have proved inadequate in the face of the rising threat of fentanyl.

Fentanyl flooded Los Angeles’ street drug supply from 2019 onward and contributed to an uptick in overdoses in homeless hubs like Skid Row, as well as in MacArthur Park where many people go to purchase the drug.

Overdose deaths are driven both by people addicted to fentanyl who use it deliberately and by those who unknowingly consume it laced into other drugs.

In Skid Row specifically, Black people are disproportionately impacted by rising overdoses and made up 59% of the fatalities reported in 2022.

While men made up 76% of overdose deaths in 2022, this racial disparity was particularly pronounced among women. Of the 33 female overdose deaths, 73% were Black women.

Danielleneika Graham, 31, of United Coalition East Prevention Project, talks about loosing three friends to overdoses, one being fentanyl, as a coalition of service providers gather in front of The Alexandria Hotel in Los Angeles for a press conference on overdoses. Overdoses in skid row and the surrounding area increased over 1,000% from 2017 to 2022 according to United Coalition East. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

“I’ve also had three friends pass away from overdoses, three black women actually,” said Danielleneika Graham, who was homeless in Skid Row for over a decade and recently became housed. “I’m only 31 years of age and it’s really scary for me.”

This sentiment was echoed by Suzette Shaw, who now lives in a Skid Row Housing Trust building after being homeless in the area for many years.

“What I’ve learned in the course of the last ten years that I’ve been here in Skid Row is that Black middle-aged and elderly women, we track as one of the top demographics,” she said. “We have to really draw attention to these systemic inequalities as they relate to drug addiction in our community.”

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There are efforts in the area to address substance use issues. One of the most critical is a mobile overdose team run by the nonprofit organization Homeless Health Care Los Angeles.

This team operates daily between 9 a.m. to 3 p.m., traveling a route around Skid Row and Downtown L.A. where overdoses are known to occur frequently. They use naloxone and oxygen tanks to try to reverse the overdoses.

The nonprofit also runs two centers in Skid Row offering a range of services and supplies including a syringe exchange, naloxone, food, clothing, hygiene kits, wound care, a place to rest, showers, WiFi and referrals to housing services.

Outreach workers from other agencies also distribute supplies like fentanyl test strips and cans of naloxone spray daily.

But it’s not enough, advocates say.

“The efforts that have been made, maybe they have kept the (overdose) numbers from being way higher,” said Porter. “But we are concerned that more definitely needs to be done.”

Kuti said he not only wants to see efforts to reverse overdoses, but also to prevent them from occurring in the first place through increased access to substance use treatment.

In particular he would like to see a methadone clinic open in Skid Row.

Methadone is a drug commonly used to treat opioid use disorder. Its use is heavily restricted by state law and people must typically pick up a single dose every day. Having a nearby clinic is essential for people experiencing homelessness, to be able to take the substance regularly.

Gregory is living in a tent on skid row in Los Angeles on Friday, May 19, 2023. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

“How is it possible that with all the opioid addiction on Skid Row there is no access to methadone?” Kuti questioned.

Kuti and Porter are also concerned about the fact that 72 overdose deaths took place inside Skid Row shelters and housing developments in 2022. They want to see improved systems to protect residents such as regular wellness checks and support groups.

“We need a range of strategies including overdose prevention, (substance use) treatment and harm reduction,” said Porter. “We must also advocate for the equitable distribution of resources to save lives and end racial disparities.”