On a narrow North Philadelphia street lined with row houses and a busy auto body shop, Marsella Elie climbs the front steps of a private residence and knocks hard on the front door.
A middle-aged man appears with a wary look on his face.
"Hello sir, how are you doing today?" asks Elie. She wears a royal blue jacket embroidered with the city government's Liberty Bell logo.
"Hold on, two seconds. My name is Marsella. I'm working with the city. You heard about the overdoses that are going around in the neighborhood, right?"
The man gives a cautious nod.
Elie gestures to the pamphlets and booklets she's holding, about drug overdoses and local addiction treatment programs. She holds up a box of Narcan, a common brand of the opioid overdose reversal medication naloxone.
"So basically, what we're trying to do is get this in everybody's household. Have you ever heard of this before?" Elie asks before handing the man a tote bag full of the resource materials, fentanyl test strips, and the box of Narcan.
Elie and other part-time city workers and volunteers are carrying out a new large-scale, citywide door-to-door movement that aims to equip private households with naloxone and other drug overdose prevention supplies.
City officials and advocates hope that this proactive approach will normalize naloxone as an every-day medicine cabinet item, and prevent more people from dying of overdoses, especially Black residents.
A record 1,413 people died in Philadelphia in 2022 from drug overdoses, according to city data.
Deaths were up 20 percent among Black residents from the year before, with many happening in private homes.
"The best thing we can do to make these things more accessible is to just give them to people," says Keli McLoyd, director of the city's Opioid Response Unit.
"We're not asking you if you're using drugs. The goal here is really to build sort of a collective responsibility."
"As Black and brown folks, as we saw during the COVID epidemic, nobody's coming to save us. For us, this is a tool that we can use to save ourselves," she adds.
The aim of the canvassing initiative is twofold: bring prevention supplies directly to people who may not otherwise seek it out themselves, and spread awareness about overdoses beyond the neighborhood of Kensington. That's the epicenter of the city's addiction epidemic, where drug use, and harm-reduction support, are concentrated and most visible.
Canvassers intend to knock on more than 100,000 doors in Philadelphia's overdose "hotspots" — zip codes with escalating rates of opioid overdose deaths in recent years, many in Black and brown communities.
These widening racial disparities in overdose deaths are just another long-term consequence of the War on Drugs, McLoyd says.
Those policies meant decades of aggressive police tactics, racial profiling, and lengthy prison sentences, disproportionately affecting people of color and their communities.
Research shows that Black Americans still account for a disproportionate number of drug arrests and cases involving child protective services.
"Because of that, it's very clear why Black or brown people might be hesitant to raise their hand and say, 'I'm a person who uses drugs, I need those resources,'" McLoyd says.
Other cities and communities have initiated similar canvassing efforts to distribute naloxone and other supplies, albeit on a smaller scale or by targeting specific populations of people.
What Philadelphia is doing could be a model for many other densely populated cities and communities, according to Daliah Heller, vice president of drug use initiatives at Vital Strategies, a public health organization working with local governments in seven states to address the opioid epidemic.
"There's something intensely personal about a human engagement," Heller says. "And somebody knocking at your door to talk about drug use and overdose risk and that there's something that can be done, I think is really powerful."
Over the years, naloxone has become more accessible than ever before, Heller points out. People can order it online and through the mail, it's available in specialized vending machines, and drug stores now sell Narcan nasal spray as an over-the-counter product.
But data show that tens of thousands of Americans every year still die from opioid overdoses.
Which means prevention efforts and messaging about the crisis are still not reaching some people, Heller says.
"If you're meeting people where they're at, that means physically, that means in terms of what they know about something, what their perception is of something, and their beliefs," she says.
"We need to think like that when we think about naloxone distribution."
Outreach funded by opioid lawsuit settlements
The Philadelphia canvassing project is funded in part by the city's share of settlement payouts from national lawsuits against opioid manufacturers and distributors.
The city is set to receive about $200 million total over roughly 18 years from settlements with AmerisourceBergen, Cardinal Health, McKesson, and Johnson & Johnson.
The initiative is staffed by many of the same people who initially started canvassing as part of the 2020 Census count.
Not everyone answers the door for the canvassers. Some aren't home when they come around. In those cases, workers hang fliers on the door handles with some information about overdose risk, and contacts for further resources.
After the first round, teams will later make a second sweep through neighborhoods to reach people they missed the first time around, and bring along language interpreters.
On a recent Thursday, Philadelphia canvassers were knocking doors in the neighborhoods of Franklinville and Hunting Park.
In this zip code, about 85 people died of drug overdoses in 2022, according to city data. It's a smaller figure than the 193 people who died of overdoses in Kensington the same year, but much higher than the few deaths seen in the city's most affluent neighborhoods.
They approached resident Katherine Camacho on the sidewalk, as she came out of her garage. As they talked, Camacho told the teams she was aware of the overdose problem in her community and eagerly accepted a box of Narcan.
"I will carry this with me, because like I said, sometimes you're in the street driving somewhere and you could save a life," Camacho told them. "And if you don't have these things, it's harder to do so, right?"
Camacho said she's seen how the opioid crisis has caused suffering in her neighborhood and across the city. In regards to the new canvassing effort, she said she believes that "God is putting these people to help."
As she headed inside, carrying the box of Narcan, Camacho said she wanted to do her part to help, too.
This story comes from NPR's health reporting partnership with WHYY and KFF Health News.
