The prevalence of drug overdoses and homicides is helping drive down life expectancy in the nation’s sixth largest city as premature deaths have been rising since 2015

Trina Singleton’s son died a day before his 25th birthday, gunned down on the same day 10 people were shot in Philadelphia.

Elise Schiller’s daughter died of a heroin overdose at the treatment center where she had gone to seek help breaking her addiction.

They were victims of two tragedies – drug overdoses and homicides – now so prevalent in Philadelphia that they’ve helped drive down life expectancy in the nation’s sixth largest city.

Premature deaths have been increasing since 2015, according to the report released this month by the Philadelphia department of public health. Life expectancy began to fall after 2014, the city says. For men, it was 72.4 in 2017, down from 73.2 in 2013. Women had a longer life expectancy at 79.7, but that number has stopped improving.

The city counts the years of its citizens’ lives lost to early death, before the age of 75. The number hit a low of 9,004 years in 2014 and then reversed course – rising to 9,901 years in 2017.

Life expectancy has also fallen across the nation as opioid overdoses claimed more and more lives, but the drug epidemic has hit Philadelphia harder than any other large city. In 2017, there were 1,217 overdose deaths in the city – the third highest cause of death, trailing only heart disease and cancer.

“It’s a huge crisis that has really affected the health of the entire city,” the health commissioner, Tom Farley, told the Guardian. The last time life expectancy dropped like this was during the Aids epidemic.

Elise Schiller’s daughter Giana became addicted to painkillers she was prescribed for injuries she suffered as an athlete and a veterinary nurse, before turning to heroin.

“I was so blindsided,” said Schiller, 67, of Germantown. “I became increasingly confused and disturbed by the way in which they were treating her.”

Schiller has become an advocate for better treatment, the kind her daughter did not get – using medications like methadone and buprenorphine, which research shows are more likely to succeed in combating opioid addiction. Treatment programs also neglected her mental health problems.

“In her case, it was fatal,” Schiller said.

Philadelphia’s crisis is especially bad because it lies at the intersection of two trends, Farley said. The city has long been a hub for the distribution of heroin around the east coast, most of it now mixed with the more deadly synthetic opioid fentanyl. Add to that doctors overprescribing opioids for pain. One in three Philadelphians report taking a prescription opioid in the last year.

Facebook Twitter Pinterest The most notorious public face of Philadelphia’s overdose crisis is the Kensington neighborhood, where drugs are sold openly, and the city has cleared out encampments of homeless people addicted to heroin. Photograph: Matt Rourke/AP

The most notorious public face of Philadelphia’s overdose crisis is the Kensington neighborhood, where drugs are sold openly, and the city has cleared out encampments of homeless people addicted to heroin.

One still remains on Emerald Street – entrenched enough that its nickname, Emerald City, pops up as a destination in Google Maps. People live in tents under a bridge, but orange notices warn residents that they must clear out or be cleared out by 31 January.

“It’s an open-air drug market. The city let that happen,” said Carol Rostucher, who founded the group Angels in Motion to help people living on the street with addictions after seeing her son, who is now in recovery, go through the same experience.

Highly potent fentanyl factored in 84% of deaths in 2017, according to the city’s report. Its effects wear off faster than heroin, which leads people to use more of it, which leads to more deaths. “You’re using every couple hours so you’re not sick,” Rostucher said. “Every single time, it’s a gamble.”

At a town hall meeting in the basement of Kensington’s Mother of Divine Grace church, Farley told neighbors the city is laser-focused on one goal: “To keep people from dying.”

Philadelphia is looking to open a supervised injection site, where people addicted to heroin would inject the drug with medical help immediately on hand to prevent overdoses. But there’s no timeline for it to open and the idea faces fierce opposition from the Trump administration.

Over the last year and a half, the city has distributed 70,000 doses of naloxone, which can reverse an overdose.

Destinie Campanella carries three of those doses with her at all times. Around her neck hangs a locket reminding her of the reason why: her uncle Christian, who was her best friend, died of a heroin overdose six years ago.

“I give it out like water,” said Campanella, 28.

While the crisis may be most visible in Kensington, it is killing people in neighborhoods around the city. Most people who die of overdoses die in their homes.

There were 8,065 visits to the emergency room for overdoses in 2017, according to the city’s report.

“There’s no poster child for the opioid epidemic,” said Dr Priya Mammen, an emergency room physician at Methodist Hospital-Jefferson Health. Her South Philadelphia hospital deals with the third highest number of overdoses in the city.

Many of the overdose victims in South Philadelphia are construction workers or manual laborers. They’re often reluctant to look for treatment because of the stigma.

“People who have homes, who have jobs, who have a family are like, ‘Eh, I’m not that bad,’” Mammen said. “They feel like they have control over their use … Except fentanyl is a game changer. None of us have control.”

As part of her job at Mental Health Partnerships, Campanella does homeless outreach on the streets of Kensington. On her own time, she does the same in South Philadelphia, where she has lived her whole life.

“In South Philly, it’s more hidden. People are using behind closed doors,” she said, adding that people are reluctant to take the anti-overdose drug because they can’t accept that their loved ones may need it. “They live at home. They have jobs. They’re working. A lot of people might go to the gym, go to the tanning salon, even do steroids to make their appearance look better.”

While overdoses remain at crisis levels, there’s a hint of good news: deaths began to tick down for the first half of 2018. “I’m hopeful we’ll be able to look back and say this is the year we turned the tide,” Farley said.

The murder rate, on the other hand, only got worse .

Facebook Twitter Pinterest Homicide was the tenth leading cause of death in 2017, with 322 Philadelphians slain, according to a health department report. Photograph: Joseph Kaczmarek/AP

Homicide was the tenth leading cause of death in 2017, with 322 Philadelphians slain, according to the health department report. The murder rate was nearly 10 times higher for black Philadelphians than whites. It helps explain why black men have the lowest life expectancy of any group in the city, at 69.1 years.

“A black boy is shot and killed, and that’s that,” said Singleton, whose son Darryl was shot and killed in 2016 near his childhood home. “It’s always the same story: no motive, no suspects.”

But Singleton, 47, remembers her son as an outgoing young man who was going to school to be an EMT, loved spending summers with his grandmothers in Georgia and South Carolina, and doted on his youngest brother, who was just five when Darryl was killed. The younger boy made a card that sits on a corner table in Singleton’s home next to a photo of Darryl: “I hope you feel good in heaven. Love you.”

After Darryl’s murder, his mother discovered a poem he had written for her but never gave her, expressing appreciation for the way his parents raised him. “I just wanted my sons to be better,” said Singleton, a real estate agent.

Darryl Singleton’s life is now remembered in an obituary written by the Philadelphia Obituary Project. So are murder victims like Paris Wright, 21, who died before he could meet his newborn daughter, and Dominique Oglesby, 23, a student at Penn State who had overcome a health condition to become a talented singer.

Attorney Cletus Lyman started the project, distressed that victims’ lives were getting lost in the sheer number of murders, most of them by gun.

“I didn’t think people should just become statistics,” he said.

Many of the murders are never solved. That’s true for Darryl Singleton, whose killer has not been arrested. “These young people think they can get away with murder. They know they can get away with murder,” Trina Singleton said.

Philadelphia’s mayor has asked for a new plan to tackle gun violence, treating it as a public health problem. “Law enforcement is important, but it’s not alone going to solve this problem,” Farley said.

Carmen Pagan, 41, became an advocate against gun violence after her brother was caught in the crossfire and shot to death three years ago.

“I could have chosen to stay in bed and be depressed and just let him be another number,” said Pagan, who founded the group Somber (Sisters of Murdered Brothers Emerging and Revolutionizing). “I wanted to take a stand.”

From her home in West Kensington, she sees the gun violence and drug crises collide. Her 13-year-old daughter designed a gun out of bullet casings on a canvas with the words: “Our zip codes define our life expectancy.” There’s truth to that: there’s a gap of more than two decades between the part of the city with the lowest life expectancy, 64, and the highest, 87. Her seven-year-old daughter has already learned to look out for needles in the street.

“We have to help ourselves because nobody’s going to come help us,” Pagan said.