Baltimore has become the epicenter of the worst drug crisis ever seen in a major American city, an examination by The New York Times and The Baltimore Banner has found. The city’s death rate from 2018 to 2022 was nearly double that of any other large city — a fact not known by several top leaders, including the mayor and the deputy mayor, who used to lead the city’s Health Department.

The city once had an aggressive overdose prevention strategy, but as officials became preoccupied with other crises, many of their efforts stalled.

Reporters for The Banner teamed up with The Times’s Local Investigations Fellowship, which gives local journalists a year to pursue an investigative story about their communities. They reviewed thousands of pages of government documents and interviewed more than 100 health officials, treatment providers and people who have been addicted to drugs to examine the city’s response.

Here are five takeaways from our reporting.

Baltimore’s fatal overdose rate has always been high, but fentanyl drove it to unheard-of levels.

Baltimore has long been known as the United States’ heroin capital — a reputation cemented by the HBO series “The Wire” — and for decades it has had one of the highest fatal overdose rates of any large U.S. city. But the synthetic opioid fentanyl, up to 50 times more potent than heroin, has taken over the city’s drug supply, and the death rate has shot up. These days, nearly all illegal opioids available in the city contain fentanyl, and heroin is almost impossible to find.