Yet for one pocket of commerce in Philadelphia, supplies appear as plentiful as ever.
In Philadelphia’s Kensington district, home to one of the largest open-air drug markets in the United States, crowds of sellers and buyers flock to corners as if there never were a pandemic.
“The blocks [where drug dealing takes place] never closed,” said Christine Russo, 38, who’s been using heroin for seven years. She waited Friday near Kensington and Allegheny Avenues, at the heart of the city’s opioid market, while a friend prepared to inject a dose of heroin. “Business reigns. The sun shines.”
Yet plentiful supply does not mean that what is on offer isn’t dangerously unpredictable. Over the last few years, Philadelphia’s drug supply has been contaminated with fentanyl and other adulterants. Now, that danger has been compounded by the financial, social, and emotional upheavals of the coronavirus pandemic.
Earlier this year, as countries closed borders and restricted travel in efforts to contain the pandemic, some officials predicted major disruptions in the global supply chains of illicit drugs. Far from a silver lining, such a disruption could push prices up, leading to lacings in drugs that can cause dangerous side effects in desperate, unsuspecting users — including death.
The United Nations noted in a May report that there were opioid shortages around the world, including in North America, and cautioned that the resulting price hikes and losses in purity could lead to riskier drug use.
In underground economies like the drug market, disruptions in the global supply chain can wreak havoc for people in addiction, said Leo Beletsky, the director of the Health in Justice Action Lab at Northeastern University. A shortage in heroin, for example, can prompt dealers to turn to cheaper — but deadlier — synthetic alternatives like fentanyl.
“As supply chains get disrupted, there’s going to be more unpredictability, more synthetics, more violence, because that’s what happens when drug markets get disrupted,” he said. “The more constraints there are on the market, the more it’s going to mutate toward synthetic, cheaper, lab-produced drugs, where a few people can produce a lot of product.”
And because drug markets are unregulated and difficult to monitor outside of hard-to-access law enforcement channels, it’s tough for researchers to glean a full picture of the effects of the pandemic, Beletsky said. It’s not enough to rely on the word of law enforcement about conditions on the street, he said.
After shortages early in the pandemic, Philadelphia’s drug supply appears to have stabilized, said advocates for those in addiction and law enforcement officials alike.
“We did hear internationally that overseas there were some supply-chain disruptions for precursor chemicals for drugs like fentanyl and methamphetamine, but as far as Philadelphia proper, we haven’t noticed significant disruptions in supply or price,” said Patrick Trainor, a spokesperson for the local branch of the U.S. Drug Enforcement Administration.
“It would indicate that the current drug supply, before the pandemic, was, quite frankly, pretty plentiful.”
At the onset of the pandemic, advocates in Philadelphia had braced for changes in the drug supply, said Silvana Mazzella, the associate executive director of Prevention Point, the public health organization based in Kensington. “What we were seeing is, in fact, it looks like there still appears to be the same drug supply as before,” she said.
But even if the drug supply in Philadelphia is stable, the drugs themselves remain unpredictable.
Philadelphia long was known for some of the purest and cheapest heroin in the country, but in recent years, much of the heroin supply was replaced by fentanyl, sometimes without users’ knowledge. The synthetic opioid is both cheaper to produce and much stronger than heroin.
Fentanyl is behind most of the city’s fatal overdoses, and over the last few years has been added into drugs that aren’t even opioids, with entirely different effects on users. Stimulant drugs like cocaine are being cut with depressant fentanyl. So are synthetic cannabinoids like K-2. Mazzella said she was concerned that contamination had only accelerated during the pandemic.
On the street in Kensington, some people said the quality of drugs has diminished since the lockdown, though it was unclear whether the pandemic was driving that. Several people gathered near McPherson Square Park said there do appear to be more people using drugs on the street.
The purity of the drugs on offer in Kensington is a running concern for people in addiction there, and not necessarily because unadulterated drugs allow for a more pleasurable high.
Heroin cut with fentanyl can be deadly to an inexperienced opioid user, and other cutting agents used in Kensington, like the animal tranquilizer xylazine, can produce dangerous side effects in people who aren’t expecting them. Drug users do their best to keep themselves safe: Russo specifically seeks out the few dealers in the neighborhood that still sell pure heroin.
Globally, the pandemic has spurred worries about an increase in drug deaths.
Fatal overdoses have gone up since the beginning of the year in Philadelphia, health officials here said, but are currently about level with last summer. But other communities in Pennsylvania and other states have been reporting increases in overdoses during the pandemic — so much so that the American Medical Association issued a memo earlier this summer saying it was “greatly concerned.”
“Overdoses are spiking in a bunch of places, and we don’t even know how much it’s spiking,” Beletsky said. Health systems that would, in normal times, be able to sound alarms about overdose spikes may be overwhelmed with responding to the pandemic instead.
While fentanyl already had largely overtaken Philadelphia’s drug market, markets on the West Coast, which are not as accustomed to its lethal effects, could see more fentanyl sales as a result of the pandemic. “I think it’ll just catalyze that transition that was already occurring,” Beletsky said.
Business closures and the economic downturn related to the pandemic make life harder in Kensington, like everywhere else — though many here were living hand to mouth long before March. Some treatment programs refused to take new clients or otherwise cut back on services as money grew tighter, staffers feared contagion, and some contracted the virus. The isolation, fear, and loneliness so many have experienced with the pandemic can be especially acute for people with substance use disorders, especially those with underlying mental health problems. People in recovery may relapse.
All of those pressures, plus economic shock and deprivation, may push more people — including those who have not experienced addiction before — to use drugs problematically, Beletsky said.