Racism, childhood trauma, and the COVID-19 pandemic have dramatically affected opioid overdose deaths in Philadelphia, and must be considered as part of the city Health Department’s efforts to curtail rising overdose deaths, according to a new city report.
The inaugural OD Stat report summarizes findings of a panel of public health experts who reviewed in depth 22 individual overdose death cases in an effort to identify and address gaps in services. Though a small sample of the 1,214 people who died of an overdose in Philadelphia in 2020, the findings provide valuable insight to the experience of individuals in active addiction.
“We go to great lengths when we’re choosing cases to identify different people, from locations all around the city, different age groups and socioeconomic status,” said Zoe Soslow, OD Stat’s central administrator. “Across the board we see a lot of trauma.”
Of the 22 cases reviewed, about half were individuals with documented childhood trauma. A quarter had a family member who died of an overdose. Nearly three-quarters had a behavioral health diagnosis. The vast majority — 95% — had been arrested and incarcerated at some point in their life, according to the report.
The OD Stat initiative was launched in 2019 in response to a rising opioid overdose death rate in Philadelphia, largely driven by fentanyl and other synthetic opioids. Periodically reviewing cases in detail has helped medical professionals like Jeanmarie Perrone who are tasked with caring for patients in active addiction understand gaps in the health system.
For instance, “if someone was in drug treatment and found to be using drugs, they were discharged from treatment. That’s the time to increase their resources, not take away resources,” said Perrone, a professor of emergency medicine at Penn’s Perelman School of Medicine and director of the Penn Medicine Center for Addiction Medicine and Policy. She was part of the committee that reviewed cases, but was not involved in drafting the report.
A major gap identified in the report is the need for racial equity in the city’s outreach efforts, Soslow said.
While the overdose death rate among white individuals has declined in recent years, it is climbing in Black and Hispanic communities.
“We’ve always had a white face to this crisis, and when you have a white face to the crisis you have a white face to the solution,” said Sheila P. Vakharia, a deputy director at the Drug Policy Alliance in New York, which advocates for drug policy reform legislation.
The report found that stigma is a significant barrier to people getting treatment for addiction. Others may not have treatment options in their neighborhood or didn’t trust city health workers who didn’t look like them.
The stress and economic hardship of the COVID-19 pandemic contributed to overdose deaths in 2020. Black and Hispanic communities, where overdose deaths are rising fastest, were also hardest hit by the pandemic: They account for a disproportionate share of COVID-19 deaths and essential workers with a greater risk of exposure to the virus.
The OD STAT report recommends the health department partner with community organizations to educate people about where to get treatment if they want it, and how to keep themselves safe with syringe exchanges and fentanyl test strips, which can detect whether the potent opioid, linked with most fatal overdoses, is present.
The Health Department also plans to partner with an outside consultant to improve hiring diversity and adjust its educational messaging, Soslow said.
Vakharia said she thinks the report and the committee’s recommendations are an important first step toward improving resources for people in active addiction — especially in underserved Black and Hispanic communities.
“When we don’t build equity into how we allocate resources, how we develop programs, who we target in outreach, what ends up happening is our programs end up leaving behind people who’ve always been left behind,” she said.
The Philadelphia Inquirer is one of more than 20 news organizations producing Broke in Philly, a collaborative reporting project on solutions to poverty and the city’s push toward economic justice. See all of our reporting at brokeinphilly.org.