At a time when coronavirus shutdowns threaten the Philadelphia restaurant industry and its workers’ livelihoods, another epidemic — the worst big-city overdose crisis in America — is compounding the pain.

On Nov. 10, Thomas Jefferson University Hospital reported a spike in overdoses to city public health officials; in the days following, at least three people died of overdoses connected to cocaine tainted with fentanyl, said Mary Craighead, who oversees the overdose prevention program at Prevention Point, a public health organization for people who use drugs.

The spike is concentrated among restaurant-industry workers in Center City and Old City.

Word of the overdoses spread quickly through a tight-knit working environment that can feel like a family, rattling employees already stressed by unemployment and precarious finances. With COVID-19 cases surging and new closures in effect, many are staring down a long, uncertain winter.

“It’s a tough time right now for anyone in the service industry — let alone the pressures on a daily basis pre-pandemic,” said Bobby Clarke, a Center City bartender who lost a former coworker to an overdose earlier this month. “A lot of people have looked for a way to cope, get through the day.”

The city health department was first alerted to the Center City overdoses through social media posts, said Jennifer Shinefeld, a field epidemiologist for the agency.

The department launched a general outreach program in Center City and then began to target bars and restaurants after realizing service-industry workers had been most affected by the overdose spikes.

Even in normal times, restaurant work is high-stress and fast-paced. Some employees even face “often exploitative work expectations and cultures,” an environment that can mean turning to drugs or alcohol to blow off steam, said Hemi Park, a former restaurant-industry worker who is now an academic researcher at the Center for Asian Health at Temple University’s medical school.

In Center City this month, health workers encouraged people to test their drugs for fentanyl, and if the test turned up positive, to use less, use more slowly, or not use at all.

“There’s a concerted community effort to keep people safe,” Shinefeld said.

Philadelphia’s heroin supply was almost entirely adulterated long ago by the more powerful opioid fentanyl, which is behind most of the city’s overdose deaths.

Opioids are depressants, and kill by slowing respiration. But fentanyl is turning up in methamphetamine and cocaine, all stimulants that some use to party, or even get through long work hours.

Deaths from stimulants mixed with fentanyl have been on the rise in Philadelphia for years. It’s sometimes unclear whether those deaths are attributable to fentanyl that’s intentionally added to stimulants; mixed in through cross contamination during packing; or bought separately and combined by drug users for a different high. Craighead believes the cocaine behind the recent Center City overdoses was unintentionally mixed with fentanyl.

But however it makes its way into cocaine, fentanyl is not necessarily “balanced” by the stimulant. It can be just as deadly in combination.

Many of the city’s heroin users now expect that the drugs they buy contain fentanyl, and even seek out fentanyl because the stronger drug has increased their tolerance to opioids. But people who aren’t accustomed to using opioids risk overdose and death if fentanyl turns up unexpectedly in the drugs they buy.

In the summer of 2018, nearly two dozen people who normally used crack cocaine were sickened in West Philadelphia when they were sold fentanyl in place of crack, prompting a public campaign in the area about the dangers of the powerful opioid.

“What’s happening right now is my worst fears realized from then,” said Allison Herens, the city’s former harm-reduction coordinator and a longtime restaurant server herself. “Fentanyl is not just a heroin problem, and I think that was hard for even people in harm reduction to digest back then.”

Two years ago, Herens walked through West Philadelphia with fliers warning residents about fentanyl-tainted crack; now, she’s handing out naloxone and fentanyl test strips to colleagues in the restaurant industry.

Those efforts have had some success, Craighead said. Though Prevention Point is based in Kensington, Craighead deploys outreach teams across the city to respond to overdose spikes.

Part of the battle is getting people who aren’t accustomed to opioids to understand the risks of fentanyl.

“In a place like Kensington” — the heart of the city’s opioid epidemic — “many folks know fentanyl is in a lot of the drugs,” Craighead said. “But it’s not the case in many other parts of the city. And we hear a lot of ‘I trust my drug dealer.’ We try to remind folks that drug dealers might not be testing their products, either. They’re getting it from someone else, who gets it from someone else.”

And stigma surrounding drug use means it’s harder to get people to open up about what they need to keep themselves safe from overdose.

At the Plough & the Stars in Old City, manager Erin Callahan doesn’t expect her employees to talk to her about drug use, and the restaurant hasn’t had any staffers overdose. But she took a set of fentanyl testing kits from the health department all the same.

“I put them in the locker room. All the kids that work for me are like, ‘Oh, we would never,’” she said. “I’m like, ‘Well, you’re not going to tell me if you need it. But it’s there.’”

Clarke said some of his colleagues in the industry have begun to use the test strips more regularly, and others have dialed back on substance use, worried about overdoses.

“I definitely encourage people to test their stuff. I get it — it’s 2020. It’s been a tough year. Everyone has to find a way to get through the day,” he said. “While some measures are better than others, if you’re going to use a substance to get you through your day, I want you to know that it’s not something that’s going to kill you.”