Fatal overdoses in Philadelphia rose through the first six months of 2020, and health officials now fear that the city is on track to surpass the death toll from 2017, the worst year for fatal overdoses on record.
In addition, the city’s overdose crisis is undergoing an alarming demographic shift.
In the first quarter of the year, white residents — as they have been for some time — were most likely to die of overdoses in Philadelphia. But between April and June, Black Philadelphians’ share of the city’s fatal overdoses nearly doubled, surpassing that of white Philadelphians.
The city’s rise in fatal overdoses mirrors evidence from around the country that overdoses have been rising during the stress, uncertainty, and isolation of the COVID-19 pandemic. While comprehensive national data take time to compile, reports from first responders around the country show a significant rise in overdoses this year.
In a study published in JAMA Psychiatry this week, researchers monitoring an emergency medical systems database in 47 states found that medics were responding to more than double the number of overdose-related cardiac arrests in May, at the height of the pandemic lockdowns, than they had in 2018 and 2019.
“There have been controversies around the lockdowns — people arguing the treatment is worse than the disease, that it’s going to cause mental health and substance use issues, and that we shouldn’t have lockdowns,” said Leo Beletsky, a Northeastern University professor who runs the school’s Health in Justice Action Lab and was one of the study’s authors.
“That’s not what we’re saying. What we’re saying is that when you design COVID response measures, you have to keep in mind that additional measures are necessary to mitigate the negative consequences of these mandates to stay home,” he said.
“People need access to [overdose reversal drugs] and treatment. People need access to economic and social supports. And in all of those, the COVID response measures are really lacking.”
In Philadelphia, between January and March 2020, 273 people died from overdoses. Between April and June, there were 309 fatal overdoses — the highest number in a single quarter since the third quarter of 2017.
“It’s preliminary still, but Quarter 3 of 2020 is going to look even worse than that,” said Kendra Viner, the director of the Division of Substance Use Prevention and Harm Reduction at the city health department.
The drugs driving the city’s fatal overdoses are shifting as well. More people are dying with a combination of a stimulant like cocaine and the powerful synthetic opioid fentanyl in their systems. Prescription opioids — long targeted by law enforcement and the medical community — are much less of a factor than illicit drugs. Philadelphia’s heroin supply, once famous for its purity, now is virtually all tainted with fentanyl, officials say.
And finding victims with a combination of stimulants and opioids, which act as depressants, suggests fentanyl contamination is spreading, killing drug users who never built up a tolerance for opioids, making even a small dose of fentanyl deadly, health officials said.
(Many opioid users keep naloxone on hand because it can reverse an opioid overdose. There’s no such rescue medicine for cocaine users, and if it’s not clear that their drugs were tainted with opioids, no one would know to revive them with naloxone.)
“We sort of felt like we understood the scope of the opioid crisis and who the populations were that were using opioids and were at highest risk for fentanyl and highest risk for a fatal overdose, and really put all our resources and attention on those individuals,” Viner said.
“Now we’re talking about all drug users in Philadelphia. That’s a much larger beast. Individuals who are opioid naive — we haven’t been targeting them with naloxone or overdose prevention and training or outreach. There are all these new populations we need to interface with.”
She said the department is working in particular to help Philadelphians of color access overdose-prevention resources. Health officials and advocates said too often, outreach efforts are not geared to reach people in those communities and haven’t kept up with how the drug crisis has morphed over recent years.
Nationwide, victims of fatal overdoses are often stereotyped as young white people from the suburbs who became addicted to opioids through prescription drugs. But for years, overdose rates among Black and Hispanic Philadelphians have been rising.
The health department recently asked local organizations to submit proposals for harm-reduction outreach among Philadelphians of color. SELF Inc., the largest emergency housing provider in the city, was one of them.
Its president, Michael Hinson, said the communities he serves — Black, brown, and poor Philadelphians — are often left out of conversations about harm reduction and the overdose crisis, even as their risk of overdose has increased.
“We have always had heroin use in Black communities. So why is it that our public health system, our messaging, our media, continue to misrepresent the possibility of this getting to our communities, and then not have the right public health response because they’re not talking to us?
“For the first couple years when the overdose [crisis] was really happening, the message was, it was happening to white folks. So you have folks in our communities who say, ‘Oh, this isn’t a problem for us, because look what the message is,’ ” Hinson said.
Hinson’s organization requires its entire staff carry and know how to use naloxone, and he’s reversed three overdoses himself. The staff has recently begun to hand out fentanyl testing strips to clients still in addiction, warning them that any of their drugs could be tainted with the powerful opioid.
Hinson has long been aware of how vulnerable his clients are, especially when they have no tolerance for opioids. In 2019, a client who had spent two years sober, living in SELF housing, was moved to his own apartment. He died of a heroin overdose within a week.
Last year, a friend of Hinson died of an overdose of fentanyl-laced heroin in his own home; his family had not known he was using drugs. Last month, Hinson lost another friend to an overdose at age 42.
“He was in West Philadelphia for a whole week. They couldn’t find him, and he was in the morgue for over a week,” Hinson said. “He died of a drug overdose, alone. And it’s because our communities aren’t getting the same message.”
At Prevention Point, the Kensington-based public health organization for people with addiction, staff have also begun outreach in Black communities in North Philadelphia and West Philadelphia.
“In white communities, there are billboards about drug use. [In Black communities], there’s less information about it, there’s less outreach about it,” said Mary Craighead, who runs Prevention Point’s overdose prevention program. “There’s a lot of indoor use, a lot of hidden use.”
The COVID-19 pandemic has disproportionately affected communities of color, both because of higher rates of illness and death, as well as job losses. It has also made the drug situation worse, Hinson said.
“We can’t figure out how to offer [COVID] testing to people when they are not symptomatic — what does that say to a mostly Black and brown, underpaid workforce, and how are they supposed to live with that trauma, going home knowing that any day they go home to a family member, they could be infected with COVID?” he said.
“People are having to deal with not being able to work, not having economic resources. On top of homelessness, on top of joblessness, how do you cope with that? How do you not turn to something to offer you some peace?”