Earlier this month, the body of a young man came through the city Medical Examiner’s Office: another victim of a fatal overdose amid the COVID-19 pandemic, during which drug deaths have reached record levels in Philadelphia.
The man had been found with a few pills in his pocket; his parents told investigators that they had known him to only seek out the opioid painkiller OxyContin.
But the pills weren’t OxyContin, or Percocet, or any other pharmaceutical opioid. An initial test showed the man died with fentanyl in his system — the powerful synthetic opioid that has made its way into almost every corner of the city’s drug supply.
The Medical Examiner’s Office tested the pills, too. Fentanyl.
Increasingly, illicit fentanyl, which first turned up in the city’s heroin supply, can now be found in Philadelphia in pill form: drugs that look as though they came from a pharmacy, but, in reality, are composed of fentanyl or other adulterants, pressed into the shape of an opioid painkiller, or an antianxiety drug like Xanax. They’re cheap to produce and can turn a high profit for dealers.
“People have been selling fake pills for a while, but not quite to this extent,” said Pat Trainor, a spokesperson for the local Drug Enforcement Administration. “We’ve seen counterfeit pills for many years, but the availability has really skyrocketed over the past year. It’s of great concern to us — as if Philadelphia isn’t saturated enough with fentanyl products.”
As recently as 2017, none of the DEA’s drug seizures in Pennsylvania or Delaware included counterfeit pills. By 2019, they made up 9% of the agency’s total fentanyl seizures.
Last week, city health officials issued a news release warning drug users that any drug they consume may contain fentanyl. The synthetic opioid has turned up in stimulants like cocaine and methamphetamine, and hallucinogens like PCP — putting people with no tolerance for opioids at higher risk of an overdose.
“Pressed pills,” too, are of particular concern, because they may appeal to drug users with a lower tolerance for opioids. Some may even seek out pharmaceutical pills over powder heroin or fentanyl, believing they know what they’re getting.
In Philadelphia, that’s increasingly not the case.
In interviews Friday in McPherson Square in Kensington, the heart of the city’s drug trade, several people in active addiction said they had long avoided pills because it’s often impossible to tell what’s in them — fentanyl or otherwise.
“People that are not from around here seek them out, and they think they know the difference between a real pill and a fake pill,” said a young man sitting on the curb at the edge of the park. “And bodies are dropping left and right.”
For his part, the man said, he stopped buying pills years ago: Between fentanyl and other adulterants, they were just too unpredictable. “It’s safer to buy regular fentanyl — because you know what you’re getting,” he said. (Years ago, powdered fentanyl replaced most of the heroin in Philadelphia; many opioid users, especially in Kensington, are now accustomed to it.)
Another man who was preparing a dose of heroin nearby, and gave his name as “Jay,” said dealers “put anything they can get in [pills] to make you buy it.”
Jay said he primarily used heroin and methamphetamine, and sometimes tests his meth for fentanyl, as well. When asked how he keeps himself safe from overdose, he replied: “What’s safe? I don’t even know what that means.”
Compounding the problem is the difficulty of tracking deaths caused by fentanyl-laced counterfeit pills — as opposed to a death from injected fentanyl.
“Unless a sample of the drug is found on the person at the scene, or the next of kin has a sample of it, we have no way of knowing how the drugs were taken in — whether ingested, injected, swallowed — or in what form the drug was in,” said Kendra Viner, the director of substance-use prevention and harm reduction for the city health department.
Often, the only clues the health department has to go on are the drugs found near an overdose victim — like the young man with pills in his pocket.
Viner said the city’s anecdotal evidence shows pressed pills are a particular problem in South Philadelphia, where drug use is heavily stigmatized and tends to happen behind closed doors. But they’re available in the open-air drug markets in Kensington, too.
“In Kensington, folks know that fentanyl is in everything — so I think the knowledge is there,” said Mary Craighead, the overdose prevention and harm reduction coordinator at Prevention Point, the Kensington-based public health organization for people with addiction.
“Folks getting pills in different parts of the city might disassociate pill use from heroin use — it’s perceived as maybe a less risky behavior because it’s not injection drug use. They don’t think fentanyl can make its way into this pill that maybe they got from their friends, or someone they trusted.”
Craighead and Viner said it’s crucial to educate drug users about fentanyl, regardless of what drug they use, and to encourage them to test for the synthetic opioid — especially as overdoses skyrocket. The city health department offers training on how to use fentanyl testing strips on its website.
Officials say that 2020 likely saw the highest-ever number of drug overdose deaths in Philadelphia.
By Sept. 30, 950 people had died of drug overdoses, more than in the entirety of 2016. (Until 2020, 2017 was the worst year for drug deaths on record; 1,217 Philadelphians died of an overdose that year.)
Nationally, public health officials have noted that the stress and isolation of the pandemic had hit people with addiction hard: Overdose deaths spiked across the United States in the early months of the pandemic, a trend that continued through June, according to the most recent available data.
In Philadelphia, 81% of the drug overdose deaths in 2020 involved fentanyl — “the highest proportion ever reported,” the city said in a news release.
City officials say they’re launching a community education initiative to prevent fentanyl overdoses — whether alone, in combination with stimulants, or in pill form. In the news release, the city said it plans to conduct street outreach, give out fentanyl test strips and naloxone, and launch a media campaign early this year.
“The risk of overdose is becoming more and more an issue,” Viner said. “We need as many prevention mechanisms in place as possible to prevent an overdose.”