After years of skyrocketing overdoses, some of the Philadelphia neighborhoods hit hardest by the opioid crisis saw encouraging drops in drug deaths last year, data from the city’s health department show.

But overdoses are still on the rise in other city neighborhoods. And the scope of the crisis in Philadelphia means that some communities that saw decreases are still weathering staggering death tolls.

For example, the 19134 zip code — for Kensington, Port Richmond, and Harrowgate, the communities at the epicenter of the opioid epidemic — saw a 23% drop in overdose deaths between 2017 and 2018.

But that still means that 160 people lost their lives to drug overdoses there in 2018, after the neighborhood hit an all-time high of 209 deaths the previous year. The area lost more people than any other in the city.

In neighboring Frankford and adjacent areas in the 19124 zip code, overdose deaths also dropped by 23%, from 92 to 71. In Fairhill, in the 19133 zip code, overdose deaths dropped by 32%, from 62 to 42.

"There’s some hope. Some of the measures that we’ve suggested, harm reduction measures, actually work,” said Jose Benitez, executive director of Prevention Point, a public health organization for people in addiction based in Kensington.

Benitez said that the city’s efforts to flood the neighborhood with naloxone, the overdose-reversing drug, seem to have had an effect. He added that Prevention Point and the city health department have also improved their response to overdose spikes in the neighborhood, identifying unusual overdose patterns earlier and handing out more naloxone more quickly.

Still, he said, “the sad part about what we do is that we’ve made some strides, and yet there’s still 160 people who died in the zip code. It’s the most difficult part of the job.”

The Kensington area and the communities bordering it have been the focus of some of the city’s most concerted efforts to combat the opioid crisis, under a disaster declaration instituted by Mayor Jim Kenney last year. He recently extended the initiative, which city officials have termed the Philadelphia Resilience Project, through the end of 2019.

“What I was really struck by was how big the drop was in Kensington — that’s the site of the Resilience Project, the site of the most drug activity. It’s the hot spot in the city,” said Thomas Farley, the city’s health commissioner. “It’s an encouraging sign that we are really making progress in the area. But the rest of the city is following different trajectories."

Overall, the city’s 1,116 overdose deaths in 2018 — an 8% drop since 2017 — represent one of the worst urban drug crises in the country. And some neighborhoods saw increases in overdoses even as overdoses in communities around them dropped or stabilized. Overdoses in the 19148 zip code in South Philadelphia increased by 20%, from 44 to 53 deaths between 2017 and 2018.

Overdose rates decreased in the other neighborhoods in South Philadelphia. Just across Broad Street, the 19145 zip code dropped from 40 deaths in 2017 to 30 deaths in 2018.

It’s unclear what caused the spike in 19148. Priya Mammen, an emergency physician and public health advocate from South Philadelphia, said drug trends in those neighborhoods tend to be slightly behind trends in Kensington. Drug users in South Philadelphia, for example, may have been introduced to the deadlier synthetic opioid fentanyl — which has contaminated much of Philadelphia’s heroin — later than their counterparts in Kensington, she said.

Benitez said that South Philadelphia still struggles with adequate access to harm reduction services. Prevention Point sends a syringe-exchange van to the neighborhood several days a week, and some outreach groups regularly visit the area. But it’s a far cry from the resources available in Kensington. “We don’t have that kind of support in South Philly,” Benitez said.

Elsewhere in the city, the 19106 zip code, in Old City, went from six fatal overdoses in 2017 to 12 in 2018. Other neighborhoods that had seen deaths steadily rise for years saw small declines, or reported the same number of overdose deaths as the year before. Hunting Park (19140), which went from 32 overdoses in 2016 to 52 in 2017 (a 62.5% spike), saw just two fewer overdoses in 2018.

The population of people in addiction in Kensington is unique, Farley said — largely people who are homeless and who inject drugs multiple times a day. “The most severe end of the spectrum," he said. Addiction looks different for other people in Philadelphia.

“They’re far more hidden. They’re living at home, maybe injecting once a day, holding down a job,” he said. “And they don’t see themselves, generally, at risk. But there’s a lot of those folks, and cumulatively, they have a lot of overdoses. How do we reach those folks? It’s a sign that the problem has not been solved."

Benitez said stigma keeps many from seeking treatment, or even seeking harm reduction services.

“We have to start talking about this out loud, and tackling the stigma that surrounds this disease — so people feel safe to come in and ask for help,” he said.

The city has launched a media campaign aimed at people in active addiction who aren’t on the street, encouraging them to start on the treatment drug buprenorphine. Farley added that it’s key to encourage health providers of all disciplines to help their patients in active addiction enter treatment.

City officials believe that their general strategy to combat overdose deaths — reducing the overprescribing of opioid painkillers, handing out the overdose-reversal drug naloxone, and making it easier to access medication to treat addiction — has helped decrease deaths.

There’s likely a fourth factor as well, Farley said: People using drugs in Philadelphia may have begun to acclimate to fentanyl contamination by learning to be more careful with the way they use drugs. Some drug users have also reported developing a tolerance for the much more powerful opioid that makes it harder to return to heroin.

Mammen, who’s based at the Lindy Institute of Urban Innovation at Drexel University, said it’s crucial that Philadelphians not become inured to the city’s enormous death toll.

“Because we are, and have been, dealing with these big numbers, it’s really easy to forget what they mean. To go from 44 to 53 deaths in South Philadelphia, that’s nine more families that are broken,” she said. “When you look at it from a 50,000-foot view, they become a number. But they are individuals, and they are adding to the strength of the city. And we’re losing them.”