The overdose crisis in Philadelphia is not relenting. According to data released last week by the city’s Department of Public Health, the number of overdose deaths in Philadelphia increased in 2019 by 3% compared with 2018 — for a total of 1,150 lives lost. The data suggest that for all the good work being done by the city and its partners, Philadelphia is still not doing enough. This is especially troubling since it’s less likely to improve while focus, attention, and resources are being diverted to dealing with the coronavirus crisis.
About half of all fatal overdoses also involved both an opioid and a stimulant — cocaine or meth. In addition, the number of overdose deaths involving only a stimulant and no opioids has been increasing. It is a reminder that the drug supply in Philadelphia is ever-changing and dangerous, with the potent fentanyl finding its way into other drugs, or into the use habits of users who typically don’t use opioids.
Philadelphia’s numbers are frustrating. Other localities that have been responding to the crisis using similar strategies to Philadelphia — naloxone training and distributions, warm handoffs, increasing access to medications for opioid use disorder — have been experiencing meaningful reductions in deaths. Allegheny County, for example, cut overdose deaths by 40% between 2017 and 2018.
But Philadelphia is not like other cities — it is poorer, segregated, and has a decades-old open-air drug market with distribution networks that replenish supply faster than any law enforcement response.
The data also shows alarming racial trends. While the majority of victims of overdose are white, the overdose rates for both black and Hispanic Philadelphians increased in 2019 by 14% and 24%, respectively, at the same time that the death rate for white Philadelphians decreased by 3%.
A growing number of studies show that while the U.S. has been increasing the number of treatment slots for opioid use disorder, these slots are primarily accessible to white people in addiction. There are also few efficacious treatment options for people addicted to stimulants. According to Public Health Commissioner Thomas Farley, the population that uses both opioids and stimulants tends to be black and Hispanic.
The city and its partners are doing a lot of the right things and have covered many of the bases — though supervised injection sites would help. It’s been three years since the mayor’s Opioid Task Force released its recommendations, many of which were implemented, and the crisis is worse than it was when the task force was convened.
The persistence of overdose deaths suggests that something in Philadelphia’s response needs to change. To figure out what that change is exactly, Philadelphia should reconvene a task force that will look beyond opioids and review drug use and overdose in general. It could be an opportunity to bring stakeholders together, assess the city’s response, and ask critical questions. For example: How close is Philadelphia truly to treatment on demand, and why are treatment slots not always utilized?
The coronavirus made the already hard work of overdose prevention even more difficult — but that is what also makes this overdose crisis all the more urgent.