Philadelphia is on track to record 1,200 drug overdose deaths this year, a 33 percent increase over last year.
"Every week it is worse. Every month it's more," Caroline Johnson, the city's acting deputy health commissioner, said Tuesday at an opioid forum at the Union League hosted by Philadelphia Media Network, parent company of the Inquirer, Daily News, and Philly.com.
Despite the continued increase in opioid overdose deaths, Johnson pointed to a bright spot for the future. "Overprescribing of opiates has started to level off," she said.
Johnson and other experts who addressed an audience of more than 150 described the roles that law enforcement, government, medicine, and treatment facilities must play in a multipronged approach to combat the opioid epidemic, which is killing 147 people a day nationwide.
Gary Tuggle, special agent in charge of the U.S. Drug Enforcement Administration's Philadelphia office, said the current heroin-addiction epidemic is worse than the post-Vietnam War heroin epidemic and the crack cocaine epidemic of the 1980s combined.
"Please understand how critical this epidemic is," Tuggle said. "You're living through the worst in our history. It takes a multipronged approach to dealing with it. It's not a total law enforcement problem. You can't arrest your way out of it."
"It's got to be a marriage between public safety, public health, and prevention," Tuggle said.
Richard L. Snyder, chief medical officer at Independence Blue Cross, described some of the steps that the Philadelphia region's largest health insurer is taking to overcome what he described as the "inertia in the prescribing system" that leads to too much reliance on prescription opioids.
Soon, Snyder said, IBC is going to limit physicians' initial opioid prescriptions to five days of treatment and the equivalent of 90 milligrams of morphine a day. "Physicians aren't going to like it, but they are going to have to get over it," he said.
IBC also educates doctors by sending them a list three times a year showing their patients who are being prescribed opioids outside the Centers for Disease Control and Prevention guidelines. In some cases, such as with cancer and hospice patients, that is fine, but in many situations, it is not, Snyder said.
"What we find is that 50 to 60 or 65 percent, depending on the time period, of the physicians who are advised that they are prescribing outside the CDC guidelines drop off the list the next time we run the list," Snyder said.
Mayor Kenney's task force to combat the opioid epidemic in Philadelphia is scheduled to release its report Friday, and one of the topics discussed in that group was harm reduction, which is "the philosophy that not every person who uses drugs is ready to quit at any particular time, and that maybe what our goal needs to be is to prevent the negative consequences of drug use," said Johnson, the city's acting deputy health commissioner.
Examples are needle exchanges and the distribution of naloxone, a drug that can save overdose victims by reversing the suppression of the respiratory system caused by opioids.
More controversial is the creation of safe-injection facilities, Johnson said. "The idea is that if you give individuals a safe and protective place to use drugs — you're not giving them drugs, you're not condoning drug use — but you're giving them some level of supervision to the benefit of those individuals and the community at large," she said.