In just four hours on Wednesday, Camden authorities responded to 14 nonfatal drug overdoses, prompting a frantic alert via Twitter from New Jersey Attorney General Christopher Porrino. But that toll only hints at the most alarming new facts about the opioid epidemic: All across the Philadelphia region, people are dying of drug overdoses at a faster pace than ever, an Inquirer and Daily News analysis of data from county coroners and medical examiners shows.
Across Philadelphia and the seven surrounding counties, 1,314 people died of overdoses between January and June this year, up from 874 in the same period of 2016, about a 50 percent increase. The epidemic's impact varies considerably by county. Comparing the first half of 2017 with 2016:
- Overdose fatalities in Camden County more than doubled.
- Drug deaths in Burlington County jumped 74 percent.
- Bucks County posted a 65 percent rise.
- Chester County, the wealthiest in the region, this year has already passed its toll for all of 2016.
- And in Philadelphia — where people passing out in public with needles in their arms in some neighborhoods has jolted city officials into considering a supervised site for injecting heroin — fatal overdoses increased by 58 percent.
The one bright spot was Montgomery County, where fatalities dropped 4 percent for the first six months of the year. "This is by no means a victory lap for us," said Val Arkoosh, chair of the county commissioners and an anesthesiologist. Just last week, law enforcement officials announced seizing nearly one kilo of illicit fentanyl, representing enough doses to kill hundreds of thousands of drug users.
All of those figures would undoubtedly be higher if not for the efforts of emergency responders, fellow drug users, passersby, and even librarians to save people from an epidemic that often begins with a prescription for opioid pain relievers and ends with heroin on the street. Police and emergency crews equipped with the reversal medication naloxone responded to the 14 overdose calls Wednesday in South Camden. Everyone survived.
Police calls for nonfatal overdoses are down 50 percent this year, said Scott Thomson, chief of the Camden County Police Department, which covers the city. But fatal cases — people who couldn't be revived or died on the way to the hospital or in the emergency room — are up more than 50 percent. The reason appears to be fentanyl, Thomson said, which is so potent that the reflex to stop breathing can kill the user before police can even be summoned. Most of Camden County's deaths occur in the city, especially around the Walter Rand Transportation Center and nearby streets, although a majority of those who died resided elsewhere and may have been in the city solely for drugs.
Camden has been among the most proactive counties in the region battling addiction, starting up sober sports leagues to help people in recovery, paying for uninsured users to begin treatment, and holding an annual candlelight vigil where hundreds of families who have lost children, parents, brothers, and cousins can come together to start to heal.
This year's event will be Saturday evening at Camden Waterfront Stadium.
Beth Borchers went last year to honor her nephew Nick Munro, who spent part of his childhood with her in Haddon Heights but later moved with his family to Orlando, where he died of drugs laced with fentanyl in 2014. She works with the county's addiction task force and was asked to read names aloud.
"I read Nick's name and the very next name, I burst into tears," said Borchers, who gave up her real estate career as she struggled with the 23-year-old's death. By the end of the evening, "a bit of the weight lifted off my shoulders," she said.
The drug-dealing business
Wide disparities in drug overdose fatality data compiled by the Inquirer and Daily News from county coroners and medical examiners data partly reflect changes in the drug-dealing business. Mid-level distributors can order fentanyl over the dark web from China and mix it with heroin or other drugs closer to the level of neighborhood sales, boosting potency and profit while reducing prices.
A pinch of fentanyl equal to seven or so grains of table salt can kill. A deadly batch might be limited to several of a dealer's soldiers on a single street corner or show up over the county line.
"If the fentanyl or fentanyl analog is not uniformly distributed," said Jeremiah Daley, director of the Philadelphia/Camden High Intensity Drug Trafficking Area, a multi-agency task force led by the White House, "it may not hit it until later."
Toxicology tests are detecting prescription opioids like Vicodin and Percocet less often, some medical examiners said, while cocaine and methamphetamine are showing up more. Tests also are finding more combinations of drugs, like fentanyl and cocaine, as well as more fentanyl by itself in addition to the typical mix with heroin.
"We're starting to see a higher proportion of heroin being cut with cocaine. We don't know what that means," said Janice Pringle, an epidemiologist at the University of Pittsburgh who oversees OverdoseFreePA.org, an analysis and information site. The traditional patterns have been consecutive, with heroin rising in the 1970s and then cocaine and crack in the '80s, "depression and stimulating, back and forth," Pringle said.
Dying away from home
Counties' fatality data reflect where people died, not their county of residence; one-third of overdose deaths in Philadelphia are nonresidents. While trends over time in the same county should be more or less consistent, comparisons among counties may not be meaningful, as reporting practices vary widely.
New Jersey, for example, releases total deaths, while many Pennsylvania counties give accidental deaths, which on average represent about 80 percent of the total. And while Montgomery County could not determine the reason — accident, suicide, homicide —for only six of its 249 drug-related deaths in 2016, the Delaware County Medical Examiner's Office categorized 31 of its 227 drug deaths as undetermined.
The six-month data don't necessarily forecast the entire year. Philadelphia officials have projected that 2017 overall deaths will be up over 30 percent from 2016 if current trends continue.
State and federal data lag behind. The most recent federal projections show a 20 percent increase — to 65,000 deaths — for the 12 months ending in February.
Michelle Carroll died of a heroin overdose on May 31, sitting in her car parked near her mother's house in the Barclay section of Cherry Hill. Her pug, Gup, was beside her.
"She's just great. Giggly," Janet Keane said, her voice quavering on the phone. Carroll graduated from Drexel University with a bachelor's in environmental science, including a stint in Equatorial Guinea studying ants.
Heroin is "a very tough drug. It just keeps calling you," Keane said.
She submitted her daughter's name to be read at Saturday's candlelight vigil, where she will be at a table for Shatterproof, a national nonprofit.
"If I can help anybody else not have to go through it–."
Camden County's Regional Candlelight Vigil — 17 counties are cosponsoring it — to remember loved ones lost to addiction is Saturday evening.
When: Saturday, Oct. 14, at 6 p.m. (doors open at 5:30), rain or shine.
What: Speakers include Justin Phillips, founder of Overdose Lifeline; Tara Conner, the Miss USA 2006 who has struggled publicly with her addiction; and Inquirer columnist Mike Newall, who lost a brother to the disease and has chronicled the heroin epidemic in Philadelphia.
Information: www.camdencounty.com or 1-866-226-3362.