Just as it is in Philadelphia, the synthetic opioid fentanyl is driving the overdose crisis throughout Pennsylvania, new data from the Drug Enforcement Administration show.
Fentanyl was present in 67 percent of the state's 5,456 overdose deaths in 2017 — up from 52 percent of overdose deaths in 2016, when 4,642 people died.
Since 2015, overdose deaths across the state have risen by 64 percent, the DEA said. But the rate of that increase slowed last year: from 2015 to 2016, deaths rose by 38 percent; from 2016 to 2017, deaths rose by 18 percent.
In Philadelphia, which has the worst opioid death rate of any major city in the country, 1,217 people died of a drug overdose in 2017 — about 22 percent of the state's total overdose deaths. Fentanyl was present in 84 percent of those cases.
Thomas Farley, Philadelphia's health commissioner, said the new state-level data suggest that Pennsylvania's opioid crisis is no longer confined to urban areas.
"We've always had a bigger heroin problem than the rest of the state," he said. "What I'm struck by is how much of a problem we have in the rural areas that were previously untouched by this. The opioid crisis is raging through Pennsylvania like the wildfires are raging through California."
He said the rise in fentanyl-related overdoses was particularly concerning.
"That's the top drug here — and it's 50 times as potent as heroin, much more likely to get people addicted, much more likely to cause an overdose," he said. "It's changed the entire nature of the problem."
The DEA will issue a more detailed report on the state's overdose death rate this month. But it released these preliminary numbers as the Centers for Disease Control and Prevention released its own provisional data on the overdose crisis nationwide, predicting data will show 71,568 overdose deaths between January 2017 and January 2018.
It's difficult to say what's driving the national spike in overdoses — up from 64,000 overdose deaths in 2016 — because county coroners often don't report the types of drugs that killed overdose victims on death certificates, which is the only way for the CDC to track such information, said Bob Anderson, chief of the mortality statistics branch at the CDC's National Center for Health Statistics.
Still, he said, the increases since 2016 were alarming, although some states in the West and New England reported declines in overdose deaths.
"The fact that we are seeing some declines in some states is certainly encouraging," Anderson said. "But the numbers continue to rise in several of the other areas. I'm hopeful that what we're seeing here in the most recent months is kind of a peak in the problem for the nation, and we'll start to see some declines here. But it's impossible to know for sure until we get some more data. It could be just a stall and then start going up again."
Farley said the statewide data show the enormity of the task ahead for local health departments.
"Now every small town and every city in Pennsylvania need to do all the steps that are important: reduce overprescribing of opioids, make drug treatment available, and distribute naloxone," the overdose-reversing drug, he said.