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Philadelphia Taking Fentanyl Fight to the Streets

Fentanyl is killing more and more people in Philadelphia, and most people who take the drug don’t even know they are taking it, health officials said Friday.

Overdose deaths from fentanyl, an extremely potent opioid 100 times stronger than morphine, have risen sharply in the city over the past several years. And the problem, which looks to be getting worse, requires a new strategy to combat it, they said.

“This is the most significant epidemic that this country has seen, in regards to opioids,” said Dr. Arthur Evans, Philadelphia’s Behavioral Health Commissioner.

Most people who take fentanyl think they are taking heroin.

A synthetic, short-acting opioid originally developed for medical use during surgery or for acute pain relief, fentanyl is often sold as heroin to users or mixed with heroin by dealers to create a more intense euphoria. But the combination of drugs also promotes drowsiness, nausea and confusion. That combination of effects, and fentanyl’s rapid potency, is especially dangerous as users may not realize how much they’re taking.

That makes it much more likely for a user to stop breathing and die from an overdose.

At City Hall on Friday morning, Evans joined Dr. Thomas Farley, the city’s health commissioner, and Jeremiah Laster, deputy fire commissioner for emergency medical services, to raise awareness about the disturbing rise in usage and overdose deaths both locally and nationally.

Deaths by overdose of all drugs in Philadelphia grew by 50 percent, from 459 in 2013 to 701 in 2015, the officials said. During that same period, fentanyl overdose deaths grew by more than 600 percent, from 23 in 2013 to 184 in 2015.

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During a press conference on Friday, Philadelphia health officials Dr. Arthur Evans, Jeremiah Laster and Dr. Thomas Farley said overdose deaths from the drug fentanyl are rising dramatically.

Already, Farley said, in the first four months of 2016, fentanyl-related overdose deaths are up 17 percent over the same period last year. Of the 262 overdose deaths so far this year, he said, 99 of them — about 38 percent — were due to fentanyl. In the first four months of 2015, by comparison, about 20 percent of overdose deaths were attributed to fentanyl.

“This is a drug that is far more likely to kill you than heroin is,” said Laster.

According to Farley, one of the most difficult things about fighting this epidemic is that most people who use the drug have no idea that they are using it.

“Probably, most of them think they are buying heroin,” he said.

And while Narcan, a life-saving heroin antidote, also can be effective at arresting the effects of fentanyl overdose, health officials downplayed it as a solution.

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Fentanyl, shown at top in brick form, is often mixed with heroin, bottom, by dealers. It’s a dangerous combination.

Fentanyl “stops you from breathing,” Laster said. “Narcan isn’t going to stop the problem. Only prevention can do that.”

Moreover, the cost of Narcan is steadily raising, making it a more expensive solution to the problem.

All Philadelphia fire companies and EMTs are stocked with Narcan, but each shot costs about $34 today. In 2014, Laster said, Narcan shots only cost the city about $13 a piece.

The problem is shocking enough that the city is stepping up efforts in a multi-pronged approach to prevent overdose deaths.

Evans said street teams from the health department will canvass neighborhoods where drug use is most rampant — “Kensington, in particular,” he said — to engage with users and try to get them to recovery houses before they die of an overdose.

“Prevention is the key to stopping this problem,” he said. “People need help.”

His office is also working with physicians and health officials in area hospitals, to educate them on the specific risks of fentanyl and to push them to prescribe fewer opioids to patients or use lower amounts, Evans said.

And an initiative called “Centers of Excellence” is launching that will help connect Medicaid patients who have substance abuse disorders to access and use services that can help them. Thomas Jefferson University Hospital, The Wedge Medical Center and Temple University have all been named as “Centers of Excellence.”

Funding for these initiatives, city officials said, is being provided by the Pennsylvania Department of Human Services.

In addition, Evans said he’s working with the city’s methadone treatment centers to find ways to help 500 more people a day who are trying to overcome their addictions. That could mean more people are served at each center or the centers are open longer hours, but either way, there will be a push to help more users looking to quit.

“This is a very complicated issue and, I think, we need to use multiple strategies,” said Evans.

As Fentanyl ODs Have Surged in Philly, Price of Antidote Has Tripled

Fatal overdoses involving the powerful synthetic painkiller fentanyl have surged more than 600 percent in Philadelphia during the last three years, city officials said Friday. Illicit use of the opioid was implicated in 184 deaths in 2015, up from 25 in 2013.

“Clearly, we have an epidemic of overdoses in Philadelphia involving this drug fentanyl,” said Health Commissioner Tom Farley at a Friday news conference.

At the same time, the price of the antidote used to treat opioid overdoses has skyrocketed.

In 2013, a dose of Narcan, the brand name of the antidote naloxone, cost the city $13.34. Last year, the cost soared to $37.82.

“It’s a drastic increase and that’s the government rate that we pay,” said Jeremiah Laster, Deputy Commissioner of Emergency Medical Services. “There are other departments in the country that pay more than $100 a dose for Narcan.”In hospitals, fentanyl is an effective painkiller used in operating rooms. It is sometimes used to manage severe chronic pain. Though overdoses on legally prescribed fentanyl are not common, the death of musician Prince in April was attributed to the drug.

On the street, illicit fentanyl is often added to heroin to boost the drug’s potency. According to the Drug Enforcement Administration, fentanyl is 25 to 50 times more powerful than the equivalent amount of heroin.

“Users are often using this drug unaware how potent it is, putting them at greater risk for overdose,” said Arthur Evans, the city’s behavioral health commissioner.

The city has been issuing alerts about fentanyl since 2006.

“This has been a significant issue that has happened over the last decade with increasing frequency,” Evans said.

In Philadelphia, the number of all fatal drug overdoses has risen dramatically, spiking from 458 in 2013 to 701 last year.

“That means we have more than twice as many overdose deaths as we had deaths from homicide,” said Farley.

Many emergency services workers carry a supply of Narcan. Last year, EMTs in Philadelphia administered 3,035 doses. But not all overdose victims immediately respond, Laster said.

Due to fentanyl’s strength, EMTs often need to use more than one Narcan dose to bring a drug user back from the brink of death.

Fentanyl Overdose Deaths Skyrocket 636 Percent Over 2 Years in Philly, City Officials Say Prevention Is Key to Saving Lives

A disturbing 636 percent increase in overdoses from the medical-grade opioid fentanyl in Philadelphia has city health officials warning medical professionals and the public about the increased pervasiveness of the dangerously strong drug.

City health officials said Friday that 184 people died last year as a result of a fentanyl overdose, whether by using the drug alone or in combination with another, like heroin. Two years prior, in 2013, the drug killed 25 people. The change equates to a seven fold increase.

“Clearly, we have an epidemic,” Philadelphia’s Health Commissioner Dr. Thomas Farley said at a news conference in City Hall.

This year’s data shows there’s no expectation the epidemic will slow down. In the first four months of 2016, 99 of the overdose deaths involved fentanyl, city data shows.

Fentanyl is a synthetic opioid in the same family as heroin, oxycontin and morphine. But it is 50 to 100 times stronger than morphine. A small dose can prove fatal by causing a person to stop breathing. Often the drug is used to cut another, like heroin, for a stronger high. Sometimes, it’s sold by itself.

“People are buying this drug in the same way as others,” Farley said.

Fentanyl was developed for the medical community. Recently, however, drug traffickers have begun producing their own version of the drug. It can be cut with heroin, injected on its own or be ingested as a pill.
Photo credit: Denver Post via Getty Images

Those suffering from opioid drug addiction quickly grow tolerant to the highs prescription painkillers and heroin provide. The result forces them into increasingly painful withdrawal. So they seek stronger highs, putting themselves at further risk with each hit and each new drug they try.

Heroin users explained the vicious cycle to NBC10 earlier this year as part of our special investigation Generation Addicted. The project, which debuted in March, explored the tragic world of opioid addiction in Philadelphia and beyond. It also looked at its effects on the addicted, their families and society.

Drug overdoses continue to rise despite frantic efforts by local, state and federal health and law enforcement officials to stem a tidal wave of deaths nationwide. More people died of a drug overdose than in a car wreck for the past three years, according to the Centers for Disease Control and Prevention. Opioid overdose deaths accounted for more than 28,000 of the lives claimed in 2014 — the highest on record.

A recently released Drug Enforcement Administration report showed similar trends involving fentanyl across Pennsylvania. Agents saw a 93 percent jump in deaths involving the drug from 2014 to 2015. Further troubling is the fact that “fentanyl was the most commonly reported drug” among people who overdosed from heroin, the agency wrote.

Derik Lawley, 25, died last year when he took a fatal dose of fentanyl as he struggled with addiction. He thought it was heroin, his family said. His sister, Tara, wrote a heartbreaking letter about his death, whichyou can read here.

The overdose reversal medicine naloxone — commonly known as Narcan — has helped to bring countless people back to life, but doses may not be large enough to overcome fentanyl’s effects.

Deputy Fire Commissioner Jeremiah Laster said while naloxone typically will coax a person back to consciousness and allow them to breathe on their own following a heroin overdose, the same isn’t true for fentanyl. Medics often try to keep a person’s airway open as they rush them to the closest emergency room, he said.=

“The goal is to get somebody to the hospital to get them help,” he said.

Laster, who oversees emergency medical services, said the department is conducting a time-consuming review of patient records to determine whether an increase in naloxone dosage could make a difference in reversing fentanyl overdoses.

Increased dosage will undoubtedly result in higher costs — an issue that’s already becoming a problem for the city and other naloxone providers. Three years ago, the city paid $13.74 for a dose of the medicine. Today, that same dose costs $37.52. Laster said that’s still at a deep discount since the city gets government pricing. Some providers pay upwards of $100 a dose.

Nalaxone, sold under the name Narcan, is an overdose reversal drug. It can be injected or sprayed up a person’s nose.
Photo credit: NBC10

Everyone sees the medicine as a stopgap, preventing a person from ending up at the morgue. “Prevention is key to solving this problem,” Laster said.

Dr. Arthur Evans, Philadelphia’s behavioral health commissioner, said the city is taking a number of steps to address the crisis.

Evans said the city is “significantly expanding” access to services and medicine-assisted treatment. These medicine therapies help stabilize a person as they work to wean themselves off of drugs over a long-period of time.

The city is adding 500 extra slots for methadone treatment, 500 additional detox opportunities and doubling access to buprenorphine, widely known as Suboxone, to offer people help when they are asking for it, Evans said.

Behavioral health staff are doing outreach in communities with the highest concentrations of drug addicted people, like hard-hit Kensington, to let people how they can get help.

An assessment center at the North Philadelphia Health System (801 W. Girard Ave.) operates 24 hours a day helping to connect people to treatment offerings. A phone hotline (888-545-2600) does the same, Evans said.

Three state-sponsored Centers for Excellence will begin offering expanded treatment for Medicaid patients starting in the fall. Evans is hoping new money appropriated through the recently-passed federal Comprehensive Addiction and Recovery Act will makes it way to the city through grants.

Outreach is also taking place among the medical community. For years, doctors freely prescribed prescription opioids, in the form of pills like Oxycontin, Percocet and Vicodin, and benzodiazepines like Xanax contributing to the epidemic’s wide scope. Now officials are trying to help physicians balance managing a patient’s pain and preventing addition from taking hold.

The Pennsylvania Medical Society and Pa. Gov. Tom Wolf’s administration issued new prescribing guidelines in July issuing a number of recommendations to doctors including putting a limit of seven days on opioid prescriptions doled out in the emergency room.

Addiction experts say many times patients are given too many pills to treat a minor issue leaving the door open for dependence or abuse by another person in their home.

Farley couldn’t say whether the city’s emergency rooms were following the guidelines (they are not required), but said his office plans to conduct outreach with doctors to keep them abreast of the epidemic.

And as the city works to address this latest facet of the complex crisis, there are new concerns from law enforcement about even stronger opioids hitting Philly’s streets.

Narcotics officers and DEA agents believe the synthetic opioid W-18 has begun to seep into the the local drug market. Designed in China, the drug can be up to 10,000 times stronger than morphine. Large amounts of the drug were seized in Miami and Alberta, Canada. Police drug labs have begun testing for it.

But as addiction specialist Dr. Brian Work told NBC10 earlier this year, with the heroin and fentanyl problem as pervasive as it is, “it’s hard worrying about the next thing down the pipe.”


Explore NBC10’s digital exclusive investigation Generation Addicted by visiting our special section here.

Wednesday, August 31 is International Overdose Awareness Day. NBC10 will be re-airing our 30 minute documentary from Generation Addicted at 7 p.m. that night.

Officials: Overdose Deaths Involving Fentanyl Up 600% Since 2013

PHILADELPHIA (CBS) — Philadelphia health officials say overdose deaths involving the drug fentanyl continue to rise, despite years of warnings about its dangers. And the cost to the city is going up as the price for the emergency drug to prevent fatalities spikes.

It was deja vu for Behavioral Health Commissioner Arthur Evans, as he reported that the 99 fentanyl deaths in the first four months of this year are more than double where they were last year, which was a record year for fentanyl deaths.

“We also did an alert in 2013, and we did an alert in 2014,” he said.

Clearly, the alerts are of limited use.

Photo Credit, By Pat Loeb

Credit: Pat Loeb

Evans says the city is also doing outreach and expanding treatmentservices. And Deputy Fire Commissioner Jeremiah Laster says Emergency Medical workers are using twice as much of the overdose reversal drug Naloxone compared to two years ago.

“3,035 doses in 2015.” Laster said.

That’s straining budgets because the cost of the drug has tripled in that time. Laster says he doesn’t know the reason. Calls to the manufacturer have not been returned. But Laster adds Naloxone doesn’t get at the root of the problem.

“Prevention is the issue we’re going to have to deal with.”

Health Officials Warn About Sharp Increases in Drug Overdoses Involving Fentanyl

Philadelphia, PA – Health Commissioner Dr. Thomas Farley, Behavioral Health Commissioner Dr. Arthur Evans and Deputy Fire Commissioner for Emergency Medical Services Jeremiah Laster today warned about sharp increases in fatal overdoses involving the opioid drug fentanyl.  The Philadelphia Department of Public Health (PDPH) and Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) also released a Health Alert to Philadelphia medical and behavioral health providers describing the increase in overdoses and steps that providers can take to reverse the effects of an overdose involving fentanyl.  Fentanyl is 50-100 times more potent than morphine, which makes it more likely that people who inject the drug will stop breathing and overdose, and overdoses from fentanyl may require higher doses of antidote to reverse.

Fatal drug overdoses have risen sharply in Philadelphia in the past several years, growing by more than 50% from 459 deaths in 2013 to 701 deaths in 2015.  During that time period, overdoses involving fentanyl grew more than 600%, from 25 deaths in 2013 to 184 deaths in 2015.In addition, in the first four months of 2016, 99 (38%) of 262 overdoses have involved fentanyl, compared to 44 (20%) of 224 overdoses in the first four months of 2015.

“Drug overdose, which is a national crisis, has now become a leading cause of death of young adults in Philadelphia,” said Commissioner Farley, “killing more than twice as many people as homicide and more than four times as many as suicide.  We all can help prevent these overdoses.  In particular, physicians should prescribe fewer opioid painkillers to reduce the number of people who become addicted to these drugs, and everyone who comes in contact with people who use heroin or other opioid drugs should encourage them to seek drug treatment.”

“The rise in fentanyl-related overdoses makes it even more important to expand the work we do to prevent addiction, treat substance use disorders and reduce overdoses,” said Commissioner Evans.  “Fatal overdoses are preventable, through medication-assisted treatment for substance use disorder and increased availability of drugs that reverse overdoses.”

Opioid drugs are chemically similar to morphine and heroin.  Opioid painkillers include oxycodone (in OxyContin and Percocet) and hydrocodone (in Vicodin).  Fentanyl is a synthetic, short-acting opioid drug, with effects similar to heroin.  It was originally developed for medical uses, including anesthesia during surgery and acute pain relief.  It has recently been appearing around the country as an illicit drug, and is sold on the street the same way that heroin is.  Most users probably believe that fentanyl is heroin when they purchase and inject it.

Fatal drug overdoses have been growing nationwide.  In 2014, more than 47,000 people in the United States died of drug overdoses, more than double the number of fatal drug overdoses in 2000.  The opioid drug overdose epidemic was initially related to the overuse of prescription opioids such as OxyContin, but since 2010 overdose deaths have increasingly involved heroin and more recently involved fentanyl.  Opioids are also more dangerous when used in combination with drugs called benzodiazepines, such as Xanax and Klonopin.

PDPH and DBHIDS are using several approaches to reduce opioid overdoses, including those involving fentanyl.  City health officials say the best way to prevent drug overdoses is to prevent opioid addiction, which Philadelphia seeks to do by encouraging physicians and other health professionals to prescribe opioids to fewer patients, in lower amounts, and for shorter time periods.  The agencies also encourage physicians to prescribe benzodiazepines less often.

For those who are already dependent on opioids, the City is working to expand the number of providers who offer medication-assisted treatment with buprenorphine (Suboxone).  In addition, the Pennsylvania Department of Human Services seeks to improve treatment with “Centers of Excellence” that will help Medicaid patients with substance use disorders access and use services.  Thomas Jefferson Narcotic Addiction Treatment/Maternal Addiction Treatment, Wedge Medical Center and Temple University have all been selected as “Centers of Excellence” in Philadelphia and will begin providing these additional services by this fall.   These Centers of Excellence are also funded by DBHIDS.

PDPH and DBHIDS are also expanding the availability of the opioid antidote naloxone (Narcan) for people in contact with those who overdose.  Naloxone reverses the effects of overdoses and can be life-saving; when treating overdoses involving fentanyl, higher or repeated doses of naloxone may be needed.  Pennsylvania ACT 139 of November 2014 greatly expanded access to naloxone and provides legal protections for those who intervene in the case of an overdose.  These groups including first responders and family members of people addicted to opioids.

In coordination with today’s event and press release, PDPH and DBHIDS are working to educate physicians about the specific risks that fentanyl presents to opioid users and how to manage overdoses that may involve fentanyl.  This outreach and education includes a Health Alert released today to PDPH’s Health Alert Network, which includes primary, specialty and emergency-room based providers throughout Philadelphia.

Drug overdoses from fentanyl are happening across the city and affecting multiple demographic groups.  Of the 99 overdose deaths involving fentanyl this year through April, 64% were male, 57% were white and 56% were aged 25-44.  More details on the rise in drug overdoses are available in the PDPH CHART Volume 1 Issue 1.

 

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