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.