Philadelphians who died of a drug overdose often had sought help for addiction, report finds

They came from all over the city: the northern corners of Philadelphia and its southwest border, fast-gentrifying South Philly neighborhoods and long-troubled Kensington.

Some were experiencing homelessness, others were unemployed. Most had been arrested.

More than half had been diagnosed with a mental health disorder and almost as many had experienced childhood trauma.

Three had lost a family member to an overdose, and six had overdosed at least once before themselves.

A new report from Philadelphia’s OD Stat program, which analyzes a handful of deaths per quarter, details the lives and deaths of 17 people who died of an overdose in 2021. The city has not released finalized overdose numbers for 2021, but according to preliminary data from the state, which tallies deaths from every county, Philadelphia saw at least 1,274 deaths in 2021, the city’s highest count on record.

That number will likely be higher when the count is completed.

Though far from comprehensive, the OD Stat report offers a snapshot of an overdose crisis compounded by other health, economic and structural challenges that, for many, make overdoses almost unavoidable despite their efforts to get help.

Many of the people in the report had tried to do just that: Seven had taken methadone or buprenorphine — opioid-based treatment drugs shown to be more effective than quitting opioids cold-turkey. Three were receiving such treatment when they died. Six repeatedly turned to emergency rooms and crisis centers for help, but were rarely transferred to longer-term treatment, investigators found.

One of the victims had sought help at an emergency room or crisis center 69 times in the last seven years.

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Nicole O’Donnell, a recovery specialist at Penn Medicine who also participates in the OD Stat project, said she was struck by “how many touch points were missed” for some of the victims whose cases she reviewed this year.

O’Donnell, who is in recovery herself, lost a sister to an overdose. At first, she was apprehensive about reviewing overdose deaths as part of OD Stat because they are all cases in which someone didn’t get help that was needed.

“You know the end of the movie, you know they have passed,” she said. “I want to be able to make the ending different for people.”

For the last three years, Philadelphia health officials have cataloged the city’s grim overdose death tally and more thoroughly examined a handful of cases in an effort to learn more about the complexities of a crisis that has claimed more than 5,000 lives in the last five years in Philadelphia.

The crisis is not limited to Philadelphia. An estimated 5,319 people died of overdoses in Pennsylvania in 2021. But Philadelphia’s overdose crisis is among the most visible and severe in the country.

OD Stat, a city Department of Health project that reviews overdose fatalities to come up with recommendations on overdose prevention, goes beyond victims’ age, their race, and what drugs were in their system when they died. Health department staffers interview victims’ families, learn about their living situations and medical histories.

“The purpose [of the program] is to identify missed opportunities, to serve as a learning environment, and develop recommendations that we think will lead to a reduction in overdoses,” said Zoe Soslow, OD Stat’s central administrator.

Though the number of victims OD Stat profiles is small, the details of their lives reflect larger trends in the city’s overdose crisis. More than half of the victims profiled in 2021 were Black – a continuation of a disturbing shift in the crisis.

For years, white victims made up the bulk of overdose victims in Philadelphia; now, more Black residents are dying, likely because the powerful synthetic opioid fentanyl is turning up in stimulants such as cocaine and methamphetamine.

It’s also being pressed into counterfeit prescription pills, which less experienced opioid users often seek out because they’re perceived as safer.

But for people without high tolerance to opioids, fentanyl can be fatal. Many victims aren’t aware they are taking it until it’s too late. Four of the victims profiled by OD Stat last year were recreational drug users without a substance use disorder who regularly used drugs other than opioids.

Since 2020, Soslow’s group has recommended that the city make fentanyl test strips more readily available, especially for people who don’t usually use opioids.

“People were unaware of the risk of fentanyl in the drug supply,” she said. Because of the contamination of the drug supply, many drug users are using multiple substances — whether they intend to or not, she added.

It’s crucial, Soslow said, that health officials around the country recognize these trends and provide help for people with addiction who aren’t using opioids. One of OD Stat’s recommendations is that the city advocate for the use of an addiction treatment program called contingency management, which offers financial incentives to stimulant users to reduce their use.

There are no approved medical treatments for people addicted to such stimulants as cocaine and meth, and contingency management is technically illegal under a federal law designed to prevent kickbacks, Soslow said. But California health officials recently obtained a waiver to treat patients with contingency management; Pennsylvania should do the same, she said.

At Penn, emergency rooms recently began asking a universal screening question that asks patients whether they’ve struggled with opioid use in the last year.

Hospitals need to be able to more easily prescribe addiction medications to patients, O’Donnell said. She also recommends having more recovery specialists and social workers staffing ERs around the clock so that people seeking help aren’t forced to wait.

For people with addiction, delays in accessing treatment mean that many people who want help end up returning to drug use because they can’t take the pain of withdrawal.

It’s also crucial to expand harm-reduction access outside of the places in the city that are typically associated with drug use, like Kensington, Soslow said. OD Stat members are recommending more harm-reduction treatment in hard-hit but relatively underserved neighborhoods, such as West Philadelphia. The group has been pushing for mobile methadone treatment, a relatively rare concept in the U.S., and more widespread fentanyl test strip distribution.

“We see throughout our report that the knowledge around what an opioid is, what the risk of an overdose is, is not equal [around the city],” she said. “There are areas of this city that have historically not had as many harm reduction, treatment, jobs, resources — and these are areas that have these rising overdose rates.”

Join the conversation

Inquirer addiction reporter Aubrey Whelan and health editor Letitia Stein will appear on “Inquirer Live: Opioid Addiction and Philadelphia” on July 27 at 4:15 p.m. to discuss the rising overdose death toll in Philadelphia and challenges to treatment. The virtual event is free to attend, but register at Inquirer.com/live.