Philadelphia continues to see an increase in unintentional drug overdose deaths, the majority of which have been attributed to heroin and fentanyl, an extremely potent synthetic opioid analgesic. Between December 1-5, 2016, 35 deaths in Philadelphia are strongly suspected of being due to unintentional drug overdoses. The decedents were 19 to 66 years old; 69% were men and 60% non-Hispanic white. Visits to Philadelphia emergency departments for overdoses increased over the same period of time (figure). This sharp rise in fatal overdoses occurred in the context of an escalating public health problem in Philadelphia, which may experience as many as 900 overdose deaths in 2016. Fentanyl has been increasingly involved in fatal overdoses. The Philadelphia Department of Public Health (PDPH) is working closely with other city agencies and community organizations to address the opioid crisis through three complementary approaches: 1. Reduce opioid prescribing: Most heroin users initiate opioid use by taking prescription opioids. Prescription opioid painkillers are addictive and can result in overdoses. PDPH and the Department of Behavioral Health and Intellectual disAbility Services, recently released Opioid and Benzodiazepine Prescribing Guidelines to promote judicious and safer prescribing. 2. Increase access to treatment: Addiction to opioids is a chronic disease for which there are several effective treatments. Medication assisted treatment with methadone or buprenorphine, in conjunction with therapy, has been shown to reduce opioid misuse. PDPH encourages expanded access to treatment with buprenorphine by primary care providers. 3. Increase access to naloxone: Naloxone is an opioid receptor antagonist that rapidly reverses the effects of an opioid overdose. First responders in Philadelphia have used it hundreds of times in 2016, preventing people from fatally overdosing. PDPH is working to increase the awareness and availability of naloxone, and ensure that first responders and community members in high risk areas are trained. PDPH urges medical personnel to help prevent opioid addiction and overdose by:
- Avoiding long term use of opioids. Refer to the Prescribing Guidelines and the PDPH Health Information Portal (https://hip.phila.gov/EmergentHealthTopics/Opioids) for more detail.
- Using Pennsylvania’s Prescription Drug Monitoring Program to identify patients with or at risk for opioid addiction.
- Helping patients with addiction begin substance use treatment. Because nonfatal overdoses often precede fatal overdoses, it is particularly important to assist patients who have experienced nonfatal overdose initiate treatment immediately.
- Prescribing naloxone to patients who are chronic users of opioids so that the antidote is readily available if needed emergently.