The Impact of COVID-19 on Unintentional Drug Overdoses in Philadelphia

This issue of CHART summarizes preliminary data to understand the impact of COVID-19 on non-fatal and fatal drug-related overdoses in Philadelphia. Data shown are from the Philadelphia Medical Examiner’s Office, the Philadelphia Department of Public Health’s Syndromic Surveillance System, and the Philadelphia Fire Department. Data presented on fatal overdoses are as of July 29, 2020, and data from March 2020 to June 2020 are preliminary and subject to change.

Overdose-related EMS responses have increased since the COVID-19 stay at home order

• The weekly average number of calls for overdose/poisoning events before and after the stay at home order was 263 and 275, respectively. (Philadelphia’s stay at home order was issued March 23, 2020 and restricted business and personal activities to those deemed essential. Philadelphia moved to the yellow phase on June 5th, 2020 which allowed the gradual reopening of businesses with precautions in place.)
• The weekly average number of naloxone administrations by EMS before and after the stay at home order was 59 and 65, respectively.
• Due to COVID-19, Philadelphia’s alternative response unit (AR-2), which responds alongside medic units to overdoses in the Kensington area, was not in service from mid-March through the end of June (data not shown).

Drug-related emergency department visits decreased after the stay at home order and then rebounded

• The weekly average number of ED visits for overdoses from opioids or unspecified substances decreased slightly from 123 to 118 before and after the stay at home order, respectively. The weekly number of ED visits for individuals seeking withdrawal or detox decreased from 109 to 90 before and after the stay at home order, respectively.
• As the City began to reopen, the number of visits for overdose, withdrawal, and detox increased.

The number of overdose deaths per month has remained similar to 2019

• The number of unintentional overdose deaths by month in 2020 was similar to the number of overdose deaths by month in 2019.
• Approximately 30–40% of pending cases are typically confirmed as overdose deaths; numbers are preliminary and subject to change

Non-fatal overdoses have increased among Black, non-Hispanic individuals

• Since Philadelphia EMS began administering naloxone, the highest number of non-fatal overdoses has consistently been among white, non-Hispanic individuals.
• Since May 2020, the number of non-fatal overdoses has been higher for Black, non-Hispanic than White, non-Hispanic individuals.

Fatal overdoses have increased among Black, non-Hispanic individuals

• Since at least 2010, the highest number of overdose deaths in Philadelphia has been among White, non-Hispanic individuals. In 2019, there were 566 (49%) White, non-Hispanic, 385 (33%) Black, non-Hispanic, and 183 (16%) Hispanic unintentional overdose deaths.
• From March 23, 2020 to June 30, 2020, the highest number of overdose deaths were among Black, non-Hispanic individuals. Preliminary data indicates that there were 119 (37%) White, non-Hispanic deaths, 147 (46%) Black, non-Hispanic, and 47 (15%) Hispanic unintentional overdose deaths.
• Increases in unintentional Black, non-Hispanic overdose deaths have primarily occurred among those between the ages of 25–44 and 55–64 years and are largely driven by opioids, with and without the presence of stimulants (data not shown).

What can be done

The Health Department is:

• Working to reduce the harms of drug use by:
• distributing naloxone, the opioid overdose reversal drug, to organizations serving at-risk populations,
• training the public on opioid overdose recognition and naloxone use at both in person and virtual trainings,
• creating educational materials and developing a media campaign about risks associated with stimulant use, and
• developing an overdose awareness campaign that considers the diversity of people who use drugs and Philadelphia’s rapidly changing drug market.
• Raising awareness and promoting guidelines about safer substance use during the COVID-19 pandemic.
• Providing access to a safe place to isolate for the unsheltered and homeless populations of Philadelphia who have tested positive for COVID-19 or are awaiting test results.
• Treating patients with opioid use disorder with buprenorphine in the City’s health centers.
• Improving access to buprenorphine city-wide by promoting waivers and training of doctors to prescribe buprenorphine.

Health care providers should:

• Prescribe opioid painkillers less often, in lower doses, and shorter duration, following PDPH guidelines.
• Co-prescribe naloxone with opioid prescriptions.
• Receive training to prescribe buprenorphine to opioid dependent patients.
• Help patients who are dependent on opioids access treatment. This can be done through referral to a substance use treatment provider or through prescribing buprenorphine.
• Warn patients who use non-opioid street drugs that their drugs may be contaminated with fentanyl.
• Educate people who use drugs to test their drugs for the presence of fentanyl using fentanyl test strips.

People can:

• Avoid taking opioids that are not prescribed for them, and question medical providers who prescribe opioids for pain about alternative, safer forms of pain control.
• Avoid using illicit drugs such as heroin, fentanyl and cocaine, which are extremely dangerous.
• Seek medication-assisted treatment if dependent on opioids.
• Check their drugs for the presence of fentanyl using fentanyl test strips. Any illicit drug that is purchased on the street, including cocaine and pills, may contain fentanyl.
• Obtain and get trained on how to use naloxone to prevent opioid overdose fatalities. Naloxone is available at pharmacies in Pennsylvania without a prescription under a “standing order” signed by the Pennsylvania Secretary of Health.

Resources

For resources for safer substance use during COVID-19:

https://www.phila.gov/2020-04-16-resources-for-safer-substance-use-during-covid-19/

For help on how to obtain and use naloxone or to attend a virtual training:

http://phillynaloxone.com

For more information on Philadelphia’s response to the opioid crisis:
https://www.phila.gov/opioids

For information on how to access treatment:

https://dbhids.org/addiction-services/

For harm reduction resources including syringe exchange:

https://ppponline.org/

For housing referrals for unsheltered persons who are awaiting test results or have tested positive for COVID-19:

https://redcap.phila.gov/surveys/?s=9JP9W98HXR

Suggested citation:
Philadelphia Department of Public Health. The Impact of COVID-19 on Unintentional Drug Overdoses in Philadelphia. CHART 2020;5(6): 1–6.

CHART is a publication of the Philadelphia Department of Public Health, and is intended to highlight under-reported or under-appreciated public health issues in an effort to kick-start a conversation. Readers can subscribe to CHART on Medium, or on our website.