City officials released finalized reports Tuesday confirming that drug overdose deaths dropped slightly in 2023 and providing a more detailed picture of how the addiction crisis has been impacting Philadelphia.
Fatal drug overdoses were down to 1,310 in 2023 — a 7% decrease from a record high of 1,413 in 2022. But 2023 was the second-highest year for drug overdose deaths in Philadelphia, nearly three times higher than in 2013 (460).
The Philadelphia Department of Public Health has projected a continued drop in overdose deaths for 2024 to about 1,100. But these numbers are only provisional. And the 2023 figures don't reflect the intensified withdrawal symptoms and overdose impact of a newer, potent veterinary tranquilizer used to cut fentanyl in the illicit drug supply.
The animal sedative xylazine is present in about 90% of the street fentanyl supply, according to the Philadelphia Department of Public Health. Dealers cut the synthetic opioid with xylazine – which can slow breathing, heart rate and blood pressure to dangerously low levels – to extend its sedating effects. Emergency department clinicians began seeing aggressive flesh wounds caused by xylazine in people who use drugs around 2019, and xylazine was involved in 38% of overdose deaths in 2023 – all of which also involved fentanyl, according to the new reports.
These reports also don't reflect the impact of the rise in medetomidine, an animal sedative similar to xylazine in its sedating effects but exponentially more potent, which showed up in 80% of illicit fentanyl samples the health department had analyzed in 2024, according to an email from the city last week. An alert the health department sent out in December said medetomidine was causing severe reactions that were complicating withdrawal management and sometimes requiring treatment in intensive care units for people who use drugs.
"Our reports don't discuss medetomidine because medetomidine was first detected in 2024 … but we do have experience with xylazine," Dr. Daniel Teixeira da Silva, medical director of Substance Use Prevention and Harm Reduction (SUPHR) at the Philadelphia Department of Public Health, said at a media briefing Tuesday.
The opioid reversal medication naloxone, which goes under the brand name Narcan, doesn't touch the effects of xylazine or medetomidine. In addition to administering naloxone to reverse the effects of fentanyl in drug overdose situations, emergency medical responders, harm reduction and outreach workers, and emergency department personnel have learned they need to support breathing with supplemental oxygen, Teixeira da Silva said.
But because medetomidine can lower heart and breathing rate so dramatically, it is "reinforcing the myth that naloxone does not work, and people who overdose are receiving more naloxone than they need which leads to precipitated withdrawal," a health department spokesperson said in an email Thursday.
Some people who use fentanyl cut with medetomidine have a rapid transition from intoxication to withdrawal, often accompanied by intractable vomiting, racing heart rate, tremors and other intolerable symptoms. Giving someone too much naloxone too fast because they appear not to be responding can ignite these intense withdrawal symptoms and increase risk of fatal overdose, according to the health department.
People who go into precipitated withdrawal are more likely to use again sooner to alleviate the unbearable symptoms. People who use drugs may be more likely to use alone to avoid the chance of getting dosed with naloxone. People may also be less likely to carry naloxone and be less likely to use it on other people, according to the health department.
To address these complications, the city has been providing overdose trainings for first responders, updated with adaptations for medetomidine. The health department also convenes regular meetings of emergency department personnel and addiction specialists to share what they have learned about how to help people experiencing overdose or withdrawal involving medetomidine.
The health department also plans to distribute medetomidine test strips that providers and individuals can use to check for the presence of the sedative in bags of street dope to make informed choices about their use, Teixeira da Silva said.
The city does not have a timeline on when medetomidine test strips may be available, Teixeira da Silva said.
In 2023, the city distributed 105,178 doses of naloxone in 2023, up from 54,036 in 2022. It distributed 186,470 fentanyl test strips, up from 115,267 in 2022, according to the reports SUPHR released Tuesday.
Xylazine test strips became available in Philadelphia in June 2023, and the city distributed 44,475 of them that year, according to the reports.
The city's drug surveillance program sends discarded street drug samples to the Center for Forensic Science Research and Education in Horsham, Montgomery County, for testing. Information from the city's surveillance program, as well as from the statewide drug checking program PA Groundhogs, helps keep providers and the public informed about new and potentially dangerous chemicals in local street drugs.
