Philadelphia drug deaths soared again in 2020, hitting Black residents hardest

Jun. 3—Overdoses killed 1,214 Philadelphians in 2020, marking the city's second-highest drug death toll on record, and one likely worsened by COVID-19 lockdowns, city officials said.

Just as they were by the coronavirus deaths, Black Philadelphians were hit hardest by overdose deaths, an alarming demographic shift in drug fatalities that began before the pandemic and worsened in 2020.

Overall, overdose deaths increased by 9% from the year before. But fatal overdoses soared by 29% among Black Philadelphians, even as they decreased by 10% among white Philadelphians. The death rate among Hispanic Philadelphians remained about the same from 2019 to 2020, though it had increased in prior years.

Fentanyl remained the major drug killer in Philadelphia. The powerful synthetic opioid began making its way into the city's heroin supply in the mid-2010s and was present in 84% of the city's drug deaths last year.

Deaths involving heroin and cocaine decreased, while deaths involving fentanyl and pharmaceutical opioids increased. Fentanyl was present in 94% of all opioid-related deaths, and in 77% of stimulant-related deaths.

Deaths involving both stimulants and opioids, which have the opposite effect, have been on the rise for several years. But toxicology reports cannot determine whether overdose victims are using stimulants and opioids together intentionally, whether dealers are knowingly selling stimulants cut with opioids; or whether stimulants are being contaminated with fentanyl during the drug packaging process.

The social distancing and lockdown policies imposed to control the COVID-19 pandemic likely influenced the rise in overdose deaths in 2020, said Jewell Johnson, a city substance use epidemiologist.

For years, the majority of the city's fatal overdoses have taken place in private homes. The lockdown only made that trend worse, city officials believe.

"We know for a fact that a lot of our fatal overdoses happened in the home. People live alone and they're not being checked on by family or friends, and the odds of fatally overdosing does increase," Johnson said. "I think that's the main difference in terms of fatalities from 2019 to fatalities for 2020."

Johnson also noted that pandemic-related unemployment among Black Philadelphians may be linked to the high overdose death toll in 2020.

Throughout 2019 and into the early months of 2020, the unemployment rate among Black overdose victims hovered around 30%. But in the second quarter of 2020 — as lockdowns began and millions around the country suddenly were out of work — the rate among Black overdose victims jumped to 48% percent, and stayed high for the rest of the year. (Nationwide, the unemployment rate among Black Americans was second only to Hispanic Americans at the height of the pandemic, and remains the highest in the country, three percentage points higher than the national average.)

Jim Garrow, a spokesperson for the health department, said city officials believed that lockdown orders would likely affect overdose deaths, and tried to mitigate that toll, continuing to send harm-reduction teams to Kensington, which still sees the highest number of overdose deaths in the city. Training sessions in using Narcan, the overdose-reversal drug, were offered online in the first months of the pandemic.

"Implementing public health measures that the city believes saved lives exacerbated other things that made it worse," he said. "When faced with two evils, what is the top concern? What is the one that could most negatively affect large portions of the city? How can we target it to make sure the damage we're doing is minimized? It's something we're actively looking into. There's no playbook for this."

The city did not anticipate some geographic shifts in overdose deaths that emerged during the pandemic. Fatal overdoses rose in West Philadelphia, North Philadelphia and Southwest Philadelphia communities, away from typical overdose hotspots like Kensington and South Philadelphia.

"We do have some of our harm reduction team in South Philly," Johnson said, "but, we didn't anticipate these specific zip codes [in West, North and Southwest Philadelphia] having such large increases in fatal overdoses."

Garrow said that the health department has been encouraged by some federal efforts to mitigate the effects of the lockdowns. One example: relaxing rules around prescribing buprenorphine, a popular opioid addiction treatment drug more heavily monitored by the federal government before the pandemic. He said he hoped the easing of those rules would get more doctors prescribing buprenorphine — and more Philadelphians into treatment.

And with COVID vaccines more readily available and the city poised to fully reopen, Johnson said she "would hope that the [overdose] trends decline."

"But only time will tell, unfortunately," she said.

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