The number of annual overdose deaths in Philadelphia dropped sharply last year and appears on track to continue falling, reflecting the ramped-up efforts of healthcare providers to help people in addiction amid the city’s controversial push to address the Kensington drug market.
In 2024, fatalities involving overdoses fell for the second year in a row, down to 1,045, according to the city’s Health Department. That was a 20% decrease from 1,310 the previous year. Deaths had peaked at 1,376 in 2022.
This year, from January to August, there were 469 overdose deaths in the city, according to preliminary data from the state Department of Health. That figure may end up higher once delayed reports come in, but the trend suggests it could be the first year since 2016 that Philadelphia sees fewer than 1,000 OD deaths.
The decrease resulted in part from the ubiquity of Narcan, a nasal spray that reverses opioid overdoses, according to health and service providers working in Kensington and other neighborhoods.
“We are going to offer Narcan repeatedly to every person who walks in here, in every service, to a point where people say, ‘OK, yeah, five people already offered me Narcan. I’ve got six of them in my bag,’” said Silvana Mazzella, lead executive officer at the harm reduction provider Prevention Point. “That’s what we want to hear. We want to hear that it’s everywhere.”
Prevention Point “drastically” scaled up Narcan distribution, giving out nearly 114,000 doses over its last fiscal year, a 13% increase, she said. The goal was to make sure a wide range of people always have one on hand in case they see someone overdose, or someone sees them overdose.
Communities are broadly seeing the payoff of a big push by government, healthcare providers and nonprofit organizations in response to the frightening surge of drug fatalities during the pandemic, said Adam Al-Asad, director of operations at Savage Sisters Recovery, which provides harm reduction services and mobile outreach, and runs recovery houses around the region.
“We have, as a nation, embraced harm reduction — or we did, pre-election,” he said. “There’s been a lot more funding, a lot more acceptance of the data-proven methods of harm reduction, whether it’s medication-assisted treatment or needle distribution or whatever it is.”
Expanded use of Sublocade, an injection that suppresses opioid cravings for a month, has in particular made it easier for people to stay in recovery, eliminating the need to obtain a new dose every day and helping them bounce back quickly from relapses, experts say. Another similar product, Brixadi, can be given weekly or monthly.
The reduction in deaths may also be related to changes in the drug supply.
Most street fentanyl is now adulterated with animal tranquilizers, which are less likely to cause a fatal overdose. However, they cause other devastating harms, including severe withdrawal symptoms that are difficult to manage, slow-healing wounds that can result in amputations, and cardiac problems, and can lead to deaths that are not recorded as being overdose-related.
An expanding “wellness ecosystem”
City officials argue that Mayor Cherelle Parker’s efforts to address Kensington’s decades-old drug market have also helped save lives and generally improve conditions around the neighborhood, although those are still relatively new and have come in for criticism.
Last year, Parker launched the Kensington Community Revival, a crackdown on crime and nuisance activities that included sweeps to clear homeless encampments. The neighborhood’s homicide rate has plunged, and the number of people living on the area’s streets fell from over 900 in early 2024 to as low as 300 in recent months, Chief Public Safety Director Adam Geer said. It’s now a little over 400 people.
The city then geared up the mayor’s $100 million-plus “wellness ecosystem” initiative, which includes a low-barrier shelter in Kensington, a Wellness Court, and Riverview Wellness Village, a long-term recovery home in Northeast Philadelphia.
The shelter, Philly Home at Girard, is operated by Prevention Point and Project Home and has 180 beds, all of which are full, said Isabel McDevitt, the city’s executive director of Community Wellness and Recovery. The average stay there is 100 days, during which time some residents are still using drugs and some begin treatment. The goal is for them to then move in with family members, transfer to Riverview, or get permanent supportive housing, she said.
Riverview has 234 available beds and space for 102 more; currently 191 people are living there. They can stay for up to a year, getting on-site medical and mental health care, access to medication-assisted treatment like buprenorphine, job training and placement, housing assistance, and a range of other services to help them move back into the community, McDevitt said.
“We’re hitting a part of the continuum that has been underresourced, this sort of transition out of treatment and into independence,” she said. “We’re really acting as the convener of all the different services under one roof.”
The city has gotten zoning approval for a new building at Riverview that will add 300 beds and a medical clinic, McDevitt said. Once built, the facility will have capacity for 636 residents.
The wellness ecosystem plan calls for some people to go to Riverview after initially being taken to Wellness Court and doing a 30- to 90-day treatment program. Geer, the safety director, has described the one-day-a-week court as “somewhat of a game-changer” that moves people off the streets and helps them rebuild their lives.
The court, which has a $2.7 million annual budget, was designed by the public safety office in collaboration with the courts and police. Geer recently announced the hiring of its first dedicated director, Eleni Belisonzi, and noted the downtrend of fatal overdoses.
“It is so important that we don’t rest on these successes, but continue to build on them,” he said. “Neighborhood Wellness Court is about restoring a sense of normalcy to the neighborhood of Kensington and, by extension, the entire city of Philadelphia.”
The court operates on Wednesdays. Police arrest people for sleeping on sidewalks and other minor summary offenses and bring them to the Kensington Wellness Support Center, a triage center on Lehigh Avenue, where they see a doctor or nurse and are sent to the hospital if necessary. People judged fit are taken to Wellness Court and offered the choice of either accepting services — typically drug treatment or shelter — or of facing a quick trial that could result in fines or, in theory, a jail term.
A debate over Wellness Court
The effectiveness of Wellness Court is disputed, however. Since it was launched in January, 217 people have been arrested and 72 accepted the treatment option, according to the Defender Association, which provides legal services for some arrestees. Ten people have successfully completed the program, including one who later died of a drug overdose.
People will often agree to participate so they can avoid punishment, even when they aren’t ready for or actually interested in treatment, chief defender Keisha Hudson said. Two-thirds of those who agreed to participate now have bench warrants, meaning they didn’t show up to a court date and effectively skipped out on the program, she said.
“We’ve literally had clients that, when the transport pulls up to a red light, have exited the car and ran,” Hudson said. “We’ve also had people who got there and were taken into a treatment program and then left within the hour, within the same day.”
“Because the numbers have been so low, we don’t know that this is an effective way to address the opioid issue. It isn’t best practice to force someone into treatment. The research is pretty clear there,” she said.
Hudson suggested the court could be improved by being folded into other successful court diversion programs, such as the Accelerated Misdemeanor Program. She and District Attorney Larry Krasner contend that Geer’s office has excluded them from discussions about how to structure the program.
“The Wellness Court is a work in progress in which my office, the courts, the public defenders, medical experts around the city, would love to play a fundamental, meaningful and involved role,” Krasner said.
In an interview, Geer defended the Wellness Court as a pilot program that provides “soft touch points” or interventions for the “hardest cases,” people who are deeply enmeshed in addiction and very difficult to reach.
He said research shows it can take a dozen or more such touches before someone in addiction gets on the path to stability. He said he was “thrilled” that the Wellness Court had already helped several people, and noted that it’s one small part of a much larger wellness ecosystem.
“We thought the smartest thing to do would be to create this ability to get people into the Kensington Wellness Support Center, where professionals and doctors and experts are co-housed, where they can have an intervention and give those folks a better shot, when we know they are suffering,” he said. “This isn’t a light drug we’re talking about here. These are the most destructive drugs on planet Earth, in Kensington. That’s what we’re dealing with.”
Geer said the goal of the program is not punitive, the judges are sympathetic, and they haven’t sent anyone to jail. He also pointed to a study showing that “mandated care” was somewhat more successful than voluntary treatment — although other studies have shown the opposite — and noted the lack of research comparing the effects of involuntary treatment to no care at all.
Parker has said she intends to expand Wellness Court to five days a week. Geer said there’s no schedule for that yet, but his office will invite experts from different city agencies — including Krasner’s office — to a planning meeting later this month to discuss the court’s future.
His office is already planning to set up a van in the Support Center’s parking lot that will offer medication-assisted treatment like buprenorphine to people who have been arrested and are on their way to court.
“They’re going to do a 180 in terms of their state of mind and their health, and be even more ready to accept the services that we avail there,” he said. “We think that is going to be another gamechanger in the evolution of Wellness Court.”
“Just so grateful to be here”
While the Wellness Court appears to have helped just a few people so far, other programs have assisted many others escape the street and rebuild their lives.
They include housing shelters, the Police Assisted Diversion (PAD) program located at the Lehigh Avenue center, health programs run by Penn Medicine and other providers, and outreach and treatment programs run by nonprofits like Savage Sisters and Prevention Point, among many others.
At a Recovery Month event held at Prevention Point late last month, case workers and program directors highlighted the services they offer, including a drop-in shelter, clean syringes, withdrawal care, referral for medication-assisted treatment, and a mobile unit. Several speakers told wrenching stories of living in addiction for years before finally making their way out of it.
Diamond Stahl, a Delco native who now lives in West Philly, described getting hooked on opioids in the late 1990s, losing custody of her children, and then trying to escape her addiction by fleeing to Mississippi, where she underwent a traumatic attempt to detox in the shed of a trailer.
At one point she swallowed handfuls of the diarrhea medication Imodium, a weak opioid, to try to stave off the cravings, she said. But eventually she abandoned her son and partner to return to Kensington, where finding fentanyl was as easy as walking down the street.
For a time she lived in a car with her mother, she said. She turned tricks for money to buy drugs. And then one day, she ran into an old friend who had quit using and become an outreach worker.
“I was so embarrassed,” she recalled. “Like, I was stinky. I didn’t shower. I had blood all over my sleeves.”
That friend “opened his arms” to her and would check in on her, she said. She also had the benefits of a changed scene in Kensington, where overdose-reversing Narcan had become available everywhere. Without it, Stahl said she might not be around to celebrate her ongoing recovery.
“I’m so grateful for every 4 milligram Narcan that went in my nose,” she said, to knowing laughter from those gathered for the event. “OK, mighta hated it in the moment, ’cause it sucks, but I’m very grateful.”
After years of trying and failing to quit, in April 2022 she finally got high for the last time, initially with the help of daily buprenorphine doses to suppress her cravings and then with Sublocade. She’s now raising her son and working as a health navigator for a University of Pennsylvania program, where she takes calls from opioid users seeking to get connected to care.
“I never saw myself as somebody that could be a mom, you know,” she said, her voice quavering. “I’m rediscovering these new details of me that I never even knew existed. Like, I get to learn who I am as a partner, I get to learn who I am as a mom. I get to learn who I am as a co-worker.”
“Recovery has truly given me these huge blessings that sometimes I feel like I don’t deserve,” she said, “but it is so attainable, and I’m just so grateful to be here.”
A shifting political environment
Service providers in Kensington say they’re hopeful the trend of decreasing fatalities will continue as they pour more manpower and resources into supporting people in addiction. Yet some also point to new challenges that could eventually slow or even reverse those gains.
One is the ever-changing drug supply. Xylazine, or tranq, which causes slow-healing wounds, has recently been largely replaced by medetomidine, a different animal tranquilizer with severe withdrawal symptoms that include a fast heartbeat and dangerously high blood pressure.
David Malloy, executive director of mobile services for Merakey Parkside Recovery, said users also go into withdrawal quickly, creating a complicated scramble for healthcare providers working to keep patients alive. Merakey runs PAD and part of Riverview’s housing operation, and Malloy works out of the Kensington Wellness Support Center building on Lehigh Avenue.
“The vital signs they’re getting — I’ve never seen nothing like it. Their vitals are very elevated or very low. It could oscillate between the two,” Malloy said. “They’re in full-blown withdrawal within two or three hours of when they come into the office. The toxic nature of the drug supply is just a bear that we’re all trying to contend with right now.”
Doctors at different hospitals and health centers have been trying a variety of medications to ease withdrawal in people who have injected medetomidine, like the blood pressure drug clonidine, Imodium, certain benzodiazepine depressants, ketamine, and high doses of buprenorphine, Mazzella said.
Another complication is a pullback from or hostility toward harm reduction at the local and federal levels in favor of a tougher approach toward people in addiction.
After taking office, Parker canceled city funding for Prevention Point’s clean needle program, and Savage Sisters’ landlord declined to renew its lease after Councilmember Quetcy Lozada said residents complained that it attracted drug users to the block. Lozada sponsored legislation that sharply restricts when and where mobile units providing food, medical care and other services can operate in Kensington, although the new rules have yet to be enforced.
The Parker administration also changed the process for distributing its share of funds from the National Opioids Settlement, putting more money toward city programs and eliminating subsidies for some harm reduction groups. Savage Sisters is no longer receiving funds it had used to pay two outreach workers and help cover its rent, Al-Asad said.
Over the next five years, Philadelphia expects to spend $210 million in settlement funds, including $167 million to operate Riverview Wellness Center and $22 million for drug treatment in the city’s jails, the Kensington Voice reported.
Meanwhile, earlier this year the federal government canceled billions in grants for addiction and mental health services, and it’s drastically shrinking the federal agency that funds such programs around the country.
For now, the efforts of outreach and health programs in Philadelphia and elsewhere will continue to bring more people into recovery and drive down the rate of overdose deaths, Al-Asad predicted. But as funding cuts for street outreach and anti-drug education begin to bite, those gains could be lost.
“I do suspect that unfortunately, long-term, that number will begin to increase again, probably in late 2026, early 2027, because I’m just seeing so many programs shut down, and I imagine that with all of those people that are being left in the wind, that there will be a lot of negative consequences,” he said.
“With the way things are going right now in the political world, I don’t have a good feeling about that,” he said. “I don’t think that trend is going to continue.”
The post Philly overdose deaths keep declining as wellness ecosystem expands appeared first on Billy Penn at WHYY.
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