Overview of Overdose Crisis in Philadelphia

The trauma of Philadelphia’s overdose crisis is felt city wide -impacting medical staff in emergency rooms, outreach crews and EMTs who reverse overdoses in the field, the families of people who use drugs, and the people who use drugs themselves--who risk, confront, and reverse overdoses daily. We are all impacted by the grief of so many overdose deaths in our city, compounded by the replacement of heroin and prescription pills with fentanyl–and the introduction of new toxic additives such as xylazine, a tranquilizer that does not respond to the medications used to reverse an opioid overdose.

Overdose prevention centers (OPCs), which already operate in New York City and abroad, focus on preventing overdose deaths and providing safe spaces for people to get the services they need - including wound care, drug testing, clean needles, narcan, connection to mental health and social services, and low barrier connection to treatment.

Chief among the barriers, the social stigma of drug use often prevents people from getting the care and services they need. The compassion of meeting people where they are, without judgment, is critical to creating safe spaces.

In 2021, 1,276 people died from drug overdose in Philadelphia. This is the most drug overdose deaths reported in a year in Philadelphia. The recently released Department of Public Health report on 2021 unintentional drug overdose fatalities detailed that non-Hispanic Black Philadelphians experienced the highest increase in reported overdose deaths compared to other racial and ethnic groups and more deaths from overdoses than non-Hispanic White Philadelphians.

The overdose crisis has steadily gotten worse over the past few years and it’s clear that our current scope of services is not enough. While narcan distribution reduces deaths, it is clearly insufficient as the sole means of saving lives–particularly when people would be using alone. We need additional methods to prevent more overdose deaths and provide care and services to people who use drugs.

In the past two years, the conversation about overdose prevention centers in Philadelphia has centered the voices of those opposed to them, yet there are many people in Philadelphia who are looking for more information or are supportive of these life-saving facilities opening in Philadelphia, as they have in New York City.

This blog is intended to share information about our overdose crisis and what services Overdose Prevention Centers could provide.

Philadelphia has the highest overdose death rate of the top 10 largest US cities

Fentanyl remains the chief cause of overdose, but deaths from common mix-in xylazine have risen 36% in the last year

The Overdose Crisis is affecting all races in Philadelphia

And it is affecting every region of Philadelphia

What are Overdose Prevention Centers?

Overdose Prevention Centers are places designed to prevent people from dying of a drug overdose and to encourage connection to services, including treatment. The most prevalent cause of overdose deaths in Philadelphia is fentanyl in the drug supply. An overdose from fentanyl can be reversed with oxygen or naloxone but only if someone is nearby who knows how to administer them.

You’re probably aware of organized efforts to train Philadelphians to carry and administer Narcan. While we can all do our part individually to respond in the moment during an overdose, our city’s crisis requires a citywide response that includes systems and services that are equipped to reach more people and provide them with life saving services.

Staff at OPCs do not directly assist in drug consumption, distribution, or administration and do not handle any drugs clients bring into the facility.

However they do provide clients with:

Medically supervised consumption room
- Sterile equipment
- Fentanyl test strips
- Overdose reversal and emergency care
- Safe disposal of equipment
Medically supervised observation room
- Overdose reversal and emergency care
- Certified peer specialists
- Offer of services
Medical services
- Wound care
- On-site initiation of MAT (Medically Assisted Treatment) and recovery counseling
- HIV and HCV counseling, testing, and treatment
- Referral to primary care
Wraparound services
- Connection to social services
- Connection to legal services
- Connection to housing opportunities
- Safe, compassionate spaces for people who use drugs

OPCs are supported by the Philadelphia Medical Society, Philadelphia County Medical Society, American Public Health Association and the American Medical Association, which note that, in addition to the central mission of saving lives, OPCs can:

Minimize the risk of HIV, hepatitis C, and hepatitis B transmission.
Increase referrals to drug treatment and other health services.
Minimize public drug use.
Improve public order and nuisance concerns such as improperly disposed syringes.
Do all of these without negatively impacting neighborhoods; evidence also shows facilities don’t increase crime or encourage those who have never taken drugs to begin doing so.

Philadelphia’s City Administration supports the opening of Overdose Prevention Centers in Philadelphia. Read more from the Substance Use Prevention and Harm Reduction division of Philadelphia’s Department of Public Health here.

The primary purpose of an Overdose Prevention Center is to save lives. However, a compassionate space with skilled staff also provides the opportunity to minimize the physical health risks associated with drug use, minimize the negative effects of social determinants of health, and provide connections to drug treatment that may ultimately support people in their long term recovery from substance use. Those connections are key components of OPC efforts.

What Is Harm Reduction?

8 Principles of Harm Reduction

Adapted from the National Harm Reduction Coalition www.harmreduction.org

Healing and safety requires accepting the reality of all forms of drug use – minimizing harms instead of condemning or ignoring use
Drug use is complex, ranging from abstinence to severe use, but at every part of the spectrum, some approaches are safer than others
Successful interventions and policies enhance quality of individual and community life, not just cessation of use
Services should be non-judgmental and non-coercive
People who use drugs or have used drugs have real voice in development of programs and policies (“nothing about us without us”)
People who use drugs are the most able to reduce the harms of their own drug use, share information, and provide mutual support
Poverty, class, racism, social isolation, trauma, sex-based discrimination, and other social inequities are inextricable from the harms of drug use—addressing social determinants improves people’s capacities to deal with drug-related harm
Advocates and people doing the work will not minimize or ignore the real harms and dangers associated with illicit drug use

What’s stopping Philly from opening an OPC?

In February of 2020 Safehouse took action to open an Overdose Prevention Center in South Philadelphia. The conversation that arose in the wake of that decision exposed a lack of communication and sparked contentious, stigmatizing conversation. This framing pulled focus away from the lives that would be saved and OPCs as one of many tools needed to effectively and compassionately address the crisis Philadelphia has been in for years.

Bill McSwain, former US Attorney for the Eastern District of PA under the Trump Administration, sued Safehouse to stop them from opening and ultimately a federal court agreed that Safehouse could not open. This ruling only applied to the Third Circuit Court of Appeals, which oversees Pennsylvania, New Jersey, and Delaware. This means that other states and cities in America are not federally restricted from opening OPCs, only Philadelphia and other locations located in the Third Circuit.

What’s changing right now to make a Philly OPC more possible?

Safehouse is currently in settlement discussions with the Biden Administration’s Department of Justice. Biden has signaled support for harm reduction and prioritizing community-focused methods to serve localities experiencing unprecedented numbers of overdose deaths. Federal health agencies have begun openly supporting harm reduction approaches. The Substance Abuse and Mental Health Services Administration (SAMHSA) website notes that “harm reduction is critical to keeping people who use drugs alive and as healthy as possible …”

New York opened OPCs in two neighborhoods in 2021, and have reversed 565 overdoses in 42,304 visits to date. That’s 565 lives saved in a year.

More Overdose Prevention Centers are slated to open in Rhode Island, Cambridge, MA, and other areas experiencing high rates of overdose deaths across the country.

The medical and public health community strongly supports Overdose Prevention Centers. Data from recently opened U.S. OPCs shows immense success, and the federal administration finally acknowledges the overdose crisis and supports harm reduction. This swell of acceptance is not a historical blip, but rather a gathering, country-wide tide toward opening OPCs and recognizing this moment as the national and local crisis that it is.

What can you do to support OPC in Philly?

Sign this petition and share it

Share this blog about OPCs with your neighbors and friends.

Learn about stigmatizing language and avoid using it.

Philly Needs Overdose Prevention Centers