Germantown is tied with Tacony for having the eighth highest number of overdose deaths in the city in 2021, according to the City of Philadelphia’s overdose statistics report released last week.

There were a total of 1,276 fatal overdoses in Philadelphia last year – the highest number recorded in city history. Kensington, where 169 people died, reported the highest number – almost twice as many as in Hunting Park, the neighborhood which reported the next highest number of 84. Also in the top ten for overdose deaths that year were Frankford, with 80; Fairhill, with 56; Allegheny West, with 52; Kingsessing, with 42; Pennsport, with 37 and Pennypack Park with 34.

Chestnut Hill, meanwhile, was one of only six city neighborhoods that experienced zero overdose deaths during the same time period. The other five are Manayunk and East Falls, Logan Circle/Center City West, Northern Liberties and Fairmount. 

Of those neighborhoods that experienced a significant number of overdose deaths, many saw an increase from the previous year – including Germantown, where the number of people who died from drug overdoses rose from 33 in 2020 to 36 in 2021. Most, but not all, of those deaths were due to opioids.

“There are some hot spots in and around Northwest Philly,” said Shawn Westfahl, overdose prevention & harm reduction coordinator at Prevention Point, a Kensington-based non-profit that serves people with addiction. “The 19144 zip code seems like it's always been pretty consistently high.” 

Mt. Airy is 35th on the list, with nine fatal overdoses last year. Seven of those were opioid-related.

According to Westfahl, neighborhoods like Germantown and Mt. Airy do not have the kind of open-air drug use found in Kensington, which can make it more difficult to reach the people who are suffering from addiction. 

“In most sections of Philly, like the Northwest, most people who died of a fatal overdose were in a residence,” said Westfahl in a phone call with the Local. “It’s hard to be able to do that outreach and talk to people to find out what kind of resources they need.”

It also means that accidental deaths happen more easily, Westfahl explained, because people are often using their drugs alone. Opioid overdoses can be reversed with Narcan, but only if there is someone present who can administer the drug.

“Most people die from overdoses because nobody was there to save them,” Westfahl said.

Xylazine the newest threat

In the first four of her six years working as a clinical supervisor at Merakey Parkside Recovery in Germantown, Cristina Marino only saw one of her patients overdose. In the past two years, she said, she’s seen about “six or seven.”

“I think tranquilizers are contributing to it in some ways because it increases chances of going into respiratory failure,” Marino said. “They’re so relaxed that their body doesn’t have the capacity to breathe so you may not be able to fully reverse it with just Narcan.”

The tranquilizer Marino is referencing is xylazine, better known on the street as “tranq” for its medically-intended use – which is an anesthetic that veterinarians give to horses. Couple that with the rise of fentanyl, which has virtually replaced heroin on the East Coast, and you have a deadly combination.

“We see very little heroin out there anymore,” Westfahl said. “We might see traces here and there.”

The percentage of drug overdose deaths due to fentanyl, a synthetic opioid produced for pain management, began skyrocketing in 2013. By 2016, it had surpassed heroin as the most common drug found in victims of fatal overdoses. Since that time, that trend has continued – a major reason why 82% of the city’s 1,276 overdose deaths were due to opioids.

“People are inserting fentanyl into different aspects of the drug supply and it’s reaching different demographics of people,” said David Malloy, director of mobile services at Merakey. “A lot of times it's high school kids who want percocet, and think they’re getting percocet, but it’s fentanyl.”

Lawmakers respond

The trend is leading state lawmakers to act – and make it easier to test for the presence of fentanyl.

Last Wednesday, the Pennsylvania Senate unanimously passed a bill decriminalizing drug testing tools, including fentanyl test strips. The legislation previously passed the House in June.

“We’re waiting for the governor to sign legislation that will decriminalize them statewide,” Westfahl said.  “Just a person knowing there’s fentanyl in a substance they’re about to consume – those decisions save lives every day.

But even as legislators are finally making headway in the fight against fentanyl in Philadelphia’s drug supply, tranq is wreaking new havoc.

In 2021, 41% of all opioid-involved overdose deaths in Philadelphia and 44% of all fentanyl-involved deaths in the city also involved xylazine. More broadly, xylazine was detected in 34% of all overdose deaths in 2021. This represents a 39% increase from 2020. 

“Tranq is not an opioid, it’s an anesthetic,” said Dr. Andrew Best, director of the Department of Health’s Substance Use Prevention and Harm Reduction division. “But we’re seeing it in collaboration with opioids.”

When taken with fentanyl, tranq presents a whole new way to die. Fentanyl alone is always an invitation for an overdose, but when taken with tranq, people can easily stop breathing due to the drug’s extreme ‘downer’ effect. 

“We can give them Narcan [to combat the overdose], but you have to stimulate their breathing by running your fist up and down their chest until paramedics come,” Marino said. “You’re still dealing with somebody who could have a respiratory system that’s too relaxed to breathe. People just fall asleep and don’t wake up.”

Another side effect of tranq is that it causes soft tissue wounds.

“Xylazine causes these wounds to pop up in places where a person has never injected before,” Westfahl said. “The wounds become really severe and it leads to a lot of amputations.”

Changing demographics

While deaths due to opioid overdose have long been associated with white people, that pattern seems to be changing, Best said. 

Citywide, non-Hispanic Black Philadelphians experienced the highest increase in reported overdose deaths compared to other racial and ethnic groups, according to the report. They also experienced more deaths from overdoses than non-Hispanic white Philadelphians.

“We are extremely concerned about the continued rise in overdose deaths and ripple effects of these deaths on individuals, families, and communities in the City,” Health Commissioner Dr. Cheryl Bettigole said. “With fentanyl contaminating Philadelphia’s entire drug supply, anyone who takes street drugs of any kind is at risk. We are determined to use every strategy available to reverse these trends.”