Philly paramedics used much less naloxone in 2018 than the year prior, most likely because of how widespread the anti-overdose medicine has become.

Deaths by overdose were down last year, the first decline since Philadelphia’s opioid epidemic erupted into a public health crisis. However, there’s little indication the actual number of ODs fell — it’s just that fewer of them were fatal.

The Philadelphia Fire Department, which handles all EMT calls for the city, actually sent out 5 percent more ambulances last year, according to data reviewed by Billy Penn. Only a fraction of those 300,000-plus incidents involved dangerous drug use, but the 23,000 overdose calls were more than any other year in recent memory.

Despite that uptick, EMTs actually administered 35 percent less naloxone than they did in 2017.

City officials and harm reduction advocates largely attribute the decline to the growing availability of naloxone (the generic name for Narcan). In other words, first responders are no longer the first person on the scene with the OD antidote.

“Because so many more people are carrying naloxone today,” said Fire Dept. spokesperson Kathy Matheson, “some people have already been administered naloxone before PFD arrives.”

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Naloxone is everywhere

The Department of Public Health became the city’s primary naloxone distributor two years ago. It not only purchases the (egregiously pricey) antidote to distribute among city agencies, but also facilitates trainings for personnel to learn how to administer it properly.

Per department spokesperson James Garrow, last year’s distribution efforts ramped up considerably. More than 26,500 doses of naloxone were distributed among first responders, law enforcement agencies, the city’s jail system, and community organizations. By the end of last year, that circulation had nearly doubled to more than 47,700 doses doled out citywide.

Private residents have also begun carrying more naloxone — and the combination make for a city well-equipped to save lives at the moment an opioid overdose happens.

Between last year and this year, the shift was palpable, emergency room physicians and community-based harm reduction groups confirmed.

“The one thing I can say that is meaningful is that we see so many more cases where patients received Narcan from a bystander,” said Dr. Joseph D’Orazio, the director of the Division of Medical Toxicology in the hospital’s North Philadelphia emergency department.

However, at Temple’s Episcoal campus, which sits in the trenches of the city’s overdose crisis in Kensington, D’Orazio noted another new trend among overdose victims that complicated the crisis last year: The rise of heroin and fentanyl mixed with synthetic cannabinoids, better known as K2, although sometimes called “spice” or “tookie” on the street drug market.

The potentially toxic combination has led to mass poisonings. According to the Department of Public Health, more than 200 people were sickened by K2 over a 48-hour period in Kensington last September. 2018 also saw an isolated outbreak of fentanyl-contaminated crack cocaine in West Philly, resulting in two fatalities.

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Where to go from here?

Toxicology reports can help identify if a particularly deadly combination of drugs has landed on the street market. But not all overdose victims choose to go to the hospital — even after receiving naloxone from first responders. Hundreds of overdose victims declined to see doctors after they were revived by medical personnel, data shows.

Naloxone, of course, isn’t the end solution for harm reduction advocates. Health experts estimate that a safe injection site, such as the one Philly is pushing to open, may save an additional 75 people a year from fatal overdoses.

More frontline efforts are needed, said Sterling Johnson, an organizer with ACT UP Philadelphia. He supports the city and state’s initiatives to increase the availability of naloxone, but says saving more lives is a matter of increasing treatment options and social services — as well as jobs and housing for people in the early stages of recovery.

Johnson believes the city would benefit from investing more heavily in efforts led by community-based organizations.

“These organizations and their frontline workers continue to be underfunded or asked to rely on volunteers to meet important benchmarks for the city,” Johnson said. “Overdoses will only go down by investing in the frontline workers that are currently doing the work to create true community healing.”

Max Marin (he/him) was Billy Penn's investigative reporter from 2018 to 2021. A graduate of Temple University, he has produced award-winning journalism on local politics, criminal justice, immigration...