David Malloy, MSW, hasn’t seen a urine test without fentanyl in it for four years.

Key Takeaways

  • In 2020, the number of fatal overdoses rose sharply in Philadelphia and nationwide.Synthetic opioids, like fentanyl, were present in a majority of the overdose cases.To combat the overdose epidemic, experts and harm reduction advocates say people should carry Naloxone (Narcan) even if they don’t use drugs.

Malloy is an intake director at Merakey Parkside Recovery, one of Philadelphia’s largest medication-assisted treatment clinics for people with opioid use disorder. At work, he is fighting a national problem: the widespread contamination of fentanyl in addictive substances, a leading contributor to fatalities in Philadelphia and across the United States.

“We are seeing people that test positive for fentanyl and negative for opiates, which is pretty detrimental,” Malloy tells Verywell. “It highlights how drastic and how poisoned the drug supply has become.”

Philadelphia reported 1,214 unintentional overdose fatalities in 2020, the city’s second highest on record. Fentanyl was involved in 81% of the cases recorded.

Nationwide, trends in overdoses from synthetic opioids are also on the rise. The Centers of Disease Control and Prevention (CDC) reported a nearly 30% increase in overdose deaths in 2020. It is the country’s highest number ever recorded in a 12-month period.

People With Low Opioid Tolerance Have Higher Risk of Overdosing

Malloy and his team work to combat overdoses through medication-assisted treatment (MAT), which combines behavioral therapy and medications. They use methadone, an alternative synthetic opioid, in controlled doses to help patients wean off another more dangerous substance.

What Is Fentanyl?

Fentanyl is a synthetic opioid that is 10,000 times more potent than morphine and it contributes to a large number of overdose deaths in the United States. When used legally, it is approved for treating severe pain, typically from advanced stages of cancer.

MAT programs can be controversial because people are still using an opioid. But MAT can help patients overcome substance use disorder without reducing their tolerance too quickly and making them vulnerable to an overdose.

Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), says that MAT programs can be life-saving.

“When you have been repeatedly exposed to opioids, you become tolerant to them, and as a result, you need higher doses to get that same high,” Volkow tells Verywell. However, if someone stops taking opioids abruptly, their tolerance will dissipate, which makes them more susceptible to an overdose, she adds.

People with opioid use disorders may become abstinent through recovery programs, or in prison, if they were apprehended for a crime involving drugs. A study found that the risk of death among people who were incarcerated were almost 13 times higher than others, a figure driven by drug overdose deaths.

The increased likelihood of death after detoxing is most alarming, Volkow says.

“Those [numbers] highlight how crucial it is for people that are in jail or prison [and then] released, to give them medications for their opiate use disorder because that will protect them from overdosing,” Volkow says.

While MAT may be able to help a person avoid a future overdose, it won’t help someone who is at immediate risk of overdosing. If a person is overdosing, a bystander will need to intervene quickly to save a life.

Reversing Overdoses With Narcan

To combat overdoses in the moment, harm reduction advocates encourage people to carry and learn how to use Naloxone (Narcan), an overdose-reversal drug.

What Is Methadone?

Methadone is a synthetic opioid that can be described for pain management or as medication-assisted treatment (MAT) to treat opioid use disorder. Some clinics administer methadone to help people wean off substances, like heroin, without experiencing extreme withdrawal. Its use is controversial in the harm reduction community because it is a type of opioid itself.

Narcan is an emergency medication that can help reverse the effects of an opioid overdose. It is administered as an injection or a nasal spray, which takes effect within two to five minutes. Adverse side effects from Narcan are rare, but for a person who is using drugs but not overdosing, it may cause withdrawal.

Rosalind Pichardo, leader of the organization Operation Save Our City, offers in-person Narcan training and accepts payment in the form of pizza and Pepsi.

Pichardo lives in the Kensington neighborhood of Philadelphia, where she largely serves residents who use substances or experience homelessness, whom she calls her “Sunshines.” She has reversed 706 overdoses using Narcan. 

“It’s very important to take care of our neighbors,” Pichardo tells Verywell. “It’s important to be prepared for a crisis like that, for something that I see on the regular.”

Pichardo recommends that people carry Narcan on them at all times, even if they are untrained or afraid to administer it. There’s always a chance that someone else nearby can step in to help out, she adds.

Pichardo says that sometimes people are afraid to reverse an overdose because of what they had experienced the first time.

How to Tell Someone Is Overdosing

Pichardo says a person may be overdosing if:

“It’s important to really practice self care and take some time and deal with what you’ve seen and what you had to experience,” Pichardo says. “Then move forward."

She suggests self care such as talking about your experience with others, writing, listening to music, or finding a quiet place to relax.

Malloy also carries Narcan and advocates for others to do the same. In addition to his work at Merakey, he is involved in Philadelphia’s Police-Assisted Diversion (PAD) program, where he helps direct people who are using substances to social services.

Who Can Carry Narcan?

The U.S. allows Narcan prescriptions for most people even if they are not individually at risk of overdosing, according to the Network for Public Health Law. Most states also have Good Samaritan laws in place that protect bystanders from legal consequences and drug charges when reversing an overdose.

Quick Facts About Narcan

According to the Center for Opioid Education in Washington state, Narcan is:

  • Only effective for someone on opioids
  • Not addictive
  • Largely free of side effects
  • Effective within 2–5 minutes

In some states, however, there are barriers like insurance costs or dosage limits on Narcan prescriptions. “When you limit the number of doses, you’re going to restrict the capacity of that person to save someone’s life,” Volkow says.

Ensuring access to multiple doses of Narcan is increasingly important in the presence of fentanyl, which is more powerful in lower doses and often requires more than one dosage to reverse an overdose, according to the American Addiction Centers.

How the COVID-19 Pandemic Is Exacerbating the Opioid Epidemic

Pandemic-related hardships, such as social isolation, deaths of loved ones, and uncertainty of the future have contributed to increased stress for many people, including those who use substances, Volkow says. As a result, drug relapses have increased and people have been engaging in riskier behaviors, like using drugs alone, she adds.

Narcan Training in Philadelphia

If you live in Philadelphia, you can sign up for a PDPH webinar on how to use Narcan, or a virtual or in-person training with Prevention Point Philadelphia, a harm reduction organization based in Kensington. Residents in Philadelphia can find nearby pharmacies that carry Narcan at the PDHP website.

“We have been very much distracted by the urgency of the COVID-19 pandemic,” Volkow says. “But the numbers that we’re seeing in terms of overdose deaths are actually so alarming that we cannot ignore them.”

The latest statistics highlight the need for more rigorous harm reduction strategies and overdose prevention measures, she says. This includes expanding access to Narcan and other MAT programs as well as educating the public and insurance companies on the need for affordable, readily available treatment.

Malloy agrees that the pandemic has exacerbated the need for overdose prevention. Since the pandemic may have affected the raw drug supplies, it prompted increased circulation of cheaper synthetic substances like fentanyl, he says. 

For now, experts say that the country needs to tackle the joint burden of the COVID-19 pandemic and the overdose epidemic, together.

“We have to be able to deal with the strategies to control the pandemic, while at the same time addressing the needs of the opioid epidemic,” Volkow says. “They’re not exclusive and they have to be coordinated. We should be able to do both.”

What This Means For You

If you are dealing with opioid use disorder, experts say not to use drugs alone and to carry Narcan. You can find treatment centers and other forms of help here.

Otherwise, experts still recommend carrying Narcan in case someone is need. Check with your local pharmacy to see if they carry Narcan.