PBS News –
Nearly all of Philadelphia’s heroin supply contains some amount of fentanyl
The night after Philadelphia announced it would cancel indoor dining, bars and restaurants in Old City were already starting to board up their windows. For Allison Herens, that only added urgency to an already pressing situation: She needed to get to bartenders, servers and other workers before they were all sent home.
The bartender, like many of her colleagues in the restaurant industry, had seen posts on social media cautioning that a handful of workers in Old City restaurants had overdosed in recent days, after using what they thought was cocaine. Toxicology reports showed the overdoses were, in fact, caused by the powerful opioid fentanyl.
Since Nov. 12, the Philadelphia Medical Examiner’s office has confirmed three overdose deaths among workers in the restaurant and bar industry. The city’s Department of Public Health could not confirm the number of nonfatal overdoses.
Herens, who has worked at Black Sheep Pub and Restaurant in Center City for nearly a decade, also held the post of harm reduction “czar” for the city health department, where she helped those who use drugs do so safely. If anyone was uniquely positioned to handle this particular tragedy, it was Herens.
She teamed up with a former Health Department colleague, epidemiologist Jennifer Shinefeld. Together, they stuffed a bag full of naloxone nasal spray and fentanyl test strips and traveled from bar to bar in Old City, spreading the word about safe drug use.
Nearly all of Philadelphia’s heroin supply contains some amount of fentanyl, which can be 100 times as potent. Because of this, naloxone, a nasal spray that reverses the effects of an opioid overdose, has gained traction among people who use opioids regularly as an important tool to keep on hand. The medication works by knocking opioids off the receptors in the brain, restoring air flow and reversing the effects of an overdose. It is available over the counter without a prescription in Pennsylvania. Anyone who wants to learn more about where to get naloxone can do so at the Philadelphia Public Health Department website.
Though not as readily endorsed by health officials, a number of grassroots harm reduction organizations offer fentanyl test strips, which detect the presence of any fentanyl by dipping the strips in water with the residue from drugs. While they are technically illegal, the Health Department recommends test strips as a harm reduction tool.
Neither is as mainstream among people who use cocaine or other uppers, said Shinefeld.
“We are explaining that this is an issue for people who use cocaine and crack and who may smoke K2 and use meth,” she said. “Explaining that, I think, is very eye-opening for people. This can save a life.”
It’s common for fentanyl to end up in drugs without being advertised as such, said Patrick Trainor, supervisory special agent for the Philadelphia division of the Drug Enforcement Agency.
He added that there is no evidence that the blending of substances is intentional — from a marketing perspective, in fact, that would be backward.
“When you’re combining a drug like cocaine, which is by its very nature a stimulant, with fentanyl, which is an opioid, a downer, it doesn’t necessarily make sense,” Trainor said.
He noted that some people in active addiction may use a combination of uppers and downers at different times, for example, to stay up at night or stave off withdrawal symptoms. But that’s on the consumer side.Cocaine Fentanyl naloxone Overdose