Pubdate: Wed, 11 Jan 2017
Source: Philadelphia Daily News (PA)
Copyright: 2017 Philadelphia Newspapers Inc.
Author: Don Sapatkin, Stephanie Farr


Last weekend's frightening and widely reported string of overdoses in
Philadelphia - nine deaths in 36 hours, according to police - was just
part of what officials suspect was a devastating five days that left 35
people dead.

It started Dec. 1, when 12 people died between 6 a.m. and 10 p.m. "We have
never seen that before," said Sam P. Gulino, the city's chief medical

Then came four more deaths last Friday, seven on Saturday, nine on Sunday,
and three on Monday. The total could still rise, as deaths that initially
appeared natural are investigated for drug links.

The overdoses may have resulted from heroin that was cut with more
powerful synthetic opioids such as fentanyl. But police said there were
other possibilities, such as the appearance of heroin that was more pure
than the users were accustomed to.

"It's a lengthy process of figuring it out," said Lt. John Stanford, a
police spokesman. It was clear from narcotics packaging found at the scene
that the users who died did not all buy their drugs from the same location
or person, he said.

Many of the deaths occurred in and around Kensington, where people come
from elsewhere in the city and the suburbs to buy and use heroin. Bucks
County authorities said there had been five suspected overdose deaths this
week in Falls Township, although it was not clear if any were linked to
Philadelphia. Other suburban counties said there had been no discernible
uptick in fatalities recently.

Surges in drug overdoses, many related to fentanyl, have been reported
around the country over the last year. Seven people died on one September
day in Cleveland, according to news reports. Three were found within five
hours in separate parts of York County, Pa., on Nov. 30. In Washington
County, south of Pittsburgh, with a population of 208,000, eight overdoses
were recorded in 70 minutes in August 2015, contributing to a total of 25
over two days. Three of the overdoses were fatal.

But Gulino and others said they could not remember a cluster as extreme as
Philadelphia's 35 deaths anywhere in the country.

The cases are considered "suspected" drug deaths until toxicology tests
determine what drugs were present in each body, a process that typically
takes about eight weeks. Results are not needed to determine overdose as
the likely cause of death, however.

" 'Suspected fatal drug deaths' means that the circumstances, scene
investigations, and autopsy findings strongly indicate that the death was
a drug-related death," said Jeff Moran, a spokesman for the Philadelphia
Department of Public Health, which includes the Medical Examiner's Office.

In mid-November, the health department issued an alert after data that are
automatically reported by hospital emergency departments showed something
alarming: 40 nonfatal overdoses on Nov. 17, with more reported the
following day. These reports do not include people who declined hospital
treatment after the overdose-reversal medication naloxone was administered
by police, emergency medical technicians, or other drug users.

Gulino said that the number of fatalities over that November period was
not significantly higher than usual.

The Drug Enforcement Administration has an active criminal investigation
into the source of the November overdoses, said Patrick J. Trainor, a
spokesman for the federal agency's Philadelphia division. Based on the
numbers, he said, the latest spate of deaths would be "of very great
interest, no question," to DEA investigators.

The Philadelphia Medical Examiner's Office confirmed 702 drug-related
deaths last year, a number that has been incorrectly reported as 720 based
on a DEA report over the summer. The city is on track to end this year
with 25 percent to 30 percent more deaths than in 2015, Gulino said,
"almost entirely on the back of heroin and fentanyl."

Anecdotal reports from county coroners around the region suggest
significant increases are likely this year statewide, on top of jumps of
more than 20 percent in both Pennsylvania and New Jersey last year. Deaths
involving fentanyl nearly doubled in Pennsylvania and tripled in New
Jersey in 2015. National data lag more than a year behind state reports.

Some chemical variations of fentanyl that are not necessarily more
dangerous than the original have appeared in Philadelphia. But Gulino is
worried about the possible emergence here of another fentanyl relative,
known as carfentanil, that has received attention elsewhere.

With a potency that has been reported up to 10,000 times greater than
morphine, deadly amounts of carfentanil might not even be detectable in
toxicology testing, Gulino said.

Despite the latest surge, he said, he is confident carfentanil has not
arrived in Philadelphia because "were it to show up. it would cause a
large number of fatalities. and it wouldn't be over in a few days."

When dangerous drugs are detected, authorities struggle with how specific
to get in public warnings, because announcing that stronger drugs are on
the street can attract more users and increase the death count.

"When people are addicted and they are seeking that high and they hear
about a drug that is leading to overdoses ... they try to acquire that
drug for the ultimate high. So warning the public is a double-edged
sword," said Jeanine M. Buchanich, who studies overdose mortality trends
at the University of Pittsburgh's Graduate School of Public Health.

Buchanich is used to seeing disturbing statistics from around the country.
But nothing as high as Philadelphia's 35 deaths in five days, which she
heard from a reporter.

"Honestly, I was really shocked," she said.
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