Stories about the death toll from the opioid crisis have focused largely on the plight of rural and small-town Americans in the Midwest and Appalachia. But the perils of drug abuse and drug prohibition have also visited urban environments, and none so dramatically as Philadelphia. In 1999, the year the Centers for Disease Control and Prevention began tracking overdose fatalities by county, it topped the list of cities with populations over 1 million. For 2017, nearly 20 years later, the Philadelphia Department of Public Health reports that 1,217 residents died of a drug overdose. New York City, which has a population roughly five times that of Philadelphia, experienced only about 200 more drug poisoning deaths last year, according to a May report from that city’s Department of Health and Mental Hygiene.
As in many places, the leading cause of overdose deaths is no longer prescription meds. A report from the Philadelphia Department of Public Health noted that 84 percent of such deaths involved fentanyl (or a fentanyl analog), a potent and inexpensive painkiller that dealers are increasingly mixing in to heroin to make their product cheaper. That number was up from 57 percent just a year earlier. The government response to the opioid crisis—especially the aggressive interdiction and enforcement around pain pills such as Oxycontin—has also driven up demand for heroin, making the problem worse, not better.
Philadelphia journalist Christopher