Philadelphia has been at the center of the opioid crisis for years. But the nature of that crisis has shifted — and if you're a family member, a social worker, or a provider in this region, understanding what's actually in the drug supply right now is one of the most important things you can know.
The current landscape
According to the Philadelphia Department of Public Health, fentanyl is now present in over 90% of the city's illicit drug supply. In 2023, 80% of all drug-involved deaths in Philadelphia involved fentanyl — and 63% involved cocaine. That means fentanyl isn't just an opioid problem. It's in cocaine, pressed pills, and other substances, often without the user's knowledge.
More recently, Philadelphia's drug supply has also seen the emergence of medetomidine — a potent non-opioid veterinary sedative detected by the Philadelphia Department of Public Health in a May 2024 health alert. Unlike xylazine ("tranq"), medetomidine presents different clinical challenges and doesn't respond to naloxone.
What this means for overdose risk
Fentanyl is roughly 50 times more potent than heroin. Because it's mixed into the drug supply inconsistently — what's called "hot spots" in a batch — even experienced users can't reliably predict what dose they're getting. This is one of the primary drivers of accidental overdose deaths.
For families, this means that someone who has used substances for years without overdosing is not protected. Tolerance to one batch offers no protection against the next.
Harm reduction tools that work
Naloxone (Narcan). Naloxone reverses opioid overdoses and is available free in Philadelphia — from the Health Department, community organizations, and as of August 2025, from Philadelphia Fire Department stations. Everyone should have it. A 2025 PubMed study found that fentanyl test strip legalization was associated with a 7% decrease in overdose mortality nationwide.
Fentanyl and medetomidine test strips. The Philadelphia Department of Public Health distributes free fentanyl and medetomidine test strips through community-based organizations. A 2025 JAMA Network Open study of 732 people who use drugs found that those using fentanyl test strips reported significantly more overdose risk reduction behaviors.
Never use alone. The risk of fatal overdose is significantly higher when someone is alone. The Never Use Alone hotline (1-800-484-3731) provides a live person who will call 911 if you stop responding.
For providers: what to know about treatment
Buprenorphine (Suboxone) remains one of the most effective tools for treating opioid use disorder in the fentanyl era. The x-waiver has been eliminated — any DEA-licensed prescriber can now prescribe buprenorphine. If you're not yet prescribing it, the Philadelphia Department of Public Health offers training and support.
For patients who need a structured level of care, IOP and PHP offer intensive support without requiring inpatient admission. Early engagement matters: the longer someone remains in active use, the higher the cumulative overdose risk.
Philadelphia Recovery Solutions accepts provider referrals for same-week IOP and PHP intake. If you have a patient who needs a higher level of outpatient care, our team is responsive and will communicate back to you. Submit a referral →
Sources: Philadelphia Department of Public Health 2023 Annual Report & May 2024 Health Alert; JAMA Network Open (2025); PubMed / McMichael et al. (2025); substanceusephilly.com. This article is for educational purposes and does not constitute medical advice.