Substance use and overdose touch all Philadelphians.

Harm Reduction and Substance Use

Substance use and overdose are matters that touch all Philadelphians. While the Division of Substance Use Prevention and Harm Reduction (SUPHR), City agencies, and community partners work to monitor overdose trends, provide harm reduction resources, and institute policy changes to increase the health and well-being of people who use drugs in Philadelphia, Philadelphians deserve the tools to take care of themselves and others.  

While opioids are still present in the majority of overdoses in Philadelphia, they are not the only substances involved in our city’s overdose crisis. In 2021, almost 80 percent of Philadelphians who died of an overdose had multiple drugs in their systems. Some people who use drugs may be polysubstance users who use multiple drugs in order to enhance the effects of either drug, but others may be mixing drugs unintentionally. The unregulated illicit drug supply means that people who use drugs (and even people who sell drugs) are likely unaware of the actual composition of illicit drugs, so some people who use drugs may be mixing substances and not even realize it. For example, someone taking cocaine may not realize that there has been cross-contamination, so they’re also snorting a small amount of fentanyl, or someone injecting dope may not realize that it’s been cut with xylazine (tranq), a veterinary tranquilizer that was detected in 90 percent of dope samples tested in 2021. This can lead to overdose or severe skin wounds. Fortunately, there are tools and behaviors that can reduce the risks.

Universal Precautions

Four steps people who use drugs can take to keep themselves safe and prevent overdosing.

1..Carry naloxone

Naloxone (also called Narcan) is a medication that reverses opioid overdoses by temporarily blocking the effect of opioids (including Percocet, Oxycontin, methadone, heroin, and fentanyl). This medication is safe, easy to administer, and will not cause any harm if the individual is having another health emergency.

Naloxone is not just for people who use drugs. Overdoses can happen in a home, on the street, in the park, on a bus, or at your workplace. Carrying naloxone and keeping it in your home means you’re equipped to save a neighbor, friend, roommate, or loved one if needed.

2. Test your drugs

The criminalization of drugs combined with the unregulated drug market means that people who use drugs cannot be sure of what is in their drugs. Fentanyl has been found in pressed pills, cocaine, crack, and heroin in Philadelphia, and over 90 percent of dope samples tested positive for the powerful tranquilizer xylazine (tranq). Fentanyl test strips (FTS) are a simple tool to determine if there is fentanyl in drugs. Xylazine test strips (XTS) can also help identify the presence of xylazine in drugs. The tests can be done using drug residue, which means it doesn’t require much of a drug and shows results within minutes. While fentanyl and xylazine are the most common drug adulterants found in the Philadelphia supply, other drugs are sometimes found as well. Read our quarterly drug checking reports to see what substances we’ve found in the drug supply.

3. Go low and slow

Do a test shot or bump! Start by using a small amount of a substance and give it some time to kick in so you know how strong it is before taking more, especially if you’re also drinking or taking multiple drugs at once. Mixing drugs makes each of them stronger, so start with less of each than you normally would. Remember, you can always take more later.

4. Use with others if you can

Using with others means that if something happens and you overdose, someone will be there to administer naloxone or get help. If you’re using with other people, try to stagger your use so that you’re able to help each other if needed. If you don’t want to use with others, or can’t, let someone know you’re using or use an app like Brave App or call a hotline like Never Use Alone (for English call 800-484-3731; for Spanish call 800-928-5330).   

Also, be mindful of any change in your tolerance.

If you’ve been hospitalized, incarcerated, in inpatient treatment, or just haven’t used for a while, you’re at higher risk of an overdose. Now is the time to be especially careful. 

Harm Reduction Services in Philadelphia

  • Syringe service programs (SSP) are well-established interventions supported by health and social service providers and agencies including the CDC. Providing clean syringes is vital because sharing syringes and other equipment can lead to the transmission of infections like hepatitis C (HCV) and HIV. Hepatits C (HCV) infection occurs at very high rates among people who inject drugs, particularly among those who share injecting equipment and other materials like cookers. In Philadelphia, 60 percent of acute HCV patients report that they’ve injected drugs.

    Studies have shown that SSPs reduce HCV transmission and even prevented an estimated 10,000 new cases of HIV among people who inject drugs in the first 10 years of their existence in Philadelphia. In Philadelphia, the only sanctioned SSP is Prevention Point Philadelphia (PPP). PPP, like many other SSPs, provides clean syringes, HIV testing, wound care, linkage to medical care and medications for opioid use disorder, as well as the opportunity to safely dispose of used syringes.

    Want to learn more? Click to read information from the National Harm Reduction Coalition and CDC on syringe service programs.

  • Overdose Prevention Site (OPS) are centers where people can bring their own drugs, like heroin or cocaine, to use under medical supervision. Philadelphia does not have an OPS, but the first sanctioned OPS in the United States opened in late 2021. The New York City program, OnPoint, reversed almost 700 overdoses in its first year of operation. While the primary goal of these sites is to prevent fatal overdose, they also improve community health by providing a sterile and safe environment with medical support to help prevent skin infections and abscesses, the transmission of diseases like HIV and hepatitis C, and dangerous conditions like endocarditis. At an OPS, people also have the opportunity to connect with case managers and mental health treatment. Clients can access support and be connected to substance use treatment, primary medical care, and other social services, like housing, if needed.

    The City supports having one or more OPS in Philadelphia to reduce drug overdose deaths, reduce public drug use and discarded drug-related litter, prevent the spread of HIV and hepatitis C, and improve access to substance use treatment. As we are seeing an increase in skin and soft tissue infections (SSTIs) in Philadelphia related to xylazine (tranq), these centers would also provide essential wound care treatment services.

  • Guide to using Acidifiers.

    Guide to using hammer pipes.

    Information on party drugs.

  • Find a participating location to dispose of unused prescription medications.

Need help? See Services and Supports to get information on harm reduction and substance use treatment options in Philadelphia.

Want to learn more? See our Data Dashboard to get information on city-wide substance use, hospitalization, and overdose death trends, and visit Community Engagement to see what our division is doing to address racial disparities and barriers to care. Check out our Material Library to download materials in English and Spanish on safer drug use, overdose prevention, fentanyl testing, and emerging drug trends.