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 use multiple drugs on purpose, but others may be mixing drugs unintentionally. The lack of regulation of the 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 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. This is harm reduction.

Fast facts

  • Opioids are a class of drugs that are used to relieve severe pain. In medical settings, they are usually prescribed to patients after surgery, during cancer treatment, and for other serious conditions. In the street drug market, opioids can be used to relieve pain, but are more often used for the euphoric (“high”) effects they can produce. However, taking opioids can also result in unwanted side effects like nausea, constipation, and drowsiness. The repeated use of opioids, for any purpose, can lead to a physical dependence that requires a person to continue using the drug, or else they may experience withdrawal symptoms. This does not only happen after taking opioids like heroin or fentanyl. It applies to all opioids including:

    • Codeine (Lean)

    • Oxycodone (Percocet, 30’s, Blues, OxyContin, or Roxicodone)

    • Hydromorphone (Dilaudid)

    • Hydrocodone (Vicodin, Lortab, Norco)

    • Oxymorphone (Opana)

    • Morphine

    • Fentanyl (Fetty)

    • Heroin (Dope)

  • Naloxone (also known as Narcan) is a medication that reverses opioid overdoses. Signs of an opioid overdose are slow or stopped breathing, blue or purple fingernail beds and lips, and a gurgling snore. There are a few ways to check if someone is having an overdose, but the most basic trick is to shout the person’s name and rub their chest (sternum) with your knuckles. If the individual is unable to respond, they may be having an opioid overdose. Watch the videos on our get supplies page to learn where to get naloxone, how to administer it, and how to provide rescue breathing while you wait for help to arrive.

    Naloxone comes in two forms, nasal spray or intramuscular injection, and both formulations work the same way in the body. The medication temporarily blocks the effect of opioids and helps a person to start breathing again. This means if naloxone is administered to someone who isn’t having an opioid overdose, it won’t hurt them. Naloxone is safe to use and keep in your home, even if you live with children and pets.

  • Fentanyl is an opioid like heroin, OxyContin, Percocet, Dilaudid, and methadone. These drugs block pain and create a warm calm feeling (a high). Fentanyl is added to drugs and sold as heroin or dope because it is cheap, strong, and easy to make. It has also been increasingly found in street-bought pills (Xanax, OxyContin, Percocet), cocaine, and crack, sometimes without the buyer’s knowledge.

    Fentanyl is 50-100 times stronger than morphine so it can cause an overdose, regardless of how frequently someone uses drugs. An opioid overdose occurs when someone takes more of an opioid than their body can handle, and their breathing slows until it stops. The rise in fentanyl laced stimulants (like crack, cocaine, and meth) has contributed to the increase in overdoses, especially among minorities. That is why it is important to practice safe habits like using fentanyl test strips and carrying Naloxone.  

  • Fentanyl test strips can be a useful tool to detect the presence of fentanyl in drugs. The strips are used with a small amount of drug residue (what is left in a cooker or baggie) mixed with water. Pills can be broken in half and a small amount can be scraped from the middle to be tested.  

    The strips show one line for a positive result and two lines for a negative. Unfortunately, the strips cannot tell us everything! A positive result does not show how much fentanyl is in the drugs and a negative does not mean that it is what you purchased–it could contain types of fentanyl that are not detected by the test strips as powerful drugs like xylazine. Additionally, the test strips themselves aren’t always right. For example, methamphetamine and MDMA sometimes show the wrong result depending on the amount of water in the mixture. Visit our get supplies page to watch a demonstration video and learn where to find free test strips.

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 at 877-696-1996.   

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.