Drug overdose deaths in Pennsylvania jumped more than 23 percent last year, the Drug Enforcement Administration reported Tuesday, by far the biggest increase in at least a decade and a sign that the addiction epidemic remains out of control.
An analysis of drug-related fatalities by the DEA's Philadelphia Field Division found a 5 percent rise in deaths involving heroin, along with an astonishing increase - up 93 percent in one year - in the presence of the synthetic opioid fentanyl in the bodies of people who died of overdoses. It also found a resurgence in cocaine, which was detected in 41 percent more cases. Most people had multiple types of drugs in their bodies, coroners found, so it's not always possible to blame one substance.
"The nation and the commonwealth are in the throes of the worst drug epidemic in the country's history," Gary Tuggle, special agent in charge of the Philadelphia division, said at a news conference.
He said his division is the only one in the country to produce a state report, so comparable DEA data for New Jersey and other states were not available. Annual mortality data from the U.S. Centers for Disease Control and Prevention have not yet been updated for 2015. Pennsylvania had the eighth-highest overdose death rate in the nation based on 2014 CDC data.
But Tuggle said his colleagues in DEA offices across the country have told him that they, too, are seeing considerable increases.
Just a few years ago there was short-lived evidence of a plateau. A raft of state and federal actions - from making the overdose-reversal medication naloxone more available, to new guidelines on prescribing the painkillers that can lead to addiction - have been taken since then. Yet deaths keep climbing.
The U.S. Senate on Wednesday is expected to approve and send to President Obama a comprehensive bill to expand treatment and prevention programs. The compromise measure passed overwhelmingly by the House last week leaves out nearly $1 billion in funding sought by the administration; Republicans said money would be added during the regular appropriations process.
"This problem is growing," Jeremiah A. Daley, executive director of the Philadelphia-Camden High Intensity Drug Trafficking Area, an interagency antidrug program, said at the Philadelphia news conference. He described the new numbers as "absolutely stunning and very discouraging." He said that Southeastern Pennsylvania was in an "acute crisis."
Opioid addiction cuts across racial, geographic, and economic lines. The DEA reported that white males ages 30 to 39 accounted for 15 percent of last year's drug-related deaths, the largest demographic group, even though they made up less than 5 percent of the state's population.
Philadelphia historically has had high drug overdose fatality rates, but some suburban counties drew nearly even with the city in recent years, CDC data showed, as overdoses from prescription drugs such as Percocet and hydrocodone rose quickly in higher-income areas.
Philadelphia has once again pulled ahead, with 720 drug-overdose fatalities last year, the DEA reported, a 10 percent increase over 2014. That equals 46 deaths per 100,000 residents, the highest rate in the state.
Another disturbing surprise was in Delaware County, where officials have aggressively sought to reduce overdoses. The county was among the first in the state to distribute naloxone to first responders in late 2014, soon after state law was changed to allow it.
But Delaware County had 202 overdose deaths last year, up 41 percent from 2014, for a rate of 36 per 100,000 residents.
County-level numbers vary from year to year, so short-term changes do not necessarily indicate a trend.
Locally, Bucks County reported 117 drug-related deaths last year, up 4 percent, for a rate of 19 per 100,000 residents. Chester County's 63 deaths was unchanged from the previous year and remained the lowest in the region, with a rate of 12 per 100,000. Montgomery County's 136 deaths represented a 16 percent decline for a rate of 17 per 100,000.
The DEA said that 3,383 Pennsylvanians died of drug overdoses last year, a rate of 26 per 100,000.
Coroners found heroin in 55 percent of those who died. Fentanyl, which is many times more powerful and is mixed into heroin by drug dealers to make their product both cheaper and stronger, was detected in 27 percent of cases, and cocaine in 24 percent.
Fentanyl is a prescription painkiller but is more frequently showing up in forms created in illegal laboratories, Tuggle said, often shipped from Mexico, China, and India. Pennsylvania coroners for the first time detected another form of the drug, acetyl fentanyl, which has no medical purpose. It was found in only 4 percent of cases but often would not be part of the standard toxicology screen.
Also found were several prescription opioids, such as oxycodone (19 percent) and hydrocodone (6 percent).
There is evidence that use of prescription opioids is declining nationwide, but drug officials and addiction specialists say that the changes in law and prescriber practices responsible for that decrease are likely leading to more heroin use as people addicted to pills seek a way to avoid opioid withdrawal.
At Tuesday's news conference at the William J. Green Federal Building, down the block from Independence Mall, three career law-enforcement officials - Tuggle, Daley, and Zane D. Memeger, U.S. Attorney for the Eastern District of Pennsylvania - stressed the importance of expanding treatment.
Catching people before they make the move to heroin is critical, Tuggle said. He recalled some of the drug crises that have struck America in the past, from opium in the mid-1800s, to LSD in the 1960s and crack cocaine in the 1980s.
"Heroin has something that the others did not," he said. "It has a feeder system: prescription opioids."