Tag: Philadelphia

Researchers at the University of Pennsylvania have developed a way to help identify people at risk of overdosing on stimulants, including cocaine and methamphetamine.

“We wanted a tool that would help us predict people at high risk in order to be able to provide them with the services and interventions and supports,” said Dr. Rebecca Arden Harris, who specializes in addiction medicine and research at Penn.

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Harris and colleagues used data from more than 70 million Medicaid recipients to track emergency department visits related to stimulant overdoses. Then the team identified key risk factors, including diagnosis of substance use disorders, prior overdoses, higher poverty rates, crowded housing and being male.

The motivation for the research is a spike in overdose deaths involving stimulants, Harris said.

Nationwide, fatal overdoses linked to stimulant use jumped from 4,681 in 2011 to 29,449 in 2023 nationwide. Nearly 60% of fatal overdoses between 2021 and 2024 involved stimulants, according to the Centers for Disease Control and Prevention.

And while opioids, fentanyl in particular, remain the primary cause of fatal overdoses in Philadelphia, 70% of people who died from opioid overdoses in 2023 had cocaine, meth or other stimulants in their systems. About one-quarter of illicit opioid samples between January and June also contained cocaine or crack, according to the city’s drug-checking program.

The findings reflect how the make up of Philly’s dope supply increasingly is becoming poly-chemical, and in addition to stimulants, drugs are heavy with animal sedatives, mainly medetomidine, that can reduce heart rate and cause severe withdrawal symptoms.

People who think they are buying dope on the street may be getting bags with stimulants mixed in. Also, people who use opioids, which are sedatives, sometimes also use stimulants, or uppers, to combat the drowsiness, according to the Philadelphia Department of Public Health.

City addressing cardiovascular dangers

In reaction to the spike in overdose deaths involving cocaine and meth, Philadelphia recently started a campaign to educate people about the links among stimulant use, heart disease and overdose risk.

Cocaine and other stimulants increase heart rate and blood pressure and cause vasoconstriction and vasospasm – so people who use them have heightened risks of stroke, heart failure, sudden cardiac death and other cardiovascular problems.

Stimulant use poses other serious health problems, including the potential of meth-induced psychosis and permanent brain damage.

Philadelphia’s outreach focuses on the heart health risks of stimulant use. It also aims to reduce barriers to primary care and help people learn how to talk to providers about stimulants, said Fatimah Maiga, a spokesperson for the health department’s Substance Use Prevention and Harm Reduction Division.

“We really want people to be able to have an open conversation with their provider, make sure that they’re reporting their drug history, any symptoms and signs that they’ve experienced that might be related to heart disease, and then talk to their doctor about next steps, what they hope to accomplish from that visit, or continued visits with that provider,” Maiga said.

The campaign’s website lists walk-in primary care clinics around the city. It also has a guide for how to talk to health care providers about substance use and tools for clinicians for assessing people who use stimulants.

Limited of treatment options

Part of the challenge of helping people who use stimulants is that no medication exists to reduce cravings or to help prevent and reverse overdoses.

For people who use opioids, there are medications, like methadone and buprenorphine, which help reduce cravings and dependency. Narcan, the brand name for naloxone, reverses opioid overdoses by temporarily blocking their effects.

Although research is ongoing, the U.S. Food and Drug Administration has not approved such medications for cocaine or meth addiction. In the meantime, contingency management – which offers monetary or other tangible rewards for people who reach specific goals for reducing or stopping cocaine or meth use – is considered the most effective treatment for people addicted to stimulants.

The health department wants providers to consider a harm-reduction approach, advising that “reduction in stimulant use is often more achievable than total abstinence” and that “reduced use improves health outcomes” and “should be considered a valid, positive outcome for patients who use stimulants.”

Prediction as means to help prevention

Penn’s Dr. Harris hopes the stimulant overdose prediction model she and her colleagues developed will assist in efforts to address the dangers of using cocaine, meth and other stimulants.

Limitations of the study include the fact that it was confined to people with Medicaid and only looked at overdoses that resulted in emergency department visits. While more research is needed, Harris said the tool has potential for integration into public health surveillance systems. It could help identify not just individuals at risk of stimulant overdoses, but also neighborhoods that could benefit from targeted interventions, she said.

“Part of prevention is being able to match the intervention and resources to the individuals who would most benefit from it,” Harris said.