Opioid overdoses are nearing record levels in the city that's become a 'mecca' for addicts

During the first weekend of December, nine people died of apparent drug overdoses in and around Kensington, a neighborhood in northern Philadelphia.

Those deaths came just weeks after the city, which has become a "mecca" for addicts, saw 50 overdoses — five of them fatal — in one day on November 17.

Philadelphia's overdose deaths have put the city on pace to hit 900 fatal overdoses this year, a 30% increase over last year and a number that would triple the city's homicide rate, according to The Philadelphia Inquirer.

The cause of death for the nine overdoses over the weekend has yet to be verified, but authorities said all seemed to be related to drug use.

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The overdoses on November 17 are believed to be the result of heroin laced with fentanyl, a potent painkiller that can be 50 times stronger than heroin and 100 times stronger than morphine, according to the US Centers for Disease Control and Prevention.

The additional deaths this weekend may have also been caused by fentanyl, Jose Benitez, executive director of the nonprofit Prevention Point Philadelphia, told The Inquirer.

Philadelphia usually sees three overdoses a day, not all of which are fatal, said Benitez, whose organization provides health services to drug addicts. On a typical day, Benitez's group typically hands out four or five kits with the opioid antidote Naloxone.

On November 18, it handed out 75.

'It's killing people slowly'

fentanyl heroinReuters/Andy Clark

Philadelphia, and the neighborhood of Kensington in particular, has become a focal point for the US's deepening opioid crisis.

Reports this summer indicated the city was seeing an influx of a cheap, highly potent version of heroin, thought be pushed by Mexico's Sinaloa cartel, which has expanded heavily into the synthetic-drug trade recently.

One addict who spoke to the LA Times in July said Philadelphia had become a "mecca" for out-of-towners looking for the drug.

Philadelphia Mayor Jim Kenney called Kensington the "epicenter of the city's opioid use" on Monday.

Kensington Philadelphia heroin use drug distribution mapReuters/Andy Clark

"The purity is the best on the East Coast, and it's easily accessible," Patrick Trainor, spokesman for the US Drug Enforcement Agency in Philadelphia, told the LA Times. "It definitely draws people."

The city is centrally located among the Mid-Atlantic's heroin markets, and it sits alongside Interstate 95, a major artery for illegal drug smuggling.

I-95 is also adjacent to Kensington, which narcotics officers who spoke to the LA Times this summer called one of the "most flagrant open-air drug markets" on the eastern seaboard.

Emergency responders and researchers are often behind the curve when it comes to identifying the drugs in use during such crises, The Inquirer notes.

Related: What opioids do to your health

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Opioid painkillers capitalize on our body's natural pain-relief system. We all have a series of naturally produced keys ("ligands") and keyholes ("receptors") that fit together to switch on our brain's natural reward system — it's the reason we feel good when we eat a good meal or have sex, for example. But opioids mimic the natural keys in our brain — yes, we all have natural opioids! When they click in, we can feel an overwhelming sense of euphoria.

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Opioid painkillers can have effects similar to heroin and morphine, especially when taken in ways other than prescribed by a doctor.

When prescription painkillers act on our brain's pleasure and reward centers, they can make us feel good. More importantly, though, they can work to reinforce behavior, which in some people can trigger a repeated desire to use.

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You may also feel sleepy.

Opioids act on multiple brain regions, but when they go to work in the locus ceruleus, a brain region involved in alertness, they can make us sleepy. Why? The drugs essentially put the brakes on the production of a chemical called norepinephrine, which plays a role in arousal.

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Your skin may feel flushed and warm.

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You'll begin to feel their effects 10 to 90 minutes after use, depending on whether they're taken as directed or used in more dangerous ways.

Some drugmakers design versions of their medications to deter abuse. Extended-release forms of oxycodone, for example, are designed to release slowly when taken as directed. But crushing, snorting, or injecting the drugs can hasten their effects.

It can also be deadly. Between 2000 and 2014, nearly half a million Americans died from overdoses involving opioid painkillers and heroin, a report from the US Centers for Disease Control and Prevention found. The most commonly prescribed painkillers were involved in more overdose deaths than any other type of the drug.

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Your breathing will slow as well.

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Depending on the method used, the effect can last anywhere from four to 12 hours.

For severe pain, doctors typically prescribe opioid painkillers like morphine for a period of four to 12 hours, according to the Mayo Clinic. Because of their risks, it's important to take prescription painkillers only according to your physician's specific instructions.

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Overdosing can stop breathing and cause brain damage, coma, or even death.

2014 report from the American Academy of Neurology estimates that more than 100,000 Americans have died from prescribed opioids since the late 1990s. Those at highest risk include people between 35 and 54, the report found, and deaths for this age group have exceeded deaths from firearms and car crashes.

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Combining them with alcohol or other drugs — even when taken according to the directions — can be especially deadly.

Since they slow breathing, combining opioid painkillers with other drugs with similar effects can drastically raise the chances of accidental overdose and death.

Yet they're often prescribed together anyway, according to the National Institute on Drug Abuse. "Unfortunately, too many patients are still co-prescribed opioid pain relievers and benzodiazepines [tranquilizers]," the institute said. In 2011, 31% of prescription opioid-related overdose deaths involved these drugs.

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Abusing opioid painkillers has been linked with abusing similar drugs, like heroin.

A CDC report found that people who'd abused opioid painkillers were 40 times as likely to abuse heroin compared with people who'd never abused them. The National Institute on Drug Abuse says that close to half of young people surveyed in three recent studies who'd injected heroin said they'd abused prescription painkillers before they started using heroin.

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You may also develop a tolerance for the drugs so that you need more to get the same effect over time.

Tolerance to opioid painkillers happens when the brain cells with opioid receptors — the keyholes where the opioids fit — become less responsive to the opioid stimulation over time. Scientists think that this may play a powerful role in addiction.

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Suddenly stopping the drugs can result in withdrawal symptoms like shakiness, vomiting, and diarrhea.

Taking prescription painkillers for an extended period increases the likelihood that your brain will adapt to them by making less of its own natural opioids. So when you stop taking the drugs, you can feel pretty miserable. For most people, this is uncomfortable but temporary.

But in people who are vulnerable to addiction, it can be dangerous because it can spurn repeated use.

"From a clinical standpoint, opioid withdrawal is one of the most powerful factors driving opioid dependence and addictive behaviors," Yale psychiatrists Thomas Kosten and Tony George write in a 2002 paper in the Journal of Addiction Science & Clinical Practice.

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Some labs have equipment that is not able to recognize newer drugs, and, in some cases, the amount of the narcotic in the bloodstream is so minute as to avoid detection.

"I'm really concerned by what we're hearing now," Roland Lamb, and official with Philadelphia's Department of Health, told The Inquirer. "I'm very concerned."

Hard drugs like heroin and related narcotics like fentanyl have gained traction with a broader base of users in recent years, in part because of profligate use of prescription pain medicine that often hooks users and leaves them craving stronger highs.

In response to those urges, many users turn to heroin, with additives like fentanyl seeping into batches as addicts clamor for stronger doses.

Mexican cartels heroin USReuters/Andy Clark

The spread of the crisis has stirred alarm around the US and prompted a resurgence of ineffective and counterproductive punitive responses. Opioid addiction and drug use has also become common in working-class and Rust Belt communities.

Victor Colon, a Philadelphia man who died of an overdose this weekend, had surgery for a knee infection at the beginning of this year, for which he was prescribed pain medication. According to The Inquirer, his family thinks that may have led him into heroin addiction.

"It's just this heroin. This heroin. It's killing people slowly," Colon's sister, Edna Villafane said. "I don't think the meaning of brotherly love is here anymore."

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