Philadelphia overdose deaths are surging, the latest data show, to such an extent that the city is calling on all residents to arm themselves with overdose reversal medication. 

A total of 1,413 overdose deaths — most of which involved fentanyl — were reported in 2022, the city’s public health department announced Monday, an 11 percent increase from the previous year. Deaths of Black Philadelphians increased the most, by nearly 20 percent. 

Crime, drug addiction, and homelessness have become the focus of the city’s heated mayoral race as Philadelphia’s Democratic leadership has come under fire for its lack of law enforcement. 

In the city’s announcement about the increase in overdoses, it encourages a “community-based harm reduction” approach by encouraging “all Philadelphians to obtain, carry, and get trained to use naloxone,” also known as Narcan, a medication that can reverse opioid overdoses. 

Doctors and public health agents say making Narcan more accessible saves lives, but similar policies at New York have raised concerns — including by the Wall Street Journal’s editorial board — about whether calling on private citizens to treat overdoses on the streets demonstrates a failure of government officials to address the drug epidemic. 

Additionally, though xylazine — an animal tranquilizer that is mixed with illicit drugs and can cause flesh-rotting in humans — is present in all 50 states, Philadelphia is the ground zero of the xylazine crisis, with more than 90 percent of the city’s street opioid samples found to contain the substance. Narcan doesn’t counteract xylazine, posing an additional challenge to harm reduction efforts. 

“We’re trying to do community distribution of saturation of Narcan, but Narcan doesn’t work for xylazine. I mean, we would never stop using Narcan, we want to give as much Narcan as we can,” a physician assistant who treats patients affected by drug addiction at Philadelphia, Baltimore, and Washington, D.C., Jonathan Cohen, tells The New York Sun. 

“When these patients arrive to us in an emergency department situation, they have a pulse, they have an airway, but they are still sort of stuporous for a really long time. There’s no reversal agent but time,” he says. “Where things are now with emergency department crowding, we’ll have people that will sit in front of the triage desk for hours” waiting for the xylazine to wear off, Mr. Cohen adds. 

Philadelphia’s mayor, Jim Kenney, who could not be reached by the Sun for comment, has been supportive of sites that would make injecting drugs safe and accessible. The mayor has long faced criticism that he is mismanaging the city.

“The 2022 overdose report underscores the urgent need for greater awareness and more tools to fight the growing overdose epidemic at Philadelphia and across the U.S.,” Mr. Kenney said on Monday. “It is no longer accurate to call this an opioid epidemic; it is an overdose epidemic driven by an increasingly contaminated drug supply.”

The city’s public health department plans to go door-to-door to up to 600 houses a day, as well as launch a press and mail campaign to encourage residents to learn about overdose prevention. It also plans to distribute Narcan and to give out fentanyl and xylazine test strips, all of which, the health department says, can “literally save the life of a friend or loved one.” Representatives of the department did not respond to requests for comment by the Sun.

Although distributing Narcan can save lives, “it’s an indication that something has gone terribly wrong” when a city urges private residents to keep the medicine on hand “and be on the lookout for drowsy strangers or fentanyl poisoning on the playground,” the Wall Street Journal editorial board wrote when New York City urged for a similar approach.