Pure and cheap, Philadelphia is known to have the best heroin on the East Coast, said Prevention Point Executive Director Jose Benitez, as he addressed a crowd at Penn’s Houston Hall last week. “It’s a really good high, as our guys call it.”

And fentanyl, he added, which is equally inexpensive and can be bought online, “is an even better high than heroin.”

Easy access only adds to the “perfect storm,” as Benitez called it, that has cultivated the city’s opioid epidemic seen today. Last year, Philadelphia saw more than 1,200 lives claimed from drug overdoses, mainly involving opioids—an unfortunate, growing trend. Earlier this month, Governor Wolf even declared the crisis a statewide disaster emergency.

“If these numbers keep climbing,” Benitez said, deaths in Philadelphia will be close to 1,500 in 2018 “if we don’t do something about this soon.”

Benitez’ talk, a free, open-to-the-public “streets perspective” seminar hosted by the Center for Public Health Initiatives (CPHI), touched on the overprescribing of opioids, barriers to treatment, stigma, provider bias, and the vital need to have naloxone on hand. Specifically, he noted how most people don’t know about the standing order allowing access—without a prescription—to the medication, which reverses an opioid overdose.

“If you all don’t have naloxone in your possession, you need to go to your pharmacist today,” he said, adding that Prevention Point also gives it out for free. “Give this stuff out like water.”

He also discussed Philadelphia’s potential for safe injection sites, what he called the “elephant in the room.” Less than a week later, city officials announced support for the sites, a consequential decision for the city, concluding they’d be an important harm reduction measure.

Bringing speakers with unique experiences and perspectives like Benitez to campus only scratches the surface of all the ways CPHI is playing a role in addressing the opioid epidemic. Its interdisciplinary team of faculty members, researchers, and students have been proactive for years in “taking the bull by the horns and doing something as meaningful and as quickly as possible,” says Jennifer Pinto-Martin, CPHI’s director.

For instance, CPHI Senior Fellow Douglas Wiebe, director of the Penn Injury Science Center, and Sara Solomon, the center’s deputy director, are leading a new working group funded by the Leonard Davis Institute at Penn that will inform the process of where a potential safe injection site would go in Philadelphia.

“We are conducting a needs assessment to help address the location question,” explains Wiebe. “With our report, we can present it to the city and they can consider it when making it their decision.”

One approach the group is taking is a mapping exercise, where they will look at different features of the city’s built and social environments, mapping each layer and scoring them.

“Each block in the city will be scored from high to low on its suitability,” Wiebe says. “What do we mean by that? Well, we will be pulling together criteria, for example, it needs to be near public transportation, away from gentrification pressures, and within a certain distance from other health services.”

After figuring out structurally and socially the top three suited places in Philadelphia for a safe injection site, they will go to the areas and interview residents and business operators, as well as opioid users, to garner thoughts on whether they think it’d be a reasonable fit.

“Injection drug users want to be part of the solution,” says CPHI Senior Fellow Evan Anderson, a member of the working group and a senior lecturer in the School of Nursing.

“They make decisions about where they inject out of concern for the community,” he continues, drawing evidence from a study he published with recent Penn alumnus Robert Harris. “But by putting themselves in secluded spaces, they are exposing themselves to fatal overdose or infection.”

When thinking about the opioid epidemic, it’s inevitable to point to problems about space, “and the riskiness of locations,” Anderson adds. “I’d like to think our working group can measurably improve the risk environment for injection use in Philadelphia.”

Like Anderson, most folks involved with CPHI are well-aware of the ways social environments can influence health. Carolyn Cannuscio, CPHI’s director of research, takes particular interest in public libraries, and the role their staff members play as community health specialists. A recent study Cannuscio led found 12 percent of public libraries in Pennsylvania experienced an opioid overdose on site in the last year.

To address this issue, Cannuscio and her team at the Healthy Library Initiative, along with Prevention Point and the Philadelphia Department of Public Health, have been designing and implementing extensions of already-established health trainings to educate library staff on the use of naloxone. There will also be convenient “drop in” trainings for community residents.

“We will demonstrate how to recognize the signs of an opioid overdose, how to engage a person who is showing potential signs, show how to administer Narcan, and how to get that person appropriate care once the overdose is reversed,” she says, adding that CPHI and Healthy Library Initiative staff will use the same model to train library workers from all over the country at the Public Library Association’s national conference in March.

Penn Nursing’s state-of-the-art Helene Fuld Pavilion for Innovative Learning and Simulation—a practice lab for learning clinical skills—is playing host to a variety of trainings, too.

Pinto-Martin, a professor in Penn Nursing and the Perelman School of Medicine, and Annie Hoyt Brennan, Penn’s simulation education specialist, are planning their first opioid-centered event for Feb. 23, where attendees can experience a scenario of a heroin and fentanyl overdose by a standardized patient, or actor, and learn the best way to respond. Utilizing the lab’s high-fidelity simulators and task trainers, participants will be able to practice administering Narcan. The time of the event is still being determined. For more information, contact Graceann Palmarella at gpalm@pennmedicine.upenn.edu. 

“We are combining the actor with the simulator to give you a full picture of what this looks like, and what you can do about it,” says Pinto-Martin. She says they also plan to have the session taped to make it available for an online audience, boosting accessibility.

“With Philadelphia and its increased amount of deaths from opioid use, it’s just so important we reach out to the community and give back,” says Brennan. “This is one way we can educate and disseminate knowledge.”

Pinto-Martin agrees.

“That’s what public health is all about, identifying problems that are in our community that we can do something about,” she says.