(U) This product was prepared by the DEA Philadelphia Division

and the University of Pittsburgh. Comments and questions may be

addressed to the Chief, Analysis and Production Section at

dea.onsi@usdoj.gov. For media/press inquiries call (202) 307-7977.

DEA-PHL-DIR-034-17 JULY 2017

Analysis of Overdose Deaths 

in Pennsylvania, 2016

JOINT 

Intelligence 

REPORT

UNCLASSIFIED

UNCLASSIFIED
Table of Contents

Executive Summary .........................................................................................................................

Background.........................................................................................................................................

Key Findings.......................................................................................................................................

Methodology .....................................................................................................................................

Data Overview.....................................................................................................................................

Toxicology.........................................................................................................................................

Comparison between 2015 and 2016............................................................................................................ 

Toxicology Overview............................................................................................................................................. 

Toxicology Trends by County............................................................................................................................ 

Toxicology Trends by Time................................................................................................................................. 

Toxicology Trends by Drug Category............................................................................................................. 

Demographics.................................................................................................................................

Age................................................................................................................................................................................

Gender.........................................................................................................................................................................

Race..............................................................................................................................................................................

Gender and Age.......................................................................................................................................................

Race and Age............................................................................................................................................................

Race and Gender.....................................................................................................................................................

Data Challenges..............................................................................................................................

County Analysis..............................................................................................................................

Outlook..............................................................................................................................................

Bibliography.....................................................................................................................................

Appendix...........................................................................................................................................

Tables..........................................................................................................................................................................

Overdose Death Counts by County.................................................................................................................

Overdose Data by District Overdose................................................................................................................

Data by County.........................................................................................................................................................

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4

5

6

8

11

20

27

28

28

28

29

29

35

36

44

20

21

22

24

25

26

11

11

13

14

15
UNCLASSIFIED 3

Executive Summary

The Commonwealth of Pennsylvania is in 

the midst of an unprecedented epidemic of 

drug abuse and drug-related overdose deaths 

impacting every corner of the state and all 

of its residents. In 2016, more than 4,600 

Pennsylvanians died as a result of drug abuse, 

with thousands more affected by addiction, 

either personally, or through family, friends, and 

loved ones. 

The analysis of drug-related overdose death 

data plays a pivotal role in law enforcement’s 

efforts to identify and combat drug suppliers, 

and ultimately drug abuse and related 

overdoses. At the most basic level, the drugs 

that contribute to death are an indicator of drug 

availability in the user market. Analysis of this 

data also highlights geographic patterns of 

abuse and identifies at-risk populations, and 

when coupled with drug treatment statistics, 

law enforcement drug seizure data, and public 

health indicators, allows for multi-disciplinary 

data-driven decisions regarding resource 

placement and strategic initiatives. 

In addition, disseminating the results of this 

analysis contributes to a robust information 

sharing environment amongst law enforcement, 

public health, and public policy entities in 

support of our unified efforts to fight the scourge 

of drug abuse in Pennsylvania.

The coroners and medical examiners of 

Pennsylvania are critically important partners 

in the joint endeavors of the aforementioned 

stakeholders and are commended for their 

efforts in data collection and sharing, especially 

in light of the limited resources of personnel, 

equipment, and budgets that impact many.

The DEA Philadelphia Field Division requested 

assistance from the University of Pittsburgh, 

School of Pharmacy, Program Evaluation 

Research Unit (PERU), Technical Assistance 

Center (TAC), in analyzing this public health 

data. I extend my gratitude to PERU Director Dr. 

Janice Pringle, and the TAC, including Program 

Director Dr. Lynn Mirigian and Research 

Specialists Laken Ethun, Allison Burrell, Erin 

Straw, and Marco Pugliese, for their assistance 

in interpretation and visualization of the data. 

Through this collaboration, DEA is able to ensure 

the Commonwealth’s stakeholders and citizens 

receive a professional and accurate analysis 

generated by experts in the law enforcement 

and public health fields.

Gary Tuggle

Special Agent in Charge

U.S. Drug Enforcement Administration

Philadelphia Division

The collection, analysis, and 

dissemination of overdose 

death data contributes to a 

robust information sharing 

environment amongst the fields 

of law enforcement, public health, 

treatment, and public policy, all 

of whom are working together 

to address the drug crisis in 

Pennsylvania.
4 UNCLASSIFIED

Background UNCLASSIFIED

In 2008, the DEA Philadelphia Field Division 

(PFD) Intelligence Program initiated a data 

collection process in Philadelphia County 

to collect drug-related overdose death data. 

This collection process continued for several 

years, expanding to statewide collection 

of drug-related overdose death data from 

Pennsylvania’s 67 counties in 2013; the PFD 

published statewide overdose death reports 

reflecting 2014 and 2015 data in 2015 and 

2016, respectively. These reports were used 

by law enforcement to drive investigations into 

drug trafficking organizations (DTOs) and to 

identify trends in drug distribution and use. They 

also provided vital data for state and county 

law enforcement agencies, public health and 

treatment entities, and opioid overdose focused 

task forces to use in making informed decisions 

regarding resource allocations and to develop 

strategies to address the overdose epidemic.

In late 2016, the PFD requested the assistance 

of the University of Pittsburgh, School of 

Pharmacy, Program Evaluation Research Unit 

(PERU), Technical Assistance Center (TAC) in 

the analysis of Pennsylvania’s drug-related 

overdose death data. The expertise of the TAC 

in the analysis and interpretation of public 

health data, which is outside the traditional 

scope of law enforcement intelligence analysis, 

resulted in the creation of this scientifically 

sound statewide overdose report that meets 

established standards for public health and law 

enforcement data analysis and production. This 

partnership is an example of the type of crossdisciplinary collaboration required to develop 

and implement effective strategies to combat 

the drug overdose crisis in Pennsylvania.

OverdoseFreePA (www.overdosefreepa.pitt.edu) 

is an interactive website developed, hosted, 

and maintained by the University of Pittsburgh, 

School of Pharmacy, PERU. OverdoseFreePA 

provides a variety of information related to the 

current crisis of opioid overdose and substance 

use disorder and is tailored to five audiences: 

friends and family, health professionals, public 

safety professionals, persons using opioids, and 

people in recovery. 

Additionally, OverdoseFreePA works with 22 

coroners and medical examiners across the 

Commonwealth to collect, standardize, analyze, 

and present drug-related overdose death 

information. Coroners and medical examiners 

who participate submit overdose death data 

directly to the website via an online form or bulk 

submission, where it is analyzed by public health 

personnel trained in standardizing toxicology 

test results using a protocol developed by Dr. 

Karl Williams, Medical Examiner of Allegheny 

County, Pennsylvania1,i. 

i Full descriptions of the data standardization processes can be found at 

www.overdosefreepa.pitt.edu/datastandardization.

The opioid overdose crisis in 

Pennsylvania and across the 

United States is a public health and 

public safety emergency.
UNCLASSIFIED 5

Key Findings

In 2016, 4,642 drug-related overdose deaths 

were reported by Pennsylvania coroners 

and medical examiners, an increase of 37 

percentii from 2015. In 2016, approximately 

13 people died of a drug-related overdose 

each day. 

The Pennsylvania drug-related overdose 

death rate in 2016 was 36.5 per 100,000 

people, an increase from 26.7iii per 100,000 

people in 2015. The national drug overdose 

death rate in 2015 was 16.3 per 100,000.2

The presence of an opioid,iv illicit or 

prescribed by a doctor, was identified in 85 

percent of drug-related overdose deaths in 

Pennsylvania in 2016.

Fentanyl and fentanyl–related substancesv

(FRS) were the most frequently identified 

in decedents (52 percent of deaths), a 

significant increase from 2015 when 

fentanyl/FRS were noted in 27 percent of 

deaths. More than 95 percent of counties 

reporting drug-related overdose deaths in 

2016 indicated the presence of fentanyl/

FRS.

Heroin was the second most frequently 

identified substance in decedents 

(45 percent of deaths), followed by 

benzodiazepines (33 percent of deaths), 

cocaine (27 percent of deaths), and 

prescription opioids (25 percent of deaths). 

Of counties reporting drug-related overdose 

deaths in 2016, 95 percent showed the 

presence of heroin.

In 2016, individuals aged 15-24 saw a 380 

percent increase in the presence of fentanyl 

in toxicology reports compared to other age 

groups. Conversely, individuals in the 25-

34 age group experienced a 970 percent 

increase in instances of fentanyl present in 

toxicology reports compared to other age 

groups. 

The percent increase in drug-related 

overdose deaths between 2015 and 2016 

was larger in rural counties (42 percent) 

compared to urban counties (34 percent).vi

In 2016, 70 percent of drug-related overdose 

decedents were male, consistent with 2015, 

but not consistent with the population 

distribution across Pennsylvania. 

Males were more likely to die from a fentanyl 

and/or heroin overdose compared to 

females. Females were more likely to have 

alprazolam, clonazepam, and/or oxycodone 

present in overdose deaths, while males 

were more likely to have fentanyl, heroin, 

cocaine, and/or ethanol present in overdose 

deaths. 

In 2016, 77 percent of decedents were 

White, 12 percent were Black, 4 percent 

were Hispanic, and 7 percent were identified 

as Other, consistent with 2015 and the 

population distribution across Pennsylvania. 

Finally, the continued lack of standardized 

and centralized reporting of drug-related 

overdose death data in Pennsylvania inhibits 

timely analysis necessary for stakeholders to 

drive decision-making. Efforts must continue 

amongst the myriad data collectors to 

streamline compilation and develop a 

common mechanism for information sharing 

that serves the public interest.

iiCorrected value of 3,376 for 2015 drug-related overdose deaths in 

Pennsylvania

iiiAdjusted based on updated overdose death counts from 2015.

ivSee Figure 1 for list of opioids included in this analysis

v

See Figure 1 for list of fentanyl-related substances (FRS) included 

this analysis

viSee Appendix Table 1 for list of urban and rural counties
6

Methodology

UNCLASSIFIED

UNCLASSIFIED

The PFD requested information on drug-related 

overdose deaths from Pennsylvania’s coroners 

and medical examiners for 2016, to include the 

following data points: 

 Coroner Name and Reporting County

 Death date and time 

 Manner of death (ex. accidental, 

 undetermined, suicide)

 Demographic information (ex. age, 

 gender, race)

 Incident and Resident Zip Codevii

 Drugs found in toxicology report

For this report, only drug-related overdose 

deaths ruled accidental or undetermined 

(if provided and toxicology was present) 

were analyzed.viii Suicides were excluded 

due to previous studies demonstrating 

the toxicology, demographic information, 

genetic predisposition, and other factors of 

suicide decedents are dissimilar to those of 

accidental overdose.3 The PFD received data 

on 4,642 accidental or undetermined drugrelated overdose deaths from 64 counties in 

Pennsylvania. 

The data collection process varied by county 

and included submissions directly to the PFD, 

as well as to TAC via OverdoseFreePA. Data 

submitted directly to TAC was shared with 

the PFD upon request and with agreement 

from the submitting coroner or medical 

examiner. Counties that do not participate on 

OverdoseFreePA shared information with the 

PFD directly. 

The data request for 2016 overdose deaths was 

made in April 2017; therefore, it is possible that 

additional deaths were finalized by coroners/

medical examiners after that date, and were not 

included in the county and statewide totals. 

While collecting and verifying overdose related 

information for the 2016 report, data from 2015 

was simultaneously verified with coroner and 

medical examiner offices. The total number 

of drug-related overdose deaths in 2015 was 

adjusted to 3,376 (previously reported as 3,383). 

With the assistance of the TAC, death data 

was standardized in accordance with the 

aforementioned protocol to determine drug and 

metabolite relationships. Once standardization 

was complete, drugs of interest (see Figure 

1) were selected for analysis based on law

enforcement intelligence regarding frequency

of abuse and diversion, as well as those

identified as the most common drugs present

in drug-related overdose deaths by national

public safety and public health sources.

Drugs of interest present in toxicology reports

were combined into the following categories

described in Figure 1.

In addition, ethanol was analyzed as a separate 

category in the demographic analysis of drugrelated overdose deaths due to its propensity 

to exacerbate the effects of other drugs 

when used in combination.4 Methadone and 

buprenorphine were analyzed and reported 

independently from other drug categories in the 

statewide toxicology analysis due to differences 

in supply, availability and use patterns when 

compared to other drug categories.

For the full description of each drug and its 

corresponding placement in the Controlled

VIIOnly 34.8 percent of the death data included zip code, therefore, further 

analysis was not conducted due to lack of representative data.

VIIIExcept for Lycoming County, where deaths ruled as homicides were 

included in the data set per the Coroner’s decision detailed in “Heroin 

Overdoses will now be considered homicides,” PennLive, March 23, 

2016. 
UNCLASSIFIED 7

Urban and rural rates were calculated using the 

following population adjusted rate formula: 

 ((Number of drug related deaths)/(Sum 

Rate= of Population of Rural or Urban 

 Designated Counties)) x 100,000 people

At the PFD’s request, the TAC used logistical 

regression modeling to measure the effect of 

age, race, and gender on fentanyl and heroin 

deaths. The logistic regression models shown 

here can be utilized as predictive measures, in 

that they predict the odds of a heroin or fentanyl 

death based on three dependent variables: 

gender, age, and race. Eight age groups 

(Young: 0-14, 15-24, and 25-34; Middle Aged: 

35-44, 45-54; and Older: 55-64, 65-74, 75+), five

racial groups (Black, White, Hispanic, Other,

and Unknown), and two genders (male and

female), were used for the analysis to determine

statistical significance.

UNCLASSIFIED

Substances Act (CSA), please see Appendix 

Table 3. Due to lack of available data (see Data 

Challenges section for more information), 

synthetic cathinones, synthetic cannabinoids, 

and marijuana were not included in this analysis. 

Rates were calculated to allow the number of 

overdose deaths to be compared in relation to 

the population size of each county. Across all 

analyses, rates were determined using the 2010 

U.S. Decennial Census.5 Across all analyses, 

rates were determined using the 2010 U.S. 

Decennial Census. The following formula was 

used to calculate county-specific and state-level 

rates throughout the analysis: 

 ((Number of drug related deaths)/

Rate=(Population within county)) x 100,000 

 people

Drug Category Substances Included in Analysis

Benzodiazepines Alprazolam

Chlordiazepoxide

Clonazepam

Delorazepam

Diazepam

Estazolam

Flurazepam

Lorazepam

Midazolam®

Oxazepam

Temazepam

Cocaine

Fentanyl/Fentanyl-Related 

Substances (FRS)/Non-Prescription Synthetic Opioids 

(NPSOs)

3-Methylfentanyl

4-Methoxy-Butyryl Fentanyl

Acetyl Fentanyl

Acryl Fentanyl

Carfentanil

Fentanyl

Fluorobutyrfentanyl

Fluorofentanyl

Furanyl Fentanyl

Para-Fluoro-Isobutyryl Fentanyl/FIBF

Sufentanil

U-47700

Heroin

Other Illicit Drugs Lysergic Acid Diethylamid (LSD)

Methylenedioxy-amphetamine (MDA)

3,4-Methylenedioxymethamphetamine (MDMA)

Methamphetamine

Phencyclidine (PCP)

Prescription Opioids Hydrocodone

Hydromorphone

Meperidine

Morphine

Oxycodone

Oxymorphone

Tapentadol

Tramadol

(U) Figure 1: Drugs Included in Analysis of Drug-Related Overdose Deaths, Pennsylvania, 2016

Source: DEA Philadelphia Field Division
8

 Data Overview

UNCLASSIFIED

UNCLASSIFIED

In 2016, Pennsylvania coroners and medical 

examiners reported 4,642 drug-related overdose 

deaths. The rate of drug-related overdose 

deaths in Pennsylvania increased from 26.7ix per 

100,000 in 2015 to 36.5 per 100,000 in 2016, 

far exceeding the national average (16.3 per 

100,000)6. Among individual counties, rates 

ranged from 0.00 to 74.10 per 100,000 people. 

Figure 2 depicts the counties in the highest 

25 percent, upper 25-50 percent, lower 25-50 

percent, and lowest 25 percent with regard to 

overdose rates per 100,000 people. A full listing 

of county rankings from highest overdose rate to 

lowest can be found in Table 1.

Philadelphia County dropped in rank from first 

to fifth in rate of overdose deaths, despite a 26 

percent increase in the raw number of overdose 

deaths; 2016 is the first year of this reporting 

that Philadelphia did not rank first among the 

Pennsylvania counties in the rate of overdose 

deaths.

ixAdjusted based on updated overdose death counts from 2015.

(U) Figure 2: Rate of Drug-Related Overdose Deaths per 100,000 people in Pennsylvania Counties,

2016

Source: Pennsylvania Coroner/Medical Examiner Data

The drug-related overdose death 

rate in Pennsylvania in 2016 is 

36.5 persons per 100,000.
UNCLASSIFIED 9

UNCLASSIFIED

2016 Rank 2015 Rank County 2016 Rate 2016 Rank 2015 Rank County 2016 Rate

1 32 Fulton 74.1 35 46 Mercer 26.6

2 3 Cambria 65.4 36 49 Franklin 26.1

3 29 Beaver 59.8 37 19 Carbon 26.1

4 5 Armstrong 59.5 38 55 Clinton 25.5

5 1 Philadelphia 59.4 39 23 Wyoming 24.8

6 10 Allegheny 52.9 40 39 Cumberland 24.6

7 9 Washington 51.0 41 25 Monroe 24.1

8 4 Indiana 50.6 42 26 Northampton 23.5

9 6 Greene 49.1 43 47 Lancaster 22.3

10 11 Westmoreland 47.6 44 53 Bedford 22.1

11 17 Fayette 43.9 45 61 Perry 19.6

12 12 Lawrence 43.9 46 51 Chester 19.4

13 18 Luzerne 43.6 47 50 Susquehanna 18.5

14 21 Butler 40.2 48 56 Clarion 17.5

15 42 Schuylkill 39.8 49 52 Pike 17.4

16 14 Lackawanna 39.2 50 33 Venango 16.4

17 13 Lehigh 38.3 51 64 Juniata 16.2

18 7 Delaware 36.9 52 36 McKean 16.1

19 15 Crawford 36.1 53 63 Union 15.6

20 40 Blair 33.8 54 45 Sullivan 15.6

21 8 Wayne 32.2 55 37 Jefferson 15.5

22 24 Erie 32.1 56 38 Huntingdon 15.2

23 16 Dauphin 31.3 57 59 Tioga 14.3

24 30 Lycoming 29.3 58 44 Clearfield 13.5

25 28 York 29.2 59 57 Centre 13.0

26 34 Montgomery 28.8 60 54 Mifflin 12.9

27 41 Northumberland28.6 61 48 Lebanon 12.0

28 43 Berks 28.4 62 62 Potter 11.5

29 60 Adams 27.6 63 58 Elk 9.4

30 2 Montour 27.4 64 65 Snyder 7.6

31 22 Bradford 27.1 65 66 Cameron 0.0

32 31 Somerset 27.0 65 20 Forest 0.0

33 35 Bucks 26.9 65 66 Warren 0.0

34 27 Columbia 26.7

(U) Table 1: Ranking of the Rate of Drug-Related Overdose Deaths per 100,000 People in

Pennsylvania Counties, 2015 and 2016

Source: Pennsylvania Coroner/Medical Examiner Data
10

 Data Overview

UNCLASSIFIED

UNCLASSIFIED

Within the top 10 counties, the distribution of 

rural and urban counties was similar to 2015; 

six rural counties were ranked in the top 10 in 

2016, compared to seven in 2015. Of note, 78 

percent of counties that reported an overdose 

death in 2016 had rates per 100,000 people that 

exceeded the national average.

Between 2015 and 2016, there was a 37 percent 

increase in the number of drug-related overdose 

deaths in Pennsylvania. The change in deaths 

(percent) from 2015 to 2016 varied across 

the counties and ranged from a 37.5 percent 

decrease to a 300 percent increase. Figure 3 

depicts the counties in the highest 25 percent, 

upper 25-50 percent, lower 25-50 percent, and

 lowest 25 percent of percent change from 2015 

to 2016. In 2016, the number of drug-related

overdose deaths increased in 53 counties (79 

percent), compared to 14 counties (21 percent) 

where there was a decrease or no change in the 

number of overdose deaths. There was a larger 

percent increase (42 percent) in the number of 

drug-related overdose deaths in rural counties 

than urban counties (34 percent) from 2015 to 

2016.

(U) Figure 3: Percent Change in Drug-Related Overdose Deaths in Pennsylvania Counties, 2015-2016

Source: Pennsylvania Coroner/Medical Examiner Data

78 percent of Pennsylvania 

Counties had overdose death rates 

higher than the national average.
UNCLASSIFIED 11

UNCLASSIFIED Toxicology

In 2016, the number of drug-related overdose 

deaths increased among each of the identified 

drug categories from 2015 (see Table 2). 

Fentanyl/FRS/NPSOs demonstrated the largest 

increase (130 percent). Heroin, the most 

frequently reported drug in 2015, increased 23 

percent from 2015 to 2016. In order to allow for 

cross year comparison, morphine was attributed 

to heroin, not prescription opioids, in this section 

of the report.XI However, in the remainder 

of the report, morphine was attributed to 

prescription opioids pursuant to the toxicology 

standardization protocol named earlier.

Although the category of Other Illicit Drugs 

increased by 56 percent from 2015 to 2016, the 

drugs contained within the category were 

represented in only 5.5 percent of deaths 

in 2016. Methamphetamine saw the largest 

increase from 2015 to 2016 but remained 

present in low levels when compared to other 

drugs.

Within toxicology reports of the 2016 drugrelated overdose deaths, 208 different drugs 

were identified. Of the 4,642 drug-related 

overdose deaths, 83.5 percent contained two or 

more drugs, 40 percent contained four or more 

drugs, and 12.5 percent contained six or more 

drugs in the associated toxicology reports. 

Figure 4 demonstrates the presence of each 

analyzed substance in the dataset. 

When the drugs were narrowed by category of 

interest, fentanyl/FRS/NPSOs were observed in 

more than half of the decedents (52 percent). 

Heroin, the most identified drug in 2015, was 

second most prevalent in 2016 (45 percent). 

Benzodiazepines, which included 11 individual 

substances, were the third most prevalent (33 

percent), followed by cocaine (27 percent). 

Prescription opioids, which included eight 

individual substances, were observed in 25 

percent of decedents, followed by ethanol in 20 

percent, and other illicit drugs were present in 

5.5 percent.

xiThe methodology used for the 2015 statewide overdose report 

attributed all morphine to heroin.

Comparison between 2015 and 2016 

Drug-Related Overdose Deaths

Drug Category Percent 

Reported Among 

2016 Decedents

Percent 

Change from 

2015-2016

Fentanyl/FRS/

NPSOs

51.6 130

Other Illicit Drugs 5.5 56

Cocaine 27.0 33

Benzodiazepines 33.2 29

Heroin 45.0 23

Prescription 

Opioids

25.0 3

(U) Table 2: Frequency of Drug Categories and

Rate of Change in Drug-Related Overdose

Decedents, Pennsylvania, 2015-2016

Source: Pennsylvania Coroner/Medical Examiner Data

Fentanyl/FRS/NPSOs increased 

130 percent from 2015 to 2016.

Toxicology Overview

208 different drugs were identified 

in 2016 drug-related overdose 

deaths.
12

Toxicology

UNCLASSIFIED

UNCLASSIFIED

(U) Figure 4: Number of Drug-Related Overdose Deaths by Drug Presence, Pennsylvania, 2016

Source: Pennsylvania Coroner/Medical Examiner Data
UNCLASSIFIED 13

UNCLASSIFIED

In 2016, the most commonly identified drug 

category in toxicology reports varied for counties 

across Pennsylvania (see Figure 5). Fentanyl/

FRS/NPSOs and heroin were the first and second 

most common drug categories, respectively, in 

both urban and rural counties. The third most 

common drug category in rural counties was 

prescription opioids, and in urban counties it 

was benzodiazepines. 

Overall, fentanyl/FRS/NPSOs were the most 

common substances in 33 counties that

reported a drug-related overdose death. 

Geographic analysis revealed a large 

concentration of western Pennsylvania counties 

ranking fentanyl/FRS/NPSOs as the leading 

cause of overdose death, while eastern 

Pennsylvania counties continued a high 

presence of heroin. Ten counties demonstrated 

a tie for most prevalent drug category. In these 

instances, the drug category displayed was 

ranked in order of fentanyl/FRS/NPSOs, heroin, 

prescription opioids, and benzodiazepines.

Toxicology Trends by County

(U) Figure 5: Most Frequently Reported Drug Category in Drug-Related Overdose Decedents by

Pennsylvania County, 2016

Source: Pennsylvania Coroner/Medical Examiner Data
14

Toxicology

UNCLASSIFIED

UNCLASSIFIED

Toxicology Trends by Time

The percentage of drug-related overdose deaths 

was calculated each month by drug category 

(see Figure 6). The presence of fentanyl/FRS/

NPSOs in overdose deaths was relatively low at 

the beginning of 2016 (32 percent presence in 

all January overdose deaths). The percentage 

increased steadily throughout 2016 until it was 

present in 73 percent of all December overdose 

deaths. 

Fentanyl/FRS/NPSOs availability and use in 

Pennsylvania increased throughout 2016, 

both in the amount and variety of substances 

available. DTOs supplied increasing amounts 

of fentanyl to Pennsylvania opioid markets, and 

a wider variety of FRS/NPSOs were introduced 

by both traffickers and individuals ordering 

substances online. 

This increase is in contrast to heroin, which 

remained steady across all months (42-51 

percent of overdose deaths each month) and 

prescription opioids, which declined from 

January (32 percent) to December (22 percent).

The presence of benzodiazepines in overdose 

deaths remained consistent throughout the 

year, ranging from 39 percent in January to 34 

percent in December. The presence of ethanol 

and cocaine remained steady through the year, 

ranging from 18 to 20 percent and 26 to 34 

percent, respectively.

Fentanyl was present in 73 percent 

of overdose deaths in December 

compared to 32 percent in 

January.

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 6: Percent of Drug-Related Overdose Deaths by Drug and Month, Pennsylvania, 2016
UNCLASSIFIED 15

UNCLASSIFIED

When identifying drug-related overdose deaths 

where only one or two analyzed drugs were 

present in toxicology, nearly half of these cases 

(47 percent) contained fentanyl, heroin, and/

or cocaine (see Figure 7). Decedents with 

toxicology reports containing only cocaine 

remained relatively consistent each quarter of 

2016 (18-24 counts per quarter). With regards 

to heroin and fentanyl, decedents with positive 

toxicology reports changed through the year. 

While the number of fentanyl-only deaths rose 

from 39 in the first quarter to 103 in the last 

quarter of 2016, the number of heroin-only 

deaths decreased from 50 in the first quarter 

to 34 in the last quarter of 2016. Analyzed 

together with information from Figure 6, the data 

demonstrates a shift during the fourth quarter 

of 2016 from heroin to fentanyl being the most 

common drug reported. 

This change is a significant indicator of 

Pennsylvania opioid use possibly shifting 

from primarily heroin to primarily fentanyl/FRS. 

However, it is important to note that a higher 

number of fentanyl-related deaths alone is not 

confirmation of this shift. 

Because fentanyl is so potent, it can cause a 

much higher rate of overdose death than heroin, 

despite lower user rates. Additional indicators 

reported by law enforcement indicate that 

users are now seeking out fentanyl instead of 

unknowingly purchasing fentanyl disguised as 

heroin, and street-level traffickers are openly 

marketing fentanyl to customers instead of 

disguising it as heroin.7 It is likely that traffickers 

will continue to aggressively distribute fentanyl/ 

FRS in the local opioid markets, whether openly 

or clandestinely, because fentanyl is less 

expensive to produce and acquire than heroin.8

Benzodiazepines

Benzodiazepines were present in 33 percent 

of toxicology reports, and in 93.8 percent of 

reporting counties. Alprazolam was reported 

most frequently within this category. The 

counties with the highest rate of alprazolam 

per 100,000 people were Philadelphia (16.9), 

Wyoming (10.6), Beaver (10.5), Armstrong (10.1), 

and Allegheny (10.1), in rank order. Other drugs 

present with alprazolam in toxicology reports 

included fentanyl (49 percent), heroin (49 

percent), cocaine (29 percent) and oxycodone 

(25 percent). Ethanol usage, in combination with 

benzodiazepines and/or prescription opioids, 

increases overdose risk9, and was found with 

alprazolam in 16 percent of toxicology reports. 

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 7: Drug-Related Overdose Deaths

Where Only One or Two Analyzed Drugs Were

Present in Toxicology

Toxicology Trends by Drug Category

The potency of fentanyl can result 

in a much higher rate of overdose 

death than heroin.
16

Toxicology

UNCLASSIFIED

UNCLASSIFIED

Cocaine

The presence of cocaine was noted in 82.8 

percent of counties reporting an overdose death 

in 2016. Cocaine- related overdose deaths 

increased 33 percent from 2015 to 2016 after 

a 40 percent increase from 2014 to 2015. Law 

enforcement sources indicate the production 

of cocaine in source locations is increasing and 

will directly impact local and regional availability 

through established illicit drug supply 

mechanisms.10 Local law enforcement sources 

indicate DTOs selling heroin are increasingly 

switching to cocaine distribution due to the 

fear of law enforcement prosecution for deaths 

resulting from heroin and fentanyl sales. 

Geographically, the presence of cocaine was 

concentrated in the two largest metropolitan 

areas (Philadelphia and Pittsburgh), which 

accounted for 78 percent of cocaine-related 

overdose deaths when combined. Cocaine was 

most often found in combination with heroin, 

ethanol, and levamisole. Levamisole is an antiparasitic drug currently approved for use in the 

United States by veterinarians, and is a common 

cocaine adulterant.11

Fentanyl, Fentanyl Related Substances (FRS), 

and Non-Prescription Synthetic Opioids 

(NPSOs)

Fentanyl/FRS/NPSOs emerged as the most 

frequently reported drug category in overdose 

deaths in 2016. When analyzed separately, 

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 8: Presence of Fentanyl Related Substances and Non-Prescription Synthetic Opioids in

Drug-Related Overdose Deaths, Pennsylvania, 2016
UNCLASSIFIED 17

UNCLASSIFIED

fentanyl was found in 61 of the 64 counties 

that reported an overdose in 2016, with Beaver 

(43.9), Allegheny (33.4), Cambria (33.4), 

Westmoreland (29.8), and Washington (29.8) 

counties having the highest rate of fentanyl 

presence per 100,000 people. Fentanyl was 

found in combination with heroin (64 percent), 

cocaine (34 percent), ethanol (22 percent), and 

alprazolam (21 percent) most frequently.

Nine out of 10 fentanyl-related substances found 

in toxicology reports from 2016 overdose deaths 

were not reported in 2015. The number of 

toxicology reports that mentioned FRS increased 

from 119 in 2015 to 221 in 2016, an increase 

of 86 percent. In addition to the increase in 

FRS, the presence of U-47700, an NPSO, was 

identified for the first time in 2016. With the rapid 

expansion in the production and distribution 

of FRS/NPSOs, many tests have not been 

developed or added to toxicology panels, thus 

the numbers herein are likely not representative 

across counties (see Data Challenges section 

for more information). However, 10 FRS/NPSOs 

were identified in toxicology reports of drugrelated overdose decedents, with an asterisk 

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 9: Drugs Found in Combination with Acetyl Fentanyl, Furanyl Fentanyl, and U-47700 in

Drug-Related Overdose Decedents, Pennsylvania, 2016
18

Toxicology

UNCLASSIFIED

UNCLASSIFIED

(*) denoting a new compound not previously 

reported:

3-Methylfentanyl*

Fluorofentanyl*

4-Methoxy-Butyryl Fentanyl*

Fluorobutyrfentanyl*

Acetyl Fentanyl

Furanyl Fentanyl*

Acryl Fentanyl*

Para-Fluoro-Isobutyryl-Fentanyl/FIBF*

Carfentanil*

U-47700*

Sufentanil*

Thirty-six counties reported the presence of 

FRS/NPSOs in drug-related overdose deaths 

(see Figure 8). While the greatest presence 

was concentrated in counties near major urban 

centers, where the largest number of opioid 

users are located, FRS/NPSOs were reported 

throughout the state, to include many rural 

counties. The percentage of rural counties 

with a FRS/NPSOs present (25 percent) was 

slightly higher than the percentage of all drugrelated overdose deaths in rural counties (23 

percent). This is an indication of the widespread 

availability of FRS/NPSOs in Pennsylvania due 

to the ease of obtaining FRS/NPSOs from online 

sources.

To understand the drugs commonly found 

with FRS and U-47700, the two most prevalent 

FRS compounds (acetyl fentanyl and furanyl 

fentanyl, which comprise 77 percent of FRS) and 

U-47700 were analyzed more closely (see Figure

9). The first and second most common drug for

each of the three compounds was either

fentanyl or heroin. Interestingly, acetyl fentanyl

was almost always found with fentanyl (96

percent).

No other drug combination was found so 

frequently amongst all illicit drugs including 

FRS, NPSOs, heroin, methamphetamine, and 

cocaine. 

China is the primary source for FRS/NPSOs 

abused in the United States. Traffickers and 

users typically purchase these chemicals online 

and receive them through mail services. The 

Chinese government recently acted to control 

many FRS and NPSOs. For example, in October 

2015, acetyl fentanyl and fluorobutyrfentanyl 

were among 116 substances newly controlled, 

while China controlled acryl fentanyl, carfentanil, 

and furanyl fentanyl beginning in March 2017. 

In June 2017, China announced it will control 

U-47700 effective July 1, 2017. As substances

are controlled in China or scheduled in the

United States, illicit manufacturers makes small

structural modifications and create a new

substance, with similar opioid properties, that

is not named under the Controlled Substances

Act. These new substances may be treated

under the federal analogue provision if

intended for human consumption. The rapid

introduction of new substances is challenging

for toxicologists.12-13 The phenomenon is likely

the cause of the increased variety of FRS/NPSOs

available in Pennsylvania during 2016.

Heroin

Heroin was the second most frequently reported 

drug in toxicology tests of drug-related overdose 

decedents in 2016. Heroin was present in 95.3 

percent of counties that reported an overdose 

death in 2016. The counties with the highest 

rate of heroin per 100,000 people were Fulton 

(33.6), Allegheny (26.9), Westmoreland (25.7), 

China is the primary source for 

FRS/NPSOs abused in the United 

States. 
UNCLASSIFIED 19

UNCLASSIFIED

Washington (22.6), and Beaver (21.7). Heroin 

was found most often in combination with 

fentanyl (68 percent), cocaine (32 percent), 

alprazolam (22 percent), and ethanol (21 

percent).

Other Illicit Drugs

The presence of other illicit drugs, to include 

methamphetamine, PCP, MDMA, MDA, and 

LSD remained low in the overdose dataset. 

Methamphetamine had the largest presence 

within this category, but was only present 

in 4 percent of decedents. The presence 

of methamphetamine increased slightly 

from 3.1 percent in 2015. Geographically, 

methamphetamine was concentrated in eastern 

Pennsylvania, with the highest number in 

Philadelphia (33), Schuylkill (20), and Bucks 

(17) Counties. Methamphetamine was found

most often in combination with fentanyl, heroin, 

cocaine, and alprazolam. PCP presence was 

noted in only 55 deaths, with 78 percent of these 

deaths located in Philadelphia County.

Prescription Opioids

Prescription opioids were present in 25 percent 

of toxicology reports, and 95.3 percent of 

reporting counties. Oxycodone was reported 

most frequently within this category. The 

counties with the highest rate of oxycodone 

references per 100,000 people were Fulton 

(40.42), Cambria (13.2), Schuylkill (10.7), 

Wyoming (10.6), and Lawrence (9.8), in rank 

order. Other drugs present with oxycodone 

in toxicology reports included fentanyl (31 

percent), alprazolam (30 percent), heroin (26 

percent), and ethanol (20 percent). 

Compared to all other analyzed drug categories, 

overdose deaths with the presence of 

prescription opioids demonstrated the smallest 

increase throughout 2016. The total number 

of deaths that occurred in October-December 

2016 (Q4) was 50 percent higher than the total 

number of deaths in January-March 2016 (Q1). 

However, when deaths were filtered to include 

only those with a prescription opioid present, 

the increase at Q4 compared to Q1 was only 8 

percent, compared to Fentanyl/FRS/NPS (141 

percent), other illicit drugs (93 percent), ethanol 

(67 percent), cocaine (67 percent), heroin (32 

percent), and benzodiazepines (31 percent). 

Medication Assisted Treatment Drugs

Methadone, buprenorphine, and naltrexone can 

be used as a treatment for opioid use disorder 

when paired with counseling, called medication 

assisted treatment (MAT). Methadone is the 

only MAT drug screened in toxicology reports 

consistently across the state; thus, an analysis of 

methadone references is reported below. 

Methadone was present in 5 percent of 

toxicology reports, and 37 of the 64 reporting 

counties. The counties with the highest rate 

of methadone references per 100,000 people 

were Blair (4.7), McKean (4.6), Armstrong (4.3), 

Philadelphia (4.3), and Westmoreland (4.1), 

in rank order. Unlike every drug category 

addressed above, methadone was most 

commonly found with benzodiazepines instead 

of fentanyl or heroin. Alprazolam (44 percent), 

fentanyl (32 percent), clonazepam (30 percent), 

and heroin (26 percent) were most commonly 

found with methadone. 

Compared to all other analyzed 

drug categories, overdose 

deaths with prescription opioids 

demonstrated the smallest 

increase throughout 2016.
20

Demographics

UNCLASSIFIED

UNCLASSIFIED

Age

In 2016, 30 percent of drug-related overdose 

deaths occurred in the 25 to 34-year-old age 

group. This age group was disproportionately 

affected by overdose deaths in 2016, since 

according to 2010 Decennial Census data, 

this age group comprised only 15 percent of 

Pennsylvania’s population. The three most 

affected age groups, 25-34, 45-54, and 35-

44, account for 40 percent of Pennsylvania’s 

population but accounted for 75 percent of 

overdose deaths in 2016. Overdose deaths 

occurring in the 15-24 year age group 

accounted for 10 percent of all overdose deaths 

and comprised 14 percent of Pennsylvania’s 

population. The age distribution chart in Figure 

10 shows the bimodal distribution of the most 

common age groups that were affected by 

overdose in 2016, consistent with what was 

reported in 2015.

Age with Toxicology

As detailed in Figure 11 (for total counts, 

see Appendix Table 4), fentanyl/FRS/NPSOs 

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 10: Age Distribution of Drug-Related Overdose Decedents, Pennsylvania, 2016
UNCLASSIFIED 21

was within the top three most present drug 

categories of all age groups except 0-14 year 

olds. Aside from fentanyl/FRS/NPSOs, heroin 

was more common in younger and middle 

age groups, benzodiazepines and ethanol 

were more common in middle age groups, and 

prescription opioids and cocaine were more 

common in middle age and older age groups. 

The presence of illicit drugs declined with age, 

with the peak occurring within the 15-24 age 

group. 

A younger population demographic was 

correlated with fentanyl/FRS usage. Drugrelated overdose decedents who died between 

the ages 15-24 saw a 380 percent increase in 

the presence of fentanyl in toxicology reports 

compared to other age groups (p<0.05). 

Additionally, amongst decedents with fentanyl/

FRS present in toxicology reports, 35 percent 

and 43 percent, respectively, were within the 

25-34 age group (compared to 30 percent of all

overdoses being within the 25-34 age group).

Heroin was more likely to be present in 

the younger and middle aged population. 

Individuals in the 25-34 age group saw a 

970 percent increase in heroin presence in 

toxicology reports compared to other age 

groups (p<0.05). 

In 2016, 3,237 males died of drug-related 

overdoses (70 percent), compared to 1,403 

females (30 percent). Two deaths did not 

indicate gender. Males disproportionately 

experienced overdose deaths compared to 

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 11: Drug Presence by Age Group among Drug-Related Overdose Decedents,

Pennsylvania, 2016

Gender
22

Demographics

UNCLASSIFIED

UNCLASSIFIED

females, as males comprise 49 percent of the 

Pennsylvania population yet accounted for 

70 percent of the overdose deaths in 2016. 

Conversely, females comprise 51 percent of 

the population and accounted for 30 percent 

of the overdose deaths reported in 2016. The 

distribution of overdose deaths among males 

and females was consistent with 2015 reporting.

Gender with Toxicology

The three most prevalent drug categories in 

toxicology reports for males were fentanyl/FRS/

NPSOs, heroin, and benzodiazepines; the three 

most prevalent drug categories for females 

were fentanyl/FRS/NPSOs, benzodiazepines, 

and heroin (see Figure 12. For total counts see 

Appendix Table 5). Fentanyl/FRS/NPSOs were 

reported in 56 percent of male overdose deaths 

and 49 percent of female overdose deaths. 

Heroin was reported in 50 percent of male 

overdose deaths, followed by benzodiazepines 

in 31 percent. Conversely, benzodiazepines 

were reported in 43 percent of overdose female 

deaths, followed by heroin in 40 percent. 

Prescription opioids were reported in women (34 

percent) substantially more often than in men 

(23 percent).

For females, there was a 25 percent and 37 

percent decrease, respectively, in the presence 

of fentanyl and heroin in toxicology reports 

when compared to males (p<0.05). Additionally, 

statistical analysis revealed that toxicology 

reports with fentanyl, heroin, cocaine, and 

ethanol were more prevalent in males compared 

to females. Alprazolam (benzodiazepine), 

clonazepam (benzodiazepine), and oxycodone 

(prescription opioid) were present in more 

females compared to males. In general, male 

overdose deaths were more often related to 

illicit drugs and ethanol, while female overdose 

deaths were more often related to prescription 

medications. Interestingly, 50 percent of females 

had four or more drugs present in toxicology 

reports compared to 35 percent of males, 

which may account for some of the distribution 

observed.

In 2016, 3,574 decedents were identified as 

White (77.0 percent), 534 were identified as 

Black (11.5 percent), 195 were identified as 

Hispanic (4.2 percent), 311 were identified as 

“Other” (6.7 percent), and 28 were identified as 

“Unknown” (0.6 percent) (see Figure 13). The 

distribution of overdose deaths among race was 

consistent with that reported in 2015. The racial 

breakdown for overdose deaths also coincides 

with the racial demographics in Pennsylvania, 

as Whites comprise approximately 77.9 percent, 

Blacks comprise approximately 11.6 percent, 

and Hispanics comprise approximately 6.6 

percent of Pennsylvania’s population.

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 12: Drug Presence by Gender among

Drug-Related Overdose Decedents,

Pennsylvania, 2016

Race
UNCLASSIFIED 23

Race with Toxicology

In 2016, the most prevalent drug category 

identified in overdose deaths differed amongst 

the racial groups (see Figure 14. For total 

counts see Appendix Table 6). The three 

most prevalent drug categories in toxicology 

reports for White decedents were fentanyl/

FRS/NPSOs (55 percent), heroin (49 percent), 

and benzodiazepines (36 percent). White 

decedents were more likely to have heroin and 

benzodiazepines present in an overdose death 

compared to other racial groups. 

The three most prevalent drug categories in 

toxicology reports for Black decedents were 

cocaine (57 percent), fentanyl/FRS/NPSOs 

(46 percent), and heroin (36 percent). Black 

decedents were more likely to have cocaine 

present in an overdose death compared to other 

racial groups. 

The three most prevalent drug categories in 

toxicology reports for Hispanic decedents were 

fentanyl/FRS/NPSOs (57 percent), heroin (47 

percent), and cocaine (38 percent). Hispanic 

decedents were more likely to have fentanyl/

FRS/NPSOs present in an overdose death 

compared to other racial groups. 

The three most prevalent drug categories in 

toxicology reports for decedents of Other Races 

were fentanyl/FRS/NPSOs (49 percent), heroin 

(39 percent), and benzodiazepines (36 percent). 

Decedents identified as Other Race were more 

likely to have prescription opioids present in an 

overdose death compared to other racial groups.

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 13: Race of Drug-Related Overdose

Decedents, Pennsylvania, 2016

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 14: Drug Presence by Race Among

Drug-Related Overdose Decedents,

Pennsylvania, 2016
24

Demographics

UNCLASSIFIED

UNCLASSIFIED

At the request of the PFD, the TAC conducted 

regression analysis to measure the effect of race 

on fentanyl- and heroin-related overdose deaths. 

Individuals that were identified as Black and 

Other Race saw a 20 percent and 27 percent 

decrease, respectively, in the presence of 

fentanyl in toxicology reports, when compared 

to other racial groups (Black, p<0.05; Other Race, 

p<0.05). Additionally, individuals identified as 

Black and Other Race saw a 47 percent and 

56 percent decrease, respectively, in heroin 

presence in toxicology reports when compared 

to other racial groups (Black, p<0.05; Other Race, 

p<0.05). 

Figure 15 depicts the total number of overdose 

deaths by gender and designated age groups. 

In 2016, the majority of overdose deaths 

occurred in males aged 25-34. The 25-34 age 

group accounted for the largest percentage of 

deaths within each gender, including 31 percent 

of males and 28 percent of females.

The second and third highest percentage of 

deaths within the male population was the 

35-44 and 45-54 year old age groups (23

percent and 21 percent of total deaths per

gender, respectively). The second and third

Gender and Age

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 15: Gender and Age of Drug-Related Overdose Decedents, Pennsylvania, 2016
UNCLASSIFIED 25

highest percentage of deaths within the female 

population was the 45-54 and 35-44 year old 

age groups (26 percent and 20 percent of total 

deaths per gender, respectively). Women aged 

45-54 were disproportionately affected by

overdose compared to men of the same age.

Figure 16 depicts the total number of overdose 

deaths by race and designated age groups. In 

2016, the majority of overdose deaths occurred 

in White individuals aged 25-34. The 25-34 age 

group accounted for the largest percentage 

of deaths for individuals identified as White 

(31 percent) and Other Race (37 percent); the 

45-54 age group accounted for the largest

percentage of deaths for individuals identified

as Black (29 percent); and the 35-44 age

group accounted for the largest percentage

of deaths for individuals identified as Hispanic

(29 percent). Two noticeable differences were

apparent in the analysis of age and race. First,

Black decedents were significantly older than

other races. Second, Hispanic decedents had

a relatively even distribution between the top

three age groups, instead of a peak, as observed

in the other races.

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 16: Race and Age of Drug-Related Overdose Decedents, Pennsylvania, 2016

Race and Age
26

Demographics

UNCLASSIFIED

UNCLASSIFIED

Figure 17 details the number of overdose deaths 

within each racial group by gender. As noted 

earlier, 70 percent of all overdose deaths in 

Pennsylvania were male and 30 percent were 

female. Distribution of overdose deaths among 

males and females were similar: for White (69 

percent, 31 percent, respectively), Black (68 

percent, 32 percent, respectively), and Other 

Race (68 percent, 32 percent, respectively). 

Conversely, a significantly greater percentage 

of Hispanic males were adversely affected by 

overdose (83 percent male, 17 percent female) 

in 2016.

Race and Gender

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 17: Race and Gender of Drug-Related

Overdose Decedents, Pennsylvania, 2016
UNCLASSIFIED 27

The existence of valid prescriptions for 

opioids and benzodiazepines were not 

analyzed in this report, therefore, this report 

does not assess if these substances were 

obtained fraudulently, were diverted from 

legitimate sources, or identify the method of 

administration.

Analysis for this assessment focused 

on deaths classified as a drug-related 

overdose; cause of death was determined 

by the county coroner or medical examiner. 

However, determining causation related 

to overdoses is subjective and can vary 

widely depending on the investigative 

efforts/abilities of the coroner and the 

evidence available for review, which result 

in inherent difficulties in making causation 

decisionsxvi, especially with regard to 

heroin overdoses. Therefore, it is possible 

that the data analyzed in this assessment 

underrepresents the true number and 

nature of drug-related overdose deaths in 

Pennsylvania.

Each county in Pennsylvania is responsible 

for procuring or conducting toxicology 

testing, which is most commonly 

accomplished through the services at 

private laboratories. The scope of the 

toxicology tests is at the discretion of the 

requestor. Therefore, this dataset is not 

standardized, and the lack of reporting 

of an individual drug in a county cannot 

be construed to mean that it was not 

present, but instead may not have been 

part of the requested toxicology test panel. 

Philadelphia County (which accounted 

for approximately 20 percent of statewide 

overdose deaths in 2016) does not report 

the presence of marijuana in postmortem 

toxicology; therefore, it was not included 

Data Challenges in this analysis due to the inability to 

draw conclusions across the dataset. In 

addition, basic postmortem toxicology 

panels utilized most often by coroners and 

medical examiners do not include testing 

for synthetic cannabinoids and cathinones. 

Therefore, it is not possible to analyze or 

draw conclusions regarding the impact of 

these substances in the overdose datasetxvii. 

The data request for this assessment 

included residence and death zip code, 

however, the majority of data provided 

did not include any zip code information. 

Therefore, it was not possible to examine 

or conclude that the county in which the 

person died was their county of residence. 

Furthermore, the data does not identify 

the location from which illicit drugs or 

diverted pharmaceuticals were purchased 

or obtained. 

Finally, the continued lack of standardized 

and centralized reporting of drug-related 

overdose death data in Pennsylvania 

inhibits timely analysis necessary for 

stakeholders to drive decision-making. 

Efforts must continue amongst the myriad 

data collectors to streamline compilation 

and develop a common mechanism for 

information sharing that serves the public 

interest.

Data Challenges

xvi“No standard exists in PA to accurately track heroin overdose deaths,” 

WITF news, April 9, 2015. 

xviiBased on query and response by Philadelphia Medical Examiner’s 

Office, Allegheny County Office of the Medical Examiner, and NMS Labs. 
28

County Analysis and Outlook

UNCLASSIFIED

UNCLASSIFIED

Appendix Figure 1 shows total number of 

drug-related overdose deaths by county in 

2016. Individual analyses of Cameron, Elk, 

Forest, Juniata, Potter, Snyder, Sullivan, and 

Warren Counties were not prepared due to their 

reporting of less than five overdose deaths. 

To allow counties with fewer raw overdose 

death numbers to identify meaningful trends, 

additional analyses were conducted based on 

the six Community Health Districts used by the 

Pennsylvania Department of Health (Appendix 

Figures 2-7). Individual county analysis was 

conducted and is represented in Appendix 

Figures 10-68. Each county’s analysis contains 

the 2015 and 2016 overdose count; 2016 

rank by rate; 2016 rank by count; 2016 rate of 

overdose deaths per 100,000 people; top 10 

drugs present in drug-related overdose deaths; 

age, gender, and race distribution; drug-related 

overdose deaths for each quarter by drug 

category; and percent change from 2015 to 

2016. 

Assessing the impact of the myriad efforts 

enacted by the aforementioned parties is 

measured in years and cannot be evaluated by 

a single factor, such as overdose deaths. One 

of the most important components in reducing 

drug-related overdose deaths is to prevent 

initial drug use; as such, the impact of education 

and prevention strategies in use today will be 

shown in future years. The PFD will continue 

efforts, in conjunction with law enforcement and 

public health partners, to define and address 

the factors impacting availability and abuse of 

illicit drugs and diverted pharmaceuticals in 

Pennsylvania, and ultimately overdose deaths.

As evidenced by the upward trajectory of drugrelated overdose deaths over the past several 

County Analysis

Outlook

years in Pennsylvania, a crisis exists among 

law enforcement, public health entities, and 

educators to address drug availability, drug 

treatment, and drug education. The results of 

this analysis reinforce that the use and abuse 

of opiates, particularly fentanyl and heroin, are 

fueling this crisis, which is expected to continue 

and possibly grow over the near term.

1 ”Drug Overdose Surveillance and Information Sharing 

Via a Public Database: The Role of the Medical Examiner/

Coroner”, Academic Forensic Pathology, March 2017, 

Vol. 7. 

2 https://www.cdc.gov/drugoverdose/data/statedeaths.

html

3 Gray, D., Coon, H., McGlade, E., Callor, W., Byrd, J., 

Viskochil, J., Bakian, A., Yurgelun-Todd, D., Grey, T., 

McMahon, W. Suicide Life Threat Behav. 2014 June; 44(3): 

304-316

4 Alcohol and Medication Interactions, Ron Weathermon,

Pharm.D., and David W. Crabb, M.D.

5 Americanfactfinder.com

6 https://www.cdc.gov/drugoverdose/data/statedeaths.

html

7 DEA Philadelphia Field Division Investigative Reporting

8 DEA Philadelphia Field Division Investigative Reporting

9 Koski A, Ojanperia I, Vuori E. Interaction of alcohol and

drugs in fatal poisonings. Hum Exp Toxicol 2003;22:281–7. 10 Inside the Opioid Epidemic, The Economist, May 11,

2017

11 Study Finds 45% of Cocaine Positive Specimens

from D.C. Arrestees Also Contain Potentially Fatal Drug

Levamisole, CESAR, Vol. 18, Issue 49, December 14, 2009 12 Fentanyl: China’s Deadly Export to the United States,

U.S-China Economic and Security Review Commission,

February 1, 2017

13 China bans more synthetic opioids blamed for U.S. drug

deaths, Associated Press, June 19, 2017

Bibliography
UNCLASSIFIED 29

Appendix

Pennsylvania Urban Counties Pennsylvania Rural Counties

Allegheny Philadelphia Adams Fayette Northumberland

Beaver Westmoreland Armstrong Forest Perry

Berks York Bedford Franklin Pike

Bucks Bradford Fulton Potter

Chester Blair Greene Schuylkill

Cumberland Butler Huntingdon Snyder

Dauphin Cambria Indiana Somerset

Delaware Cameron Jefferson Sullivan

Erie Carbon Juniata Susquehanna

Lackawanna Centre Lawrence Tioga

Lancaster Clarion Lycoming Union

Lebanon Clearfield McKean Venango

Lehigh Clinton Mercer Warren

Luzerne Columbia Mifflin Washington

Montgomery Crawford Monroe Wayne

Northampton Elk Montour Wyoming

(U) Appendix Table 1: Pennsylvania Urban and Rural Counties

Source: The Center for Rural Pennsylvania

Drug Category % Reported Among 

2016 Decedents

Rates of Overdose 

Deaths per 100,000

Fentanyl/FRS/NPSOs 52% 18.8 

Heroin 45% 16.4

Benzodiazepines 33% 12.1

Prescription Opioids 25% 9.3

Cocaine 27% 9.9

Ethanol 20% 7.1

Other Illicit Drugs 5.5% 2.0

(U) Appendix Table 2. Drug Category Percentages and Rates of Overdose in Drug-Related Overdose

Decedents, Pennsylvania, 2016

Source: Pennsylvania Coroner Data and www.census.gov
30

Appendix

UNCLASSIFIED

UNCLASSIFIED

Drug Category Drug Name Description

Benzodiazepines Alprazolam Primary drug. Classified as a benzodiazepine, with the common brand name of Xanax®. Placed in Schedule IV under the 

CSA.

Chlordiazepoxide Primary drug that is in the benzodiazepine class and used 

to treat anxiety. Common brand name is Librium®. Placed in 

Schedule IV under the CSA.

Clonazepam Primary drug that is metabolized to 7-aminoclonazepam. 

Classified as a benzodiazepine and used to treat anxiety. 

Common brand name is Klonopin®. Placed in Schedule IV 

under the CSA.

Delorazepam Delorazepam also known as chlordesmethyldiazepam and 

Nordiclazepam is a drug which is a benzodiazepine and a derivative of desmethyldiazepam. Placed in Schedule IV under 

the CSA.

Diazepam Primary drug. Classified as a benzodiazepine and used to 

treat anxiety. Common brand name is Valium®. Placed in 

Schedule IV under the CSA.

Estazolam Estazolam is a benzodiazepine derivative drug developed by 

Upjohn in the 1970. Placed in Schedule IV under the CSA.

Flurazepam Primary drug. Classified as a benzodiazepine. This 

medication can be used to help treat sleep disorders. 

Common brand name is Dalmane®. Placed in Schedule 

IV under the CSA.

Lorazepam Primary Drug. Sedative. It can treat seizure disorders, 

such as epilepsy. It can also be used before surgery and 

medical procedures to relieve anxiety. Brand names 

include Ativan®. Placed in Schedule IV under the CSA.

Midazolam® Primary drug. Classified as a benzodiazepine. Used for 

anesthesia or procedural sedation. Common brand 

name is Versed®. Placed in Schedule IV under the CSA.

Oxazepam Primary drug. Classified as a benzodiazepine and used 

to treat anxiety. Placed in Schedule IV under the CSA.

Temazepam Classified as a benzodiazepine. Used to treat insomnia. 

Common brand name is Restoril®. Can be metabolite of 

Diazepam as well and can be present as a primary drug 

as well. Placed in Schedule IV under the CSA.

Cocaine Cocaine Primary drug. Local anesthetic often illegally made and 

used illicitly for its stimulant effects. Placed in Schedule 

II under the CSA.

(U) Appendix Table 3: Drug Name, Category, and Description for Substances Reported in Drug-Related Overdose Deaths, Pennsylvania, 2016
UNCLASSIFIED 31

Drug Category Drug Name Description

Ethanol Ethanol Primary reference for all evidence indicating consumption of alcohol.

Fentanyl, FRS, 

NPSOs

3-Methyl Fentanyl 3-Methylfentanyl (3-MF, mefentanyl) is an opioid analgesic that is an analogue of fentanyl. Placed in Schedule

I under the CSA.

4-Methoxy-Butyryl

Fentanyl

Primary Drug. It is a potent short-acting synthetic opioid 

analgesic drug. It is an analogue of fentanyl. It is not 

approved for medical use.

Acetyl Fentanyl Acetyl Fentanyl is an opioid analgesic similar to 

Fentanyl. It is an analogue of fentanyl. Placed in 

Schedule I under the CSA.

Acryl Fentanyl Acryl fentanyl (also known as acryloylfentanyl) is an 

analogue of fentanyl and has been sold online as a 

designer drug. Controlled in China as of March 1, 2017. 

It is not approved for medical use.

Carfentanil Carfentanil is a synthetic opioid analgesic drug. It is 

used primarily as a tranquilizer for large animals such as 

elephants and sold pharmaceutically under the brand 

name Wildnil®. Clandestinely-produced carfentanil is 

sold online for abuse. Placed in Schedule II under the 

CSA.

Fentanyl Primary drug. Classified as an opioid that is used to treat 

severe pain. Common brand names are Duragesic®, 

Abstral®, and Subsys®. Placed in Schedule II under the 

CSA.

Fluorobutyrfentanyl Analogue of fentanyl; not controlled in the United.States.

Fluorofentanyl Analogue of fentanyl; not controlled in the United States.

Furanyl Fentanyl Furanyl fentanyl is an opioid analgesic that is an analogue of fentanyl. Placed in Schedule I under the CSA.

Para-Fluoro-Isobutyryl-Fentanyl/FIBF

Analogue of fentanyl; placed in Schedule I under the CSA.
32

Appendix

UNCLASSIFIED

UNCLASSIFIED

Drug Category Drug Name Description

Sufentanil Sufentanil is a synthetic opioid analgesic drug. Placed in 

Schedule II under the CSA.

U-47700 U-47700 is an opioid analgesic drug that has no pharmaceutical indications. Placed in Schedule I under the

CSA.

Heroin Heroin Heroin is a primary drug, but rarely found in toxicology 

reports. Evidence of heroin consumption may be found 

at the scene and in toxicology reports with the presence 

of 6-monoacetylmorphine, morphine, codeine, and/or 

diacetylmorphine. Placed in Schedule I under the CSA.

Medication 

Assisted 

Treatment

Buprenorphine Buprenorphine. Primary Drug. An opioid that can treat 

moderate to severe pain. It can also be used as part of 

medication assisted treatment for opioid addiction, and 

is a partial agonist. Brand names include Suboxone® 

when combined with naloxone and Subutex®, Cizdol®, 

Temgesic®, Buprenex®, Norspan®, and Butrans®. Placed 

in Schedule III under the CSA.

Methadone Methadone. Primary Drug. An opioid that can treat moderate to severe pain. It can also be used as part of medication assisted treatment for opioid addiction, and is an 

agonist. Brand names include Diskets®, Methadose®, 

and Dolophine®. Placed in Schedule II under the CSA.

Other Illicit Drugs Lysergic Acid Diethylamide (LSD)Lysergic acid diethylamide (LSD), also known as acid, is 

a psychedelic drug known for its psychological effects. 

Placed in Schedule I under the CSA.

MDA/Methylenedioxy-amphetaminePrimary Drug. Also known as tenamfetamine. A psychoactive recreation drug. Placed in Schedule I under the 

CSA.

MDMA/3,4-MethylenedioxymethamphetamineCommonly known as Ecstasy or Molly. MDMA, which is 

an analogue of MDA, is mainly used for recreational use. 

Placed in Schedule I under the CSA.

Methamphetamine Methamphetamine is a stimulant and is placed in 

Schedule II under the CSA.

PCP/Phencyclidine Primary drug. It is a recreational dissociation drug classified as a N-methyl-D-aspartate (NMDA) receptor antagonist. Placed in Schedule II under the CSA.
UNCLASSIFIED 33

Drug Category Drug Name Description

Prescription 

Opioids

Hydrocodone Primary drug. Classified as an opioid pain medication. 

Synthesized from codeine and an opioid alkaloids. Common brand names include Vicodin®, Lortab®, Lorcet®, 

and Norco®. Placed in Schedule I under the CSA.

Hydromorphone Primary drug. Classified as an opioid pain medication. 

Hydromorphone can be a metabolite of hydrocodone. 

It is also a metabolite when morphine is present in high 

concentration. If morphine and hydromorphone both 

are present consider both as parent drug. Common 

brand name is Dilaudid®. Placed in Schedule II under 

the CSA.

Meperdine Primary Drug. Classified as a narcotic. Used to treat moderate 

to severe pain. Common brand name is Demerol®. Placed in 

Schedule II under the CSA.

Morphine An opioid medication used to treat moderate to severe 

pain. Common brand name is Duramorph®. Can be a 

metabolite of heroin along with codeine depending on 

the levels present in the body. Can also be listed as primary drug. Placed in Schedule II under the CSA.

Oxycodone Primary Drug. Oxycodone is an opioid pain medication 

used to treat moderate to severe pain. Brand names 

include, OxyContin®, Oxyfast®, Percocet®, Percodan®, 

Roxicodone®, Roxicet®, and Xtampza ER ®. Placed in 

Schedule II under the CSA.

Oxymorphone Primary drug. Oxymorphone is a narcotic pain reliever. 

It works in the brain and nervous system to reduce pain. 

It may also affect other body systems (e.g., respiratory, 

circulatory) at higher doses. Common brand name is 

Opana®. It can either be a primary drug or can also be 

metabolite

Tramadol Primary drug. Narcotic like drug which is also used as a 

pain reliever. Common brand name is Ultram®. Placed in 

Schedule IV under the CSA.

Source: Drug Enforcement Administration
34

Appendix

UNCLASSIFIED

UNCLASSIFIED

Drug Category 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+

Heroin 3 219 767 479 397 198 25 1

Ethanol 1 54 238 208 248 148 18 3

Cocaine 80 335 277 336 199 28 2

Benzodiazepines 3 130 443 377 352 213 23 1

Fentanyl/FRS/NPSOs 2 276 832 554 460 226 34 3

Other Illicit Drugs 33 86 60 50 24 1

Prescription Opioids 4 70 261 270 344 199 26 7

(U) Appendix Table 4: Number of Drug Mentions by Category and Age in Drug-Related Overdose 

Decedents, Pennsylvania, 2016

Source: Pennsylvania Coroner/Medical Examiner Data

Drug Category Female Male

Heroin 531 1,558

Ethanol 205 712

Cocaine 351 906

Benzodiazepines 563 978

Fentanyl/FRS/NPSOs 640 1,746

Other Illicit Drugs 78 176

Prescription Opioids 451 730

(U) Appendix Table 5: Number of Drug Mentions by Category and Gender in Drug-Related Overdose 

Decedents, Pennsylvania, 2016

Source: Pennsylvania Coroner/Medical Examiner Data

Drug Category White Black Hispanic Other Race

Heroin 1,689 182 91 112

Ethanol 667 142 43 63

Cocaine 818 290 72 68

Benzodiazepines 1,240 133 57 103

Fentanyl/FRS/NPSOs 1,885 236 108 140

Other Illicit Drugs 192 33 11 18

Prescription Opioids 922 120 36 94

(U) Appendix Table 6: Number of Drug Mentions by Category and Race in Drug-Related Overdose 

Decedents, Pennsylvania, 2016

Source: Pennsylvania Coroner/Medical Examiner Data
UNCLASSIFIED 35

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Appendix Figure 1: Number of Drug-Related Overdose Deaths by County, Pennsylvania, 2016 
36

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 2: Analysis of Overdose Death Data within District: Urban
37

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 3: Analysis of Overdose Death Data within District: Rural
38

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

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(U) Appendix Figure 4: Analysis of Overdose Death Data within District: North Central District
39

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 5: Analysis of Overdose Death Data within District: Northeast District
40

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

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(U) Appendix Figure 6: Analysis of Overdose Death Data within District: Northwest District
41

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 7: Analysis of Overdose Death Data within District: South Central District
42

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 8: Analysis of Overdose Death Data within District: Southeast District
43

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 9: Analysis of Overdose Death Data within District: Southwest District
44

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 10: Analysis of Overdose Death Data within County: Adams
45

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

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(U) Appendix Figure 11: Analysis of Overdose Death Data within County: Allegheny
46

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

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(U) Appendix Figure 12: Analysis of Overdose Death Data within County: Armstrong
47

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 13: Analysis of Overdose Death Data within County: Beaver
48

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

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(U) Appendix Figure 14: Analysis of Overdose Death Data within County: Bedford
49

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 15: Analysis of Overdose Death Data within County: Berks
50

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 16: Analysis of Overdose Death Data within County: Blair
51

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 17: Analysis of Overdose Death Data within County: Bradford
52

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 18: Analysis of Overdose Death Data within County: Bucks
53

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 19: Analysis of Overdose Death Data within County: Butler
54

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 20: Analysis of Overdose Death Data within County: Cambria
55

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 21: Analysis of Overdose Death Data within County: Carbon
56

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 22: Analysis of Overdose Death Data within County: Centre
57

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 23: Analysis of Overdose Death Data within County: Chester
58

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 24: Analysis of Overdose Death Data within County: Clarion
59

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 25: Analysis of Overdose Death Data within County: Clearfield
60

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

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(U) Appendix Figure 26: Analysis of Overdose Death Data within County: Clinton
61

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 27: Analysis of Overdose Death Data within County: Columbia
62

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 28: Analysis of Overdose Death Data within County: Crawford
63

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 29: Analysis of Overdose Death Data within County: Cumberland
64

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 30: Analysis of Overdose Death Data within County: Dauphin
65

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 31: Analysis of Overdose Death Data within County: Delaware
66

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 32: Analysis of Overdose Death Data within County: Erie
67

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 33: Analysis of Overdose Death Data within County: Fayette
68

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 34: Analysis of Overdose Death Data within County: Franklin
69

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 35: Analysis of Overdose Death Data within County: Fulton
70

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 36: Analysis of Overdose Death Data within County: Greene
71

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 37: Analysis of Overdose Death Data within County: Huntingdon
72

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 38: Analysis of Overdose Death Data within County: Indiana
73

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 39: Analysis of Overdose Death Data within County: Jefferson
74

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 40: Analysis of Overdose Death Data within County: Lackawanna
75

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 41: Analysis of Overdose Death Data within County: Lancaster
76

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 42: Analysis of Overdose Death Data within County: Lawrence
77

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 43: Analysis of Overdose Death Data within County: Lebanon
78

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 44: Analysis of Overdose Death Data within County: Lehigh
79

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 45: Analysis of Overdose Death Data within County: Luzerne
80

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 46: Analysis of Overdose Death Data within County: Lycoming
81

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 47: Analysis of Overdose Death Data within County: McKean
82

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 48: Analysis of Overdose Death Data within County: Mercer
83

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 49: Analysis of Overdose Death Data within County: Mifflin
84

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 50: Analysis of Overdose Death Data within County: Monroe
85

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 51: Analysis of Overdose Death Data within County: Montgomery

The death count for 2015 has been updated from 136 to 152.
86

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 52: Analysis of Overdose Death Data within County: Montour
87

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 53: Analysis of Overdose Death Data within County: Northampton
88

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 54: Analysis of Overdose Death Data within County: Northumberland
89

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 55: Analysis of Overdose Death Data within County: Perry
90

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 56: Analysis of Overdose Death Data within County: Philadelphia
91

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 57: Analysis of Overdose Death Data within County: Pike
92

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 58: Analysis of Overdose Death Data within County: Schuylkill
93

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 59: Analysis of Overdose Death Data within County: Somerset
94

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 60: Analysis of Overdose Death Data within County: Susquehanna
95

Source: Pennsylvania Coroner/Medical Examiner Data

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(U) Appendix Figure 61: Analysis of Overdose Death Data within County: Tioga
96

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 62: Analysis of Overdose Death Data within County: Union
97

Source: Pennsylvania Coroner/Medical Examiner Data

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UNCLASSIFIED

(U) Appendix Figure 63: Analysis of Overdose Death Data within County: Venango
98

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 64: Analysis of Overdose Death Data within County: Washington
99

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 65: Analysis of Overdose Death Data within County: Wayne
100

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 66: Analysis of Overdose Death Data within County: Westmoreland
101

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 67: Analysis of Overdose Death Data within County: Wyoming
102

Appendix

Source: Pennsylvania Coroner/Medical Examiner Data

UNCLASSIFIED

UNCLASSIFIED

(U) Appendix Figure 68: Analysis of Overdose Death Data within County: York
UNCLASSIFIED

UNCLASSIFIED