(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.IntelligenceProducts@usdoj.gov. For media/press inquiries call 

(202) 307-7977.

DEA-PHL-DIR-036-18 September 2018

The Opioid Threat in 

Pennsylvania

JOINT

Intelligence 

REPORT

UNCLASSIFIED

UNCLASSIFIED
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TABLE OF CONTENTS

The Opioid Threat in Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Opioid Controlled Prescription Drugs (CPDs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Heroin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Fentanyl, Fentanyl Related Substances (FRSs), 

Non-Prescription Synthetic Opioids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Efforts to Address Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Demand..................................................................................... 27

Pharmacy Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Counterfeit Pharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Demand and Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Emergency Department and Drug Treatment Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Demand Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Efforts to Address Demand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Drug-Related Overdose Deaths 2015-2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Neonatal Abstinence Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Workforce Impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Economic Impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Naloxone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Outlook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
UNCLASSIFIED ii

TABLE OF CONTENTS

Glossary of Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 

Appendix A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Overdose Death Rates and Rankings of Pennsylvania Counties

Appendix B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Methodology and Drugs Included 

Appendix C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

2017 Pennsylvania Drug-Related Overdose Death Data

Appendix D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Pennsylvania Overdose Death Data by District and County

Appendix E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197

Drug Combinations in Analyzed Drug Exhibits
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THE OPIOID THREAT IN PENNSYLVANIA 

Background

The Drug Enforcement Administration (DEA) Philadelphia Field Division (PFD) is responsible for conducting 

investigations and collecting intelligence related to the importation, distribution, and abuse of controlled 

substances in, and with connections to, Pennsylvania. As such, the PFD has dedicated considerable resources 

to cultivate strategies to stem the opioid supply in Pennsylvania, while simultaneously developing a robust 

cross-disciplinary information sharing platform to ensure collaboration with partners and stakeholders. DEA’s 

role in addressing the opioid crisis expands beyond traditional law enforcement tactics and includes partnerships with public health and treatment entities, policymakers, academia, and the public.

Purpose

Crafting initiatives and strategies to address opioid supply, demand, and misuse requires timely and 

actionable information and data, which this report endeavors to provide. Previously published PFD reports 

have assessed specific aspects of opioid supply and the associated impact of abuse. This report presents a 

comprehensive assessment of the opioid crisis in Pennsylvania, through collection and analysis of supply and 

demand indicators and intelligence, as well as detailed county level analysis of multiple opioid misuse data 

sources.

Scope

This assessment analyzes the opioid crisis via three components: Supply, Demand, and Impact. The Supply

section identifies and defines the types of opioids available, the level of availability, and the law enforcement 

response to combating supply, as measured through DEA and law enforcement investigative information 

and data sources. The Demand section summarizes intelligence gathered from drug users, substance use 

disorder treatment professionals, physicians, and pharmacists regarding the current and historical demand 

for opioids, as well as efforts underway to reduce the demand throughout the Commonwealth. Finally, the 

Impact section analyzes multiple data sources, including fatal overdose data, naloxone administration data, 

and workforce and economic impact data to assess the impact of opioid misuse from several perspectives. 

Also included are several Case Studies of counties achieving success in combating the opioid crisis in their 

respective regions. Whenever possible, multi-year data was collected and analyzed in an effort to assess the 

totality of the opioid crisis and to evaluate changes over time.

The PFD worked jointly with the University of Pittsburgh School of Pharmacy’s Program Evaluation Research 

Unit (PERU), Pennsylvania Opioid Overdose Reduction Technical Assistance Center (TAC) in the analysis of 

specific data contained in this assessment. The TAC was funded in 2016 by the Pennsylvania Commission on 

Crime and Delinquency (PCCD). The goal of the TAC is to support Pennsylvania counties in achieving their 

vision of eliminating overdose and ensuring the health, safety, and well-being of individuals with Substance 

Use Disorder and those surrounding them.
UNCLASSIFIED 2

KEY FINDINGS 

• The high availability and corresponding demand leading to the misuse of illicit and prescription opioids is a crisis without geographic, demographic, or socioeconomic boundaries in 

Pennsylvania.

• Heroin sourced from Mexican transnational criminal organizations (TCOs) presents a persistent 

and pervasive drug threat in Pennsylvania.

• The heroin threat to Pennsylvania is exacerbated by the unprecedented proliferation of clandestinely produced fentanyl and fentanyl-related substances.

• Heroin and fentanyl availability in Pennsylvania are ubiquitous and impacting more than 97 

percent of counties.

• Implementation of legislation influencing prescription opioid prescribing has resulted in a decrease in availability; however, a corresponding decrease in demand is less certain.

• Pennsylvania experienced 5,456 drug-related overdose deaths in 2017. This number represents a 

rate of 43 deaths per 100,000, far exceeding the national average of 22 per 100,000 in 2017.1

• Increased fentanyl availability and misuse contributed to a 65 percent overall increase in drug-related overdose deaths in Pennsylvania between 2015 and 2017.

• Interviews of drug users and treatment personnel indicate that users often experience multiple 

overdoses in the course of their drug use, and widespread naloxone availability has resulted in 

many lives saved; however, naloxone availability is one component of a continuum of care in a 

person with opioid use disorder’s prevention, intervention, treatment and long term recovery.

• Multi-disciplinary efforts between public health and public safety have resulted in documented 

progress in some Pennsylvania counties, thereby establishing a model for implementing strategies 

and achieving success in combating the opioid crisis.

ACKNOWLEDGMENTS

The DEA Philadelphia Field Division would like to acknowledge contributions to this report provided 

by numerous people and organizations, including the University of Pittsburgh School of Pharmacy 

Program Evaluation Research Unit’s Dr. Janice Pringle, Dr. Lynn Mirigian, Allison Burrell, Erh-Hsuan 

Wang, Nicholas Korach, Monica Gaydos, and Karley Snyder; Pennsylvania State Police Criminal 

Intelligence Center (PaCIC); Pennsylvania Commission on Crime and Delinquency; Philadelphia 

Department of Health; Liberty Mid-Atlantic HIDTA Investigative Support Center, Research & Analysis 

Section; Homeland Security Investigations Philadelphia Division; Philadelphia Poison Control Center; 

Director of Pittsburgh Poison Center and UPMC Emergency Physician and Toxicologist, Dr. Michael 

Lynch; and Beaver, Centre, Franklin, and Washington counties for their contributions to the county 

snapshots. 
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SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

Supply

DEA’s mission, in conjunction with law enforcement 

partners, is to reduce the illicit drug supply, including 

opioids, through investigation and prosecution of 

international, regional, and local controlled substance law 

violators. As part of the overall mission, the DEA Diversion 

Control Division endeavors to prevent, detect, and investigate the diversion of controlled pharmaceuticals and 

listed chemicals from legitimate sources. Finally, the DEA’s 

mission is supported by a comprehensive national drug 

intelligence program to collect, analyze, and disseminate 

strategic and operational drug intelligence information to 

inform investigators, management, and policymakers of 

trends in licit and illicit drug supply.

The PFD Intelligence Program conducted extensive 

review and analysis of law enforcement investigative data 

and intelligence gleaned from various sources to define 

and describe the complexities of the opioid supply in 

Pennsylvania. This section details the current availability 

and distribution methods of opioids, inclusive of opioid 

controlled prescription drugs, heroin, fentanyl, fentanyl-related substances, and non-prescription synthetic opioids 

in Pennsylvania.

Opioid Controlled Prescription 

Drugs (CPDs)

Drugs and other substances that are considered 

controlled substances under the Controlled Substances 

Act (CSA) are divided into five Schedules (I with highest 

potential for misuse to V with the lowest potential for 

misuse) depending upon the drug’s acceptable medical 

use and the drug’s misuse or dependency potential. 

Controlled Prescription Drugs (CPDs), specifically the 

Schedule II opioids oxycodone and hydrocodone, are 

widely available in Pennsylvania. Significant quantities 

of oxycodone and hydrocodone are prescribed each 

year; however, the overall number of dosage units 

prescribed of these products has declined since 2015. 

Concurrently, the enactment of a revamped Prescription 

Drug Monitoring Program (PDMP) took place in 2016 

and collects information on all filled prescriptions for 

controlled substances.2 This information aims to aid health 

care providers in safely prescribing CPDs. 

The vast majority of oxycodone and hydrocodone 

products prescribed are for legitimate medical purpose; 

however, some products become available in the illicit 

drug supply through diversion. While it is not possible to 

quantify the exact amount of prescription opioids available in the illicit drug supply, there may be a link between 

a higher quantity of pills prescribed and dispensed 

through legitimate circulation and a greater potential for 

diversion to the illicit drug market for possible misuse.

Availability

Nationally, the overall opioid prescribing rate declined 

from 2012 to 2016, and in 2016, the prescribing rate fell 

to the lowest level in more than 10 years, at 66.5 prescriptions per 100 persons.3

According to data from the Centers for Disease Control 

(CDC), Pennsylvania practitioners wrote an average of 

69.5 opioid prescriptions per 100 persons in 2016 (most 

recent data available), the 26th highest in the country. 

This ranking was a drop from Pennsylvania having the 

sixth highest rate in the country in both 2014 and 2015.4 

At the county level, Pennsylvania ranged from 13.8 (Fulton 

County) to 128.8 (Fayette County) opioid prescriptions 

per 100 persons in 2016 (see Figure 1).5 More than 60 

percent of Pennsylvania counties had prescribing rates 

above the national prescribing rate in 2016. 

The two most commonly prescribed opioid CPDs in 

Pennsylvania are oxycodone and hydrocodone. In 2017, 

Pennsylvania pharmacies filled more than 2.4 million 

prescriptions for almost 260 million dosage units of 

oxycodone products, and 1.6 million prescriptions for 146 

million dosage units of hydrocodone products.6 The total 

dosage units of oxycodone and hydrocodone products 

dispensed in 2017 equates to approximately 32 dosage 

units for every Pennsylvanian.7 
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SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

The total number of dosage units dispensed in 2017 

declined approximately 6 percent for oxycodone and 

approximately 14 percent for hydrocodone from 2016; 

comparing 2017 to 2015 showed an even greater decline 

of approximately 8 percent for oxycodone and approximately 24 percent for hydrocodone (see Figure 2).

The Pennsylvania Prescription Drug Monitoring 

Program 

The Pennsylvania Prescription Drug Monitoring Program (PDMP) 

collects information on Schedule II-V Controlled Substances 

dispensed in Pennsylvania. Prescribers and dispensers are required 

to register and query the PDMP before prescribing or dispensing an 

opioid or benzodiazepine drug product under a set of predefined 

conditions available on the PDMP website. This information helps 

health care providers safely prescribe controlled substances and 

helps patients get the treatment they need. As of January 2018, 

the Pennsylvania PDMP is sharing data with 16 other states and 

Washington, DC, helping prescribers and pharmacists to obtain 

a more complete picture of their patients’ controlled substance 

prescription histories. 

Source: Pennsylvania Department of Health (PA-DOH)

(U) Figure 1. Opioid Prescriptions per 100 persons by Pennsylvania County, 2016

Source: Centers for Disease Control
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SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

Pharmaceutical Fentanyl

According to DEA investigations, a small amount of 

pharmaceutical fentanyl, usually in the form of transdermal patches or lozenges, is diverted for misuse; thus, 

the majority of the fentanyl available in Pennsylvania 

is clandestinely produced and imported (see Fentanyl

section for more information). To minimize the future availability of pharmaceutical fentanyl, House Bill 1987 was 

introduced in the Pennsylvania House of Representatives 

in December 2017 to amend the circumstances under 

which pharmaceutical fentanyl could be dispensed. 

The bill calls for fentanyl to be dispensed only during 

surgery that occurs in a health care facility or to patients 

in hospice. If enacted, the measure would be effective 60 

days later and expire in 2 years.8

Laboratory Analysis

Among nationwide exhibits, Pennsylvania ranked eighth 

in the country in the highest number of opioid CPD exhibits reported to National Forensic Laboratory Information 

System (NFLIS)a in calendar year 2017.9

Analysis of NFLIS data indicated that opioid CPDsb 

comprised 8.5 percent of law enforcement’s seized and 

analyzed drug exhibits in Pennsylvania among the broad 

drug categories of heroin, cocaine, fentanyl, methamphetamine, prescription opioids, fentanyl related substances 

(FRSs), and non-prescription synthetic opioids (NPSOs), 

in 2017, which does not reflect a significant change from 

2016.10 Data reported to NFLIS contains multiple drug 

fields, therefore, exhibits found to contain opioid CPDs 

may also have contained other drugs. 

Within the category of opioid CPDs, oxycodone 

comprised the largest portion (60 percent); a decrease of 

20 percent was noted in oxycodone presence between 

2017 and 2016. As the number of pills prescribed has 

decreased in recent years, the funneling of oxycodone 

into the illicit drug supply has also decreased, therefore 

making it less likely to be seized by law enforcement. Of 

interest, the presence of tramadol, a Schedule IV opioid 

analgesic approved for the treatment of pain in adults,11

in seized and analyzed drug exhibits increased more 

than 100 percent from 2016 to 2017, and accounted for 

(U) Figure 2. Number of Prescriptions and Dosage Units 

of Oxycodone and Hydrocodone Products Dispensed 

by Pennsylvania Pharmacies, 2015-2017

Source: Pennsylvania Department of Health, University 

of Pittsburgh School of Pharmacy, Program Evaluation 

Research Unit

a

 NFLIS is a DEA program that systematically collects drug chemistry analysis results, as well as other related information, 

from cases analyzed by participating state, local, and federal forensic laboratories. These laboratories analyze substances 

secured in law enforcement operations across the country. NFLIS data are used to support drug regulatory and scheduling efforts as well as to inform drug policy, drug enforcement, and health initiatives both nationally and in local communities. Data in the NFLIS database are based on case- and item/exhibit-level information analyzed by forensic laboratories. It 

should be noted that NFLIS data are not “real time,” as participating laboratories report to NFLIS on different schedules and 

delays in evidence analysis can create backlogs on occasion. Further, during exhibit analysis, laboratories may identify 

several distinct drug reports within an exhibit; therefore a single exhibit reported to NFLIS may include several individual 

drug reports. All identified distinct drug reports are stored in the NFLIS database.

b Inclusive of oxycodone, oxymorphone, hydrocodone, hydromorphone, morphine, and tramadol.
UNCLASSIFIED 6

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

approximately 14 percent of exhibits within the opioid 

CPD category in 2017. Investigative reporting indicates 

that prescribers in Pennsylvania may be offering tramadol 

to patients as an alternative to oxycodone and hydrocodone products.12 In addition, tramadol has been identified 

in recent seizures of clandestinely produced fentanyl, 

discussed in greater detail in the Fentanyl section of this 

report.

A source of supply for opioid CPDs in the illicit drug market is unscrupulous physicians who write prescriptions 

in exchange for cash payments. These doctors often see 

a high volume of patients and do not perform a medical 

examination before writing prescriptions. 

A recent DEA investigation involved a physician who 

owned and operated two pain management practices, 

suspected to be “pill mills” in the greater Philadelphia area. 

Significant numbers of patients traveled long distances 

from areas outside of Philadelphia, and from neighboring 

states, to see this physician. The number of patients visiting the two practices was unusually high when compared 

to other practitioners in the area. Many patients received 

similar quantities, types, and strengths of medication, all 

of which are in demand on the illicit drug market in the 

Philadelphia area. Investigators identified numerous drug 

trafficking organizations (DTOs) that used the two medical 

practices to obtain oxycodone prescriptions, which were 

filled and the pills re-sold for profit.13 Prescription data 

indicated that the medical practices were writing hundreds of oxycodone prescriptions for tens of thousands of 

pills on a monthly basis.14

In the past, diverted CPDs were largely supplied by local 

DTOs that recruited “patients” to complain of ailments, 

resulting in a prescription for opioids, benzodiazepines, 

or other drugs. The “patients” then gave the filled 

prescription to the DTO in exchange for payment. DEA 

investigative reporting indicates this practice has declined 

in Pennsylvania recently. It is likely that the revamped 

PDMP has curtailed this tactic by making it more difficult 

for patients to “doctor shop” (see Role of the PDMP section 

below).15 

Criminal organizations also transport opioid CPDs into 

Pennsylvania from other areas. For example, several 

investigations conducted by DEA in western Pennsylvania 

revealed that prescription drugs destined for the illicit 

drug market were transported from Detroit, MI and several 

locations in Florida. In most cases, individuals obtained 

the diverted opioid CPDs out-of-state and subsequently 

transported to the Pittsburgh area; in other cases, 

individuals saw out-of-state physicians and brought paper 

prescriptions back to Pennsylvania, where they were filled 

at Pittsburgh area pharmacies, and the pills subsequently 

sold.16

Role of the PDMP in Drug Trafficking 

Investigations

PDMP data plays an important role in law enforcement 

investigations of “doctor-shopping” patients and of prescribers operating outside the scope of medical practice. 

The Pennsylvania Department of Health (PA-DOH), PDMP 

office reported an 86 percent decrease in patients who 

doctor shop (visit 5+ doctors and 5+ pharmacies in a 3 

month period) for Schedule II drugs in the first year of the 

PDMP.17 Further, two-thirds of the more than 110 pharmacists interviewed by DEA reported a decrease in doctor 

shopping since the implementation of the PDMP.18

A recent DEA investigation involved a physician 

who owned a family practice and was prescribing 

large quantities of prescription narcotics, particularly 

oxycodone, outside the usual course of professional 

practice and without legitimate medical purpose. 

A review of PDMP data revealed the doctor wrote 

approximately 56,000 prescriptions for Schedule II 

controlled substances over a 59 month period and 

that prescriptions were written every day, including 

Saturdays and Sundays. The number of Schedule II 

dosage units prescribed totaled over six million, most 

of which were for oxycodone, as well as hydrocodone 

and fentanyl. At the time, this physician was the top 

oxycodone prescriber in Pennsylvania, and at least 13 

of his patients ultimately died from a drug overdose. 
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SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

In December 2017, the physician was indicted on 

19 counts of federal charges in the Middle District 

of Pennsylvania, including unlawful distribution and 

dispensing of controlled substances, causing the 

death of five patients by the unlawful distribution and 

dispensing of controlled substances, and maintaining 

two drug-involved premises.19 

Pricing

CPDs sold on the illicit market in Pennsylvania vary in 

price depending on the type of CPD, the area in which 

they are sold, and the relationship between dealer and 

buyer. Many CPDs sell for approximately $1 per milligram,c

a long-known standard street price for CPDs. For example, 

oxycodone 30 mg tablets are sold for a range of $15 

to $50 per tablet, depending on the location, and this 

range is common for cities throughout Pennsylvania. 

Hydrocodone prices also range close to $1 per milligram 

throughout Pennsylvania. 

Buprenorphine (Suboxone®), used in treatment for opioid 

addiction, is sold in tablet and strip forms in Pennsylvania 

and is diverted for misuse when offered for sale or in trade 

for other opioids or illicit substances. Prices on the illicit 

market range from $6 to $10 per strip and $10 to $20 per 

tablet.20

Heroin

Heroin sourced from Mexican transnational criminal 

organizations (TCOs) presents a persistent and pervasive 

drug threat in Pennsylvania. Mexican TCOs, working in 

conjunction with regional and local distributors, supply 

Pennsylvania with wholesaled quantities of inexpensive,

yet very pure heroin to meet user demand throughout 

Pennsylvania. The heroin threat to Pennsylvania 

is exacerbated by the recent re-emergence and 

unprecedented proliferation of fentanyl and Fentanyl 

Related Substances (FRSs) used as highly potent heroin 

adulterants or substitutes with increasing frequency (see 

Fentanyl section below). 

Production

Heroin distributed in Pennsylvania originates from sources 

in South America and Mexico, as reporting from the DEA’s 

Heroin Signature Program (HSP)e indicates that retail 

heroin in Pennsylvania is predominantly derived from 

South American and Mexican grown poppies.f Analysis 

of DEA Heroin Domestic Monitoring Program (HDMP)g 

purchase data shows that heroin marketed in Pittsburgh 

and Philadelphia is consistently among the most pure 

and inexpensive in the United States. From at least 1999 

to 2016 (the most recent HDMP purchase data available), 

heroin exhibits acquired in Philadelphia had the highest 

documented purity level and were the cheapest in price 

among all HDMP heroin markets.

Availability

Metrics of drug availability, including laboratory analysis, 

drug seizures, and investigative reporting, indicate that 

heroin availability continues to rise in Pennsylvania, 

especially among rural counties;21 however, a concurrent 

increase in availability of fentanyl in Pennsylvania has 

become evident in recent years, including incidents of 

fentanyl sold as heroin. Although the increase of fentanyl 

in Pennsylvania may affect future availability of heroin, 

such impact has yet to be fully assessed. And while law 

enforcement indicators show that heroin is abundant 

throughout Pennsylvania, reports from user populations 

and treatment professionals suggest that the ability to 

obtain unadulterated heroin (i.e., heroin devoid of fentanyl) at the retail level is becoming more difficult. 

c

 All dollar amounts in this report are in U.S. currency.

d “Wholesale” is defined herein as having a net weight of 1,000 or more grams. 

e

 The Heroin Signature Program is operated by DEA Special Testing and Research Laboratory to identify and quantify the 

geographic source region, purity, and chemical components of heroin seized in the United States.

f

 Classification as defined by DEA Special Testing and Research Laboratory for analysis of heroin signatures. 

g Retail-level heroin purchase program that analyzes geographic source, price, purity, adulterants, and diluents of heroin 

sold at the street-level in 27 U.S. cities.
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SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

Laboratory Analysis

Among nationwide exhibits, Pennsylvania ranked second 

in the country (after Ohio) in the highest number of heroin 

exhibits reported to NFLIS in calendar year 2017.22

Heroin was the most frequent drug seized, analyzed, and 

reported to NFLIS in Pennsylvania in 2017, comprising 

approximately 38 percent of exhibits among the broad 

drug categories of heroin, cocaine, fentanyl, methamphetamine, prescription opioids, FRSs, and NPSOs.23 The 

(U) Figure 3. Seized and Analyzed Heroin Exhibits by Pennsylvania County, 2017

Source: NFLIS

number of heroin exhibits seized in Pennsylvania and 

reported to NFLIS increased 56 percent from 2006 to 

2016.24 Data reported to NFLIS contains multiple drug 

fields, therefore, exhibits found to contain heroin may also 

have contained other drugs. 

A review of NFLIS data found that heroin was seized in 97 

percent of Pennsylvania counties in 2017 (see Figure 3). 

Philadelphia and Allegheny county seizures accounted 

for almost half of the total analyzed heroin exhibits in 
UNCLASSIFIED 9

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

2017, with approximately 32 and approximately 17 percent, respectively.25 However, despite the concentration 

of heroin seizures occurring in the two most populated 

areas of Pennsylvania, heroin presence is ubiquitous in 

drug markets throughout the Commonwealth.

More than 80 percent of 2016 analyzed heroin exhibits 

reported to NFLIS were seized in urban counties;26 however, longitudinal analysis of NFLIS data reveals an upward 

trajectory of rural heroin seizures since 2011 (see Figure 

4).27 While the increase in rural county heroin seizures 

could reflect increased law enforcement focus on heroin 

in those counties, the rising statewide increase in heroin 

seizures indicates increased availability throughout the 

Commonwealth, including in rural counties. 

NFLIS analysis indicates that heroin is most frequently 

identified as the only substance in such exhibits (without 

controlled or non-controlled adulterants). In 2017, 

approximately 59 percent of heroin seizures reported 

to NFLIS from Pennsylvania showed the presence of 

heroin by itself, which is a decrease from 84 percent in 

2016 (Appendix E, Figure E1). The 25 percent decrease 

in heroin identified by itself can be attributed, at least 

in part, to a concurrent 200 percent increase between 

2016 and 2017 in the presence of fentanyl in NFLISreported submissions. An additional one percent of 2017 

heroin seizures tested positive for heroin with at least one 

non-controlled adulterant. When reported,h the primary 

non-controlled heroin adulterants in Pennsylvania in 2017 

have contained other drugs. 

A review of NFLIS data found that heroin was seized in 97 

percent of Pennsylvania counties in 2017 (see Figure 3). 

Philadelphia and Allegheny county seizures accounted 

for almost half of the total analyzed heroin exhibits in 2017, 

with approximately 32 and approximately 17 percent, 

respectively.24 However, despite the concentration of 

heroin seizures occurring in the two most populated areas 

of Pennsylvania, heroin presence is ubiquitous in drug 

markets throughout the Commonwealth.

(U) Figure 4. Percentage of Heroin Exhibits Seized in Urban and Rural Counties, Pennsylvania, 2011-2016

Source: NFLIS

h

 Testing and analysis of adulterants varies by laboratory.
UNCLASSIFIED 10

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

were caffeine, quinine, procaine, and xylazine. The overall 

presence of non-controlled substances in heroin exhibits 

has decreased sharply since 2012.28 

The remaining 40 percent of 2017 heroin exhibits indicated the presence of at least one other illicit substance. 

Among these exhibits, fentanyl was the substance found 

most frequently. Approximately 83 percent of 2017 

multi-substance heroin seizures also had fentanyl, a 122 

percent increase since 2014. Analysis of NFLIS data 

revealed that illicitly manufactured FRSs and the NPSO 

U-47700 emerged as new heroin adulterants since 2014 

and 2015, respectively. Figure 5i demonstrates the multiyear increase in the presence of fentanyl with heroin, the 

appearance of FRSs and U-47700 as heroin adulterants, 

and the corresponding decrease in the presence of 

cocaine and methamphetamine combined with heroin.29

As discussed later in this report, fentanyl availability 

in Pennsylvania is increasing rapidly. The increased 

presence of fentanyl and FRSs as heroin adulterants likely 

reflects recent increased production and distribution 

of the substances by Mexican TCOs responsible for 

supplying heroin to Pennsylvania. In addition, due to 

several factors, including relative ease of production and 

increased profit margin of fentanyl compared to heroin, 

it is possible that increasing availability of fentanyl and 

FRSs will reduce wholesale demand for heroin and 

consequently reduce heroin production.

Drug Seizures

Regionally,the DEA seized and analyzed more than 1,200 

kilograms of heroin in 2016 and 2017.30 In Pennsylvania, 

DEA investigative reporting reflects a steady increase 

in the number of heroin exhibits seized and submitted 

to DEA laboratories for analysis over the past 6 years. 

Concurrent increases are also apparent in the gross 

weight and average weight per seizure for heroin seizures 

submitted to DEA laboratories for analysis. The average 

weight per DEA reported seizure in 2016 was 425 grams; 

this is more than double the average of 161 grams reported in 2014 (see Figure 6).31 Calendar year 2017 seizure 

data was excluded, due to exhibits pending laboratory 

analysis. 

Seizure data provided by the Pennsylvania State Police 

(PSP) serves as an additional statewide indicator of drug 

availability by volume. PSP reported heroin seizures 

totaling more than 295 kilograms between 2014 and 

2017, with a peak of 90 kilograms in 2014, slight declines 

in 2015 and 2016, and nearly 70 kilograms in 2017.32 

(U) Figure 5. Drugs (Excerpted) Found in Combination 

with Heroin in Seized and Analyzed Drug Exhibits, 

Pennsylvania, 2014-2017

Source: NFLIS

i Numbers may be above 100% due to presence of multiple drugs in one exhibit. For example, an exhibit may contain 

cocaine, heroin, and fentanyl, of which both cocaine and fentanyl would be represented in the Figure. Heroin seized by the 

DEA Philadelphia, New York, and New Jersey Field Divisions (combined) and analyzed by a DEA laboratory.
UNCLASSIFIED 11

Trafficking and Distribution

Transportation

Philadelphia is a primary wholesale market for heroin 

trafficked primarily by Mexican TCOs. The city also serves 

as a secondary wholesale market for heroin transported 

in from U.S. ports of entry and transshipment areas such 

as the Southwest border, New York City, Chicago, and the 

Caribbean (primarily the Dominican Republic and Puerto 

Rico), and out to other parts of the Mid-Atlantic region, 

as well as into New England. Philadelphia-based heroin 

traffickers supply large portions of Pennsylvania, with 

additional source regions of northern New Jersey, Ohio, 

and Michigan providing wholesale, bulk retail, and retail 

quantities of heroin, namely to Pittsburgh and western 

Pennsylvania. 

Hispanic DTOs (mostly Mexican, Dominican, and Puerto 

Rican) dominate the transportation of heroin into and 

within Pennsylvania. Several DEA cases have involved 

Dominican DTO members with a permanent or semi-permanent presence in Mexico entrenched with command 

and control elements of Mexican TCOs. Investigations 

also revealed that Mexican TCOs employ Caucasians to 

transport wholesale quantities of heroin in vehicles across 

the country and into Pennsylvania. Available intelligence 

indicates that Hispanic, African American, and Caucasian 

DTOs distribute heroin at the retail level throughout 

Pennsylvania.

In a recent DEA investigation in Pennsylvania, a 

confidential source was provided on consignment 

three kilograms of heroin and five kilograms of fentanyl 

by a Dominican intermediary from a Mexican source of 

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

(U) Figure 6. Heroin Seizures in Pennsylvania by DEA Philadelphia Field Division, 2011-2016

Source: DEA Philadelphia Field Division
UNCLASSIFIED 12

supply. Pursuant to further investigation, six kilograms 

of heroin were seized from a stash location affiliated 

with the local organization.

Interstate 95 acts as a primary trafficking corridor for eastern Pennsylvania and connects Philadelphia to domestic 

source cities north (New York, Newark) and south (Atlanta, 

Miami). Wholesale quantities of heroin are transported 

through Pennsylvania in tractor-trailers (commingled 

among legitimate cargo) and in personal and rental 

vehicles, often containing concealed compartments. 

Regional distributors, such as those from Wilmington, 

Delaware, also use Interstate 95 to travel into Philadelphia 

and purchase wholesale quantities of heroin for further 

distribution. Other common routes used by drug transporters transiting the Philadelphia area include Interstate 

476; U.S. Routes 1, 322, and 422; and the Pennsylvania 

Turnpike. East-West oriented Interstates 80, 81, and 76 act 

as additional drug trafficking routes between Philadelphia 

and Pittsburgh, and connect Pittsburgh with drug markets 

in Ohio. 

Recently, in a joint DEA and Philadelphia District Attorney’s 

Office investigation, law enforcement personnel seized 

approximately 1 kilogram of suspected heroin from a 

concealed floor compartment of a vehicle occupied by 

two suspected local traffickers (Hispanic males). The 

suspected heroin was packaged within vacuum-sealed 

bags and was supplied by a Dominican male from New 

York. 

Packaging

Heroin sold at the retail level is packaged in small plastic 

or glassine bags, with the heroin (usually in powder form) 

contained within folded paper (see Figure 7). Bulk retail 

quantities of heroin are typically packaged in “logs” of 

ten “bundles”, each bundle containing approximately 13 

baggies. “Loose” heroin powder is also sold in multi-gram 

quantities and commonly packaged in the torn corner of 

a plastic bag. While it is still fairly common for individual 

bags of retail-quantity packaging to be stamped with 

a “brand” or logo, the role of heroin packaging “mills” 

make it less likely that a particular marking is exclusive 

to a specific DTO or distribution point. Heroin mills are 

essentially large-scale, high volume packaging operations 

dedicating to breaking down and repackaging wholesale 

quantities of heroin in preparation for street level 

distribution. 

Wholesale quantities of heroin are generally packaged in 

kilogram quantity brick form, wrapped with plastic wrap or 

layers of packaging/duct tape (see Figure 8). An emerging 

trend in heroin availability in Pennsylvania is visible in 

the wholesale quantities of heroin and fentanyl seized 

together but packaged separately. 

 (U) Figure 7. Heroin Packaged and Stamped for 

 Retail Sale in Philadelphia

 Source: DEA Philadelphia Field Division

For example, DEA, working in conjunction with the 

Philadelphia District Attorney’s Office, recently seized approximately 13 kilograms of heroin and approximately 10 

kilograms of fentanyl from a Mexican national and a U.S. 

citizen with ties to Mexico. As evident in Figure 8, different 

packaging and brick shapes distinguished the heroin 

from the fentanyl. This packaging method suggests that 

heroin and fentanyl are produced separately but trafficked 

together. DEA laboratory reporting indicates that mixing of 

fentanyl and heroin at the wholesale level is minimal.33

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs
UNCLASSIFIED 13

 (U) Figure 8. Wholesale Heroin and Fentanyl Seizure 

 in Philadelphia

 Source: DEA Philadelphia Field Division

Pricing

DEA investigative reporting indicates that heroin pricing 

has decreased statewide over the past several years. 

In 2017, the reported price of heroin in Pennsylvania 

ranged from $48 to $150 per gram; $2,000 to $5,000 per 

ounce; and $50,000 to $80,000 per kilogram. Calendar 

year 2017 heroin prices reflect a marked decrease since 

2006, during which time the reported price of heroin was 

$65 to $300 per gram; $2,100 to $6,000 per ounce; and 

$95,000 to $200,000 per kilogram. While retail prices 

of heroin have decreased rather conservatively, the 

average statewide wholesale kilogram price of heroin has 

decreased approximately 56 percent since 2006. 

The current profit margin for heroin trafficked in 

Pennsylvania is staggering. Per investigative reporting, 

a typical “baggie” of heroin in Pennsylvania contains an 

approximate average of 0.02 grams of product with a 

price of $10. One kilogram of heroin, without adulteration, 

can create approximately 50,000 bags—packaged at a 

bag weight of 0.02 grams—with an approximate street 

value of $500,000. Therefore, an average kilogram investment of $65,000 can lead to a conservative approximate 

profit of $435,000. As previously mentioned, many DTOs 

adulterate wholesale quality heroin with controlled and 

non-controlled substances to increase overall product 

volume. In turn, the number of baggies created from one 

kilogram of heroin increases with adulteration, which 

increases the profit margin of heroin sales exponentially. 

Financial

Given the cash-based nature of the illicit and diverted 

drug market, opioid sales in Pennsylvania generate a 

significant volume of bulk cash for DTOs operating in 

Pennsylvania. Subsets of DTOs or independent groups 

specializing in the movement of bulk currency often 

collect and transport cash owed to sources of supply. 

DEA investigations continue to highlight the storage and 

transportation of bulk currency for ultimate repatriation to 

domestic and foreign sources of supply. In a more recent 

trend, subjects involved in the movement or laundering of 

suspected drug proceeds are increasingly seeking “mirror 

transactions” over traditional bulk money movement 

and value transfer typologies. Investigative intelligence 

indicates mirror transactions (traits of which are similar 

to hawala transfers j), involve the collection and count 

verification of bulk cash at one location/country (usually 

drug market areas) and the immediate payout of said 

funds at another location (usually drug source countries, 

transshipment locations, etc.). Structured bank deposits, 

the use of international wire money transfer services, 

trade-based money laundering, and the operation of 

“front” companies, as well as the comingling of funds 

within operational businesses, and the use of internet 

funds transfer services are also known methods to move 

drug proceeds to domestic and foreign sources. Finally, 

an emerging trend in Pennsylvania indicates that the 

procurement of illicit or diverted substances via the 

Internet is most likely to be associated with payments in 

digital currency. 

During the first half of calendar year 2018, DEA personnel, working with a local law enforcement partner, 

seized more than $1 million in cash from a Pennsylvania 

residence being used as a suspected illicit proceeds 

stash site associated with a poly-drug DTO (see Figure 

9). While this is considered a sizeable seizure of currency, it is estimated to be only a small representation 

of the volume of proceeds generated by illicit drug 

markets in Pennsylvania. 

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

Heroin

j A system or agency for transferring money whereby the money is paid to an agent who then instructs a remote associate 

to pay the final recipient.

Fentanyl
UNCLASSIFIED 14

 (U) Figure 9. Seizure of more than $1 million in 

 Pennsylvania

 Source: DEA Philadelphia Field Division

Fentanyl, Fentanyl-Related 

Substances, Non-Prescription 

Synthetic Opioids 

Fentanyl is a Schedule II synthetic opioidk approved for 

legitimate use as a painkiller and anesthetic. However, 

the drug’s extremely strong opioid properties make it an 

attractive drug of misuse for both heroin and prescription 

opioid users. Clandestinely produced fentanyl, typically 

manufactured in China and Mexico and smuggled into 

the United States, is primarily responsible for the ongoing 

fentanyl epidemic. Clandestinely produced fentanyl 

re-emerged in the illicit drug market in Pennsylvania in 

2013,34 followed shortly thereafter by the introduction of 

FRSs.l 

FRSs are in the fentanyl chemical family, with similar 

pharmacological effects, but have minor variations in 

chemical structure. Most of these substances are not 

approved for use in humans, therefore information about 

potency and lethal dosage are frequently unknown.35

NPSOs have similar sources of supply as FRSs.

Pharmaceutical fentanyl36 is also abused and diverted, 

although this occurs on a much smaller scale. Based 

on investigations and source reporting, the fentanyl 

discussed in this and subsequent sections relates to the 

clandestinely produced fentanyl supply and market. 

Production

Investigative intelligence indicates that wholesale 

quantities of clandestinely produced fentanyl supplied to 

Pennsylvania are primarily sourced from Mexican TCOs. 

Available intelligence suggests that the fentanyl trafficked 

by Mexican TCOs is either produced in Mexico using 

fentanyl precursors sourced from China or transshipped 

via Mexico after being synthesized in China.37 Over the 

last several years, the Mexican TCOs that have been 

increasingly involved in the production and distribution of 

the white powder heroin that dominates supply throughout the northeastern United States are now supplying 

the same market with fentanyl.38 In November 2017, 

confirmation of fentanyl production in Mexico occurred 

when Mexican authorities located a clandestine fentanyl 

laboratory in the state of Sinaloa, Mexico.39 Compared 

to the poppy cultivation and processing cycle of heroin 

production, fentanyl production is less labor intensive, 

less vulnerable to environmental factors, production sites 

are less detectable, and the product offers a higher profit 

margin for Mexican TCOs.40 

To date, reports of fentanyl production in Pennsylvania 

have been very limited. However, the “recipes” for the 

production of both fentanyl precursors and fentanyl are 

available on the Open Net. In May 2018, authorities in 

western Pennsylvania responded to a suspected methamphetamine laboratory located within a hotel room;41 

subsequent information indicated the site was likely used 

to produce small batches of fentanyl for distribution.42 

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

k

 In this document, the phrase “synthetic opioid” refers to only those substances which are classified as opioids and have 

no plant-based material in their production (i.e. fentanyl, FRS, and other novel opioids) and therefore does not include 

heroin.

l

 Fentanyl related substances are in the fentanyl chemical family, with similar pharmacological effects, but with minor 

variations in the chemical structure.
UNCLASSIFIED 15

Laboratory Analysis

Among nationwide exhibits, Pennsylvania ranked 

second in the country (after Ohio) in the highest number 

of fentanyl exhibits reported to NFLIS in calendar year 

2017; this represents an increase of 156 percent from 

exhibits reported in calendar year 2016, during which 

Pennsylvania ranked third in the nation for fentanyl 

exhibits.43 

Similarly, Pennsylvania ranked third in the country in 

2017 in the number of FRSs exhibits reported to NFLIS 

(behind Ohio and New Jersey); the number of FRSs 

exhibits analyzed and reported from Pennsylvania 

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

(U) Figure 10. Seized and Analyzed Fentanyl and Fentanyl-Related Substance Exhibits by Pennsylvania County, 

2017

Source: NFLIS

increased 138 percent from 2016.44 More than 18 distinct 

FRSs were seized, analyzed, and reported to NFLIS 

from Pennsylvania in 2017, of which furanyl fentanyl 

was the most frequently identified, followed by acetyl 

fentanyl, p-fluoroisobutyryl fentanyl, 3-methylfentanyl, and 

carfentanil.45

Analysis of seized drug exhibits reported to NFLIS 

found that fentanyl was the third most frequently seized, 

analyzed, and reported drug in Pennsylvania in 2017, 

representing approximately 23 percent of exhibits within 

the broad drug categories of heroin, cocaine, fentanyl, 

methamphetamine, prescription opioids, FRSs, and 
UNCLASSIFIED 16

were found at higher relative percentages in rural counties 

than urban counties.

The inclusion of fentanyl and FRSs in the illicit drug 

market generates questions regarding fentanyl marketing 

and sales techniques; user knowledge and/or pursuit 

of fentanyl versus heroin, and the potential for fentanyl 

to supplant heroin in the user market. While in previous 

years it was common for street-level drug traffickers to be 

unaware that the substance they distributed contained 

fentanyl, recent DEA investigations have identified knowledge and active marketing of fentanyl by street-level drug 

traffickers. Undercover and confidential sources have 

specifically negotiated for fentanyl and street-level distributors are known to warn customers regarding the potency 

of the product, even if they do not explicitly disclose that it 

contains fentanyl. In contrast, investigations also revealed 

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

NPSOs.46 Data reported to NFLIS contains multiple drug 

fields; therefore, exhibits found to contain fentanyl and/

or FRSs may also have contained other drugs. Analysis of 

seized and analyzed drug exhibits revealed the primary 

non-controlled adulterants to fentanyl were similar to 

heroin and included caffeine, quinine, and xylazine in 

Pennsylvania in 2017.

In 2017, fentanyl or a FRS was seized in 95 percent of 

Pennsylvania counties (see Figure 10). Fentanyl and FRS 

exhibits seized in 2017 in Philadelphia (approximately 

33 percent) and Allegheny (approximately 20 percent) 

counties accounted for more than half of the statewide 

total, combined. 47 However, the widespread presence 

of fentanyl and FRSs shows the pervasive threat posed 

by these substances as they infiltrate every part of the 

Commonwealth’s illicit drug market. Interestingly, FRSs 

Coalition

The Beaver County Behavioral Health (BCBH) Single County Authority (SCA) convened 

a Drug Abuse Coalition in October 2012 as a direct response to the local opioid overdose 

crisis. The sectors in attendance were: The Drug Enforcement Administration (DEA), the 

Beaver County District Attorney, school directors, persons in recovery, law enforcement 

officers, and substance use disorder treatment, medication-assisted treatment, and 

prevention service providers.

Major Accomplishments

Over the past six years, the Coalition has implemented: 1) Four annual Drug Abuse Coalition town 

hall meetings, with attendance exceeding 300; 2) Community education forums; 3) Placement of 19 

Prescription Drug Take Back Boxes in the courthouse and police stations across Beaver County; 

4) In excess of 3,000 pounds of drugs destroyed from Take Back Boxes and National Drug Take 

Back efforts in 2016-2018 to date; 5) Narcan distribution to colleges, schools, police departments, 

fire departments, EMS, substance use disorder treatment nonprofits, county housing authority, and 

county offices; 6) Narcan training conducted for nonprofits, educators, police, and county employees; 

7) Successful launch of magistrate level and county-wide, court-based drug diversion programs; and 

8) Hiring of Peer Review Specialist.

BEAVER COUNTY

CASE STUDY

“In light of the frightening overdose trends and statistics evidenced throughout Beaver County in recent years, the 

continued collaboration and commitment of our Coalition demonstrates the difference a community can make.”

QUOTE FROM THE COUNTY

82%

35%

17%

Increase in 911 non-fatal 

calls from 2016 to 2017

Decrease in opioid 

prescriptions from 

2015 to 2017

120

100

80

60

40

20

Increase in ED admissions 0

from 2015 to 2017

OVERDOSE DEATHS

2014 2015 2016 2017
UNCLASSIFIED 17

organizations who make efforts to avoid fentanyl or who 

do not use stamps or markings because of the perceived 

law enforcement attention it draws.48 The prosecution of 

drug sources of supply is discussed further in the Efforts to 

Address Supply section of this report. 

According to DEA’s Fentanyl Signature Profiling Programm 

(FSPP), in 2017, fentanyl seized and analyzed in the 

United States averaged 5.1 percent pure. FSPP analysis 

indicates that fentanyl available in the United States can 

range from 0.1 percent to 97.8 percent pure depending 

on the source of the fentanyl.49 DEA and Customs and 

Border Protection (CBP) reporting indicates that fentanyl 

sourced from China is typically seized in smaller quantities 

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

Source: NFLIS

(U) Figure 11. Drugs (Excerpted) Found in Combination 

with Fentanyl in Analyzed Drug Exhibits, Pennsylvania, 

2017

but with purities commonly testing above 90 percent. By 

comparison, fentanyl trafficked overland into the United 

States from Mexico is typically seized in larger, bulk 

quantities but with much lower purity, with exhibits on 

average testing at less than 10 percent pure.50 

According to DEA laboratory analysis of fentanyl seizures 

obtained in Pennsylvania, the overall average purity for 

300 powder exhibits seized during calendar year 2017 

was 6.5 percent.51 Although these purities are much lower 

than that of average heroin purities, fentanyl is significantly 

more potent than heroin,52 resulting in a higher rate of fatal 

and non-fatal overdoses. 

More recently, regional open source articles have referenced instances and concerns over fentanyl mixed with 

other non-heroin illicit substances, to include cocaine and 

methamphetamine; however, based on available information, such mixing is the exception in Pennsylvania.53 

In 2017, approximately 62 percent of fentanyl seizures 

reported to NFLIS from Pennsylvania was considered 

to be a multi-substance sample, which is similar to 64 

percent in 2016 (see Appendix E, Figure E2). In drug 

seizure analysis of multi-substance samples containing 

fentanyl, heroin was the most frequently identified other 

substance (88 percent) in 2017. The presence of cocaine 

was noted in less than five percent of multi-substance 

exhibits containing fentanyl in 201754 (see Figure 11). 

Available intelligence indicates that instances in which 

fentanyl is sold as a substitute for heroin are increasing, 

with an expanding number of DTOs adding fentanyl to 

their product line as an adulterant or substitute for heroin.55 Drug seizure analysis supports this trend, revealing 

a decrease in multi-substance heroin seizures absent 

fentanyl, with a concurrent increase in fentanyl exhibits 

without heroin56 (see Figure 12).

In addition, recent DEA investigations in Pennsylvania 

involved seizures of fentanyl mixed with tramadol (see 

m DEA’s FSPP performs in-depth chemical analyses on fentanyl and fentanyl-related exhibits obtained from seizures made 

throughout the United States. Analytical methodologies developed by DEA give in-depth reporting on seizures and also 

link seizures for intelligence purposes. FSPP data is not intended to reflect U.S. market share, but is rather a snapshot of 

current trends.
UNCLASSIFIED 18

(U) Figure 12. Analyzed Drug Exhibits with the Presence 

of Heroin and Fentanyl, Pennsylvania, 2016-2017

Source: NFLIS

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

(U) Figure 13. Seizure of Fentanyl/Tramadol Powder in 

Philadelphia

Source: DEA Philadelphia Field Division

Figure 13). Of note, NFLIS data indicates that the number 

of laboratory-analyzed tramadol exhibits found to 

contain fentanyl doubled from 39 in 2016 to 78 in 207 in 

Pennsylvania.57

In a 3-day period in July 2018, Philadelphia experienced 

more than 165 overdoses related to a mixture of 

heroin, fentanyl, and the synthetic cannabinoid 5F-ADB, 

packaged and sold in marked bags. This was the first 

identification of this mixture, and investigative intelligence 

indicates that is may be a marketing technique by 

dealers trying to entice new customers with a novel drug 

combination.58

Drug Seizures

A review of DEA investigative data revealed that regionaln 

fentanyl seizures increased over 290 percent from 

2016 to 2017.59 In addition, the number of wholesale 

seizures grew from 12 in 2016 to more than 40 in 2017. 

Individual seizures of more than 7 kilograms of fentanyl 

have occurred with increasing frequency since 2016, 

to include a seizure of approximately 30 kilograms of 

fentanyl reportedly destined for delivery to a Philadelphia 

address when seized pursuant to a traffic stop in Illinois in 

September 2017.60 

Fentanyl seizures reported by PSP showed a marked 

uptick in total seized weight in 2017, to include more than 

65 kilograms total. This represents a sharp increase from 

previous years when seizures totaled less than 10 grams 

per year.61 As a statewide indicator of drug availability by 

volume, PSP fentanyl seizure trends mirror those of DEA in 

Pennsylvania.

Trafficking and Distribution

Wholesale fentanyl supplied by Mexican TCOs is 

generally packaged in poly-drug loads and transported 

to Pennsylvania using the same routes/methods as 

heroin, with states such as New York, New Jersey, Ohio, 

and Michigan serving as additional source locations for 

Pennsylvania. Regional and local distribution organizations and methods are similar to those discussed in the 

previous heroin section.62 

A recent DEA investigation identified the use of a 

commercial airline to smuggle two kilograms of 

fentanyl (and 5 kilograms of cocaine) from Los Angeles 

to Philadelphia in checked baggage. The passenger 

claimed to have made several prior trips to Philadelphia 

(see Figure 14). 

n Fentanyl seized by the DEA Philadelphia, New York, and New Jersey Field Divisions and analyzed by a DEA laboratory.
UNCLASSIFIED 19

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

(U) Figure 14. Seizure of Fentanyl from Luggage 

of Philadelphia-Bound Passenger on Commercial 

Airline

Source: DEA Los Angeles Field Division

(U) Figure 15. Seizure of Fentanyl from Passenger 

Vehicle in White Haven, Pennsylvania 

Source: DEA Philadelphia Field Division

More commonly, fentanyl is secreted in commercial and/

or passenger vehicles, as in a recent investigation that 

led to the seizure of three kilograms of fentanyl from a 

passenger vehicle in White Haven, Pennsylvania (see 

Figure 15). The 3 kilograms had a total average purity of 

approximately 9.2 percent.

The ease of procuring fentanyl, FRSs, and NPSOs online 

from both Open Net and Dark Web vendors has greatly 

increased the accessibility of these products to individual 

users and distributors. Investigations reveal that these 

products are purchased online in quantities ranging from 

personal use to wholesale amounts and that they are 

primarily sourced from China.63 Law enforcement partners 

operating in Pennsylvania have reported local and broader redistribution of fentanyl and FRSs obtained online from 

Chinese sources. 

For example, a recent investigation involved a 

Pennsylvania-based subject accused of importing and 

distributing wholesale quantities of fentanyl via the Dark 

Web. Two fatal overdoses in Oregon were reportedly tied 

to the Pennsylvania-based supplier, who was also the 

subject of investigation by agencies in the Western District 

of Pennsylvania and the District of North Dakota. The 

investigation uncovered over 3,700 transactions involving 

a heroin/fentanyl mixture; the transactions totaled more 

than 7 kilograms of the mixture and generated more than 

$284,000 worth of Bitcoin. Indications are that the fentanyl 

was shipped in packages originating from China and 

Hong Kong.64 

In another investigation, two Pennsylvania-based 

subjects were arrested and accused of importing fentanyl 

and carfentanil from China to Pennsylvania through 

transactions made on the Dark Web. One of the subjects 

experienced an overdose related to the handling of the 

substances. “During the investigation, authorities seized 

approximately 300 grams of fentanyl while an additional 

400 to 500 grams of carfentanil were documented as 

having been ordered and shipped from China.”65 

Intelligence from federal law enforcement partners 

indicate that street gangs engaged in the distribution 

of illicit substances increasingly view the Dark Net and 

virtual currencies as less risky venues through which to 

further their criminal activity. These investigations have 

highlighted eastern Pennsylvania as a destination for 

international parcels suspected of containing fentanyl/

FRSs.66 International courier and mail services ship the 

packages to Pennsylvania or other parts of the United 

States. Efforts taken to avoid law enforcement detection 

include the use of code words for advertising the products (FRSs are marketed online as “research chemicals”), 
UNCLASSIFIED 20

the misrepresentation of package contents on shipping 

forms, the shipping of multiple packages related to one 

order, and the strategic routing of packages through 

intermediary countries.67 

It is worth noting that the law enforcement dismantling of 

large, centralized Dark Web marketplaces previously used 

to procure illicit products have resulted in diminished 

confidence in the venue type among vendors, customers, 

and site administrators.68 The current Dark Web environment is considered to be much more fragmented in 

nature, with “the current landscape” containing “a limited 

number of unstable, unpopular, and short lived marketplaces.”69 Currently, alternate venues, including those on 

the Open Net, are being explored by parties “seeking to 

meet the demands for illicit goods and services.”70 Given 

this development, it is likely that the Open Net and other 

venues will continue to be explored for the marketing/

purchasing of “research chemicals” and “pharmaceutical 

products” which may contain fentanyl/FRSs. 

Packaging and Pricing

At the retail and wholesale levels, fentanyl is packaged 

much in the same way heroin is packaged. Typical 

street-level packaging includes glassine bags or waxed 

bags, sometimes further contained within folded paper, 

and bulk retail quantities have been observed in the 

corners of plastic bags. Wholesale quantities of fentanyl 

are commonly packaged in brick form, with the exterior 

wrapped in varying forms of tape and/or cellophane. 

When efforts are made to distinguish the fentanyl from 

other substances being transported with it, the “brick” or 

kilogram-quantity may be in a non-rectangular shape or 

have distinct markings.71

In a recent DEA investigation, approximately 8 kilograms of fentanyl were concealed within a functional 

fire extinguisher and transported to Philadelphia for 

removal and sale. The extinguisher had labels/markings 

indicating that it was likely sold and/or manufactured in 

Mexico (see Figure 16).

Wholesale fentanyl is generally estimated to be less 

expensive than wholesale heroin. Because fentanyl is a 

more potent substance compared to heroin, a kilogram 

of fentanyl can yield many more doses, thereby making 

it more profitable.72 However, this comparative savings 

is not always passed further along the distribution chain. 

The profit margin for fentanyl is maximized even further 

when heroin prices (or even slightly less than heroin 

prices) are charged for adulterated fentanyl (sometimes 

marketed as “synthetic heroin”). Based on available 

DEA investigations, a kilogram of fentanyl sourced from 

Mexico can be purchased in Pennsylvania for $53,000 to 

$55,000.73 

Barring variables in product purity, a baggie of purported 

heroin containing exclusively fentanyl is comprised of 

approximately 90 percent adulterant and 10 percent 

fentanyl, which equates to approximately 2 milligrams of 

fentanyl per baggie.74 Packaged at an average product 

weight of 0.02 grams per bag, one kilogram of fentanyl 

can produce 500,000 bags with a street value of $10 

each. Therefore, an average $54,000 investment for 1 

kilogram of fentanyl can yield an approximate $5 million 

profit. A similar profit margin is attainable for DTOs pressing fentanyl into counterfeit oxycodone pills, which also 

typically contain 2 milligrams of fentanyl and sell for $10 to 

$20 per pill.75 

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

(U) Figure 16. Seizure of Fentanyl Concealed in 

Operational Fire Extinguisher in Philadelphia

Source: DEA Philadelphia Field Division
UNCLASSIFIED 21

Forms

Seized drug exhibits containing fentanyl or FRSs are 

generally in powder form; however, liquids, tablets, 

fentanyl-soaked paper, and nasal spray have also been 

observed in Pennsylvania seizures. 

The availability of clandestinely produced fentanyl, 

FRSs, and/or NPSOs in tablet form is an emerging 

threat in Pennsylvania. Several recent law enforcement 

investigations have identified regional DTOs purchasing 

fentanyl and FRSs from Open Net and Dark Web sources, 

obtaining pill press machines illegitimately, and producing 

large quantities of tablets disguised as oxycodone.76

Specifically, law enforcement partners seized three 

such operations in Philadelphia and its suburbs since 

December 2017. The following describes one of 

several illegal pill production operations dismantled 

by Philadelphia area law enforcement: The PFD began 

collaborating with the Homeland Security Investigations 

- Philadelphia Cyber Task Force in April 2018 to target 

subjects in the Philadelphia area responsible for the 

importation of pill press machines, pill dies, and other 

paraphernalia used in the manufacturing of counterfeit 

opioids such as oxycodone and Percocet®. In May 

2018, the Task Force executed a search warrant at a 

clandestine laboratory in Philadelphia responsible for 

producing fake Percocet® and oxycodone pills. Agents, 

in conjunction with Pennsylvania State Police (PSP), 

including the PSP Clandestine Laboratory Response 

Team (CLRT), seized two industrial pill press machines, 

pill press dies, five kilograms of unidentified powder, 500 

unidentified pills, empty vessels of caffeine powders, and 

SUPPLY OPIOID CPDs HEROIN FENTANYL/FRSs

Coalition

In May 2016, the Centre County Heroin and Opioid Prevention and Education (HOPE) 

Initiative was created. Members include those from the prevention, treatment, and recovery 

communities; agencies involved in the criminal justice system; and members of the 

community affected by addiction. In the past year, members of the HOPE Initiative have 

been meeting monthly to determine what they can do to make their Vision of eliminating 

substance abuse, drug overdoses, and drug overdose deaths in Centre County a reality.

Major Accomplishments

Working collaboratively, the HOPE Initiative has achieved the following: 1) Distributing Naloxone to 

all municipal police and EMS departments in the county; 2) Tracking the use of Naloxone with first 

responders and Centre County 911; 3) Installing six additional prescription drug collection boxes in the 

county, accounting for over 2,845 pounds of drugs being properly disposed of; 4) Holding a Prescription 

Drug Take Back Day sponsored by the Centre County Sheriff’s Department on April 28, 2018 in 

Philipsburg and Spring Mills, yielding 106 pounds of disposed drugs in areas with no permanent 

collection boxes; 5) Continuing outreach efforts to educate the community about the disease of addiction, 

and to remove the stigma associated with it; and 6) Hosting two town hall meetings with DA’s office.

CENTRE COUNTY

CASE STUDY

“The Centre County HOPE Initiative will work to eliminate substance abuse, drug overdoses,

 and drug overdose deaths in Centre County.”

QUOTE FROM THE COUNTY

24

20

16

12

8

4

0

OVERDOSE DEATHS

2014 2015 2016 2017

115%

79%

20%

Increase in 911 non-fatal calls

from 2017 Q1 to 2018 Q1

Decrease in opioid 

prescriptions from 

2015 to 2017

Increase in ED admissions 

from 2013 to 2017
UNCLASSIFIED 22

acetaminophen and marijuana. The defendant admitted 

to manufacturing up to 10,000 counterfeit Percocet® and 

oxycodone pills, and that the pill press dies and one of the 

pill press machines came from China. The investigation 

revealed that multiple Philadelphia addresses were used 

as shipment destinations to conceal the location of the 

clandestine tableting laboratory, and that the contents of 

a pattern of prior shipments from China to the defendant’s 

Philadelphia addresses were declared to Customs as dog 

chains and drill bit parts (see Figure 17). 

A DEA investigation in western Pennsylvania identified 

counterfeit oxycodone 30 milligram tablets containing 

a combination of fentanyl and tramadol. The tablets 

were supplied via a New York source to a subject in 

western Pennsylvania who also supplies cocaine and 

heroin77 (see Figure 18).

Efforts to Address Supply

In addition to conducting complex investigations 

targeting drug suppliers, DEA, in conjunction with law 

enforcement partners, endeavors to stem the illicit opioid 

supply through its investigative and regulatory authorities, 

as well as special initiatives or projects, to include:

Temporary Scheduling of FentanylRelated Substances

On December 29, 2017, DEA announced the intent to 

issue an order temporarily scheduling FRSs that are 

not currently listed in any Schedule of the Controlled 

Substances Act. As stated in the press release, “given the 

gravity of the ongoing fentanyl-related overdose crisis in 

the United States, protection of the public safety demands 

the utilization of 21 U.S.C. 811(h) in a manner that cannot 

be readily circumvented by drug traffickers. Specifically, 

in issuing the upcoming temporary scheduling order, DEA 

will exercise its authority to avoid an imminent hazard to 

the public safety by placing all FRSs in Schedule I. These 

substances—including those that have not yet been 

introduced by traffickers into the U.S. market—present a 

significant risk to the public health and safety and need to 

be controlled under section 811(h) to avoid an imminent 

hazard to public safety. It should also be noted that none 

of the substances that will be temporarily controlled 

has an accepted medical use in the United States.”78 

The scheduling of these illicit substances allows for 

investigation and prosecution of sources of supply, as well 

as regional and local distributors, who previously evaded 

consequences due to lack of federal scheduling of these 

emerging substances.

Drug Delivery Resulting in Death 

Prosecutions

Holding drug suppliers accountable for harm is an important deterrent to co-conspirators. As such, Pennsylvania 

Title 18 § 2506 states that “a person commits a felony 

of the first degree if the person intentionally administers, 

dispenses, delivers, gives, prescribes, sells or distributes 

EFFORTS TO ADDRESS SUPPLY 

(U) Figure 17. Two industrial sized pill press machines 

seized in Philadelphia from a clandestine laboratory

Source: Homeland Security Investigations – Philadelphia/

Pennsylvania State Police

(U) Figure 18. Seizure of fentanyl tablets in 

Western Pennsylvania

Source: DEA Philadelphia Field Division
UNCLASSIFIED 23

any controlled substance or counterfeit controlled substance in violation of section 13(a)(14) or (30) of the act of 

April 14, 1972 (P.L.233, No.64), known as The Controlled 

Substance, Drug, Device and Cosmetic Act, and another 

person dies as a result of using the substance . . . A person 

convicted under subsection (a) shall be sentenced to a 

term of imprisonment which shall be fixed by the court at 

not more than 40 years.” The charging of violations under 

Pennsylvania Title 18 § 2506 for what is commonly known 

as “drug delivery resulting in death” occurred in 205 cases 

in 2017, an increase of more than 1000 percent since 

2013.79 

Similarly, United States Attorney’s Offices in Pennsylvania’s 

three Judicial Districts have charged defendants under 

21 U.S. Code § 841, which states that “any person who 

violates subsection(a) of this section shall be sentenced 

as follows to a term of imprisonment . . . if death or serious 

bodily injury results from the use of such substance shall 

be not less than 20 years or more than life.” For example, 

the Western District of Pennsylvania has charged this on 

more than 40 occasions since 2014, with all defendants 

who proceeded to trial being found guilty or entering a 

guilty plea.80 

A DEA investigation was initiated in 2015 in response to 

the outbreak of 80 heroin-related overdoses that occurred 

within and around Washington County, Pennsylvania, 

including six deaths. Heroin stamp bags that were 

recovered from several overdose scenes were stamped 

with the logo “Made in Colombia” and later connected to 

a DTO. After laboratory analysis, law enforcement learned 

these stamp bags contained a mixture of fentanyl and 

heroin which directly contributed to the fatal and non-fatal 

overdoses. In February 2016, based upon extensive 

evidence and testimony, a federal Grand Jury seated in 

the Western District of Pennsylvania returned a four-count 

indictment against the leader of this DTO, three counts 

of the indictment were for trafficking heroin and fentanyl, 

which resulted in serious bodily injury. Count four of the 

indictment further charged this individual with conspiring 

to distribute and distribution of heroin and fentanyl, which 

resulted in serious bodily injury to at least two people 

in August 2015. The individual pled guilty in December 

2016 was sentenced to 84 months in federal prison.81

Controlled Prescription Drug 

Collection

Leftover medications provide a significant source 

of abused CPDs in the United States. DEA’s National 

Prescription Drug Take-Back Day initiative seeks to reduce 

the supply of unused, expired, or unwanted prescription 

drugs. In April 2018, DEA’s 15th Take-Back Day took place 

at 217 collection sites across Pennsylvania, collecting 

37,290 pounds of prescription drugs. Approximately half 

of the total was collected in the Philadelphia metropolitan 

area and surrounding counties. 

In addition to the DEA Take-Back Day initiatives, the PADOH has stationed 734 permanent drug drop-off boxes 

throughout the state. Drop-off boxes are stationed at local 

police precincts, government buildings, and other public 

safety buildings. 

For community members that are homebound or unable 

to go to a drop-off location or Take-Back event, drug 

dissolving bags and local on-call medication pick up 

programs can be found throughout the Commonwealth. 

One such program is Operation Dump, offered through 

the Allegheny County Sheriff’s office, where a resident can 

call the office to send an officer to pick up medications 

directly from the person’s home.

Overdose Information Network 

(ODIN)

The Pennsylvania Overdose Information Network (ODIN) 

is a statewide, centralized collection application for 

criminal justice agencies to capture overdose, naloxone 

administration, and drug investigative information. 

ODIN was developed by the Pennsylvania State Police 

and implemented in March 2018 in response to the 

Commonwealth’s opioid use and overdose epidemic.

ODIN is designed to provide criminal justice, government 

officials, community leaders, and policymakers reliable, 

real-time information to make data-driven decisions when 

EFFORTS TO ADDRESS SUPPLY
UNCLASSIFIED 24

combating drug issues compromising public health and 

safety. 

ODIN collects characteristics of overdoses and naloxone 

administration details, tracks overdose reversal outcomes, 

and provides investigators with real-time access to 

drug markings associated with lethal drugs as well as 

investigative leads for many types of drug investigations. 

This real-time access aids criminal justice and public 

health agencies in anticipating and quickly reacting and 

responding to dramatic spikes in overdoses.

Analysis of ODIN data is being used to drive policy and 

decision-making in education, treatment, prevention 

and legislation. It also assists criminal justice agencies in 

connecting and furthering drug investigations as well as 

understanding their response to overdose incidents and 

how to mitigate the challenges to resources. 

High Intensity Drug Trafficking Area 

Heroin Response Strategy

The Heroin Response Strategy (HRS) is a public 

health-public safety partnership between the High 

Intensity Drug Trafficking Area (HIDTA) program and the 

CDC. Beginning in 2015 among five HIDTAs in 15 states, 

the HRS mission—to reduce rates of fatal and non-fatal 

overdose by supporting collaborative efforts between 

public health and public safety agencies at the federal, 

state, and local level—expanded in 2017 to include ten 

HIDTAs in 22 states. The HRS addresses increasing levels 

of overdose in a multi-faceted and cross-disciplinary 

manner—to include law enforcement, response, 

treatment and recovery, and prevention. Specifically, the 

HRS provides funding for a Drug Intelligence Officer and 

a Public Health Analyst in each participating state to work 

with public health and public safety agencies to improve 

data sharing that informs the scope of the opioid problem, 

increase sharing of criminal intelligence, and either 

support existing or help develop programs designed to 

fulfill the HRS mission.

HRS efforts to address supply are embodied in the 

network of Drug Intelligence Officers (DIOs) now 

stationed in each of twenty-two states. DIOs serve as 

communication points within their respective states for 

reporting cross-jurisdictional links among drug trafficking 

organizations, disseminating interstate drug intelligence, 

referring investigative leads, and enhancing drug 

investigations. DIOs accomplish their objectives primarily 

by collecting information on drug-related felony arrests of 

out-of-state and out-of-local area residents, then notifying 

the respective DIO or law enforcement contact in 

arrestees’ home jurisdictions either for their information or 

for further investigative action. Such information can lead 

to increased intelligence sharing among law enforcement 

agencies regionally and improve the impact of investigations into major opioid suppliers.82 

Physician Education

The introduction of pain as the fifth vital sign in medicine 

and the increased availability of opioid pain relievers in the 

late 20th century led to an increased population utilizing 

opioids and/or developing Substance Use Disorders 

(SUD)/Opioid Use Disorders (OUD). According to the 

CDC, the number of prescription opioids dispensed to 

Americans quadrupled between 1999 and 2014, with 

primary care providers accounting for half of the opioids 

dispensed.83 The alarming number of prescription opioids 

dispensed and rate of SUD/OUD led states and the CDC 

to review the prescribing guidelines for opioids and begin 

partnering with local providers to assist in educating other 

providers on safe prescribing practices. 

Between 2016 and 2017, the PA-DOH, the CDC, and 

other medical organizations created and/or revised 

their prescribing guidelines related to opioids. These 

newly adopted guidelines provide medical professionals 

and the public an overview of the best practices for 

opioid prescribing to ensure that providers are not over 

prescribing opioids. The PA DOH created a series of 

prescribing guidelines for target audiences including, 

but not limited to: dentists, emergency departments, 

providers of treatment for non-chronic cancer pain, 

and Obstetrician/Gynecologists. Prescribing guidelines 

include information on when it would be appropriate for a 

EFFORTS TO ADDRESS SUPPLY
UNCLASSIFIED 25

patient to use opioids and the opioid threshold guidelines 

for patients. The release of the prescribing guidelines 

coincided with the release of the new Pennsylvania Drug 

Monitoring Program (PDMP). The PDMP is a database that 

prescribers, dispensers, and other specified groups utilize 

to review a patient’s prescription history, to assist in the 

screening for SUD/OUD, and to report suspicious activity 

to the Drug Enforcement Administration Diversion Control 

Division. 

In addition to prescribing guidelines and the PDMP, the 

ongoing education of medical professionals regarding 

opioid use and addiction has been required by state and 

federal organizations. Traditionally, medical professionals 

have received little training on addiction; however, with 

the influx of persons using opioids, the state and federal 

medical governing agencies have instilled policies to 

expand and improve on prescriber education. Prescriber 

education topics include, but are not limited to, the PDMP, 

the science of addiction, opioid prescribing best practices, 

screening protocols (e.g., screening, brief intervention, 

referral to treatment [SBIRT]), and talking to a patient with 

a SUD/OUD. 

The DEA Philadelphia Field Division’s Diversion Program, 

under the umbrella of the 360 Strategy (discussed in the 

Efforts to Address Demand section of this report) embarked upon a campaign to educate physicians, mid-level 

practitioners, and pharmacists throughout Pennsylvania 

about the opioid epidemic. One of the venues for these 

discussions occurs through Practitioner Diversion 

Awareness Conferences (PDAC) held regionally several 

times per year.

EFFORTS TO ADDRESS SUPPLY

Coalition

The Franklin County Overdose Task Force formed in 2015 to address the opioid 

epidemic in the community. The task force, which has over 70 at-large members, works to 

facilitate connections with agencies and communities, and to create initiatives to address 

the crisis. The task force meets monthly and has subcommittees that focus on prevention, 

treatment, recovery, law enforcement, communications, and data collection.

Major Accomplishments

A variety of new programs, interventions, and strategies have been undertaken since the inception of 

the Overdose Task Force, including, but not limited to: 1) Increased access to Naloxone; 2) Good Wolf 

Treatment Court to address the overcrowded jail population and those struggling with addiction; 3) 

Grand Jury that investigates drug delivery resulting in death cases after fatal overdoses; 4) Mobile-Vivitrol Services partnership with Positive Recovery Solutions; 5) Operation-Save-A-Life training to aid in 

preventing, recognizing, and responding to opioid overdoses; 6) Get Back Up diversion program to 

link those struggling with addiction to appropriate care if they ask the District Attorney or police for 

help; and 7) Warm Handoff Services in the hospitals to better connect individuals with treatment and 

resources. 

“The Franklin County Overdose Task Force (FCOTF) is a collaborative team effort within the community, 

fostering a determined spirit to reverse the trends of the current opioid epidemic.” 

QUOTE FROM THE COUNTY

42

35

28

21

14

7

0

OVERDOSE DEATHS

2014 2015 2016 2017

16%

71%

7%

Increase in naloxone administrations 

from 2017 Q1 to 2017 Q4

Decrease in 911 

non-fatal calls from 

2017 Q1 to 2017 Q4

Increase in ED admissions 

from 2017 Q1 to 2017 Q4

FRANKLIN COUNTY

CASE STUDY
UNCLASSIFIED 26

Diversion Actions and Prosecutions

A recent report from the American Addiction Centers’ 

Sober Media Group, based on analysis of DEA’s Cases 

Against Doctors report,84 identified Pennsylvania as 

ranking second among states with the highest average 

number of physician arrests tied to opioid cases, including 

physicians who both over-prescribe and illegally prescribe 

opioids. This report indicated that for every 10,000 

physicians employed in Pennsylvania, roughly five were 

arrested for opioid-related cases.85 These statistics indicate that the vast majority of practitioners operate within 

the scope of their duties and responsibilities; however, 

a rogue physician supplying the illicit drug market with 

prescription opioids causes grave damage by facilitating 

abuse and subsequent overdoses. Investigating these 

registrants for controlled substance violations is a priority 

of the DEA. A recently adjudicated investigation exemplifies this effort: 

In 2014, DEA initiated an investigation into the 

prescribing practices of a doctor based on numerous 

complaints received from pharmacies. At that time, 

this doctor ranked second in the Commonwealth 

of Pennsylvania and fifth nationwide in prescribing 

Schedule II controlled substances among doctors practicing in the field of neurology. During the investigation, 

agents revealed that eleven of this doctor’s patients 

died of prescription drug overdoses. The doctor was 

indicted in the Middle District of Pennsylvania in July 

2016. In June 2018, the doctor was convicted of 21 

counts of Unlawful Distribution and Dispensing of a 

Controlled Substance, 1 count of Unlawful Distribution 

and Dispensing of a Controlled Substance (Resulting in 

Death), 1 count of Unlawful Distribution and Dispensing 

of a Controlled Substance to a Pregnant Individual, 2 

counts of Maintaining Drug Involved Premises, 2 counts 

of Engaging in Monetary Transactions in Property 

Derived from Specified Unlawful Activity, and 3 counts 

of Tax Evasion. The jury also ordered that the doctor 

forfeit more than $2 million and real property. The 

doctor will be sentenced in September 2018 and faces 

a possible sentence of life in prison.86

In addition, over a 3-year period (2015-2017), the 

DEA Philadelphia Field Division processed over 300 

administrative actions against DEA Registrants (typically 

practitioner cases) in the Commonwealth of Pennsylvania. 

These actions included 153 voluntary surrenders of 

DEA registrations (self-surrender resulting in the legal 

termination of registrant’s registration without any 

further administrative action by the DEA); 122 Letters of 

Admonition (written warnings issued to DEA registrants 

for non-compliance related issues following an on-site 

inspection); and 23 Memorandums of Agreements 

(agreement for a specific period of time that requires the 

registrant to take certain measures to establish corrective 

actions).87 

Additionally, diversion investigations by the PFD, in 

conjunction with the United States Attorney’s Offices in 

the Eastern, Middle and Western Districts of Pennsylvania, 

led to over $1.5 million in civil fines against five DEA 

registrants. These registrants included three individual 

practitioners, a narcotic treatment program and a hospital 

system. Several of these registrants also had concurrent 

criminal court cases for diversion and insurance fraud 

charges either related or unrelated to the civil actions.88 

EFFORTS TO ADDRESS SUPPLY
UNCLASSIFIED 27

Demand

Assessing demand is an essential element in fully comprehending the threat opioids pose to the Commonwealth. 

Supply and demand, although intrinsic to drug trafficking 

and consumption, are not always in sync. In an effort 

to assess current demand for opioids, PFD personnel 

interviewed/queried multiple sources of information 

and analyzed available data from across disciplines, to 

include pharmacists, drug users, emergency department 

providers, and drug treatment professionals.

Pharmacy Reporting

DEA interviewed and received information from more than 

110 Pennsylvania pharmacists regarding their observations on demand for opioid CPDs. Over 70 percent of 

respondents reported a decrease in opioid prescribing 

in the last 12 months, and approximately 60 percent 

reported an increase in the prescribing of non-opioid 

CPDs in the place of opioid CPDs in the past year. This 

is not necessarily indicative of a decrease in demand for 

CPDs, but is likely due to increased awareness among 

physicians of the opioid abuse epidemic.89

Pharmacist respondents reported seeing behavior among 

customers that is indicative of their increased awareness 

of the addictive properties of opioid CPDs. Approximately 

34 percent of pharmacists interviewed reported an 

increased demand for non-opioid alternatives for pain 

treatment among customers, and the majority reported 

that customers had expressed health concerns over their 

opioid prescriptions.90 

However, there were also reports of concerning behavior. 

Nearly half (48 percent) of pharmacists interviewed said 

they commonly observed customers attempting to refill 

opioid prescriptions before they were due. One pharmacist expressed frustration with this, saying that, because 

insurance companies often give a week’s grace period for 

early refills, if the pharmacist refuses to fill a prescription 

early, the patient will simply go to another pharmacy. 

Another pharmacist noted that when insurance carriers 

reject the refill, customers usually pay cash for the 

medication.91 

A review of pharmacist responses reveal that improvements made in Pennsylvania’s PDMP are positively 

impacting prescribing and prescription filling practices. 

More than 75 percent of pharmacist respondents 

indicated their belief that the PDMP is responsible for 

reducing prescribing of, and customer access to, opioid 

CPDs. More than 92 percent of respondents indicated 

that they declined to fill an opioid prescription based on 

information learned through the PDMP. Unfortunately, 

decreasing demand remains elusive, as more than half 

of respondents did not see a corresponding decrease in 

demand for opioid CPDs. 

Counterfeit Pharmaceuticals

The increasing presence of counterfeit opioid CPDs in 

Pennsylvania is an indicator of strong demand for opioid 

CPDs in the illicit market. Traffickers use substances such 

as heroin, fentanyl, and tramadol to create tablets that 

look like the opioid CPDs most commonly purchased 

on the street (e.g., oxycodone 30 milligram tablets). The 

tablets are often exact replicas with the shape, coloring, 

and markings consistent with authentic prescription 

medications. 

Demand and Use

Assessing the current and evolving demand for opioids by 

individual users is best accomplished through interviews. 

As such, the following is a synopsis of preliminary findings 

from a drug user health survey of 400 opioid userso conducted by the Philadelphia Department of Public Health 

between December 2017 and March 2018, as well as 

input provided to DEA by service provider organizations in 

several parts of the Commonwealth.p 

DEMAND

o The findings reported are for 400 individuals who reported having used opioids in the last three months. Surveys were 

administered at a syringe exchange program and homeless encampments in Philadelphia’s Kensington neighborhood. 

Most common respondent demographics: White (55 percent); Male (65 percent); 35-44 (35 percent); public insurance 

(approximately 84 percent); previously incarcerated (85 percent); predominantly housed in street/shelter in past 6 months 

(approximately 48 percent); previous mental health diagnosis (66 percent). Results may not be representative of overall 

Philadelphia area user population.

p Instruments used to survey users in Philadelphia and Allegheny counties varied by organization. Findings possibly 

skewed by the population served by the various organizations and therefore not necessarily representative of the greater 

drug user population. Allegheny County drug use data based on 707 people who provided information on drug use while 
UNCLASSIFIED 28

When questioned regarding their drug of choice, respondents indicated that heroin was the most common drug of 

choice. Reported percentages ranged from 49 percentq

to 71 percent of respondents.

Specific to Philadelphiar:

• The majority (57.1 percent) of respondents (n=382) 

indicated having used pills before heroin. 

• Heroin being “cheaper” was the most common reasons

cited for first using heroin (28 percent of respondents, 

n=382). “Curiosity/experimentation” was the second 

most common reason given for first using heroin (23.6 

percent). Other reasons included “other drugs less 

effective” (12.8 percent); “friends/family using” (11.8 

percent); “easy to find/buy” (10 percent); “pressure 

from friends, relatives, sex partner” (9.7 percent); grief/

depressiont (6.3 percent); “pain”u(5.2 percent); and 

“doctor stopped prescribing pills”v(3.1 percent). 

Fentanyl was not reported as a primary drug of choice, 

with most surveyed users indicating that they did not 

want it. However, a consensus of responses indicated that 

fentanyl is often what is readily available and that users 

were adapting to the available supply. 

• Of note, a cohort of “newer, younger” Philadelphia 

users indicated that they choose fentanyl because it 

was available to them and they have become accustomed to it. 

• One Philadelphia service provider referenced users 

examining the color of the substance as an attempt to 

determine whether it contained fentanyl (interpreted 

yellow or pink product as containing fentanyl). 

According to the Philadelphia Department of Public 

Health survey, opioid CPDs were the preferred drug 

of choice among 3.5 percent of respondents (n=400). 

However, 37 percent of respondents reported having 

used an opioid CPD in the past 3 months. 

When questioned regarding method of ingestion, respondents reported the following, specific to Philadelphiaw:

• Approximately 81 percent of respondents (n=400) 

indicated injecting opioids. Respondents (n=323) that 

the most common “age at first injection” category was 

“25-34” years old (approximately 36 percent), followed 

by “18-24” (approximately 28 percent); “less than 18” 

(approximately 20 percent); 35-44 (approximately 12 

percent); and 45 and over (approximately 2 percent). 

• Thirty-eight percent of respondents stated that they 

use an average of “5-9” injections per day; this was 

followed by “1-4” average injections per day (approximately 36 percent); and more than 10 injections per 

day (approximately 23 percent). Nearly 70 percent of 

respondents indicated that they would use a supervised injection facility if available. 

When questioned regarding drug treatment (n=400):

• The majority of respondents (73 percent) indicated 

being “very interested” in stopping drug use. 

• Nearly 54 percent of respondents indicated that they 

had received treatment during the past 12 months. 

• Roughly 27 percent of respondents indicated that they 

were currently in treatment; of this group, buprenorphine was the most commonly identified treatment 

type. 

• “Housing” and “employment” were the most common 

“incentives for treatment” with approximately 70 

percent and 57 percent of respondents, respectively. 

Respondents (n=159) indicated that the top three 

reasons cited for not seeking treatment during the past 

12 months were: “no available beds” (14.5 percent), “no 

ID or problems with ID” (approximately 11 percent), and 

“no insurance” (10 percent). Other responses included 

DEMAND

receiving training on naloxone administration in 2017. This group also included subjects who reported no opiate/opioid 

use, including friends, and family of opioid users. 

q The 49 percent value represented the highest value in the corresponding cohort. 

r Based on previously referenced Philadelphia Department of Public Health survey.

s Categories not mutually exclusive. 

t

 Category represents an “other” category fill-in. 

u

 Category represents an “other” category fill-in. 

v

 Category represents an “other” category fill-in. 

w Based on previously referenced Philadelphia Department of Public Health survey.
UNCLASSIFIED 29

“stigma” (3 percent), “no available transport” (3 percent), 

“no available appointments” (1.9 percent), and “cost of 

treatment” (1.3 percent).

Emergency Department and 

Drug Treatment Professionals

Inquiries and interviews of hospital emergency 

department (ED) personnel, as well as drug treatment 

professionals, provide insight from providers who are well 

positioned to observe and collect information regarding 

trends in opioid demand. 

When questioned regarding current demand for opioids, 

ED personnel indicated that ED patients infrequently 

inquire as to health concerns related to opioid use and 

rarely request a non-opioid alternative. Nevertheless, 

respondents indicated that the likelihood of an opioid 

CPD being prescribed to a new patient is decreasing, 

with a co-occurring rise in prescriptions of non-opioids for 

pain management. They also reported that it is common 

for opioid-treated patients to request specific drugs, 

increased dosage, and increased potency. Seeking 

opioids without a medical need persists, as ED personnel 

routinely see repeat drug-seeking patients. ED personnel 

feel that PDMP and new opioid prescribing requirements 

have reduced opioid prescribing but not necessarily 

opioid demand. 

Information collected from drug treatment providers indicates that patients receiving drug treatment most often 

report heroin/fentanyl as their primary drug of choice, with 

a majority indicating they transitioned from prescription 

opioid use. Treatment professionals indicate rising opioid 

use, demonstrated by past-year increases in treatment 

for opioids (illicit opioids, opioid CPDs, and co-occurring 

prescription and illicit opioid use). Drug treatment specialists indicate that while some of their patients seek fentanyl, 

many users will accept whatever product is available 

(some fentanyl-seeking may be attributed to the belief that 

fentanyl is not detected on certain drug testing). Specific 

to fentanyl, treatment professionals expressed concern 

with the increase in frequency of use necessary to avoid 

withdrawal. It was also suggested that ultimately users will 

require higher doses of buprenorphine and/or methadone 

to treat fentanyl dependence. 

Naloxone availability is increasing, and users frequently 

report both experiencing and witnessing overdoses. 

Treatment professionals indicate that medication-assisted treatment (MAT) is increasing, but with frequently 

reported medication misuse and access difficulty. Like 

ED personnel, treatment professionals attribute PDMP 

and opioid prescribing requirements to decreasing opioid 

prescribing, but with similar reservations on affecting 

demand reduction.

Demand Trends

Specific to opioid CPDs, queried pharmacy, ED, and treatment professionals all report a decrease in supply, most 

likely caused by the implementation of the revamped 

PDMP; however, a concurrent decrease in demand was 

less certain. Practitioners may be offering non-opioid 

alternatives to pain management to their patients, but 

this is most likely due to increased scrutiny of prescribing 

habits, as well as legislated changes, not due to requests 

from patients seeking non-opioid products.

Analysis of the trends in response to the aforementioned 

inquiries reveals that reporting of fentanyl seeking by 

users and treatment providers differs somewhat; however, 

both report that fentanyl is widely available and users will 

adapt to supply when necessary. The implications of this 

are grave, as it is an indicator that supply, without specific 

corresponding demand, is driving the illicit drug market.

DEMAND
UNCLASSIFIED 30

Efforts to Address Demand

360 Initiative

The DEA 360 Initiative was implemented in November 

2016 as an innovative three-pronged approach to 

combating heroin/opioid use through: 1) coordinating 

law enforcement actions against drug cartels and heroin 

traffickers in specific communities; 2) Diversion Control 

enforcement actions against DEA registrants operating 

outside the law and long-term engagement with pharmaceutical drug manufacturers, wholesalers, pharmacies, 

and practitioners; and 3) Community Outreach through 

local partnerships that empower communities to take 

back affected neighborhoods after enforcement actions 

and prevent the same problems from reoccurring.92

Pittsburgh was the pilot city for the 360 Strategy, and 

during the inaugural year, more than 200 presentations, 

meetings, briefings, and community engagements 

occurred. The 360 Strategy in Pittsburgh resulted in the 

establishment of relationships with community partners, 

treatment providers, educators, policy makers, and 

registrants that continues to foster information sharing, 

resource discussion, and integrated strategies to address 

the opioid crisis in the region. In May 2018, the 360 

Strategy was initiated in Philadelphia with similar efforts 

and results anticipated.

Bridging Public Health and Public 

Safety

The Pennsylvania Overdose Reduction Technical 

Assistance Center (TAC) was funded in 2016 (and started 

working with counties in July 2016) by the Pennsylvania 

Commission on Crime and Delinquency (PCCD) and is 

led by the University of Pittsburgh’s School of Pharmacy 

Program Evaluation Research Unit (PERU). The goal of the 

TAC is to support Pennsylvania counties in achieving their 

vision of eliminating overdose and ensuring the health, 

safety, and well-being of individuals with SUD and those 

surrounding them.93 

It is suggested that the best method of addressing 

overdose reduction is to apply strategic solutions at 

the community level. Since the TAC was funded, there 

are now 29 new county coalitions and support being 

provided to 19 existing coalitions aimed at reducing 

overdoses across Pennsylvania. From these coalitions, 

35 data-driven strategic plans have been developed, 

over 1,000 leadership or coalitions meetings have been 

held, and more than 220 new initiatives have been 

implemented. These county coalitions are now the nexus 

from which state level policy changes can be implemented and tested, assessment of county level overdose 

risk can be accomplished, and systematic reduction in 

overdose deaths can be achieved. The implementation 

of the coalitions and their work is derived from a systems 

transformation framework, exclusively used by PERU.

Medication Assisted Treatment and 

Engagement

As early identification and intervention to prevent the 

development of SUDs continues to be emphasized, 

many thousands of people in Pennsylvania are currently 

diagnosed with a SUD. Warm Handoff Programs have 

been developed in ED throughout the Commonwealth in 

recognition and response to the need for improved SUD 

treatment access. To achieve sustained recovery, one 

form of treatment may is MAT.94 Early initiation of MAT 

increases the likelihood that patients will engage and 

continue in treatment. ED programs initiating 

buprenorphine therapy have demonstrated significant 

improvements in opioid withdrawal relief, treatment 

engagement and reductions in drug use.95 Patients 

treated for their addiction while admitted to medical 

hospitals for either related or unrelated illness, including 

initiation of buprenorphine, reduces subsequent drug 

use and is 6 times more likely to result in ongoing SUD 

treatment.96 Buprenorphine prescribing requires a 

physician to complete specific training and ap-ply for a 

supplemental DEA license, a so-called X-waiver. 

However, physicians in the ED are permitted to 

administer single doses of either buprenorphine or 

methadone to treat acute withdrawal while arranging for 

SUD treatment 

EFFORTS TO ADDRESS DEMAND
UNCLASSIFIED 31

follow-up. This treatment may occur for up to 3 days 

under the “Three Day Rule.”97 Patients being treated in 

the hospital for medical or surgical illness may be treated 

throughout their hospitalization, without specific facility 

addiction treatment licensure, for a co-occurring addiction 

disorder complicating medical management including 

the use of buprenorphine or methadone.98

Based upon published evidence, University of 

Pittsburgh Medical Center (UPMC) hospitals have 

developed programs to initiate treatment in the ED 

and for hospitalized patients. Several UPMC EDs 

have developed pathways to initiate treatment with 

buprenorphine for patients in active withdrawal. 

Medication administration is performed in conjunction 

with established warm handoff procedures to community SUD treatment providers and has been associated 

with a significant increase in treatment engagement. 

Inpatient treatment of withdrawal and addiction has 

been provided by the medical toxicology service 

at several UPMC hospitals. In addition to relieving 

immediate symptoms of withdrawal, engagement 

with psychiatrists, peer recovery specialists, social 

work, case management, and outpatient providers has 

allowed smoother transition from inpatient to outpatient 

management of SUD as well as co-occurring medical 

illness. Expansion of these programs in conjunction 

with internists trained in addiction medicine and 

EFFORTS TO ADDRESS DEMAND

Coalition

The Washington County Opioid Overdose Coalition formed in 2016 as a response to the 

increasing number of drug overdoses in the community. The coalition meets monthly, at 

which time their subcommittees (Coordination, Naloxone, Anti-Stigma, Treatment, and 

Education) identify goals for program and activity implementation. The coalition focuses on 

data-driven, coordinated efforts and increased collaboration of various community entities.

Major Accomplishments

The coalition has developed and participated in the following programs throughout Washington County: 

1) Community and First Responder naloxone trainings and recognition events; 2) a Medication-Assisted 

Treatment (MAT) program in the correctional facility which demonstrated decreased fatality and 

recidivism rates of participants; 3) Public Quarterly Meetings to share resources and information with 

the community; 4) Collection and analysis of more than 1,500 surveys to better target initiatives for stigma 

reduction; 5) Material development including MAT informational pamphlets, leave-behind postcards 

for first responders, and pharmacy naloxone availability; 6) a collaborative hospital warm handoff with 

local Center of Excellence and Single County Authority; and 7) Drug Summits for local schools.

“The Washington County Opioid Overdose Coalition exists to eliminate opioid overdoses, stigma associated with Opioid Use 

Disorder, and to ensure every patient with an Opioid Use Disorder has access to and support throughout treatment and recovery.”

QUOTE FROM THE COUNTY

120

100

80

60

40

20

0

OVERDOSE DEATHS

2014 2015 2016 2017

50%

293%

110%

Increase in naloxone administrations 

from 2015 to 2017

Increase in EMS 

non-fatal calls from 

2014 to 2017

Increase in treatment

from 2016 to 2017

WASHINGTON COUNTY

CASE STUDY
UNCLASSIFIED 32

psychiatry is ongoing.99

Pennsylvania Department of Human 

Services Centers of Excellence

Pennsylvania’s Centers of Excellence (COE) have established a network of 45 facilities across the Commonwealth 

that work to ensure that persons with an OUD have 

access to integrated, coordinated care, including MAT, 

and facilitating care for individuals with OUD who receive 

coverage through Medicaid. Emphasizing a team-based 

approach to long-term recovery, COEs cultivate a 

supportive network for patients that include their physical 

and behavioral healthcare providers, family members, and 

others that they engage with throughout their daily life for 

sustained recovery. 

Pennsylvania Poison Centers

Pennsylvania’s Poison Centers in Philadelphia and 

Pittsburgh offer an additional resource to the public, 

public health personnel, healthcare providers, and 

law enforcement. Poison Centers are available to any 

caller, 24/7, at 1(800) 222-1222. Healthcare providers 

including nurses, pharmacists, and physicians specially 

trained in drug use, toxicity, and withdrawal are available 

to answer every call. Real-time medical evaluation and 

treatment recommendations are provided to assist in 

the treatment of any individual. There is no cost to public 

callers. Additionally, questions regarding different classes 

of drugs and their effects on the human body can be 

answered. Poison Centers assist public health and law 

enforcement in identifying changes in drug use trends

and provide expert consultation. Pennsylvania’s poison 

centers have provided education to students, community 

organizations, healthcare professionals, first responders, 

law enforcement, and public health personnel regarding 

opioids and other drugs of misuse, including recognition 

and response to toxicity as well as demonstration of 

naloxone administration. Finally, poison centers assist 

in the evaluation, treatment, and referral of individuals 

seeking help with substance use disorders.100

Governor Wolf’s Statewide Disaster 

Emergency Declaration

Governor Wolf issued a Statewide Disaster Emergency 

with regard to the heroin and opioid epidemic in January 

2018.101 This state of emergency provides for the ability 

to waive regulatory laws that state agencies are charged 

with carrying out under normal circumstances in 90-day 

increments to remove certain barriers to addressing the 

needs posed by the disaster, in this case opioid abuse and 

overdose, more quickly and efficiently. The governor may 

choose to extend the declaration at the end of the 90 days 

(which has occurred), or the legislature may act to make 

certain provisions permanent by creating laws to do so. 

The Governor’s declaration addresses 13 specific initiatives that span across all state agencies across three main 

areas: (1) Enhancing Coordination and Data Collection to 

Bolster State and Local Response; (2) Improving Tools for 

Families, First Responders, and Others to Save Lives; and 

(3) Speeding Up and Expanding Access to Treatment.

EFFORTS TO ADDRESS DEMAND
UNCLASSIFIED 33

(U) Figure 19. Drug-Related Overdose Deaths, Pennsylvania, 2015-2017

Source: Pennsylvania Coroner/Medical Examiner Data

Impact

Fully assessing the impact of the aforementioned trends in 

opioid supply and demand is a complex task that includes 

analysis of public health data, economic and workforce 

indicators, and the gravest consequence, drug-related 

overdose deaths. As such, the PFD, in conjunction with 

the PERU TAC, analyzed these data sources in an effort to 

elucidate the impact of opioid misuse in Pennsylvania. 

Drug-Related Overdose Deaths, 

2015-2017

As in 2015 and 2016, the PFD requested information 

on drug-related overdose deaths from Pennsylvania’s 

coroners and medical examiners for deaths that occurred 

in 2017. The PFD subsequently received data on 5,456 

accidental or undetermined drug-related overdose deaths 

from 67 counties in Pennsylvania, 65 of which reported 

overdose deaths. The information in this section summarizes data from 2015 through 2017 (see Figure 19). For an 

explanation of the full methodology used in collecting and 

standardizing the collected data, please see Appendix B.

IMPACT
UNCLASSIFIED 34

(U) Figure 20. Rate of Drug-Related Overdose Deaths per 100,000 people, Pennsylvania 2015-2017

Source: Pennsylvania Coroner/Medical Examiner Data

IMPACT
UNCLASSIFIED 35

Toxicology test results were reviewed, and drugs of 

interest (Appendix B, Figure B1) were selected for analysis, 

and combined into categories, 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. A detailed 

analysis of 2017 data can be found in Appendix C.

Overview

The rate of drug-related overdose deaths in Pennsylvania 

increased from 26 per 100,000 in 2015 to 43 per 100,000 

in 2017. This far exceeds the national average (22 per 

100,000 in 2017).102 Among individual counties, rates 

ranged from 0 to 77 per 100,000 people. Figure 20 

depicts the trend in overdose deaths rates per 100,000 

people for each county from 2015 to 2017.

Between 2015 and 2017, there was a 65 percent increase 

in the number of drug-related overdose deaths in 

Pennsylvania. The change in deaths (percent) from 2015 

to 2017 varied across the counties and ranged from a 

67 percent decrease to an 850 percent increase. Figure 

21 depicts the change in rates of drug-related overdose 

deaths in Pennsylvania counties from 2015 to 2017. 

There was a slightly larger percent increase in the number 

of drug-related overdose deaths in urban counties (67 

percent) than rural counties (53 percent) from 2015 to 

2017. A full listing of county rankings can be found in 

Appendix A. Within the top 10 counties, the distribution 

(U) Figure 21. Percent Change in Drug-Related Overdose Deaths in Pennsylvania Counties, 2015-2017

Source: Pennsylvania Coroner/Medical Examiner Data

IMPACT
UNCLASSIFIED 36

of rural and urban counties was similar to 2015; five rural 

counties were ranked in the top 10 in both 2015 and 

2017. Of note, 71 percent of counties that reported an 

overdose death in 2017 had rates per 100,000 people 

that exceeded the national average. By the PA-DOH 

Regions grouping (Figure 22), the southern regions of 

Pennsylvania demonstrated the largest percent increase 

in overdose deaths from 2015 through 2017. 

Toxicology Trends in Drug-Related 

Overdose Deaths, 2015-2017

Between 2015 and 2017, the percent change of drug-related overdose deaths increased in 4 out of 8 identified 

drug categories (see Figure 23), with fentanyl and FRSs/

NPSOs demonstrating the largest increases. Fentanyl, 

the most frequently reported drug in 2017, increased 

150 percent from 2015 to 2017. FRSs/NPSOs increased 

394 percent from 2015 to 2017. Prescription opioids and 

heroin decreased in consecutive years, which may be 

reflective of the information reported above in the Supply

section. 

(U) Figure 22. Percent Change in Drug-Related Overdose Decedents by Pennsylvania Department of Health

Region, Pennsylvania, 2015-2017

Region

Percent Change 

from 2015 - 2016 

Percent Change 

from 2016 - 2017

Percent Change 

from 2015 - 2017

North Central 65% -5% 57%

Northeast 12% 21% 35%

Northwest 30% 15% 49%

South Central 48% 20% 79%

Southeast 39% 26% 74%

Southwest 55% 7% 65%

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 23. Frequency of Drug Categories and Percent Change in Drug-Related Overdose Decedents,

Pennsylvania, 2015-2017

Drug Category Percent Reported 

Among 2015

Decedents

Percent Reported 

Among 2016 

Decedents

Percent Reported 

Among 2017 

Decedents

Percent 

Change from 

2015 - 2017

FRSs & NPSOs 4% 5% 18% 394%

Fentanyl 27% 47% 67% 150%

Other Illicit Drugs 7% 7% 11% 54%

Cocaine 24% 28% 32% 36%

Ethanol 20% 21% 19% -5%

Benzodiazepines 39% 35% 31% -21%

Prescription Opioids 27% 25% 20% -27%

Heroin 53% 43% 38% -28%

Source: Pennsylvania Coroner/Medical Examiner Data

IMPACT
UNCLASSIFIED 37

Toxicology Overview

Within toxicology reports of the 2015 to 2017 drug-related 

overdose deaths, a total of 282 different drugs were 

identified. Of the 13,408 drug-related overdose deaths, 83 

percent contained two or more drugs, 40 percent contained four or more drugs, and 14 percent contained six or 

more drugs in the associated toxicology reports. Figure 24 

demonstrates the presence of each analyzed substance 

in the data set between 2015 and 2017. 

Toxicology Trends by County

In 2017, the most commonly identified drug category, 

fentanyl, was present in 61 counties across Pennsylvania. 

Among toxicology reports, fentanyl was the most frequent 

substance in 92 percent of these counties. Between 

(U) Figure 24. Percent of Drug-Related Overdose Deaths per Year by Drug Presence, Pennsylvania, 2015-2017

Source: Pennsylvania Coroner/Medical Examiner Data

2015 and 2017, the most commonly identified drug 

category in toxicology reports by county changed across 

the commonwealth from heroin to fentanyl (see Figure 

25). Some counties demonstrated a tie between two or 

more prevalent drug categories. In these instances, the 

drug category displayed was ranked in order of fentanyl, 

heroin, prescription opioids, and other illicit drugs.

Toxicology Trends by Time

The percentage of drug-related overdose deaths was 

calculated each quarter by drug category from 2015 

to 2017 (see Figure 26). The presence of fentanyl in 

overdose deaths was low at the beginning of 2015 (18 

percent presence in first quarter overdose deaths). The 

percentage increased significantly until it was present in 

67 percent of all fourth quarter of 2017 overdose deaths. 

IMPACT
UNCLASSIFIED 38

(U) Figure 25. Most Frequently Reported Drug Category in Drug-Related Overdose Decedents, Pennsylvania,

2015-2017

Source: Pennsylvania Coroner/Medical Examiner Data

IMPACT
UNCLASSIFIED 39

Likewise, FRSs/NPSOs increased significantly from the 

first quarter of 2015 (1 percent) to the fourth quarter of 

2017 (20 percent). As discussed in the Supply section, 

fentanyl/FRSs/NPSOs availability and use in Pennsylvania 

increased throughout 2016 to 2017, both in the amount 

and variety of substances available. 

Toxicology Trends by Drug

Fentanyl emerged as the most frequent drug category 

reported in overdose deaths in both 2016 and 2017. 

Fentanyl was found in 61 of the 65 counties that reported 

an overdose in 2017, which increased from 53 counties 

in 2015. Fentanyl was found in combination with heroin 

more frequently each year from 2015 to 2017, appearing 

in 16 percent of overdose deaths in 2015 and 30 percent 

in 2017.

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure 26. Drug-Related Overdose Deaths by Drug Category of Interest, Pennsylvania, 2015-2017

IMPACT
UNCLASSIFIED 40

When identifying drug-related overdose deaths in which 

both heroin and fentanyl were present in toxicology, 

decedents with toxicology reports containing both drugs 

increased from 526 in 2015 to 1,659 in 2017, while the 

number of heroin deaths without the presence of fentanyl 

decreased from 1,223 in 2015 to 406 in 2017 (see Figure 

27). This data demonstrates a shift over time from 

heroin-only deaths to deaths resulting from heroin being 

combined primarily with fentanyl.

At the PFD’s request, the TAC used logistic regression 

modeling to measure the effect of age, race, and gender 

on fentanyl deaths. The logistic regression models can 

be utilized as predictive measures, in that they predict 

the odds of a fentanyl death based on three dependent 

variables: gender, age, and race. Five age groups (0-24, 

25-34, 35-44, 45-54, 55+) and two genders (male and

female), were used for the analysis to determine statistical

significance. Additionally, analysis of variance was used to

determine statistical significance between demographic

(U) Figure 27. Drug-Related Overdose Deaths with the Presence of Heroin and Fentanyl, Pennsylvania, 2015-2017

Source: Pennsylvania Coroner/Medical Examiner Data

groups. Among overdose deaths from 2015 to 2017, age 

group 25-34 was more likely to have the presence of fentanyl than any other age group. Specifically, the odds of 

age group 25-34 having fentanyl were approximately 1.25 

times the odds of age group 35-44; 1.78 times the odds of 

age group 45-54; and 2.46 times the odds of age group 

55+. Males demonstrated a significantly greater number 

of overdose deaths than females (p<0.05). Specifically, 

the odds of males having fentanyl were approximately 

1.43 times the odds of females having fentanyl present in 

toxicology.

Toxicology Trends of FRSs/NPSOs

FRSs/NPSOs demonstrated the largest increase from 

2015 to 2017. FRSs/NPSOs were found in 48 of the 67 

counties in 2017, which was an increase from 27 of the 

67 counties in 2015. Sixteen of the 18 FRSs/NPSOs found 

in toxicology reports from 2017 overdose deaths were 

not reported in 2015. The number of toxicology reports 

that mentioned FRSs/NPSOs increased from 123 in 2015 

IMPACT
UNCLASSIFIED 41

to 1001 in 2017, an increase of 714 percent. In addition 

to the increase in FRSs, the presence of NPSOs, such as 

U-47700, U-48800, and MT-45, were identified for the first

time in 2016, and showed an increase of 156 percent in

2017. With the rapid expansion in the production and

distribution of FRSs/NPSOs, many tests have not been

developed or added to toxicology panels; thus, the

numbers herein are likely not complete across counties

(see Data Challenges section for more information). In

2017, 18 FRSs/NPSOs were identified in toxicology

reports of drug-related overdose decedents. Figure 28

displays FRSs/NPSOs found in toxicology reports from

2015 to 2017.

Forty-eight counties reported the presence of FRSs/

NPSOs in drug-related overdose deaths in 2017. While 

the greatest presence was concentrated in counties near 

major urban centers, where traditionally the largest number of opioid users are associated/supplied, FRSs/NPSOs 

were reported throughout the state, to include many 

rural counties. In 2017, the percentage of rural counties 

(U) Figure 28. FRSs/NPSOs Found in Toxicology Reports of Drug-Related Overdose Decedents, Pennsylvania,

2015-2017

Year FRSs/NPSOs

2015 Acetyl Fentanyl Butyryl Fentanyl/Isobutyryl Fentanyl

2016 3-Methylfentanyl* Fluorobutyrylfentanyl/Fluorofentanyl*

4-Methoxy-Butyryl Fentanyl* Furanyl Fentanyl*

Acetyl Fentanyl Para-Fluoro-Isobutyryl-Fentanyl/FIBF*

Acryl Fentanyl* Sufentanil*

Carfentanil* U-47700*

2017 3-Methylfentanyl Furanyl Fentanyl

A-Methylbutrylfentanyl* Methoxyacetyl Fentanyl*

Acetyl Fentanyl MT-45*

Acryl Fentanyl O-Fluorofentanyl*

Benzylfentanyl* Para-Fluoro-Isobutyryl-Fentanyl/FIBF

Butyryl Fentanyl/Isobutyryl Fentanyl Para-Fluorobutyryl-Fentanyl/FBF*

Carfentanil Para-Fluorofentanyl*

Cyclopropyl Fentanyl* U-47700

Fluorobutyrylfentanyl/Fluorofentanyl U-48800*

(*) denotes a new compound not previously reported

Source: Pennsylvania Coroner/Medical Examiner Data

with FRSs/NPSOs present (63 percent) was higher than 

the 2015 percentage of rural counties with FRSs/NPSOs 

present (27 percent). This is an indication of the widespread availability of FRSs/NPSOs in Pennsylvania due to 

the ease of obtaining FRSs/NPSOs from online sources, as 

discussed in the Supply section.

Among toxicology reports from 2015 to 2017, acetyl 

fentanyl, furanyl fentanyl, and para-fluorobutyryl fentanyl/

FBF were identified as the top three FRSs/NPSOs. Acetyl 

fentanyl and para-fluorobutyryl fentanyl were found in 

combination with fentanyl most frequently (91 percent, 

76 percent, respectively), followed by heroin (53 percent, 

60 percent, respectively). Furanyl fentanyl was found in 

combination with heroin most frequently (51 percent), 

followed closely by fentanyl (49 percent) (see Figure 29). 

It is important to note that acetyl fentanyl can also be a 

byproduct of fentanyl production, which may account 

for the relatively high numbers of overdoses with acetyl 

fentanyl.103

IMPACT
UNCLASSIFIED 42

Demographic Trends by Age

The three most affected age groups—25-34, 35-44, and 

45-54—accounted for 75 percent of Pennsylvania’s overdose deaths between 2015 and 2017. However, these

groups only accounted for approximately 40 percent of

the population over this period. The age distribution chart

in Figure 30 displays consistent growth for age groups

25-34 and 35-44. Conversely, deaths attributed to age

group 45-54 declined from 24 percent to 20 percent of

Pennsylvania overdose deaths from 2015 to 2017.

(U) Figure 29. Percentage of Top 5 Drugs Present with Top 3 FRSs in Drug-Related Overdose Decedents,

Pennsylvania, 2015-2017

Source: Pennsylvania Coroner/Medical Examiner Data

Demographic Trends by Gender

On average, 70 percent of drug-related overdose deaths 

were males, compared to 30 percent of females, between 

2015 and 2017. Males disproportionately experienced 

overdose deaths compared to females, as males comprise 

49 percent of the Pennsylvania population over this 

period. The proportion of overdose deaths between males 

and females remained consistent each year from 2015 to 

2017. 

IMPACT
UNCLASSIFIED 43

Demographic Trends by Race

On average, 77 percent of drug-related overdose deaths 

were White, 12 percent were Black, 4 percent were 

Hispanic, 4 percent were “other race,” and 4 percent were 

“unknown,” between 2015 and 2017. The distribution of 

overdose deaths among race was relatively consistent 

between 2015 and 2017. The racial breakdown for overdose deaths also coincides with the racial demographics 

in Pennsylvania, as Whites comprise approximately 78 

percent, Blacks comprise approximately 12 percent, 

and Hispanics comprise approximately 7 percent of 

Pennsylvania’s population.

(U) Figure 30. Age Distribution of Drug-Related Overdose Decedents, Pennsylvania, 2015-2017

Source: Pennsylvania Coroner/Medical Examiner Data

Data Challenges

• 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 or were diverted from

legitimate sources, nor does it identify the method of

administration.

• Analysis for this assessment focused on deaths classified as drug-related overdoses; the 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 results

in inherent difficulties in making causation decisions,

especially with regard to heroin overdoses. Therefore,

IMPACT
UNCLASSIFIED 44

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

data set 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; rather, it may not have

been part of the requested toxicology test panel.

• 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.

County Analysis

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 PA-DOH (Figures D1-D6). Individual 

county analysis was conducted and is represented in 

Appendix D Figures D7-D64. Each county’s analysis 

contains data from 2015-2017, including overdose count; 

average rate of overdose deaths per 100,000 people; 

average rank by rate; percent change over time; age, 

gender, and race distribution; and drug-related overdose 

deaths by drug category and demographic group. 

Individual analyses of Cameron, Elk, Forest, Juniata, 

Potter, Snyder, Sullivan, Union, and Warren Counties were 

not prepared due to their reporting of less than a total of 

15 overdose deaths from 2015 to 2017.

Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome (NAS) is a “complex 

condition that occurs when a mother uses drugs, such 

as opioids, during pregnancy. The drugs pass through 

the placenta to the baby’s circulatory system resulting 

in drug dependence at birth. When infants are born with 

drug dependence, they are at high risk for feeding and 

developmental issues as well as problems with learning 

when they reach school age.”104

Because of the increase in opioid use in the past two 

decades, the incidences of NAS in the United States 

have increased dramatically between 1999 and 2013. 

In Pennsylvania, the rate of NAS in newborns increased 

more than 1000 percent between Fiscal Years (FYs) 

2000-2001 and FYs 2016-2017, from 1.2 to 15.0 per 1,000 

newborn stays.105

Workforce Impact 

In 2016, the United States Census cited the Pennsylvania 

workforce as including 5,354,964 persons, roughly 41 

percent of the total population. As of 2017, the highest 

rates of overdose occurred in the 25 to 54-year-old age 

range, a group that has approximately 71 to 78 percent of 

its population employed. To address growing concerns 

about the impact of the epidemic on Pennsylvania’s 

workforce, the Pennsylvania Chamber commissioned 

a survey of 428 employers regarding their experiences 

with and expectations of the workforce. Fifty-two percent 

of respondents said that it was very difficult or extremely 

difficult to recruit qualified candidates to fill the needs of 

their company, with most (61 percent) believing that it has 

gotten more difficult in the last 5 years to recruit qualified 

candidates. Only 2 percent of the employers believed that 

it would get easier to recruit qualified candidates in the 

future.106

IMPACT
UNCLASSIFIED 45

Economic Impact

According to a report published by United States Senator 

Robert Casey’s Office for the Senate Committee on 

Health, Education, Labor, and Pensions in 2018, the 

economic cost of OUDs was $53.77 billion in 2016 in 

Pennsylvania.107 This total amount included opioid-related 

costs, health care spending, addiction treatment, costs 

to the criminal justice system, and the cost related to 

lost productivity related to persons with an OUD. In 

Pennsylvania, an estimated $1.5 billion was spent on 

healthcare specifically for persons with an OUD in 2016.

Persons with an OUD spend more money on healthcare 

per year on average than those without an OUD, including 

presentations at emergency department and the 

utilization of emergency medical services in the field. In 

addition, this population spent more than $162 million 

on addiction treatment and more than $440 million on 

services related to the criminal justice system. The largest 

cost in Pennsylvania regarding the opioid crisis was the 

total cost associated with opioid-related fatalities, almost 

an estimated $50.5 billion. An additional cost attributed to 

OUD in 2016 was the lost productivity of persons with an 

OUD, totaling more than $1.1 billion. This factor addressed 

the lost potential earnings for a person with an OUD within 

the year. 

Naloxone

Policies allowing for increased access to naloxone 

has resulted in widespread deployment of naloxone 

Source: Liberty Mid-Atlantic HIDTA

(U) Figure 31. Number of Naloxone Administrations Reported to HIDTA, Pennsylvania, 2017

IMPACT
UNCLASSIFIED 46

throughout the Commonwealth.108 Although centralized 

statewide reporting of naloxone administrations is limited, 

several partial datasets exist for review. 

The City of Philadelphia, through emergency medical services (EMS) reporting, captures naloxone administration 

data and shares with stakeholders. Review of naloxone 

administration data reported through the Philadelphia 

Department of Public Health (PDPH) Information Portal 

revealed that the number of people administered 

naloxone by EMS in Philadelphia increased by more than 

153 percent from 2014 to 2017, with a marked upward 

trajectory beginning in 2016.109 This timing mirrors the 

explosion in fentanyl availability in the region that was 

discussed in the Supply section of this report. 

In addition, the Liberty Mid-Atlantic HIDTA has collected 

law enforcement naloxone administration data since 

2015. This data was collected on a voluntary basis from 

law enforcement agencies in the Commonwealth, and 

is not inclusive of all law enforcement naloxone administrations by county or within counties. In 2018, with the 

introduction of ODIN (discussed in the Efforts to Address 

Supply section), the HIDTA data collection transitioned to 

the ODIN platform.

In 2017, there were 2,306 naloxone administrations reported to the Liberty Mid-Atlantic HIDTA by law enforcement 

agencies in Pennsylvania. Among individual counties, 

Source: Liberty Mid-Atlantic HIDTA

(U) Figure 32. Age Distribution of Naloxone Administrations Reported to HIDTA, Pennsylvania, 2017

IMPACT
UNCLASSIFIED 47

the number of naloxone administrations reported ranged 

from 1 to 562 (Figure 31). The five counties with the most 

reported naloxone administrations by law enforcement 

were Delaware (562), York (319), Bucks (180), Allegheny 

(173), and Lehigh (154).

Age

Figure 32 shows the age distribution of naloxone administrations reported by law enforcement in 2017. The most 

common age group, 25 to 34 years old, represented 46 

percent of naloxone administrations. This age group was 

disproportionately administered naloxone in 2017, since 

according to 2010 Decennial Census data, this age group 

comprised only 15 percent of Pennsylvania’s population. 

The three most affected age groups—15-24, 25-35, 

and 35-44—account for 40 percent of Pennsylvania’s 

(U) Figure 33. Gender and Race Distribution of Naloxone Administrations Reported to HIDTA, Pennsylvania, 2017

Source: Liberty Mid-Atlantic HIDTA

population but represented 85 percent of reported naloxone administrations in 2017. Age group 15-24 accounted 

for 16 percent of administrations and comprised 14 

percent of Pennsylvania’s population. 

Gender and Race

In 2017, naloxone was administered to 1,550 males (67 

percent), compared to 743 females (32 percent) (see 

Figure 33). Thirteen naloxone administrations did not 

indicate gender. Males disproportionately received naloxone compared to females, as males comprise 49 percent 

of the Pennsylvania population yet accounted for 67 

percent of naloxone administrations in 2017. Conversely, 

females comprise 51 percent of the population and 

accounted for 32 percent of the naloxone administrations 

reported to HIDTA in 2017. 

IMPACT
UNCLASSIFIED 48

In 2017, 1,534 patients administered naloxone were 

identified as White (67 percent), 105 were identified as 

Black 4 percent), 85 were identified as Hispanic (4 percent), 

4 were identified as “other” (0 percent), and 578 were 

identified as “unknown” (25 percent) (see Figure 34). After 

excluding “unknown” from the category, 89 percent were 

White, 6 percent were Black, 5 percent were Hispanic, 

and 0 percent were “other.” The racial breakdown for 

naloxone administrations does not coincide with the racial 

demographics in Pennsylvania, as Whites comprise approximately 78 percent, Blacks comprise approximately 12 

percent, and Hispanics comprise approximately 7 percent of 

Pennsylvania’s population.

Outlook

The purpose of this assessment was to provide a timely and 

actionable depiction of the opioid crisis in Pennsylvania. 

Analysis of the myriad data sources referenced herein inevitably leads to the conclusion that the opioid crisis is driven 

by supply and demand factors that require a cross-disciplinary approach to combat. Law enforcement must 

continue to work to stem the supply of illicit and misused 

prescription opioids, while public health entities, educators, 

and policy makers must provide effective resources to 

reduce drug demand and misuse. Evidence suggests that 

enacting these strategies jointly reduces opioid supply 

and misuse, with success measured incrementally through 

decrease in supply, improvement in economic and health 

indicators, and reduction in overdoses and overdose 

deaths. The DEA Philadelphia Field Division will continue 

to work collaboratively with the aforementioned partners to 

meet these identified goals.

IMPACT
UNCLASSIFIED 49

GLOSSARY OF ACRONYMS

• CBP: Customs and Border Protection

• CDC: Centers for Disease Control

• CLRT: Clandestine Laboratory Response Team

• COE: Centers of Excellence

• CPDs: Controlled Prescription Drugs

• CSA: Controlled Substances Act

• DEA: Drug Enforcement Administration

• DIOs: Drug Intelligence Officers

• DTOs: Drug Trafficking Organizations

• ED: Emergency Department

• EMS: Emergency Medical Services

• FRSs: Fentanyl Related Substances

• FSPP: Fentanyl Signature Profiling Program

• HDMP: Heroin Domestic Monitoring Program

• HIDTA: High Intensity Drug Trafficking Area

• HRS: Heroin Response Strategy

• HSP: Heroin Signature Program

• MAT: Medication Assisted Treatment

• NAS: Neonatal Abstinence Syndrome

• NFLIS: National Forensic Laboratory Information System

• NPSOs: Non-Prescription Synthetic Opioids

• ODIN: Overdose Information Network

• OUD: Opioid Use Disorders

• PaCIC: Pennsylvania State Police Criminal Intelligence

Center

• PA-DOH: Pennsylvania Department of Health

• PCCD: Pennsylvania Commission on Crime and

Delinquency

• PDAC: Practitioner Diversion Awareness Conferences

• PDMP: Prescription Drug Monitoring Program

• PERU: Program Evaluation Research Unit

• PFD: Philadelphia Field Division

• PSP: Pennsylvania State Police

• SUD: Substance Use Disorders

• TAC: Technical Assistance Center

• TCOs: Transnational Criminal Organizations

• UPMC: University of Pittsburgh Medical Center
UNCLASSIFIED 50

REFERENCES

1 Ahmad FB, Rossen LM, Spencer MR, Warner M, 

Sutton P. Provisional drug overdos death counts. 

National Center for Health Statistics. 2018. 

2 Commonwealth, Volume 20, Issue 1 (2018).

3 Center for Disease Control and Prevention, U.S. State 

Prescribing Rates, www.cdc.gov.

4 Ibid.

5 Ibid.

6 Pennsylvania Department of Health, Prescription Drug 

 Monitoring Program.

7 PA population estimate dated July 1, 2017 was 

 12,805,537 per United States Census Bureau website: 

www.census.gov/quickfacts/table/PST045215/42, 

accessed on May 24, 2018. 

8 PA Legislature website: www.legis.state.pa.us, 

accessed May 21, 2018.

9 DEA Diversion Control Division. June 15, 2018, Item 

Detail Query in NFLIS.

10 Ibid.

11 Drugs of Abuse, A DEA Resource Guide, 2017 Edition.

12 DEA investigative reporting, Philadelphia Division, 

2018.

13 Ibid.

14 Ibid.

15 Ibid.

16 Ibid.

17 www.health.pa.gov.

18 DEA Investigative Reporting, Philadelphia Division, 

2018.

19 DEA Investigative Reporting, Philadelphia Division 

Office, 2017; Press Release, Mt. Carmel Doctor Indicted 

For Operating A “Pill Mill” And Causing The Death Of 

Five Patients, December 21, 2017.

20 DEA Investigative Reporting; Pennsylvania State Police 

Reporting; MAGLOCLEN reporting, 2017-2018.

21 Center for Rural Pennsylvania County Designations, 

www.rural.palegislature.us.

22 DEA Diversion Control Division. June 15, 2018, Item 

Detail Query in NFLIS.

23 Ibid.

24 Heroin Cocktail: An Analysis of Pennsylvania

Laboratory Drug Seizure Data, 2006-16; 

DEA-PHL-BUL-065-18.

25 DEA Diversion Control Division. June 15, 2018, Item 

Detail Query in NFLIS.

26 Center for Rural Pennsylvania County Designations, 

www.rural.palegislature.us.

27 DEA Diversion Control Division. June 15, 2018, Item 

Detail Query in NFLIS.

28 Ibid.

29 Ibid.

30 DEA Philadelphia, New York, and New Jersey Field 

Division Investigative reporting, 2017.

31 DEA Investigative Reporting, Philadelphia Division, 

2011-2016.

32 Pennsylvania State Police Criminal Intelligence Center 

(PaCIC), 2018.

33 DEA Special Testing and Research Laboratory report

ing, 2018.

34 DEA Investigative Reporting, Philadelphia Division, 

2018.

35 U.S. Department of Justice (DOJ)/Drug Enforcement 

Administration 2018 National Drug Threat Assessment.

36 www.deadiversion.usdoj.gov/drug_chem_info/fentan

yl.pdf.

37 U.S.-China Economic and Security Review 

Commission Staff Research Report, Fentanyl: 

China’s Deadly Export to the United States, February 1, 

2017.

38 DEA Intelligence Brief Fentanyl Remains the Most

Significant Synthetic Opioid Threat and Poses the 

Greatest Threat to the Opioid User Market in the United 
UNCLASSIFIED 51

REFERENCES

States; DEA-DCT-DIB-003-18 May 2018.

39 http://riodoce.mx/narcotrafico-2/

aseguran-laboratorio-clandestino-en-culiacan.

40 U.S. Department of Justice (DOJ)/Drug Enforcement 

Administration 2017 National Drug Threat Assessment. 

41 http://pittsburgh.cbslocal.com/2018/05/11/ 

kennedy-township-motel-6-police-respond/.

42 DEA Investigative Reporting, Philadelphia Division, 

2018.

43 DEA Diversion Control Division. June 15, 2018, Item 

Detail Query in NFLIS.

44 Ibid.

45 https://www.dea.gov/druginfo/fentanyl-faq.shtml.

46 DEA Diversion Control Division. June 15, 2018, Item 

Detail Query in NFLIS.

47 Ibid.

48 DEA Investigative Reporting, Philadelphia Division, 

2018.

49 U.S. Department of Justice, Drug Enforcement 

Administration, Office of Forensic Science, “Fentanyl 

Signature Profiling Program Report,” April 2018.

50 U.S. Department of Homeland Security, Customs and 

Border Protection, Intelligence Note, “Mexican Cartels 

Moving Low-Concentration Shipments of Fentanyl 

Across the Southwest Border,” 23 October,2017.

51 Fentanyl Remains the Most Significant Synthetic 

Opioid Threat and Poses the Greatest Threat to the 

Opioid User Market in the United States; DEA-DCTDIB-003-18, May 2018.

52 Drugs of Abuse, A DEA Resource Guide, 2017 Edition.

53 Cocaine/Fentanyl Combination in Pennsylvania, 

February 2018; DEA-PHL-BUL-061-18.

54 DEA Diversion Control Division. June 15, 2018, Item 

Detail Query in NFLIS.

55 DEA Investigative Reporting, Philadelphia Division, 

2018.

56 DEA Diversion Control Division. June 15, 2018, Item 

Detail Query in NFLIS.

57 Ibid.

58 DEA Investigative Reporting, Philadelphia Division, 

2018.

59 DEA Philadelphia, New York, and New Jersey Field 

Division Investigative reporting, 2017.

60 DEA Investigative Reporting, Philadelphia Division, 

2018.

61 Pennsylvania State Police Criminal Intelligence Center 

(PaCIC), 2018.

62 Ibid.

63 U.S. Department of Justice (DOJ)/Drug Enforcement 

Administration 2017 National Drug Threat Assessment.

64 https://www.ice.gov/news/releases/alleged-philadel 

phia-fentanyl-distributor-arraigned-federal-drug-traffick

ing-charges#wcm-survey-target-id.

65 https://www.nbcphiladelphia.com/news/local/Heroin-

 Carfentanil-Fentanyl-Montgomery-County-China-Darkeb-Drugs-Opioids-Elephants-Tranquilizer-478250623.

html.

66 Homeland Security Investigations (HSI) Investigative 

Reporting, SAC Philadelphia, 2018.

67 Ibid.

68 The National Cyber-Forensics and Training Alliance 

(NCFTA) publication “The State of the Dark Web” dated 

March 20, 2018. 

69 Ibid.

70 Ibid.

71 DEA Investigative Reporting, Philadelphia Division, 

2018.

72 U.S. Department of Justice (DOJ)/Drug Enforcement 

Administration 2017 National Drug Threat Assessment.

73 DEA Investigative Reporting, Philadelphia Division, 

2018.

74 Allegheny County Office of the Medical Examiner, Drug 
UNCLASSIFIED 52

REFERENCES

Chemistry Section, 2018.

75 DEA Investigative Reporting, Philadelphia Division, 

2018.

76 Ibid.

77 Ibid.

78 Federal Register Volume 82, Number 249, December 

29, 2017.

79 Administrative Office of Pennsylvania Courts.

80 United States Attorney’s Office, Western District of 

Pennsylvania.

81 DEA Investigative Reporting, Philadelphia Division, 

2016.

82 The Heroin Response Strategy 2017 Annual Report, 

High Intensity Drug Trafficking Area Program,

June 2018.

83 Centers for Disease Control and Prevention. Vital 

Signs: Overdoses of Prescription Opioid Pain Relievers 

— United States, 1999—2008. MMWR 2011; 60(43);

1487-1492; Daubresse M, Chang H, Yu Y, Viswanathan 

S, et al. Ambulatory diagnosis and treatment of non 

malignant pain in the United States, 2000 – 2010. 

Medical Care 2013; 51(10): 870-878.http://dx.doi.

org/10.1097/MLR.0b013e3182a95d86.

84 Cases Against Doctors, DEA Diversion Control Division, 

October 2017.

85 www.detox.net/uncover/dirty-doctors

86 DEA Investigative Reporting, Philadelphia Division, 

2018.

87 Ibid.

88 Ibid.

89 Ibid.

90 Ibid.

91 Ibid.

92 www.dea.gov.

93 www.peru.pitt.edu.

94 Bart G. Maintenance Medication for Opiate Addiction: 

The Foundation of Recovery. J Addict Dis. 2012 

July; 31(3): 207-225.; Weiss, R.D.; Potter, J.S.; Griffin, 

M.L. et al. Long-term outcomes from the National 

Drug Abuse Treatment Clinical Trials Network 

Prescription Opioid Addiction Treatment Study.

Drug and Alcohol Dependence 150:112-119, 2015; 

Tkacz J, Volpicelli J, Un H, Ruetsch C. Relationship 

between buprenorphine adherence and health service 

utilization and costs among opioid dependent patients. 

J Subst Abuse Treat. 2014 Apr; 46(4): 456-62.

95 D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski 

MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. 

Emergency department-initiated buprenorphine/

naloxone treatment for opioid dependence: a 

randomized clinical trial. JAMA. 2015 Apr 28; 313(16): 

1636-44.; Love JS, Perrone J, Nelson LS. Should 

buprenorphine be administered to patients with opioid 

withdrawal in the emergency department? Ann Emerg 

Med. 2017 Nov 3.

96 Liebschutz JM, Crooks D, Herman D et al. 

Buprenorphine Treatment for Hospitalized, 

Opioid-Dependent Patients: A Randomized Clinical 

Trial. JAMA Intern Med 2014;174(8):1369-1376.

97 Title 21, Chapter II Part 1306 (§1306.07) section b of 

the Code of Federal Regulations.

98 Title 21, Chapter II Part 1306 (§1306.07) section b of 

the Code of Federal Regulations.

99 D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski 

MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. 

Emergency department-initiated buprenorphine/

naloxone treatment for opioid dependence: a 

randomized clinical trial. JAMA. 2015 Apr 28; 

313(16): 1636-44; Love JS, Perrone J, Nelson LS. 

Should buprenorphine be administered to patients 

with opioid withdrawal in the emergency department? 

Ann Emerg Med. 2017 Nov 3; Liebschutz JM, 

Crooks D, Herman D et al. Buprenorphine Treatment 

for Hospitalized, Opioid-Dependent Patients: A 

Randomized Clinical Trial. JAMA Intern Med 

2014;174(8):1369-1376.

100 Lynch MJ, Korenoski A. Substance Use Treatment 

and Referral: Novel Use of Poison Center Services. 

Poster Presentation. North American Congress of 
UNCLASSIFIED 53

REFERENCES

Clinical Toxicology. Clin Toxicol. 2017 Aug;55(7): 

689-868.

101 https://www.governor.pa.gov/governor-wolf-de

clares-heroin-and-opioid-epidemic-a-statewide-disas 

ter-emergency/.

102 Ahmad FB, Rossen LM, Spencer MR, Warner M, Sutton 

P. Provisional drug overdose death counts. National 

Center for Health Statistics. 2018.

103 Allegheny County Office of the Medical Examiner 

(ACOME) Drug Chemistry Section.

104 Good Shepherd Rehabilitation Hospital Pediatric 

Unit. https://www.goodshepherdrehab.org/services/ 

good-shepherd-pediatrics/inpatient-pediatric-unit/ 

neonatal-abstinence-syndrome-nas. Accessed June 

29, 2018.

105 http://www.phc4.org/reports/researchbriefs/neona

tal/17/docs/researchbrief_neonatal2017.pdf.

106 http://pasenategop.com/wp-content/uploads/2017/10/

barr.pdf.

107 https://www.help.senate.gov/imo/media/

doc/Economic%20Cost%20of%20the%20Opioid%20

Epidemic%20i n%20Pennsylvania.pdf.

108 Pennsylvania Department of Drug and Alcohol 

 Programs. Opioid/Heroin Reversal (Naloxone). 

Overdose Response. Retrieved from https://www.ddap.

pa.gov/overdose/Pages/Naloxone_Reversal.aspx.

109 https://hip.phila.gov/DataReports/Opioid/

NFONaloxoneAdministration.

110 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.

111 https://www.overdosefreepa.pitt.edu/

datastandardization/.

112 Alcohol and Medication Interactions, Ron Weathermon,Pharm.D., and David W. Crabb, M.D.

113 US Census Bureau, Population Division. Annual 

Estimates of the Resident Population: April 1, 2010

 to July 1, 2017. https://www.census.gov/data/data 

sets/2017/demo/popest/counties-total.html. Accessed 

July 16, 2018.
UNCLASSIFIED 54

APPENDIX A

County 2017 

Rate

2016 

Rate

2015 

Rate

2017 

Rank

2016 

Rank

2015 

Rank 

County 2017 

Rate

2016 

Rate

2015 

Rate

2017 

Rank

2016 

Rank

2015 

Rank

Adams 19 28 7 51 30 59 Lackawanna 42 40 34 18 15 10

Allegheny 60 53 34 5 7 9 Lancaster 30 22 14 30 45 47

Armstrong 59 62 41 6 3 5 Lawrence 61 46 34 4 11 11

Beaver 49 61 22 10 4 24 Lebanon 21 12 15 49 62 44

Bedford 39 23 4 20 43 64 Lehigh 47 37 27 12 17 17

Berks 27 27 16 40 36 41 Luzerne 50 44 45 9 13 1

Blair 39 35 17 22 20 38 Lycoming 30 30 16 32 24 39

Bradford 25 28 19 41 29 31 McKean 19 17 19 50 51 33

Bucks 37 27 17 24 34 37 Mercer 36 28 14 25 31 48

Butler 49 40 25 11 16 22 Mifflin 28 13 11 35 59 54

Cambria 65 70 41 3 2 4 Monroe 34 25 27 28 40 20

Cameron 0 0 0 66 65 66 Montgomery 27 28 17 38 27 35

Carbon 42 27 27 17 35 21 Montour 66 27 27 2 32 18

Centre 7 12 9 64 60 56 Northampton 30 23 20 31 42 30

Chester 28 19 14 37 47 46 Northumberland 34 29 17 29 25 36

Clarion 16 18 13 54 48 51 Perry 22 20 7 48 46 60

Clearfield 6 14 15 65 58 43 Philadelphia 77 58 44 1 5 2

Clinton 10 26 8 59 37 57 Pike 23 18 11 43 49 53

Columbia 23 27 19 46 33 32 Potter 18 12 6 52 61 61

Crawford 28 36 32 36 19 14 Schuylkill 27 41 17 39 14 34

Cumberland 30 23 15 33 41 42 Snyder 7 7 2 62 64 65

Dauphin 35 30 29 27 23 16 Somerset 39 28 21 21 28 27

Delaware 46 37 33 14 18 13 Sullivan 16 16 16 53 52 40

Elk 23 10 10 45 63 55 Susquehanna 15 22 14 55 44 45

Erie 43 33 22 16 21 25 Tioga 22 15 7 47 57 58

Fayette 57 45 30 7 12 15 Union 11 15 4 58 55 62

Forest 14 0 27 56 65 19 Venango 8 17 21 61 50 28

Franklin 23 25 14 44 39 49 Warren 0 0 0 66 65 66

Fulton 7 75 21 63 1 29 Washington 47 51 35 13 9 8

Greene 35 51 37 26 8 6 Wayne 23 31 33 42 22 12

Huntington 29 15 11 34 56 52 Westmoreland 55 49 35 8 10 7

Indiana 44 57 41 15 6 3 Wyoming 40 25 25 19 38 23

Jefferson 14 16 14 57 54 50 York 39 29 22 23 26 26

Juniata 8 16 4 60 53 63

(U) Figure A1: Overdose Death Rates and Rankings of Pennsylvania Counties, 2015-2017

Source: Pennsylvania Coroner/Medical Examiner Data

Overdose Death Rates and Rankings of Pennsylvania Counties
UNCLASSIFIED 55

APPENDIX B

For this report, only drug-related overdose deaths ruled accidental or undetermined (if provided and toxicology was 

present) were analyzed. Suicides were excluded due to previous studies demonstrating that the toxicology, demographic information, genetic predisposition, and other factors of suicide decedents are dissimilar to those of accidental 

overdose decedents.110

While collecting 2017 overdose death reports, data from 2015 and 2016 was simultaneously verified with coroner and 

medical examiner offices. The total number of drug-related overdose deaths in 2016 was adjusted to 4,643 (previously 

reported as 4,642), and the total number was in 2015 was adjusted to 3,309 (previously reported as 3,376).

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.

With the assistance of the TAC, death data was standardized in accordance with the OverdoseFreePA protocol111 to 

determine drug and metabolite relationships. 

In addition, ethanol was analyzed as a separate category in the demographic analysis of drug- related overdose deaths 

due to its propensity to exacerbate the effects of other drugs when used in combination.112 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, as discussed in the Supply 

section of this report.

For the drug categorization, please see Figure B1. 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 calculated using intercensal population estimates from U.S. Census Bureau.113

The following formula was used to calculate county-specific and state-level rates throughout the analysis:

Rate = ((Number of drug related deaths) / (Population within county)) x 100,000 people

Methodology and Drugs Included 
UNCLASSIFIED 56

Drug Category Substances Included in Analysis

Benzodiazepines Alprazolam Estazolam

Chlordiazepoxide Etizolam

Citalopram/Escitalopram Flubromazolam

Clobozam Flurazepam

Clonazepam Lorazepam

Delorazepam Midazolam

Demoxepam Nordiazepam

Diazepam Oxazepam

Diclazepam Temazepam

Cocaine

Ethanol

Fentanyl

Fentanyl Related 

Substances (FRSs) / 

Non-Prescription 

Synthetic Opioids 

(NPSOs)

3-Methyl Fentanyl Furanyl Fentanyl

4-Methoxy-Butyryl Fentanyl Methoxyacetyl Fentanyl

A-Methylbutrylfentanyl MT-45

Acetyl Fentanyl O-Fluorofentanyl

Acryl Fentanyl Para-Fluoro-Isobutyryl-Fentanyl/FIBF

Benzylfentanyl Para-Fluorobutyryl Fentanyl/FBF

Butyryl Fentanyl/Isobutyryl Fentanyl Para-Fluorofentanyl

Carfentanil Sufentanil

Cyclopropyl Fentanyl U-47700

Fluorobutyrylfentanyl/Fluorofentanyl U-48800

Heroin

Other Illicit Drugs 3,4-Methylenedioxymethamphetamine (MDMA) Methylenedioxymethamphetamine (MDA)

Amphetamine Methamphetamine

Gamma-Hydroxybutyric Acid (GHB) Phencyclidine (PCP)

Ketamine Psilocybin

Lysergic Acid Diethylamide (LSD)

Prescription Opioids Codeine Morphine

Dextropropoxyphene Oxycodone

Dihydrocodeine Oxymorphone

Hydrocodone Tapentadol

Hydromorphone Tramadol

Meperidine

(U) Figure B1. Substances of Interest by Drug Category, 2015-2017

Source: Pennsylvania Coroner/Medical Examiner Data

APPENDIX B
UNCLASSIFIED 57

APPENDIX C

(U) Figure C1. Rate of Drug-Related Overdose Deaths per 100,000 people, Pennsylvania, 2017

In 2017, Pennsylvania coroners and medical examiners reported 5,456 drug-related overdose deaths. Among individual 

counties, rates ranged from 0 to 77 per 100,000 people. Figure C1 depicts the rates of drug-related overdose deaths 

in Pennsylvania counties in 2017. A full listing of county rankings from highest overdose rate to lowest can be found in 

Figure C2.

2017 Pennsylvania Drug-Related Overdose Death Data

Source: Pennsylvania Coroner/Medical Examiner Data

Philadelphia County rose in rank from fifth to first in rate of overdose deaths, with a 34 percent increase in the raw 

number of overdose deaths. Within the top 10 counties, the distribution of rural and urban counties was similar to 2016; 

five rural counties ranked in the top 10 in 2017, compared to six in 2016. Of note, 71 percent of counties that reported an 

overdose death in 2017 had rates per 100,000 people that exceeded the national average in 2017.
UNCLASSIFIED 58

APPENDIX C

(U) Figure C2. Ranking of the Rate of Drug-Related Overdose Deaths per 100,000 People, Pennsylvania, 2016-2017

County 2017 

Rate

2017 

Rank

2016 

Rank

2016 

Rank

County 2017 

Rate

2017 

Rank

2016 

Rank

2016 

Rank

Adams 19 51 30 59 Lackawanna 42 18 15 10

Allegheny 60 5 7 9 Lancaster 30 30 45 47

Armstrong 59 6 3 5 Lawrence 61 4 11 11

Beaver 49 10 4 24 Lebanon 21 49 62 44

Bedford 39 20 43 64 Lehigh 47 12 17 17

Berks 27 40 36 41 Luzerne 50 9 13 1

Blair 39 22 20 38 Lycoming 30 32 24 39

Bradford 25 41 29 31 McKean 19 50 51 33

Bucks 37 24 34 37 Mercer 36 25 31 48

Butler 49 11 16 22 Mifflin 28 35 59 54

Cambria 65 3 2 4 Monroe 34 28 40 20

Cameron 0 66 65 66 Montgomery 27 38 27 35

Carbon 42 17 35 21 Montour 66 2 32 18

Centre 7 64 60 56 Northampton 30 31 42 30

Chester 28 37 47 46 Northumberland 34 29 25 36

Clarion 16 54 48 51 Perry 22 48 46 60

Clearfield 6 65 58 43 Philadelphia 77 1 5 2

Clinton 10 59 37 57 Pike 23 43 49 53

Columbia 28 36 19 14 Potter 18 52 61 61

Crawford 28 36 19 14 Schuylkill 27 39 14 34

Cumberland 30 33 41 42 Snyder 7 62 64 65

Dauphin 35 27 23 16 Somerset 39 21 28 27

Delaware 46 14 18 13 Sullivan 16 53 52 40

Elk 23 45 63 55 Susquehanna 15 55 44 45

Erie 43 16 21 25 Tioga 22 47 57 58

Fayette 57 7 12 15 Union 11 58 55 62

Forest 14 56 65 19 Venango 8 61 50 28

Franklin 23 44 39 49 Warren 0 66 65 66

Fulton 7 63 1 29 Washington 47 13 9 8

Greene 35 26 8 6 Wayne 23 42 22 12

Huntington 29 34 56 52 Westmoreland 55 8 10 7

Indiana 44 15 6 3 Wyoming 40 19 38 23

Jefferson 14 57 54 50 York 39 23 26 26

Juniata 8 60 53 63

Source: Pennsylvania Coroner/Medical Examiner Data
UNCLASSIFIED 59

APPENDIX C

Toxicology

Toxicology Overview

Within toxicology reports of the 2017 drug-related overdose deaths, 221 different drugs were identified. Of the 5,456 

drug-related overdose deaths, 86 percent contained two or more drugs, 44 percent contained four or more drugs, and 

16 percent contained six or more drugs in the associated toxicology reports.

Within the identified categories, fentanyl was observed in 67 percent of decedents, while heroin was second most 

prevalent (38 percent). Prescription opioids, which included 11 individual substances, were observed in 20 percent of 

decedents, followed by FRSs/NPSOs in 18 percent. Figure C4 demonstrates the presence of each analyzed substance in 

the data set.

Toxicology Trends by County

In 2017, the most commonly identified drug category in toxicology reports varied for counties across Pennsylvania (see 

Figure C5). Fentanyl and heroin were the first and second most common drug categories, respectively, in both urban 

and rural counties. 

Fentanyl, the most commonly ientified drug category in 2017, was present in 61 counties across Pennsylvania. 

Geographic analysis revealed that the majority of Pennsylvania counties had fentanyl as the leading cause of overdose 

death. However, a few northern Pennsylvania counties demonstrated a tie between two or more prevalent drug categories. In these instances, the drug category displayed was ranked in order of fentanyl, heroin, prescription opioids, and 

other illicit drugs.

Drug Category

Percent Reported 

Among 2017

Decedents

Fentanyl 67%

Heroin 38%

Cocaine 32%

Benzodiazepines 31%

Prescription Opioids 20%

Ethanol 19%

FRSs & NPSOs 18%

Other Illicit Drugs 11%

(U) Figure C3. Frequency of Drug Categories in Drug-Related Overdose Decedents, Pennsylvania, 2017

Source: Pennsylvania Coroner/Medical Examiner Data
UNCLASSIFIED 60

APPENDIX C

(U) Figure C4. Number of Drug-Related Overdose Deaths by Drug Presence, Pennsylvania, 2017

Source: Pennsylvania Coroner/Medical Examiner Data
UNCLASSIFIED 61

APPENDIX C

Toxicology Trends by Drug Category

Prescription Opioids

Prescription opioids were present in 20 percent of toxicology reports, and 90 percent of reporting counties in 2017. 

Oxycodone was reported most frequently within the prescription opioid category. Other drugs present in the toxicology 

reports of the decedents in addition to prescription opioids included fentanyl (45 percent), alprazolam (27 percent), 

heroin (27 percent), and cocaine (25 percent).

Heroin

Heroin was the second most frequently reported drug in toxicology tests of drug-related overdose decedents in 2017. 

Heroin was present in 85 percent of counties that reported an overdose death in 2017. Heroin was found most often in 

combination with fentanyl (80 percent), cocaine (33 percent), ethanol (18 percent), and alprazolam (16 percent). 

(U) Figure C5. Most Frequently Reported Drug Category in Drug-Related Overdose Decedents, Pennsylvania, 2017

Source: Pennsylvania Coroner/Medical Examiner Data
UNCLASSIFIED 62

APPENDIX C

Fentanyl 

Fentanyl remained the most frequently reported drug category in overdose deaths in 2017. When analyzed separately, 

fentanyl was found in 61 of the 65 counties that reported an overdose in 2017. Fentanyl was found in combination with 

heroin (46 percent), cocaine (34 percent), and FRSs/NPSOs (22 percent) most frequently. 

FRSs and NPSOs

Nine out of 18 FRSs/NPSOs found in toxicology reports from 2017 overdose deaths were not reported in 2016. The 

number of toxicology reports that mentioned FRSs and/or NPSOs increased from 219 in 2016 to 1001 in 2017, an 

increase of 357 percent. 

With the rapid expansion in the production and distribution of FRSs/NPSOs, as described in the Supply section, many 

tests have not been developed or added to toxicology panels; thus, the numbers herein are likely not complete across 

counties (see Data Challenges section for more information). However, 18 FRSs/NPSOs were identified in toxicology 

reports of drug-related overdose decedents, with an asterisk (*) denoting a new compound not previously reported:

• 3-Methylfentanyl

• A-Methylbutrylfentanyl*

• Acetyl Fentanyl

• Acryl Fentanyl

• Benzylfentanyl*

• Butyryl Fentanyl/Isobutyryl Fentanyl

• Carfentanil

• Cyclopropyl Fentanyl*

• Fluorobutyrylfentanyl/Fluorofentanyl

• Furanyl Fentanyl

• Methoxyacetyl Fentanyl*

• MT-45*

• O-Fluorofentanyl*

• Para-Fluoro-Isobutyryl-Fentanyl/FIBF

• Para-Fluorobutyryl-Fentanyl/FBF*

• Para-Fluorofentanyl*

• U-47700

• U-48800*

FRSs/NPSOs were found in 48 counties that reported an overdose in 2017. FRSs/NPSOs were found in combination with 

fentanyl (81 percent), heroin (47 percent), cocaine (34 percent), and ethanol (18 percent) most frequently. 

While the greatest presence was concentrated in counties near major urban centers, traditionally associated with the 

highest number of opioid users, FRSs/NPSOs were reported throughout the state. A significant percent increase was 

found in toxicology reports with a FRSs/NPSOs present in both urban and rural counties from 2016 to 2017 (424 percent 

increase in urban counties, 163 percent increase in rural counties). This is an indication of the widespread availability of 

FRSs/NPSOs in Pennsylvania due to the ease of obtaining FRSs/NPSOs from online sources, as discussed in the Supply 

section of this report.
UNCLASSIFIED 63

APPENDIX C

Demographics

Age

Figure C6 shows the age distribution of those affected by drug-related overdose deaths in 2017. The most common age 

group, 25 to 34 years old, represented 30 percent of drug-related overdose deaths. This age group was disproportionately affected by overdose deaths in 2017, 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, 35-44, and 45-54, account for 

40 percent of Pennsylvania’s population, but accounted for 75 percent of overdose deaths in 2017. Overdose deaths 

occurring in the 15-24 year age group accounted for 9 percent of all overdose deaths and comprised 14 percent of 

Pennsylvania’s population. 

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure C6. Age Distribution of Drug-Related Overdose Decedents, Pennsylvania, 2017
UNCLASSIFIED 64

APPENDIX C

Age with Toxicology

As detailed in Figure C7, fentanyl was the top drug category for all age groups except for 75+ years old. Aside from 

fentanyl, heroin and FRSs/NPSOs were more common in younger and middle age groups. Cocaine, benzodiazepines, 

ethanol, and prescription opioids were more common in middle and older age groups (see Appendix B for group 

descriptions). The presence of illicit drugs declined with age, with the peak occurring within age group 25-34.

A younger population demographic was correlated with fentanyl usage. Over 75 percent of drug-related overdose 

decedents within the 15-24 and 25-34 age groups had fentanyl present in their toxicology reports. Additionally, between 

61 and 70 percent of drug-related overdose decedents within the 35-44 and 45-54 age groups died with fentanyl 

present.

Decedents with toxicology reports containing FRSs/NPSOs significantly increased from 5 percent in 2016 to 18 percent 

in 2017 (p<0.05).

Gender

In 2017, 3,870 males died of drug-related overdoses (71 percent), compared to 1,584 females (29 percent). Two 

deaths did not indicate gender. Males disproportionately experienced overdose deaths compared to females, as males 

comprise 49 percent of the Pennsylvania population, yet accounted for 71 percent of the overdose deaths in 2017. 

Conversely, females comprise 51 percent of the population and accounted for 29 percent of the overdose deaths 

reported in 2017. The distribution of overdose deaths among males and females was consistent with 2016 reporting.

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure C7. Drug Presence by Age Group in Drug-Related Overdose Decedents, Pennsylvania, 2017
UNCLASSIFIED 65

APPENDIX C

The three most prevalent drug categories in toxicology reports for males were fentanyl, heroin, and cocaine; the three 

most prevalent drug categories for females were fentanyl, benzodiazepines, and heroin. Fentanyl was reported in 69 

percent of male overdose deaths and 59 percent of female overdose deaths. Heroin was reported in 40 percent of 

male overdose deaths, followed by cocaine in 33 percent. Conversely, benzodiazepines were reported in 40 percent of 

female overdose deaths, followed by heroin in 34 percent. FRSs/NPSOs were reported in 19 percent of male overdose 

deaths and 17 percent of female overdose deaths.

Race

In 2017, 4,301 decedents were identified as White (79 percent), 632 were identified as Black (12 percent), 144 were 

identified as Hispanic (3 percent), 136 were identified as Other Race (2 percent), and 243 were identified as “Unknown” 

(4 percent) (see Figure C8). The distribution of overdose deaths among race was consistent with that reported in 2016. 

The racial breakdown for overdose deaths is similar to the racial demographics in Pennsylvania, as Whites comprise 

approximately 78 percent, Blacks comprise approximately 12 percent, and Hispanics comprise approximately 7 percent 

of Pennsylvania’s population.

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure C8. Race of Drug-Related Overdose Decedents, Pennsylvania, 2017
UNCLASSIFIED 66

APPENDIX C

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure C9. Gender and Age of Drug-Related Overdose Decedents, Pennsylvania, 2017

Gender and Age

Figure C9 depicts the total number of overdose deaths by gender and designated age groups. In 2017, 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 32 percent of males and 26 percent of females.

The second and third highest percentage of deaths within each gender were the 35-44 and 45-54 age groups (25 

percent and 19 percent of total male overdose deaths, 26 percent and 22 percent of total female overdose deaths, 

respectively).

Race and Age

Figure C10 depicts the total number of overdose deaths by race and designated age groups. In 2017, 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 (32 percent) and Other Race (40 percent). The 35-44 age group accounted 

for the largest percentage of deaths for individuals identified as Hispanic (35 percent). The 45-54 age group accounted 
UNCLASSIFIED 67

APPENDIX C

for the largest percentage of deaths for individuals identified as Black (24 percent). One noticeable difference that was 

apparent in the analysis of age and race is that Black decedents, on average, were older than decedents of other races.

Source: Pennsylvania Coroner/Medical Examiner Data

(U) Figure C10. Race and Age of Drug-Related Overdose Decedents, Pennsylvania, 2017

Race and Gender

Figure C11 details the number of overdose deaths within each racial group by gender. As noted earlier, 71 percent of all 

overdose deaths in Pennsylvania were male and 29 percent were female. Distribution of overdose deaths among males 

and females in each racial group were similar: White (71 percent, 29 percent, respectively), Black (71 percent, 29 percent, 

respectively), and Other Race (74 percent, 26 percent, respectively).

Conversely, a greater percentage of Hispanic males were adversely affected by overdose than Hispanic females in 2017 

(82 percent male, 18 percent female).
UNCLASSIFIED 68

(U) Figure C11. Race and Gender of Drug-Related Overdose Decedents, Pennsylvania, 2017

Source: Pennsylvania Coroner/Medical Examiner Data

APPENDIX C
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 69

APPENDIX D

Pennsylvania Overdose Death Data by District and County

Total Deaths Average Rate

(per 100,000)

(U) Figure D1: Analysis of 2015 - 2017 Overdose Death Data within District: North Central
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 70

APPENDIX D

(U) Figure D1: Analysis of 2015 - 2017 Overdose Death Data within District: North Central
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 71

APPENDIX D

Total Deaths Average Rate

(per 100,000)

(U) Figure D2: Analysis of 2015 - 2017 Overdose Death Data within District: Northeast
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 72

APPENDIX D

(U) Figure D2: Analysis of 2015-2017 Overdose Death Data within District: Northeast
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 73

APPENDIX D

Total Deaths Average Rate

(per 100,000)

(U) Figure D3: Analysis of 2015 - 2017 Overdose Death Data within District: Northwest
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 74

APPENDIX D

(U) Figure D3: Analysis of 2015 - 2017 Overdose Death Data within District: Northwest
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 75

APPENDIX D

Total Deaths Average Rate

(per 100,000)

(U) Figure D4: Analysis of 2015 - 2017 Overdose Death Data within District: South Central
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 76

APPENDIX D

(U) Figure D4: Analysis of 2015 - 2017 Overdose Death Data within District: South Central
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 77

APPENDIX D

Total Deaths Average Rate

(per 100,000) (Per 100,000)

(U) Figure D5: Analysis of 2015 - 2017 Overdose Death Data within District: Southeast
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 78

APPENDIX D

(U) Figure D5: Analysis of 2015 - 2017 Overdose Death Data within District: Southeast
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 79

APPENDIX D

Total Deaths Average Rate

(per 100,000)

(U) Figure D6: Analysis of 2015 - 2017 Overdose Death Data within District: Southwest
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 80

APPENDIX D

(U) Figure D6: Analysis of 2015 - 2017 Overdose Death Data within District: Southwest
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 81

APPENDIX D

(U) Figure D7: Analysis of 2015 - 2017 Overdose Death Data within County: Adams
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 82

APPENDIX D

(U) Figure D7: Analysis of 2015 - 2017 Overdose Death Data within County: Adams
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 83

APPENDIX D

(U) Figure D8: Analysis of 2015 - 2017 Overdose Death Data within County: Allegheny
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 84

APPENDIX D

(U) Figure D8: Analysis of 2015 - 2017 Overdose Death Data within County: Allegheny
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 85

APPENDIX D

(U) Figure D9: Analysis of 2015 - 2017 Overdose Death Data within County: Armstrong
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 86

APPENDIX D

(U) Figure D9: Analysis of 2015 - 2017 Overdose Death Data within County: Armstrong
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 87

APPENDIX D

(U) Figure D10: Analysis of 2015 - 2017 Overdose Death Data within County: Beaver
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 88

APPENDIX D

(U) Figure D10: Analysis of 2015 - 2017 Overdose Death Data within County: Beaver
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 89

APPENDIX D

Male

23

(U) Figure D11: Analysis of 2015 - 2017 Overdose Death Data within County: Bedford
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 90

APPENDIX D

(U) Figure D11: Analysis of 2015 - 2017 Overdose Death Data within County: Bedford
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 91

APPENDIX D

(U) Figure D12: Analysis of 2015 - 2017 Overdose Death Data within County: Berks
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 92

APPENDIX D

(U) Figure D12: Analysis of 2015 - 2017 Overdose Death Data within County: Berks
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 93

APPENDIX D

(U) Figure D13: Analysis of 2015 - 2017 Overdose Death Data within County: Blair
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 94

APPENDIX D

(U) Figure D13: Analysis of 2015 - 2017 Overdose Death Data within County: Blair
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 95

APPENDIX D

(U) Figure D14: Analysis of 2015 - 2017 Overdose Death Data within County: Bradford
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 96

APPENDIX D

(U) Figure D14: Analysis of 2015 - 2017 Overdose Death Data within County: Bradford
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 97

APPENDIX D

(U) Figure D15: Analysis of 2015 - 2017 Overdose Death Data within County: Bucks
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 98

APPENDIX D

(U) Figure D15: Analysis of 2015 - 2017 Overdose Death Data within County: Bucks
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 99

APPENDIX D

White

210

(U) Figure D16: Analysis of 2015 - 2017 Overdose Death Data within County: Butler
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 100

APPENDIX D

(U) Figure D16: Analysis of 2015 - 2017 Overdose Death Data within County: Butler
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 101

APPENDIX D

White

206

(U) Figure D17: Analysis of 2015 - 2017 Overdose Death Data within County: Cambria
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 102

APPENDIX D

(U) Figure D17: Analysis of 2015 - 2017 Overdose Death Data within County: Cambria
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 103

APPENDIX D

(U) Figure D18: Analysis of 2015 - 2017 Overdose Death Data within County: Carbon
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 104

APPENDIX D

(U) Figure D18: Analysis of 2015 - 2017 Overdose Death Data within County: Carbon
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 105

APPENDIX D

(U) Figure D19: Analysis of 2015 - 2017 Overdose Death Data within County: Centre
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 106

APPENDIX D

(U) Figure D19: Analysis of 2015 - 2017 Overdose Death Data within County: Centre
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 107

APPENDIX D

(U) Figure D20: Analysis of 2015 - 2017 Overdose Death Data within County: Chester
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 108

APPENDIX D

(U) Figure D20: Analysis of 2015 - 2017 Overdose Death Data within County: Chester
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 109

APPENDIX D

(U) Figure D21: Analysis of 2015 - 2017 Overdose Death Data within County: Clarion
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 110

APPENDIX D

(U) Figure D21: Analysis of 2015 - 2017 Overdose Death Data within County: Clarion
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 111

APPENDIX D

Other

3

(U) Figure D22: Analysis of 2015 - 2017 Overdose Death Data within County: Clearfield
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 112

APPENDIX D

(U) Figure D22: Analysis of 2015 - 2017 Overdose Death Data within County: Clearfield
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 113

APPENDIX D

(U) Figure D23: Analysis of 2015 - 2017 Overdose Death Data within County: Clinton
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 114

APPENDIX D

(U) Figure D23: Analysis of 2015 - 2017 Overdose Death Data within County: Clinton
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 115

APPENDIX D

(U) Figure D24: Analysis of 2015 - 2017 Overdose Death Data within County: Columbia
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 116

APPENDIX D

(U) Figure D24: Analysis of 2015 - 2017 Overdose Death Data within County: Columbia
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 117

APPENDIX D

(U) Figure D25: Analysis of 2015 - 2017 Overdose Death Data within County: Crawford
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 118

APPENDIX D

(U) Figure D25: Analysis of 2015 - 2017 Overdose Death Data within County: Crawford
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 119

APPENDIX D

White

153

(U) Figure D26: Analysis of 2015 - 2017 Overdose Death Data within County: Cumberland
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 120

APPENDIX D

(U) Figure D26: Analysis of 2015 - 2017 Overdose Death Data within County: Cumberland
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 121

APPENDIX D

White

204

(U) Figure D27: Analysis of 2015 - 2017 Overdose Death Data within County: Dauphin
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 122

APPENDIX D

(U) Figure D27: Analysis of 2015 - 2017 Overdose Death Data within County: Dauphin
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 123

APPENDIX D

(U) Figure D28: Analysis of 2015 - 2017 Overdose Death Data within County: Delaware
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 124

APPENDIX D

(U) Figure D28: Analysis of 2015 - 2017 Overdose Death Data within County: Delaware
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 125

APPENDIX D

(U) Figure D29: Analysis of 2015 - 2017 Overdose Death Data within County: Erie
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 126

APPENDIX D

(U) Figure D29: Analysis of 2015 - 2017 Overdose Death Data within County: Erie
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 127

APPENDIX D

(U) Figure D30: Analysis of 2015 - 2017 Overdose Death Data within County: Fayette
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 128

APPENDIX D

(U) Figure D30: Analysis of 2015 - 2017 Overdose Death Data within County: Fayette
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 129

APPENDIX D

(U) Figure D31: Analysis of 2015 - 2017 Overdose Death Data within County: Franklin
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 130

APPENDIX D

(U) Figure D31: Analysis of 2015 - 2017 Overdose Death Data within County: Franklin
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 131

APPENDIX D

(U) Figure D32: Analysis of 2015 - 2017 Overdose Death Data within County: Fulton
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 132

APPENDIX D

(U) Figure D32: Analysis of 2015 - 2017 Overdose Death Data within County: Fulton
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 133

APPENDIX D

(U) Figure D33: Analysis of 2015 - 2017 Overdose Death Data within County: Greene
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 134

APPENDIX D

(U) Figure D33: Analysis of 2015 - 2017 Overdose Death Data within County: Greene
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 135

APPENDIX D

White

22

Male

21

(U) Figure D34: Analysis of 2015 - 2017 Overdose Death Data within County: Huntingdon
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 136

APPENDIX D

(U) Figure D34: Analysis of 2015 - 2017 Overdose Death Data within County: Huntingdon
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 137

APPENDIX D

White

117

(U) Figure D35: Analysis of 2015 - 2017 Overdose Death Data within County: Indiana
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 138

APPENDIX D

(U) Figure D35: Analysis of 2015 - 2017 Overdose Death Data within County: Indiana
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 139

APPENDIX D

White

16

(U) Figure D36: Analysis of 2015 - 2017 Overdose Death Data within County: Jefferson
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 140

APPENDIX D

(U) Figure D36: Analysis of 2015 - 2017 Overdose Death Data within County: Jefferson
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 141

APPENDIX D

(U) Figure D37: Analysis of 2015 - 2017 Overdose Death Data within County: Lackawanna
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 142

APPENDIX D

(U) Figure D37: Analysis of 2015 - 2017 Overdose Death Data within County: Lackawanna
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 143

APPENDIX D

(U) Figure D38: Analysis of 2015 - 2017 Overdose Death Data within County: Lancaster
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 144

APPENDIX D

(U) Figure D38: Analysis of 2015 - 2017 Overdose Death Data within County: Lancaster
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 145

APPENDIX D

White

95

(U) Figure D39: Analysis of 2015 - 2017 Overdose Death Data within County: Lawrence
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 146

APPENDIX D

(U) Figure D39: Analysis of 2015 - 2017 Overdose Death Data within County: Lawrence
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 147

APPENDIX D

Other

16

(U) Figure D40: Analysis of 2015 - 2017 Overdose Death Data within County: Lebanon
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 148

APPENDIX D

(U) Figure D40: Analysis of 2015 - 2017 Overdose Death Data within County: Lebanon
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 149

APPENDIX D

(U) Figure D41: Analysis of 2015 - 2017 Overdose Death Data within County: Lehigh
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 150

APPENDIX D

(U) Figure D41: Analysis of 2015 - 2017 Overdose Death Data within County: Lehigh
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 151

APPENDIX D

(U) Figure D42: Analysis of 2015 - 2017 Overdose Death Data within County: Luzerne
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 152

APPENDIX D

(U) Figure D42: Analysis of 2015 - 2017 Overdose Death Data within County: Luzerne
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 153

APPENDIX D

(U) Figure D43: Analysis of 2015 - 2017 Overdose Death Data within County: Lycoming
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 154

APPENDIX D

(U) Figure D43: Analysis of 2015 - 2017 Overdose Death Data within County: Lycoming
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 155

APPENDIX D

(U) Figure D44: Analysis of 2015 - 2017 Overdose Death Data within County: McKean
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 156

APPENDIX D

(U) Figure D44: Analysis of 2015 - 2017 Overdose Death Data within County: McKean
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 157

APPENDIX D

White

79

(U) Figure D45: Analysis of 2015 - 2017 Overdose Death Data within County: Mercer
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 158

APPENDIX D

(U) Figure D45: Analysis of 2015 - 2017 Overdose Death Data within County: Mercer
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 159

APPENDIX D

(U) Figure D46: Analysis of 2015 - 2017 Overdose Death Data within County: Mifflin
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 160

APPENDIX D

(U) Figure D46: Analysis of 2015 - 2017 Overdose Death Data within County: Mifflin
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 161

APPENDIX D

White

128

(U) Figure D47: Analysis of 2015 - 2017 Overdose Death Data within County: Monroe
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 162

APPENDIX D

(U) Figure D47: Analysis of 2015 - 2017 Overdose Death Data within County: Monroe
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 163

APPENDIX D

White

507

(U) Figure D48: Analysis of 2015 - 2017 Overdose Death Data within County: Montgomery
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 164

APPENDIX D

(U) Figure D48: Analysis of 2015 - 2017 Overdose Death Data within County: Montgomery
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 165

APPENDIX D

(U) Figure D49: Analysis of 2015 - 2017 Overdose Death Data within County: Montour
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 166

APPENDIX D

(U) Figure D49: Analysis of 2015 - 2017 Overdose Death Data within County: Montour
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 167

APPENDIX D

(U) Figure D50: Analysis of 2015 - 2017 Overdose Death Data within County: Northampton
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 168

APPENDIX D

(U) Figure D50: Analysis of 2015 - 2017 Overdose Death Data within County: Northampton
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 169

APPENDIX D

(U) Figure D51: Analysis of 2015 - 2017 Overdose Death Data within County: Northumberland
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 170

APPENDIX D

(U) Figure D51: Analysis of 2015 - 2017 Overdose Death Data within County: Northumberland
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 171

APPENDIX D

(U) Figure D52: Analysis of 2015 - 2017 Overdose Death Data within County: Perry
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 172

APPENDIX D

(U) Figure D52: Analysis of 2015 - 2017 Overdose Death Data within County: Perry
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 173

APPENDIX D

(U) Figure D53: Analysis of 2015 - 2017 Overdose Death Data within County: Philadelphia
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 174

APPENDIX D

(U) Figure D53: Analysis of 2015 - 2017 Overdose Death Data within County: Philadelphia
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 175

APPENDIX D

(U) Figure D54: Analysis of 2015 - 2017 Overdose Death Data within County: Pike
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 176

APPENDIX D

(U) Figure D54: Analysis of 2015 - 2017 Overdose Death Data within County: Pike
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 177

APPENDIX D

White

109

(U) Figure D55: Analysis of 2015 - 2017 Overdose Death Data within County: Schuylkill
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 178

APPENDIX D

(U) Figure D55: Analysis of 2015 - 2017 Overdose Death Data within County: Schuylkill
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 179

APPENDIX D

White

63

(U) Figure D56: Analysis of 2015 - 2017 Overdose Death Data within County: Somerset
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 180

APPENDIX D

(U) Figure D56: Analysis of 2015 - 2017 Overdose Death Data within County: Somerset
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 181

APPENDIX D

(U) Figure D57: Analysis of 2015 - 2017 Overdose Death Data within County: Susquehanna
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 182

APPENDIX D

(U) Figure D57: Analysis of 2015 - 2017 Overdose Death Data within County: Susquehanna
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 183

APPENDIX D

Male

9

(U) Figure D58: Analysis of 2015 - 2017 Overdose Death Data within County: Tioga
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 184

APPENDIX D

(U) Figure D58: Analysis of 2015 - 2017 Overdose Death Data within County: Tioga
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 185

APPENDIX D

(U) Figure D59: Analysis of 2015 - 2017 Overdose Death Data within County: Venango
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 186

APPENDIX D

(U) Figure D59: Analysis of 2015 - 2017 Overdose Death Data within County: Venango
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 187

APPENDIX D

(U) Figure D60: Analysis of 2015 - 2017 Overdose Death Data within County: Washington
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 188

APPENDIX D

(U) Figure D60: Analysis of 2015 - 2017 Overdose Death Data within County: Washington
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 189

APPENDIX D

(U) Figure D61: Analysis of 2015 - 2017 Overdose Death Data within County: Wayne
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 190

APPENDIX D

(U) Figure D61: Analysis of 2015 - 2017 Overdose Death Data within County: Wayne
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 191

APPENDIX D

(U) Figure D62: Analysis of 2015 - 2017 Overdose Death Data within County: Westmoreland
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 192

APPENDIX D

(U) Figure D62: Analysis of 2015 - 2017 Overdose Death Data within County: Westmoreland
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 193

APPENDIX D

(U) Figure D63: Analysis of 2015 - 2017 Overdose Death Data within County: Wyoming
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 194

APPENDIX D

(U) Figure D63: Analysis of 2015 - 2017 Overdose Death Data within County: Wyoming
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 195

APPENDIX D

White

359

(U) Figure D64: Analysis of 2015 - 2017 Overdose Death Data within County: York
Source: Pennsylvania Coroner/Medical Examiner Data UNCLASSIFIED 196

APPENDIX D

(U) Figure D64: Analysis of 2015 - 2017 Overdose Death Data within County: York
UNCLASSIFIED 197

APPENDIX E

Drug Combinations in Analyzed Drug Exhibits

(U) Figure E1. Drugs Found in Combination with Heroin in Analyzed Drug Exhibits, Pennsylvania, 2017

Source: NFLIS

(U) Figure E2. Drugs Found in Combination with Fentanyl in Analyzed Drug Exhibits, Pennsylvania, 2017

Source: NFLIS

DEA PRB 10-04-18-43