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How opioid deaths tripled in Philly over a decade − and what may be behind a recent downturn

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theconversation.com – Ben Cocchiaro, Assistant Clinical Professor of Family Medicine and Community Health, Drexel University – 2025-02-11 07:45:00

How opioid deaths tripled in Philly over a decade − and what may be behind a recent downturn

Fatal overdose deaths in Philadelphia dropped 7% in 2023. The city is expected to release 2024 data in the spring.
Spencer Platt via Getty Images

Ben Cocchiaro, Drexel University

After nearly a decade of almost year-over-year increases in overdose deaths, the tide may finally be turning in Philadelphia.

The Centers for Disease Control and Prevention announced in May 2024 an estimated 3% decrease in overdose deaths in the U.S. in 2023 compared with 2022. Shortly after, data from the Philadelphia Department of Public Health showed a similar trend: Fatal overdoses across the city decreased 7% in 2023, from 1,207 to 1,122. The city is expected to release its 2024 data in the spring of 2025.

While these declines are notable, the city’s 2023 fatal overdose numbers are three times higher than they were in 2013.

Still, if 2024 numbers confirm the downward trend, it allows a little hope into an otherwise bleak epidemic that is killing more Philadelphians than homicides, car accidents and diabetes combined.

Something may finally be working. But what?

If over a decade spent treating and researching substance use disorders has taught me anything, it’s that the overdose epidemic is what researchers and policymakers refer to as a wicked problem. Wicked problems are constantly changing, complex, interconnected knots of other problems with no clear solution.

But let’s look at what we do know about how overdose deaths in Philadelphia spiked in the first place – and why they may finally be decreasing.

Why overdose deaths spiked

The first wave of the overdose epidemic began in the late 1990s and is attributed to overprescription of opioid pain medicines. But the largest acceleration in deaths didn’t occur until after the government and health insurers implemented prescribing controls in the early 2010s. These controls led many people who were no longer able to get prescribed opioids to turn to illicit heroin.

In a phenomenon known as the “iron law of prohibition,” stricter drug law enforcement led drug-trafficking organizations to shift from heroin toward more powerful synthetic opioids that are easier to produce, conceal and distribute. Gram for gram, pure fentanyl is over 50 times stronger than pure heroin.

But street-obtained fentanyl has proven to be anything but pure.

Local drug-testing efforts found as much as a fiftyfold difference in potency between bags of fentanyl that appear identical.

This unpredictable potency is considered to be the chief contributor to the deadliness of street fentanyl. It’s like cracking a beer and not knowing whether drinking it will get you mildly buzzed or send you to the graveyard.

Research suggests drug busts, though touted as improving public safety, can lead to more inconsistency and unpredictability in the potency of illicit opioids. An analysis of 14 studies conducted in the U.S. demonstrated a marked increase in fatal overdoses following the supply disruptions that result from drug seizures.

There’s also some evidence that the heightened economic insecurity and despair caused by the COVID-19 pandemic may have intensified the fatal overdose epidemic.

Man stands on steps of white van with sign on its outside that says Naloxone Saves Lives
Andres Freire of Prevention Point stands on the ‘bupe bus,’ a mobile service that offers medication treatment such as buprenorphine to people with opioid use disorder in Philadelphia.
Jeff Fusco for The Conversation U.S., CC BY-NC-ND

Potential reasons for decline

Just as economic insecurity was associated with rising deaths, the subsequent economic recovery as the U.S. emerged from the pandemic may have contributed to the 2023 drop in overdose fatalities nationwide.

However, the unequal distribution of that recovery seems to track with worsening racial disparities in overdose rates in the late 2010s to early 2020s.

Another possible explanation for the reduction in overdose deaths is the increasing availability of buprenorphine.

Buprenorphine, an FDA-approved medication for opioid use disorder, reduces withdrawal and cravings for fentanyl. What’s more, it decreases overdose risk by more than 50%.

However, efforts to increase access to this medication have stagnated. National prescribing rates for buprenorphine were relatively stable from 2019 to 2023, and the CDC estimates that only a quarter of those who need treatment are getting it. Efforts to make buprenorphine available without a prescription have not yet gained traction.

Access to and education around naloxone, a lifesaving drug used to reverse opioid overdoses, has also increased, and the drug is increasingly being administered by bystanders. Over 1.3 million doses were distributed in Pennsylvania since 2017. National research suggests these distribution efforts, often spearheaded by local harm-reduction organizations, have led to quicker administration of naloxone. This saves lives while also decreasing reliance on emergency medical services.

Finally, the consequences of a seemingly minor characteristic of fentanyl’s pharmacology might also be reducing the overdose death rate in Philadelphia.

Fentanyl’s effects last only a third as long as heroin. This shorter duration led drug traffickers to add the animal tranquilizer xylazine – also called “tranq” – and the veterinary anesthetic medetomidine into Philadelphia’s street drug supply. In 2019, two-thirds of heroin or fentanyl sampled in Philadelphia had xylazine in it. By 2021 all of it did.

These additives lengthen the duration of the effect, mitigate withdrawal symptoms and possibly reduce the amount of fentanyl needed per dose. Some evidence from animal studies shows that xylazine reduces fentanyl intake by suppressing fentanyl withdrawal, thereby lengthening the time before a person uses again.

What’s more, the skin wounds and sedative effects that are associated with xylazine may be motivating some people to avoid using street fentanyl.

Rows of Narcan nasal spray in its packaging
Over 1.3 million doses of naloxone have been distributed for free in Pennsylvania since 2017.
Jeff Fusco for The Conversation U.S., CC BY-NC-ND

What’s next for Philadelphia

The opioid settlement, a multibillion-dollar payment from the pharmaceutical industry to resolve legal actions against them, has led to increased funding in Philadelphia for naloxone and medications such as buprenorphine to treat opioid use disorder.

However, in the past year the city eliminated funding for needle exchanges and implemented compulsory treatment strategies, which research suggests often do not reduce drug use or criminal recidividism.

Meanwhile, at the federal level, Republican members of Congress have proposed cuts to Medicaid, the health insurance program for low-income Americans.

Whether new data, when it’s released, will show overdose deaths in Philly have continued to decline or are back on the rise is anybody’s guess. But I do know that harm-reduction advocates, medical providers and communities of people who use drugs will continue to fight this epidemic as if their lives depend on it. For many, it does.The Conversation

Ben Cocchiaro, Assistant Clinical Professor of Family Medicine and Community Health, Drexel University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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3D printing will help space pioneers make homes, tools and other stuff they need to colonize the Moon and Mars

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theconversation.com – Sven Bilén, Professor of Engineering Design, Electrical Engineering and Aerospace Engineering, Penn State – 2025-03-13 07:51:00

3D printing could make many of the components for future structures on Mars.
3000ad/iStock via Getty Images Plus

Sven Bilén, Penn State

Throughout history, when pioneers set out across uncharted territory to settle in distant lands, they carried with them only the essentials: tools, seeds and clothing. Anything else would have to come from their new environment.

So they built shelter from local timber, rocks and sod; foraged for food and cultivated the soil beneath their feet; and fabricated tools from whatever they could scrounge up. It was difficult, but ultimately the successful ones made everything they needed to survive.

Something similar will take place when humanity leaves Earth for destinations such as the Moon and Mars – although astronauts will face even greater challenges than, for example, the Vikings did when they reached Greenland and Newfoundland. Not only will the astronauts have limited supplies and the need to live off the land; they won’t even be able to breathe the air.

Instead of axes and plows, however, today’s space pioneers will bring 3D printers. As an engineer and professor who is developing technologies to extend the human presence beyond Earth, I focus my work and research on these remarkable machines.

3D printers will make the tools, structures and habitats space pioneers need to survive in a hostile alien environment. They will enable long-term human presence on the Moon and Mars.

An astronaut holding a wrench poses for the camera.
NASA astronaut Barry Wilmore holds a 3D-printed wrench made aboard the International Space Station.
NASA

From hammers to habitats

On Earth, 3D printing can fabricate, layer by layer, thousands of things, from replacement hips to hammers to homes. These devices take raw materials, such as plastic, concrete or metal, and deposit it on a computerized programmed path to build a part. It’s often called “additive manufacturing,” because you keep adding material to make the part, rather than removing material, as is done in conventional machining.

Already, 3D printing in space is underway. On the International Space Station, astronauts use 3D printers to make tools and spare parts, such as ratchet wrenches, clamps and brackets. Depending on the part, printing time can take from around 30 minutes to several hours.

For now, the print materials are mostly hauled up from Earth. But NASA has also begun recycling some of those materials, such as waste plastic, to make new parts with the Refabricator, an advanced 3D printer installed in 2019.

Manufacturing in space

You may be wondering why space explorers can’t simply bring everything they need with them. After all, that’s how the International Space Station was built decades ago – by hauling tons of prefabricated components from Earth.

But that’s impractical for building habitats on other worlds. Launching materials into space is incredibly expensive. Right now, every pound launched aboard a rocket just to get to low Earth orbit costs thousands of dollars. To get materials to the Moon, NASA estimates the initial cost at around US$500,000 per pound.

Still, manufacturing things in space is a challenge. In the microgravity of space, or the reduced gravity of the Moon or Mars, materials behave differently than they do on Earth. Decrease or remove gravity, and materials cool and recrystallize differently. The Moon has one-sixth the gravity of Earth; Mars, about two-fifths. Engineers and scientists are working now to adapt 3D printers to function in these conditions.

An illustration of an astronaut looking at a base camp on Mars.
An artist’s impressions of what a Mars base camp might look like.
peepo/E+ via Getty Images

Using otherworldly soil

On alien worlds, rather than plastic or metal, 3D printers will use the natural resources found in these environments. But finding the right raw materials is not easy. Habitats on the Moon and Mars must protect astronauts from the lack of air, extreme temperatures, micrometeorite impacts and radiation.

Regolith, the fine, dusty, sandlike particles that cover both the lunar and Martian surfaces, could be a primary ingredient to make these dwellings. Think of the regolith on both worlds as alien dirt – unlike Earth soil, it contains few nutrients, and as far as we know, no living organisms. But it might be a good raw material for 3D printing.

My colleagues began researching this possibility by first examining how regular cement behaves in space. I am now joining them to develop techniques for turning regolith into a printable material and to eventually test these on the Moon.

But obtaining otherworldly regolith is a problem. The regolith samples returned from the Moon during the Apollo missions in the 1960s and 70s are precious, difficult if not impossible to access for research purposes. So scientists are using regolith simulants to test ideas. Actual regolith may react quite differently than our simulants. We just don’t know.

What’s more, the regolith on the Moon is very different from what’s found on Mars. Martian regolith contains iron oxide –that’s what gives it a reddish color – but Moon regolith is mostly silicates; it’s much finer and more angular. Researchers will need to learn how to use both types in a 3D printer.

YouTube video
See models of otherworldly habitats.

Applications on Earth

NASA’s Moon-to-Mars Planetary Autonomous Construction Technology program, also known as MMPACT, is advancing the technology needed to print these habitats on alien worlds.

Among the approaches scientists are now exploring: a regolith-based concrete made in part from surface ice; melting the regolith at high temperatures, and then using molds to form it while it’s a liquid; and sintering, which means heating the regolith with concentrated sunlight, lasers or microwaves to fuse particles together without the need for binders.

Along those lines, my colleagues and I developed a Martian concrete we call MarsCrete, a material we used to 3D-print a small test structure for NASA in 2017.

Then, in May 2019, using another type of special concrete, we 3D-printed a one-third scale prototype Mars habitat that could support everything astronauts would need for long-term survival, including living, sleeping, research and food-production modules.

That prototype showcased the potential, and the challenges, of building housing on the red planet. But many of these technologies will benefit people on Earth too.

In the same way astronauts will make sustainable products from natural resources, homebuilders could make concretes from binders and aggregates found locally, and maybe even from recycled construction debris. Engineers are already adapting the techniques that could print Martian habitats to address housing shortages here at home. Indeed, 3D-printed homes are already on the market.

Meanwhile, the move continues toward establishing a human presence outside the Earth. Artemis III, now scheduled for liftoff in 2027, will be the first human Moon landing since 1972. A NASA trip to Mars could happen as early as 2035.

But wherever people go, and whenever they get there, I’m certain that 3D printers will be one of the primary tools to let human beings live off alien land.The Conversation

Sven Bilén, Professor of Engineering Design, Electrical Engineering and Aerospace Engineering, Penn State

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George Washington, a real estate investor and successful entrepreneur, knew the difference between running a business and running the government

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theconversation.com – Eliga Gould, Professor of History, University of New Hampshire – 2025-03-10 07:50:00

President George Washington delivers his first inaugural address in April 1789 in New York City.
Painting by T.H. Matteson, engraving by H.S. Sadd, via Library of Congress

Eliga Gould, University of New Hampshire

During his three presidential campaigns, Donald Trump promised to run the federal government as though it were a business. True to his word, upon retaking office, Trump put tech billionaire Elon Musk at the head of a new group in the executive branch called the Department of Government Efficiency.

DOGE, as Musk’s initiative is known, has so far fired, laid off or received resignations from tens of thousands of federal workers and says it has discovered large sums of wasted or fraudulently spent tax dollars. But even its questionable claim of saving US$65 billion is less than 1% of the $6.75 trillion the U.S. spent in the 2024 fiscal year, and a tiny fraction of the nation’s cumulative debt of $36 trillion. Because Musk’s operation has not been formalized by Congress, DOGE’s indiscriminate cuts also raise troubling constitutional questions and may be illegal.

Before they go too far trying to run the government like a business, Trump and his advisors may want to consider the very different example of the nation’s first chief executive while he was in office.

A man stands while behind him a man sits at a desk.
Elon Musk, left, and Donald Trump have undertaken an effort both describe as seeking to run government more like a business.
Andrew Harnik/Getty Images

The first businessman to become president

Like Trump, George Washington was a businessman with a large real estate portfolio. Along with property in Virginia and six other states, he had extensive claims to Indigenous land in the Ohio River Valley.

Partly because of those far-flung investments, the first president supported big transportation projects, took an active interest in the invention of the steamboat, and founded the Patowmack Company, a precursor to the builders of the Chesapeake and Ohio Canal.

Above all, Washington was a farmer. On his Mount Vernon estate, in northern Virginia, he grew tobacco and wheat and operated a gristmill. After his second term as president, he built a profitable distillery. At the time of his death, he owned nearly 8,000 acres of productive farm and woodland, almost four times his original inheritance.

Much of Washington’s wealth was based on slave labor. In his will, he freed 123 of the 300 enslaved African Americans who had made his successful business possible, but while he lived, he expected his workers to do as he said.

President Washington and Congress

If Washington the businessman and plantation owner was accustomed to being obeyed, he knew that being president was another matter.

In early 1790, near the end of his first year in office, he reflected on the difference in a letter to the English historian Catharine Macaulay. Macaulay had visited Mount Vernon several years before. She was eager to hear the president’s thoughts about what, in his reply, he described as “the last great experiment for promoting human happiness by reasonable compact.”

The new government, Washington wrote, was “a government of accommodation as well as a government of laws.”

As head of the executive branch, his own powers were limited. In the months since the inauguration, he had learned that “much was to be done by prudence, much by conciliation, much by firmness. Few, who are not philosophical Spectators,” he told his friend, “can realise the difficult and delicate part which a man in my situation (has) to act.”

Although Washington did not say why his situation was delicate, he didn’t need to. Congress, as everyone knew, was the most powerful branch of government, not the president.

The previous spring, Congress had shown just how powerful it was when it debated whether the president, who needed Senate confirmation to appoint heads of executive departments, could remove such officers without the same body’s approval. In the so-called Decision of 1789, Congress determined that the president did have that power, but only after Vice President John Adams broke the deadlock in the upper house.

The meaning of Congress’ vote was clear. On matters where the Constitution is ambiguous, Congress would decide what powers the president can legally exercise and what powers he – or, someday, she – cannot.

When it created a “sinking fund” in 1790 to manage the national debt, Congress showed just how far it could constrain presidential power.

Although the fund was part of the Treasury Department, whose secretary served at the president’s pleasure, the commission that oversaw it served for fixed terms set by Congress. The president could neither remove them nor tell them what to do.

Inefficient efficiency

William Humphrey, a member of the Federal Trade Commission, was unconstitutionally fired by Franklin Roosevelt in 1933.
Library of Congress

By limiting Washington’s power over the Sinking Fund Commission, Congress set a precedent that still holds, notably in the 1935 Supreme Court case of Humphrey’s Executor v. U.S.

To the displeasure of those, including Trump, who promote the novel “unitary executive” theory of an all-powerful president, the court ruled that President Franklin D. Roosevelt could not dismiss a member of the Federal Trade Commission before his term was up – even if, as Roosevelt said, his administration’s goals would be “carried out most effectively with personnel of my own selection.”

Like the businessman who currently occupies the White House, Washington did not always like having to share power with Congress. Its members were headstrong and independent-minded. They rarely did what they were told.

But he realized working with Congress was the only way to create a federal government that really was efficient, with each branch carrying out its defined powers, as the founders intended. Because of the Constitution’s checks and balances, the United States was – and is – a government based on compromise between the three branches. No one, not even the president, is exempt.

To his credit, Washington was quick to learn that lesson.The Conversation

Eliga Gould, Professor of History, University of New Hampshire

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5 ways schools have shifted in 5 years since the COVID-19

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theconversation.com – Rachel Besharat Mann, Assistant Professor in Education Studies, Wesleyan University – 2025-03-10 07:48:00

Students sit in pop-up tents during wind ensemble class at Wenatchee High School on Feb. 26, 2021 in Wenatchee, Wash..
David Ryder/Getty Images

Rachel Besharat Mann, Wesleyan University and Gravity Goldberg, Wesleyan University

The U.S. educational landscape has been drastically transformed since the COVID-19 pandemic shuttered school campuses five years ago.

Access to high-quality teachers and curriculum developed by teachers is shrinking, for example. Likewise, there has been a loss of emotional support for students and a decline in the school use of technology and social media.

As education scholars focused on literacy practices in schools, here are five ways we believe the COVID-19 pandemic – and the rapid shift to remote learning and back – has transformed education:

1. Teachers are leaving, and those staying are stressed

At the start of the 2024-2025 school year, 82% of U.S. public schools had teaching vacancies.

Schools have tried to adapt by expanding class sizes and hiring substitute teachers. They have also increased use of video conferencing to Zoom teachers into classrooms.

A teacher sits at home in front of a computer monitor.
A teacher works from her home due to the COVID-19 outbreak on April 1, 2020, in Arlington, Va.
Olivier Doulier/AFP via Getty Images

Teacher retention has been a problem for at least a decade. But after the pandemic, there was an increase in the number of teachers who considered leaving the profession earlier than expected.

When teachers leave, often in the middle of the school year, it can require their colleagues to step in and cover extra classes. This means teachers who stay are overworked and possibly not teaching in their area of certification.

This, in turn, leads to burnout. It also increases the likelihood that students will not have highly qualified teachers in some hard-to-fill positions like physical science and English.

2. Increase in scripted curriculum

As of fall 2024, 40 states and Washington had passed science of reading laws, which mandate evidence-based reading instruction rooted in phonics and other foundational skills.

While the laws don’t necessarily lead to scripted curriculum, most states have chosen to mandate reading programs that require teachers to adhere to strict pacing. They also instruct teachers not to deviate from the teachers’ manual.

Many of these reading programs came under scrutiny by curricular evaluators from New York University in 2022. They found the most common elementary reading programs were culturally destructive or culturally insufficient – meaning they reinforce stereotypes and portray people of color in inferior and destructive ways that reinforce stereotypes.

This leaves teachers to try to navigate the mandated curriculum alongside the needs of their students, many of whom are culturally and linguistically diverse. They either have to ignore the mandated script or ignore their students. Neither method allows teachers to be effective.

When teachers are positioned as implementers of curriculum instead of professionals who can be trusted to make decisions, it can lead to student disengagement and a lack of student responsiveness.

This form of de-professionalization is a leading cause of teacher shortages. Teachers are most effective, research shows, when they feel a sense of agency, something that is undermined by scripted teaching.

3. Improvements in teen mental health, but there’s more to do

Many of the narratives surrounding adolescent mental health, particularly since the pandemic, paint a doomscape of mindless social media use and isolation.

However, data published in 2024 shows improvements in teen reports of persistent sadness and hopelessness. Though the trend is promising in terms of mental health, in-school incidences of violence and bullying rose in 2021-22, and many teens report feeling unsafe at school.

Other reports have shown an increase in feelings of loneliness and isolation among teens since the pandemic.

4. Crackdown on students’ technology use in schools

COVID-19 prompted schools to make an abrupt switch to educational technology, and many schools have kept many of these policies in place.

For example, Google Classroom and other learning management systems are commonly used in many schools, particularly in middle school and high school.

These platforms can help parents engage with their children’s coursework. That facilitates conversations and parental awareness.

But this reliance on screens has also come under fire for privacy issues – the sharing of personal information and sensitive photos – and increasing screen time.

And with academia’s use of technology on the rise, cellphone usage has also increased among U.S. teens, garnering support for school cellphone bans.

A child wearing a face mask looks at a laptop computer.
A student attends an online class at the Crenshaw Family YMCA on Feb. 17, 2021, in Los Angeles during the COVID-19 pandemic.
Patrick T. Fallon/AFP via Getty Images

But banning these devices in schools may not help teens, as smartphone use is nearly universal in the U.S. Teens need support from educators to support them as they learn to navigate the complex digital world safely, efficiently and with balance.

In light of data surrounding adolescent mental health and online isolation – and the potential for connection through digital spaces – it’s also important that teens are aware of positive support networks that are available online.

Though these spaces can provide social supports, it is important for teens to understand the strengths and limitations of technology and receive authentic guidance from adults that a technology ban may prohibit.

5. Students and adults need social emotional support

Students returned to in-person schooling with a mix of skill levels and with a variety of social and emotional needs.

Social and emotional learning includes self-awareness, self-management, social awareness, relational skills and decision-making.

These skills are vital for academic success and social relationships.

Teachers reported higher student needs for social and emotional learning after they returned to in-person instruction.

While some of this social and emotional teaching came under fire from lawmakers and parents, this was due to confusion about what it actually entailed. These skills do not constitute a set of values or beliefs that parents may not agree with. Rather, they allow students to self-regulate and navigate social situations by explicitly teaching students about feelings and behaviors.

A teacher and student are separated by plexiglass as they sit across from each other at a desk.
A teacher provides instruction to a student at Freedom Preparatory Academy on Feb. 10, 2021, in Provo, Utah.
George Frey/Getty Images

One area where students may need support is with cognitive flexibility, or the ability to adapt to current situations and keep an open mind. Classroom instruction that engages students in varied tasks and authentic teaching strategies rooted in real-life scenarios can strengthen this ability in students.

Besides allowing students to be engaged members of a school community, cognitive flexibility is important because it supports the skill development that is part of many state English language arts and social studies standards.

Social and emotional learning and cognitive flexibility are key components that allow students to learn.

Due to vague or confusing state policies, many schools have stopped teaching social and emotional learning skills, or minimized their use.

This, coupled with teacher stress and burnout, means that both adults and children in schools are often not getting their social and emotional needs met.

Message of mistrust

While we described five shifts since the start of the pandemic, the overall trend in K-12 schools is one of mistrust.

We feel that the message – from districts, state legislators and parents – is that teachers cannot be trusted to make choices.

This represents a massive shift. During the initial phase of the COVID-19 lockdown, teachers were revered and thanked for their service.

We believe in teacher autonomy and professionalism, and we hope this list can help Americans reflect on the direction of the past five years. If society wants a different outcome in the next five years, it starts with trust.The Conversation

Rachel Besharat Mann, Assistant Professor in Education Studies, Wesleyan University and Gravity Goldberg, Visiting Assistant Professor in Education Studies, Wesleyan University

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