Abstract Rationale The economic impact of the opioid crisis is extensive, with costs difficult to measure. Nationally, medical costs associated with substance use disorders exceed 13 billion (1). In Philadelphia, this burden is substantial at the community hospital level (2). Understanding its financial consequences requires recognizing the volatility of the city’s drug supply: as supply lines and adulterants evolve, strain on the healthcare system worsens. By 2017, fentanyl had replaced heroin in the Mid-Atlantic, triggering a surge in overdose deaths. Between 2017-2023, xylazine (“tranq”) became the dominant adulterant, detected in 90% of fentanyl samples in 2020 per the Philadelphia Dept. of Health (3). Recently, medetomidine has supplanted xylazine, first noted locally in early 2024 (3). This shift coincides with new withdrawal syndromes marked by severe autonomic hyperactivity—hypertension, tachycardia, tremulousness—often requiring ICU-level sedation. These evolving presentations have significantly influenced opioid use disorder admission rates, lengths of stay, and hospital costs. Methods Data were collected using Qlik software from Jefferson Methodist Hospital, a community site within the Jefferson Health system. The study included 1, 915 patients admitted since April 2017 with a primary ICD code F11-23 (Opioid Use Disorder). Data points included dates of admission, length of stay, and average and total hospital billing over time. In addition, data collected by the Philadelphia Department of Health has allowed for some graphical depictions of the changes in adulterants over time, mapped onto our own charge data. Results (Graph below) Conclusion The changing paradigm of the street drug market in Philadelphia has led to a trend in increased hospitalization, increased length of hospital stay, and an increase in hospital costs. Many of these recent trends may be attributable to changes in the specific contaminants within the opioid drug supply. Optimal management of these patients is not yet known, which may contribute to longer stays and higher costs. Further studies are needed to better understand how to manage this unique aspect of the opioid epidemic. Works Cited (Excluded for word count) This abstract is funded by: None
Chakravorty et al. (Fri,) studied this question.