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Public health leaders, emergency physicians and addiction medicine specialists in Philadelphia are investigating a steady uptick in seizures among people who use drugs.
Emergency department visits related to drug use that have included a complaint or diagnosis of seizure have more than doubled over the past five years, increasing by 110%, according to a city Department of Public Health advisory issued this month.
Health officials have not yet determined what is causing the surge, but say a rapidly changing street drug supply, brain injuries that can occur with overdoses, untreated health infections and exposure to harsh environmental conditions could all be playing a role.
“When we see it, we’ve got to find out why,” said Dr. Lauren Murphy, an emergency medicine physician and toxicologist at Temple University. “It’s really important to find out if we need to change our treatments to take care of patients with seizures. So far, we haven’t had to, but that’s something we’re always following.”
More data needed on confirmed seizures and drugs at play
Emergency departments and community workers who provide harm reduction tools like clean syringes, Narcan and wound care are often the first to notice any new symptoms or health concerns among people who use drugs.
“I do anecdotally say in the ER that I have seen more and more seizure-like complaints,” Murphy said.
After collecting similar reports, the Philadelphia Department of Public Health analyzed hospital data and found an increase in related complaints from 2020 to 2025.
People who use drugs are generally at a higher risk for seizures if they have a history of traumatic brain injury, are taking combinations of stimulants and synthetic substances, or are going through withdrawal.
But Murphy said pinpointing what could be driving this increase is difficult for two reasons: the inherent complexity of seizures themselves and a lack of confirmatory testing for these incidents.
Seizures are typically confirmed with an electroencephalogram, or EEG, test that measures electrical activity in the brain, or with imaging that finds neurological damage, which can’t always be captured during a single emergency room visit.
“Sometimes you can have seizure-like activity, but it’s not an actual seizure,” she said.
There’s also a big difference, Murphy said, between someone who experiences a brief, one-time seizure event and someone who is having repetitive seizures or ones that last for many minutes.
At the same time, patients are coming in after being exposed to a lot of different toxic substances and chemicals in the street drug supply, knowingly or not.
“For instance, the pure quantity of fentanyl has gradually increased,” Murphy said. “So, does that have something to do with lowering the vulnerability of a patient to have a seizure when they’re exposed to multiple substances? That could certainly play a role.”
