Hospitals see big increase in drug overdoses
Patient admissions for heroin up 66%
Pennsylvania has seen a 66 percent increase in heroin overdose hospital admissions the past two years, according to a new report, signaling an ongoing and disturbing trend that has roots in physician prescribing practices, but is now increasingly driven by illicit street drug use.
Data released Tuesday by the independent Pennsylvania Health Care Cost Containment Council cites 1,524 heroin overdose hospitalizations statewide in 2016, compared with 919 overdoses in 2014, and only 378 going back to 2003.
Nearly 10 percent of those admitted in 2016 died in the hospital, the report found. Overall, treating those overdoses came at an estimated $27 million cost to public and private insurance companies.
The findings “continue to stress the devastating impact of drugs on Pennsylvania families, communities and taxpayers, regardless of age, race, gender, income level or where one lives,” said Joe Martin, PHC4 executive director, in a release.
The full research brief can be viewed online at www.phc4.org.
Allegheny County saw 613 overdose deaths in 2016, a 44 percent increase over 2015, which physician and county health department director Karen Hacker attributes in large part to the emergence locally of fentanyl, which may be 50-100 times more potent than heroin.
“It’s become where there is an expectation that if you buy heroin, it will have some fentanyl in it,” she said, adding that “the willingness to risk your life when you don’t even know what is in the drug is extremely scary.”
Physician Jack Kabazie, director of Allegheny Health Network’s Division of Pain Medicine, said the beginnings of the opioid epidemic trace back to the late 1980s when studies, now considered flawed, stated that opioids were an effective approach to treating chronic pain, with little risk of leading to addiction.
In addition, he said, physicians were trained to consider pain a fifth vital sign in addition to the patient’s temperature, blood pressure, heart rate and breathing rate.
“Doctors were being denigrated for not treating chronic pain appropriately.”
That thinking started to change around 2010 and now “physicians are much more often watching what they’re writing for and writing fewer opioid prescriptions,” he said.
Pennsylvania law requires physicians to review patients’ prescription drug histories before writing a script for addictive opioids and, as of Jan. 1, prescriptions for drugs such as fentanyl and oxycodone must be promptly reported to the Pennsylvania Drug Monitoring Program.
Dr. Kabazie said the seven-hospital Allegheny Health Network this month instituted a system-wide policy that requires its physicians to assess a patient’s risk of becoming addicted before prescribing opioids.
The doctors also must consult with one of AHN’s pain medicine specialists if the prescription continues beyond three months, he said.
The medical community’s prevention efforts may already be showing results, as the number of overdoses from prescription medications has flattened.
But overdoses from illicit drug use involving heroin and fentanyl “are rising rapidly,” said Michael Lynch, an emergency physician and medical director of the UPMC Pittsburgh Poison Center in Oakland, with more overdoses in the past year from illicit drug use (1,446) than from prescribed opioids.
Said Dr. Hacker: “I would argue that a lot of the strategies being used to get in front of this [opioid epidemic] don’t necessarily work with fentanyl on the scene.”
Statewide, the PHC4 data showed there were 31.1 hospital admissions for heroin and pain medication overdoses per 100,000 residents.
In southwest Pennsylvania, Beaver County had a rate of 40.2 people hospitalized per 100,000 residents, followed by Westmoreland County (38.2), Allegheny County (34.9), Washington County ( 33.8), Fayette County (32.9), Armstrong County (28.3), Butler County (19.9) and Indiana County (18.9). Data was not available for Greene County.
According to the PHC4 brief about 70 percent of the patients fell into the 20-39 year age group.