Overdose deaths from prescription drug abuse skyrocketing in southwestern Pennsylvania
January 23, 2014 5:13 AM
By Janice Crompton / Pittsburgh Post-Gazette
Prescription drug abuse is an epidemic in Pennsylvania, and legislators and law enforcement officials are scrambling to address the rapidly growing problem.
“I think we’re in a culture in which everything gets fixed — there is no level of uncomfortableness that we think we should have to endure,” said Elaine Stano, treatment specialist with the Fayette County Drug and Alcohol Commission, referring to the use of prescription narcotics for pain relief. “It’s a quick way to alleviate discomfort. There’s just an idea that we don’t ever have to be uncomfortable, and I think that’s a major reason drugs are a problem."
PG graphic: Overdose death rates (Click image for larger version)
Addiction to prescription pills — mainly to narcotic painkillers such as oxycodone, sold as Percocet and other brands, and hydrocodone, sold as Vicodin and other brands — has proven to be more deadly than some illegal drugs. According to the Centers for Disease Control, prescription drug overdoses in 2007 resulted in four times as many deaths as heroin overdoses and twice as many as cocaine. And that trend has continued.
Across the region, the number of overdose deaths from prescription and illegal drugs has increased dramatically, according to the Pennsylvania Department of Health, Bureau of Health Statistics and Research, with Fayette County leading the way.
Fayette County has one of the highest death rates from drug overdoses in the country, more than that of West Virginia, the state with the highest rate of overdose deaths in the nation.
And in Westmoreland County, drug overdose deaths for the first time have surpassed all other types of unnatural deaths combined, including car accidents, homicides and fires.
In 2011, the most recent data available for research, drug overdose deaths in Allegheny County totaled 243, a rate of 20.5 per 100,000 residents. That’s up from 2010 and 2009, when 228 and 222 people died from overdoses, respectively. Compare that to the rate in 1990, when 87 people, or 6.3 per 100,000 residents, died of an overdose in the county.
The numbers for outlying counties also have climbed. In 1990, a total of 18 people died of drug overdoses in six counties in the region — Beaver, Butler, Fayette, Greene, Washington and Westmoreland.
Three of the 18 died in Fayette County that year. By 2009, the number in Fayette County had reached 23. It rose to 28 in 2010, then to 43 in 2011 — representing 33.5 per 100,000 residents, surpassing West Virginia's nation-leading rate of 28.9 overdose deaths per 100,000 residents.
“I think we have some stronger prescription drugs now,” said Jana Kyle, executive director of the Fayette County Drug and Alcohol Commission, about the increase in that county. “We have Opana, oxymorphone, Oxycontin … Doctors prescribe these highly addictive drugs and aren’t aware that people are becoming addicted."
PG graphic: Drugs from a familiar source (Click image for larger version)
In the region's other counties, the number of overdose deaths from both prescription and illegal drugs in 2011 was, listed from the highest rate to lowest: Greene, 10 deaths, or 28.2 per 100,000 residents; Beaver, 37 deaths, or 24.2 per 100,000 residents; Washington, 40 deaths, or 21.2 per 100,000 residents; Westmoreland, 78 deaths, or 20.4 per 100,000; and Butler, 30 deaths, or 17 per 100,000 residents.
All counties in southwestern Pennsylvania outpace the state in the number of deaths per 100,000 people. Statewide, the rate is 15.3 — 14th highest in the nation, according to a recent study by the nonprofit, Trust for America’s Health.
In Westmoreland County, Coroner Ken Bacha is on a mission to educate the public about prescription drug abuse.
“If you take all of the other types of unnatural death and put them together, they don’t equal the number of drug overdoses we had in 2013,” he said of his county.
When Mr. Bacha took office in 2002, 22 people died of drug overdoses that year, mostly from heroin use. In less than 10 years, that number had risen to 78 deaths. Last year, the county saw about 92 people die from drug overdoses, and so far in 2014, seven people are suspected to have died as a result of a drug overdose.
What is perhaps most striking about the data, Mr. Bacha said, is that about two-thirds of the overdoses now involve prescription drugs, with about a third caused by illicit drugs.
"The biggest problem is that people think it’s prescription medication that comes from a doctor — it’s OK,” he said.
The two drugs most often involved in overdose deaths are hydrocodone and oxycodone, Mr. Bacha said. Sometimes added to the deadly cocktail are the “benzo” family of drugs — benzodiazepine, sold as Valium or Xanax — which are sometimes used to treat anxiety and depression. Both are central nervous system depressants that can cause a person to stop breathing.
PG graphic: Commonly abused medications (Click image for larger version)
Mr. Bacha is sponsoring prescription drug summits in schools throughout the county. He said the problem crosses demographic divides.
“This addiction does not discriminate,” he said. His youngest overdose victim was a 15-year-old who died from heroion use, while the oldest was a 72-year-old woman who overdosed on prescription drugs, he said. “It affects down-and-out people and people who live in million-dollar houses. Our biggest percentage of deaths is among white males, ages 41 to 60."
Mr. Bacha is among those advocating legislative overhaul, and lawmakers are hearing the outcry. They have introduced several bills aimed at creating a prescription drug monitoring program and database that could alert doctors and pharmacists to abuse. In particular, the efforts would expose so-called “doctor shopping”— when a patient visits multiple doctors to obtain duplicate prescriptions.
Pennsylvania does not do a good job of monitoring, Mr. Bacha said. “It is essential. It will help cut down on the supply, but on the negative side, we think it’s going to push people to use heroin.”
He and other addiction experts believe heroin use will increase because patients who are exposed as doctor shoppers will need another way to feed their addiction.
U.S. Attorney David Hickton said the law treats addicts and dealers differently.
“We’re highlighting addiction awareness and addiction education because addiction is an illness that’s determined largely by your DNA. Once you become an addict to these powerful medications, you can’t stop taking them any more than you can stop breathing," he said.
''The goal of law enforcement and the Obama administration is not to jail drug users but to rehabilitate them through treatment programs and close monitoring,'' he said.
“This administration has realized the distinction between the illness of addiction and people who are trafficking drugs. The treatment option is a huge piece of the equation.”
Mr. Hickton’s office has been concentrating its efforts on the supply-side of prescription narcotics. In 2012, he secured a conviction against Oliver Herndon, 41, a doctor from Peters who pleaded guilty to accusations that he prescribed powerful narcotics to patients without obtaining their medical history and without a thorough examination.
Investigators had described the Stanford-educated physician as a major supplier of narcotics in Western Pennsylvania, so much so that after his arrest in March 2012, the street value of oxycodone doubled to $40 per pill. He was sentenced to 11 years and 3 months in prison.
“What we’re finding is the use of these pills is just increasing geometrically in all areas,” said Mr. Hickton, who helped launch a drug take-back program in which boxes are located throughout the state where people can drop off leftover prescription drugs. “The data shows that most people are beginning their pill problem right out of the medicine cabinet.”
Several bills pending in the state Legislature would create a prescription drug database, including House Bill 1694, introduced last year by state Rep. Matthew Baker, R-Tioga. It passed the House by a 191-7 vote and is now being considered by the state Senate Public Health and Welfare Committee.
The bills vary in how much access law enforcement would have to such a database. In Mr. Baker’s bill, a search warrant would be required in most cases. He and others point out the importance of the bill’s objective — to help addicts, not necessarily to punish them.
Mr. Baker said he hopes the bill moves quickly through the Senate because Pennsylvania is lagging behind other states that have already addressed the monitoring of prescription opiates. Pennsylvania, along with every other state except Missouri, has a prescription drug monitoring program but it does not monitor Schedule II, III, IV or V drugs, such as hydrocodone or oxycodone.
The bills are supported by industry groups, including the Pennsylvania Pharmacists Association, which represents 1,200 pharmacists statewide.
“I would say that we’re pretty strongly supportive of it,” Pat Epple, CEO of the association, said of the efforts.
The group had concerns early on about whether pharmacists would be required to investigate all patients through the database system. Ms. Epple said the group favors a voluntary approach.
But some groups don’t want to see any of the bills move too quickly through the Legislature due to privacy concerns.
“It’s extremely concerning that the government wants to collect this type of personal information about people,” said Andy Hoover, legislative director of the American Civil Liberties Union in Pennsylvania. “There needs to be some serious privacy controls, and the existing bills don’t have them.”
Mr. Hoover is concerned that any patient, including a child, who gets routine dental work or takes medication for attention deficit disorder will end up in the system.
“The medications on this list are very common,” he said. “It goes all the way down to prescription cold and flu medications because it’s based on the federal Controlled Substances Act.”
Schedule II drugs that would be covered by the monitoring bills include the highly addictive painkillers such as oxycodone and hydromorphone, sold as Dilaudid and other brands. But the bills also would cover drugs in the Schedule V category, which include cough suppressants and anti-diarrheal medications and are considered to have a low potential for abuse.
“Millions of people will end up on this database,” Mr. Hoover said.
He also expressed concern about abuse of the database, citing information from the Medical Identity Fraud Alliance that indicates medical identity theft is on the rise, increasing 20 percent between 2012 and 2013.
The ACLU also takes issue with the search warrant requirements for law enforcement access to the database. Right now, Mr. Baker’s bill provides a search warrant requirement but not for all police inquiries.
“We think it should be broader. It should cover any attempt from a prosecutor into this database. If they want this type of information, they should have to explain to a court what they want,” Mr. Hoover said. “They can’t get into our personal medicine cabinets without a warrant.”
Ron and Judi Owen of O'Hara have taken up the cause of combatting drug abuse. Their daughter Sarah overdosed on heroin 10 years ago at age 23, leaving behind a 5-year-old daughter.
“We are part of fraternity of many families who have lost kids who pushed the envelope and never thought they had a problem,” Mr. Owen said. “Our Sarah was a loving mother and a caring daughter, but she always wanted to have an extra rush. It’s a dangerous road.”
He said his daughter began taking drugs while she was a student at Fox Chapel Area High School.
He and his wife have been active since their daughter’s death, serving on nonprofit boards and speaking to groups about the way drug use tears families apart.
“It takes over your desire to live a normal life,” said Mr. Owen, who serves on the board of directors for Gateway Rehabilitation. “It takes one shot too much of that stuff and it’s over. Your family and friends mourn for life.”
The couple has created an organization devoted to giving young women a chance to move beyond their addictions. It is called R.O.S.E.S from Sarah, which stands for Recovery Or Single-Mother Educational Support.
"People need to be educated about what they’re taking,” said Erica Usher, a prevention supervisor with the Fayette County Drug and Alcohol Commission. “We have to be responsible for what we put in our bodies.”
Kenneth Martz, director of the Bureau of Treatment, Prevention and Intervention, part of the state Department of Drug and Alcohol Programs, believes the problem must be addressed from many different angles, including drop-off boxes to collect unneeded prescription medicines, expanded treatment options to address addiction and a monitoring program to track possible abusers.
“No one element will be the silver bullet that will stop this,” said Mr. Martz, who noted that treatment options can be outpatient or inpatient and most insurance covers substance abuse treatment.
“It usually takes them getting arrested to get forced into treatment,” Mr. Bacha said of those who are addicted.
He added: “Parents need to be in their kids' business with tough love or they’ll be picking out their casket.”
For information on treatment programs and a list of drug take-back locations: www.ddap.pa.gov.
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