Study finds surge in hospitalizations for heroin, drug overdoses
January 26, 2016 12:11 AM
Connor Mulvaney for PublicSource.
The soaring epidemic of heroin and prescription overdoses has sparked thousands of inpatient admissions across Pennsylvania
By Adam Smeltz / Pittsburgh Post-Gazette
The soaring epidemic of heroin and prescription overdoses has sparked thousands of inpatient admissions across Pennsylvania, socking urban and rural hospitals with robust surges in case rates, a state agency has found.
Clinicians handled 1,848 inpatient hospitalizations in 2014 for overdoses of heroin and pain medication, a near tripling of the statewide numbers in 2000, the Pennsylvania Health Care Cost Containment Council said. The sharpest increase emerged among heroin overdose patients in rural counties, where hospitalizations jumped 315 percent, according to the PHC4 report released Tuesday.
By comparison, urban areas logged a 143 percent bump in the same category.
“No one knows the reason” for that discrepancy, said Christina Mair, a University of Pittsburgh faculty member who is studying rural overdose patterns. She said Pennsylvania “certainly [ranks] in the top 10 worst states in the country in terms of the rates of overdose and dependence.”
The report should help researchers analyze the trends through regional and historic breakdowns often lacking in death counts from the epidemic, Ms. Mair said. The new assessment uses hospital discharge data to tally overdoses among Pennsylvanians at least 15 years old who were admitted to general acute-care facilities, but it leaves out other cases.
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“I think the more data we can get that help us understand, in real time, what’s happening, the better it is. Right now, it is still very difficult for us to know,” said Karen Hacker, the Allegheny County Health Department director.
Upticks in hospital patients may suggest that more people know to seek emergency care for an overdose, Dr. Hacker said, while growing availability of the antidote naloxone may steer an unknown number of others away from the emergency room.
Total fatalities from drug-connected overdoses reached at least 326 last year in Allegheny County, up from 307 the year before, according to OverdoseFreePA.org, a collaboration involving Pitt. A breakdown specific to individual drugs and medications was not immediately available Monday.
“Whether urban or rural, this issue is an equal-opportunity offender,” PHC4 executive director Joe Martin said in a statement. He said his agency, which collects and analyzes hospital data, dug into the numbers amid deepening concerns over heroin and opioid overdoses in particular.
In southwestern Pennsylvania, heroin overdoses represented 9.1 inpatient hospitalizations per 100,000 people in 2014, compared with 2.3 hospitalizations per 100,000 in 2000. For pain medicine overdoses, the rate was 7.3 hospitalizations per 100,000 last year, about three times the figure in 2000.
Heroin overdoses now virtually match those involving pain medications, which spiked at 1,142 in 2011 before receding to 929 in 2014.
Doctors said that suggests a couple of shifts: Physicians may be taking a more conservative approach to prescribing potentially addictive opioids, and more drug users may be shifting to cheaper, easy-to-find heroin from illegal dealers.
“Clearly, the prescription-drug epidemic has led to the heroin epidemic,” said Jack Kabazie, who directs the pain-medicine division at the North Side-based Allegheny Health Network.
He said much of the epidemic stems from a shift in prescribing standards more than 20 years ago. “Faulty studies” in that era led to over-prescription of addictive opioid painkillers, Dr. Kabazie said.
Although physicians are becoming more aware of the epidemic, he said, the state should mandate continuing education in opioid prescription-writing. He said Pennsylvania also needs a real-time database to let doctors and pharmacists monitor patients’ earlier and ongoing prescriptions, no matter where patients may seek the drugs.
The Pennsylvania Medical Society expects such a database could begin running this year, said society president Scott Shapiro. Plans have gotten hung up in the ongoing state budget impasse.
“We’re seeing the opioid-abuse problem span all financial demographics of society. It’s not just the underprivileged that this affects,” said Dr. Shapiro, a cardiologist outside Philadelphia.
Still, data in the PHC4 report show a demographic split: The highest hospitalization rate for pain-medication overdoses in Pennsylvania was among patients 50-59 years old, and the highest rate for heroin overdoses occurred in the 20-29 age bracket.
“You wouldn’t expect people in their 20s and 30s to take as many pain medications as people in their 50s and older do,” said Marylou Buyse, a senior medical director at Highmark Inc.
The company and other health care groups, including UPMC, have put a premium on cutting abuse by expanding education for physicians and by making antidotes more available to combat overdose symptoms, among other approaches.
Michael Lynch, the Pittsburgh Poison Center medical director and a Pitt faculty member, called the overdose trends scary.
“It’s going to take more than one or two strategies,” Dr. Lynch said. “It’s going to take a lot of collaboration.”
Staff writer Steve Twedt contributed. Adam Smeltz: email@example.com, 412-263-2625.