‘…not a moral failing’

Overdose statistics reveal the impact of the disease known as addiction beyond Warren County

Times Observer file graphic This stock image illustrates a variety of drugs and drug paraphernalia that can lead to dependence, overdose and death. In December, The state Department of Health handed out 6,105 doses of the overdose reversing drug naloxone in an effort to save lives as well as to combat the many stigmas of addiction.

Statistics for 2018 are not yet available, but from 2016 to 2017 Warren County saw the number of deaths due to drug overdose increase significantly.

No overdose deaths were reported in the county in 2016, according to Susan Shanaman, legislative liasion for the Pennsylvania State Coroners Association. That number rose to 6 in 2017, Shanaman said.

In comparison, from 2015 to 2017, Erie County saw a 92-percent increase in drug-related overdose deaths while Crawford County had a 14 percent decrease, according to a joint intelligence report titled “The Opioid Threat in Pennsylvania.”

The report, dated September 2018, was prepared by the DEA (United States Drug Enforcement Administration) Philadelphia Division and the University of Pittsburgh.

Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription; such as oxycodone, hydrocodone, codeine, morphine, and many others.

Times Observer file graphic This stock image illustrates a variety of the different types of drugs and drug paraphernalia that can lead to dependence, overdose and death. In December, The state Department of Health handed out 6,105 doses of the overdose reversing drug naloxone in an effort to save lives as well as to combat the many stigmas of addiction.

The report provides an assessment of the opioid crisis in the state. It addresses issues of supply and demand and includes a detailed county-level analysis of multiple opioid misuse data sources.

Statewide statistics reflect nearly twice the number of overdose deaths in the state as compared to the nationwide average in 2017.

There were 5,456 drug-related overdose deaths in the state in 2017, according to the report. This number represents a rate of 43 deaths per 100,000, far exceeding the national average of 22 per 100,000 in 2017.

The report shows an effort throughout the state to reduce the overdose rate by controlling the supply of opioids.

According to data from the Centers for Disease Control (CDC), Pennsylvania practitioners wrote an average of 69.5 opioid prescriptions per 100 persons in 2016, the 26th highest rate in the country. The 2016 ranking was a drop as the state had the sixth highest rate in the country in both 2014 and 2015.

Warren County had 76 opioid prescriptions written per 100 people in 2016, according to the report.

The total number of dosage units dispensed statewide in 2017 declined approximately 6 percent for oxycodone and approximately 14 percent for hydrocodone from 2016; comparing 2017 to 2015 showed an even greater decline of approximately 8 percent for oxycodone and approximately 24 percent for hydrocodone, according to the report.

The report also includes results of a survey that show a tendency for progression from opioid misuse to heroin use.

The report cites preliminary findings from a drug user health survey of 400 opioid users conducted by the Philadelphia Department of Public Health between December 2017 and March 2018, as well as input provided to the DEA by service provider organizations in several parts of the Commonwealth.

While the report includes much more detailed results, it indicates that (specific to Philadelphia) the majority (57.1 percent) of respondents indicated having used pills before heroin. Heroin being “cheaper” was the most common reason cited for first using heroin.

Naloxone has been an integral tool in reducing the number of overdose deaths.

Policies allowing for increased access to naloxone have led to widespread disbursement of naloxone throughout the Commonwealth.

Governor Tom Wolf’s office reported the state distributed 6,105 naloxone kits in a statewide effort to save lives in December. During the day-long event, the Warren County State Health Center gave out 12 doses of the overdose reversal medication.

Naloxone, a medication that reverses the effects of an opioid overdose, was provided at no cost at more than 70 locations.

The number of doses dispersed at locations varied significantly from a low of nine handed out in Cameron County to 1,027 at the Philadelphia Department of Public Health.

The free distribution was intended not only to save lives, but also to promote treatment for those suffering with opioid-use disorder and to combat the stigma associated with the term “addiction.”

“It is very important that people understand that addiction is a disease, and is not a moral failing,” said Nate Wardle, press secretary at the Department of Health, following the distribution. “The disease of addiction changes the wiring in the brain, and is extremely difficult to overcome. That is why in some cases it may take several attempts at treatment, or several revivals with naloxone before someone looks to get into treatment.”

Interviews of drug users and treatment personnel, conducted in order to compile the DEA report, indicate that people who misuse opioids often experience multiple overdoses in the course of their drug use, and widespread naloxone availability has resulted in many lives saved. While an increase in naloxone availability is one component in treating a person with opioid use disorder, intervention, treatment and long term recovery must be included to overcome addiction.

The report shows evidence of how some counties are making gains in battling the opioid crisis.

Centre County is being used as a “model county” that has achieved some success in battling the crisis. In May 2016, the Centre County Heroin and Opioid Prevention and Education (HOPE) Initiative was created.

Since then, there has been a 115 percent increase in admissions to an emergency department for overdose treatment from 2013 to 2017, a 20 percent decrease in opioid prescriptions from 2015 to 2017, and a 79 percent increase in 911 non-fatal calls from the first quarter of 2017 to the first quarter of 2018.

Multi-disciplinary efforts between public health and public safety have resulted in documented progress in some Pennsylvania counties, thereby establishing a model for implementing strategies and achieving success in combating the opioid crisis.

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