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Drug overdose deaths surge among young women, Pitt study shows

| Thursday, March 10, 2016, 2:03 p.m.

Young white women are dying at a higher rate than other drug users amid a sustained statewide surge in overdoses, according to a new study from the University of Pittsburgh Graduate School of Public Health.

Death rates in Pennsylvania increased 17-fold among women and 14-fold among all users from 1979 through 2014, the study showed, a period when opioids became more popular and heroin spread from the state's biggest cities to less populous areas.

Researchers don't know why the increase is greatest among women but hope the data will let policymakers and law enforcement agencies shape efforts to stop the trend, said Jeanine Buchanich, a research assistant professor of biostatistics at Pitt Public Health, who worked on the study. The study was published Thursday in research journal PLOS ONE.

“I don't know that there's any one kind of overwhelming theory of why it's occurring, but the data really are showing that (white women) are dying more rapidly at younger ages than white males or black males or females,” Buchanich said.

She said women tend to become serious addicts more quickly than men, possibly a result of experienced drug users introducing new female users to strong drugs. Women may be more hesitant than men to seek treatment if they believe they will be separated from their children, she said.

About 825 women ages 15 to 64 died of drug overdoses in the state in 2014, a rate of 19.5 women per 100,000, according to the study. That's up from 38 deaths in 1979, a rate of 1.12 per 100,000. Researchers examined death certificates listing a cause of accidental poisoning, which typically means drug overdose.

While the rate grew most among women, men still made up two-thirds of the approximately 2,500 deaths for the year, the study shows. Death rates increased most among people ages 35 to 44.

In addition to revealing the trend among women in Pennsylvania, the Pitt study found an increase in rural drug deaths. Rural counties such as Washington and Cambria have some of the highest rates of overdose, the study shows.

Overdoses are increasing across the country, and Pennsylvania is one of 20 states with higher-than-average rates of the deaths, according to the study. Over the past few decades, the culture of pain treatment morphed to one in which doctors started prescribing opioids to relieve any and all pain, experts said.

As young doctors work to correct that trend, people who have become dependent on opioids often seek out heroin, a cheaper alternative, said Alice Bell, the overdose prevention project coordinator for Prevention Point Pittsburgh. Meanwhile, drug enforcement agencies' efforts to stop illegal drugs at the borders prompt people to smuggle in more concentrated drugs, which are more likely to cause overdoses, Bell said.

Treatment should be tailored to the individual drug user — whether they are young, old, white, black, male or female — in the setting in which they live, said Janice Pringle, an associate professor of pharmacy at Pitt and one of the study's authors.

“You have to approach those different populations differently,” Pringle said.

Pitt's new Pennsylvania Heroin Overdose Prevention Technical Assistance Center is working to change how every county in the state approaches prevention and treatment, she said. Cultural resistance is stronger in some rural parts of the state than in urban areas, often a result of the stigma that surrounds drug abuse, she said. The center promotes the idea that addiction is a disease.

The center wants to increase access everywhere to naloxone, a drug that can halt or reverse an overdose, and promotes doctors prescribing naloxone anytime they prescribe opioids, she said.

The most effective treatment programs administer replacement drugs such as methadone and Suboxone rather than promote abstinence, Pringle said.

Increased use among middle- and upper-class white people is starting to change the dynamics of prevention and treatment and could spur positive changes, she said.

“It's been a horrible thing that has killed valedictorians and white upper-class kids in good neighborhoods. ... I'm very, very sad that so many people died and it took this circumstance to get to this point. But I am hearing more people speak of addiction as if it were a disease.”

While state trends show an increase in deaths among young white women, overdose trends have not changed in Allegheny County, Bell said. Overdose deaths increased from 74 in 2010 to 104 in 2015 among women, according to county data, while deaths among men increased from 153 to 268.

Bell noted that many deaths occur in people who only occasionally use drugs.

“People want to talk about addicts overdosing, but you don't have to be an addict to overdose,” she said.

Occasional users have less tolerance, and they are not as familiar with what doses they can tolerate, increasing their danger, she said.

Researchers expect the trends shown in the study to hold for 2015, and they could continue.

“It's too soon to tell whether the (prevention) efforts are going to be able to slow this rapid increase, especially in young white women,” Buchanich said.

The next step for researchers, Buchanich said, is to look at communities — neighborhoods in Pittsburgh and towns across the state — to identify more specific trends and profiles of people who die from overdose.

“By combining all these pieces, we're hoping we can get a better understanding of the overdose epidemic and then be able to appropriately target resources,” she said.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or wventeicher@tribweb.com.

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