Hospital admissions for opioid overdoses decline in Pennsylvania
A significant decrease in hospital admissions for opioid overdoses across Pennsylvania may have more to do with evolving treatment and the widespread availability of a lifesaving antidote than any major drop in drug abuse, experts said following the release of a report on overdose hospitalizations.
Researchers at the Pennsylvania Health Care Cost Containment Council tracked overdose hospitalizations in the state between 2016 and 2018 and found that admissions for opioid overdoses dropped from 3,500 to 2,667 — or nearly 24%.
Those numbers come on the heels of reports that showed overdose deaths in the Pittsburgh region declined by more than 40% in 2018 after years of slow-but-steady increases and sharp climbs between 2016 and 2017.
In Westmoreland County, preliminary numbers indicate that trend continued during the first five months of 2019.
Experts are reluctant to suggest such numbers mean the region has turned the corner on the opioid epidemic that continues to claim lives across Pennsylvania.
Joe Martin, executive director of the Pennsylvania Health Care Cost Containment Council, said his team can’t link the numbers to the increased availability of the anti-overdose drug naloxone.
“But a great deal of work and resources, both public and private sector, have gone into battling this problem, and it is reasonable to assume that naloxone has played a significant role,” Martin said. “I would also say that while the opioid numbers are encouraging, we should not lose sight of the fact that hospitalizations for cocaine and methamphetamines are increasing.”
Researchers found hospitalizations for cocaine overdoses increased from 949 in 2016 to 1,204 last year, while hospitalizations for amphetamine overdoses increased from 189 in 2016 to 314 last year.
Among those hospitalized for opioid overdoses, about 42% were attributed to heroin, with the average age of the user being 38, while about 58% were for prescription opioid overdoses, with the user’s age averaging 52.
Dr. William Jenkins, director of emergency medicine at Excela Frick Hospital, said the decline in opioid admissions statewide reflects trends at local hospitals. But he said a number of factors likely are contributing.
“First of all, there are a lot of overdoses still happening that aren’t even being transported. With the widespread availability of (naloxone), some families are just using it to wake up their family members who overdose and not calling EMS. Even if EMS is called, a lot of them are refusing to be transported. (First responders) wake them up and they observe them and then they refuse to even go to the hospital,” Jenkins said. “And with funding that has been infused into the problem, there are a lot of new treatment centers trapping up people who might have otherwise come to the hospital.”
Stuart Fisk, director of Allegheny Health Network’s Center for Inclusion Health, said the decrease also could be attributed to people having more access to treatment with suboxone and methadone.
At AHN, patients who come into the emergency room with an overdose get a dose of suboxone or methadone to ease withdrawal symptoms and help protect them from overdosing for 24 hours or so, Fisk said.
“If they relapse and use an opioid like heroin, they’re not going to have the same effect,” he said. “It’s going to block a lot of the impact of the opioid.”
Fisk said opioid users have started testing their heroin for fentanyl with test strips and adjusting their doses so they don’t overdose.
Another factor contributing to the drop in hospitalizations is the reduction of prescriptions of opioids, said Dr. Jack Kabazie, system director of AHN’s Division of Pain Medicine
“(We’ve) reduced the quantity of opioids going out by approximately 37 percent across the system,” he said.
Among the troubling trends that experts continue to see is that hospitalizations for opioid overdoses continue to be significantly higher in low-income communities and those where education levels, on average, are low.
Fayette County, where the poverty rate is about 50% higher than the state average, saw residents’ hospitalizations for opioid overdoses increase from 33.2 per 100,000 in 2016 to 40 last year.
It was the only county in the region that includes Allegheny, Armstrong, Butler, Washington and Westmoreland to see that number increase.
“There is a saying that addiction thrives in communities that don’t,” Martin said.
A recent study of opioid overdoses at 647 hospitals found opioid overdoses are costly. The study by Premier, Inc. found the cost to treat overdoses at those hospitals totaled nearly $2 billion in a 12-month period in 2017-18.
At Excela Frick, Jenkins said treatment options have evolved with the opioid epidemic.
“There are definitely fewer overdoses coming here than there were before, but I don’t think that sharp decline represents the same decline in overdose activity. A lot of the EMS agencies are working with county agencies. So they can introduce and refer (overdose victims) to treatment directly from the scene. It’s just the system learning how to take care of these patients,” he said.
Fisk said that while more people survive overdoses, they still require care for other health problems. He said they’ve seen an increase in people who, after getting treatment with naloxone, suffer from brain damage because they were without oxygen for so long.
“(They’re) not surviving unscathed,” he said.
Some people show up to the hospital with deep tissue infections, heart valve infections, infections of the spinal cord, bone infections, organ infections and Hepatitis C that are most commonly related to the use of dirty needles, he said.
Dr. Michael Lynch, UPMC emergency department physician and medical director of the Pittsburgh Poison Center and substance use disorder services at UPMC Health Plan, said while the numbers in the PHC4 report are encouraging, there is still work to be done.
He worries about a rise in the use of cocaine and methamphetamine. Early intervention efforts like educating children and the public about other drugs outside of opioids are still needed, he said.
“The transitions highlight that we also should have been and need to be paying attention to substance use epidemic regardless of the substance,” Lynch said. “The underlying motivation for drug use and potential for drug use will remain even if we are able to address one specific drug.”