Lancaster Blog
Independent Journalism Serving Lancaster County, Pennsylvania
Opioid Overdoses on the Rise in Pennsylvania | PERSPECTIVE

Opioid Overdoses on the Rise in Pennsylvania | PERSPECTIVE

By The Editor 2,511 comments

By Trey Garrison

A day after the Department of Justice reached an agreement that includes three felony guilty pleas, a $3.54 billion criminal fine, a separate $2 billion criminal forfeiture and $2.8 billion in civil liability damages for Purdue Pharma – but which won’t send members of the criminal Sackler family to jail – news comes that opioid overdoses are rising again in Pennsylvania.

The number of Allegheny County residents dying of opioid overdoses is rising again, after a drop of 40% in 2018 had many health experts hoping the tide of the epidemic had turned.

The most recent data shows that the county had a 15% increase in overdose deaths in 2019. The 564 overdose deaths in 2019 were the third highest yearly total, according to data from Overdose Free PA. In 2016 and 2017, there were 650 and 737 total overdose deaths respectively.

And the epidemic may only be getting worse in 2020, according to overdose data provided by the city of Pittsburgh, the county health department and the nonprofit Prevention Point Pittsburgh. 

* During the first five months of 2020 Allegheny County recorded a 28% increase in the total number of times emergency responders administered naloxone for an overdose compared to the first five months of 2019. 

* Pittsburgh recorded a 50% increase in overdose calls during that same time period.

* Prevention Point Pittsburgh, which tracks how many of its clients report using naloxone to reverse an overdose, said the number of overdoses reported to them has increased each of the past four quarters. The 223 overdoses logged between January and March this year was the largest number the organization has ever recorded. 

Although there isn’t complete data on how many have died so far in 2020, when all these sources of data are moving in the same direction, it typically means the number of deaths will increase as well, said Stuart Fisk, the director for inclusion health at the Allegheny Health Network

You can read the full story here.

We’re digging into the data on opioid overdoses here in Lancaster County to see if there’s a similar increase this year, and initial research seems to indicate that there is, especially in the category of synthetic opioids like fentanyl.

Source

So far there have been 83 overdose deaths in Lancaster County, according to OverdoseFreePA.

This is down over 2019 and 2018 if the rate holds steady to the end of the year, but number of deaths can be misleading as police and other first responders have more training and access to naloxone aka NARCAN, meaning there could be a higher number of actual overdoses but a lower overdose death rate.

As of Sept. 19, 2020, 43,854 doses of naloxone have been administered to Pennsylvanians by first responders.

It’s something I’ve seen way too often.

I spent much of 2019 traveling through the South, through Appalachia and through the Rust Belt researching the opioid crisis – a largely silent crisis because of who it most affects.

It mostly affects the proverbial “forgotten man” – working class and white males, a demographic the media seems to resent and politicians of all stripes can’t even name.

Lancaster County has not been spared this plague of opioid overdoses, and the impact tracks along with what I saw in my travels through small town America – from Florida up through Kentucky and West Virginia, in Pennsylvania, in Ohio and Michigan.

It goes grimly hand in hand with the epidemic of the “deaths of despair” – the phenomena where the life expectancy of white males has actually declined in the past few years because of suicide, addiction and alcoholism concurrent with loss of wages, jobs and esteem in American life.

Between 2015 and 2019, there were 566 opioid overdose deaths in Lancaster County alone.

Of those 71% were male, and 81% were white.

Asked about this, Melinda Zipp, director of the Lancaster, Harrisburg, York Harm Reduction Projects, said that there are a number of reasons.

“Opioids tend to make up a higher percentage of whites drug of choice compared to other races,” she said.

And she’s not wrong, entirely.

But “drug of choice” seems to imply simple recreational use and abuse. However, with opioids, unlike marijuana and cocaine, the primary route of introduction for users is legal prescriptions, not simple recreational thrill-seeking.

That is to say, their first taste came from a person they trusted most – their doctor.

Some might sneer at “pill poppers” for a moral failing, but the number one way Americans are introduced to prescription opioids is when they get them for acute pain for minor or major surgeries. The second most common way is wisdom tooth removal. The average age of the recipients of opioids for wisdom tooth removal?

About 17.

And while politicians have paid some lip service to the opioid epidemic in recent years, it hasn’t received the attention it deserves.

Think that’s an exaggeration? According to the latest data from the Center for Disease Control and Prevention, overdoses involving opioids killed more than 47,000 Americans in 2017. More than a third of those deaths involved legal, prescription opioids.

The Vietnam War lasted 19 years and 58,000 Americans died. So in 2017, almost as many Americans died of opioid overdoses as died in 20 years of war in Southeast Asia. And let’s make no mistake – the bulk of these deaths come from prescription drugs and synthetic opioids. Drugs like fentanyl, opioid painkillers such as Oxycotin and Percocet, and then after all that heroin comes into play.

This crisis – this epidemic – shows no signs of slowing. Death by overdose is now the leading cause of mortality for Americans under the age of 50, according to the CDC.

One reason this opioid plague gets neither the attention nor solutions it needs is because of who the primary victims are – working class, white males.

Ironically, Zipp hits on this point in a roundabout way when she admits it’s taboo to talk about how bad the opioid epidemic is.

“Although [white males being the primary victim of the opioid crisis] has been touched on at various meetings when discussing data, I do not believe with the heightened political climate it is something that many want to focus on currently; as many groups already feel the only reason the opioid epidemic has received so much attention and resources is because it is affecting white constituents and families at a higher rate than other communities of color, as compared to the crack epidemic in the 80s and early 90s that resulted in increased crime and violence in inner city neighborhoods as well as tough on crime policies that were seen as discriminatory against minorities, mostly blacks, who were more likely to use crack.”

The greatest irony of this whole grim tragedy that has befallen white, working class America is that it didn’t have to happen at all.

Last year I spoke to Dr. Robert Valuck, professor at the University of Colorado-Denver’s School of Pharmacy and Pharmaceutical Sciene. He said the greatest, grimmest irony of all is that it shouldn’t have happened.

For the acute pain most people experience after surgeries – both minor or major – 93 percent of people take 15 tablets or fewer of their entire prescription. For those getting wisdom tooth surgery, they are typically prescribed 30 and use just four. For those who suffer soft tissue injuries, they are on average given between 30 and 60 tablets, and end up using just 10-12.

“So the thing is it should be doctors giving 10 tablets for soft tissue injuries, or 6 for a wisdom tooth extraction or 15 for surgery, and then call me if you need more, but doctors have been socialized into ‘don’t let people be in pain, don’t leave them in pain trying to contact you over the weekend, don’t let that happen,’” Valuck said. “So you give them plenty more than they need. That’s how doctors were socialized, trained and taught and marketed to.”

“Everyone thinks pain equals opioid – patients and doctors alike,” he said. “That’s wonderful for pharmaceutical manufacturers but not for anyone else.”

Since we’re all finally talking about world pandemics, how about we spare some time for the other ongoing epidemic right here in our own back yard?