Pennsylvania hospitals are admitting more people for heroin overdoses but fewer for prescription opioid overdoses, a Pennsylvania Health Care Cost Containment Council analysis has found.
Hospitalizations for pain medication overdoses decreased by 2.2 percent from 2016 to 2017, while those for heroin overdoses increased by 12.7 percent. Those trends are in keeping with other research findings that use of prescription medicines — often blamed for fueling the opioid crisis — is being curtailed after years of legal and medical efforts, as well as heightened public awareness of the drugs' addiction potential.
"There have been tremendous efforts to combat this epidemic by government and the private sector," Joe Martin, executive director of the cost council, wrote in an email. "Hopefully we are beginning to see the impact of those efforts, but we cannot call this a trend without more data."
The rapid increase in illicit drug use has long been noted. But the new analysis found that the heroin hospitalization increase also appears to be slowing down. Between 2011 and 2016, hospital admissions for heroin overdoses increased each year by an average of 24 percent, nearly double the most recent rate. And during the last half of 2017, hospitalizations for heroin overdoses dropped. It's also too soon to tell whether that trend will continue, Martin said.
Philadelphia, where 1,217 people died of drug overdoses in 2017, had the state's second-highest rate of opioid overdose hospitalizations, 100.6 per 100,000 residents. Only Cambria County, with a population less than one-tenth of Philadelphia's, had a higher rate, 102.1 per 100,000 residents. Cambria's largest city is Johnstown.
The council found that lower-income Pennsylvanians have been hit particularly hard by the overdose crisis: the rate at which they visited hospitals for overdoses was nearly double the statewide rate in 2016 and 2017. Black residents were hospitalized for overdoses at a slightly higher rate than whites — 67.5 admissions per 100,000 residents vs. 65.9. The Hispanic rate was 50.4 hospital admissions per 100,000 residents.
The study did not look at patients who visited emergency departments but were not admitted to inpatient beds. And many people who overdose never go to the hospital; revived by the reversal drug naloxone, many refuse medical attention, even though authorities say it is the wisest course. Others die before they can be admitted.
"This is only the tip of the iceberg – a snapshot," Martin wrote.
The study did not consider whether people who overdosed on pain medicines were using pills specifically prescribed for them, or for someone else. It's also difficult to determine how many of the overdose cases in the study involved fentanyl, the potent synthetic opioid that's often used to cut heroin. Hospitals don't specify whether a patient overdosed on fentanyl, just that they overdosed on a "synthetic pain medication." (There were 225 hospital admissions for overdose of a synthetic pain medication in 2017, up from 201 in 2016.)
And, Martin said, his researchers aren't sure how many fentanyl overdose patients die before they make it to the hospital.
The data for heroin and for pain medication both will contain fentanyl cases. Fentanyl could be categorized with heroin (if the heroin was "laced with/cut with" illicit fentanyl) or categorized with pain medication (the result of illicit use of fentanyl or a prescribed fentanyl patch used in the management of chronic pain).
The study found that people who overdosed on heroin were less likely to survive than those who overdosed on pain medications: 9.6 percent, nearly one in 10, of the patients hospitalized for heroin overdoses in 2017 died in the hospital, up from 9.3 percent in 2016. Five percent, one in 20, of those with pain medicine overdoses in 2017 died, up from 2.9 percent in 2016.
Opioid overdoses as a whole cost $32 million in hospital payments in 2017, the council found. Medicaid, the government program for the poor, covered the costs of most heroin overdoses; Medicare, the program for seniors and the disabled, covered most pain medication overdoses.