More Pennsylvanians were admitted to a hospital for a heroin overdose in 2017, and the increases were especially pronounced among Hispanics, those 55 and older, and lower-income residents, according to new data released by the Pennsylvania Health Care Cost Containment Council. At the same time, hospital admissions for those overdosing on prescription opioids declined.
The data represent some of the most serious overdose cases, as they include only those who had to spend at least one night in a hospital after overdosing on heroin, fentanyl, or prescription opioids. Many overdose victims are administered Narcan on the street, or revived in an emergency department, and don't require hospital admission. Others die before medical help arrives.
"This is a tiny sliver of the problem," said Tom Farley, Philadelphia's health commissioner. (State officials said they were working to better track overdoses across the state; last month, state Health Secretary Rachel Levine said, Pennsylvania launched a new data tool that tracks overdoses in emergency rooms across the state in real time. In Philadelphia, officials also track emergency-room visits and Narcan revivals by police and paramedics.)
Of the 1,753 Pennsylvania patients hospitalized for heroin overdoses in 2017, 9.6 percent died — up from 9.3 percent the year before. Pain-medication overdose victims admitted to the hospital died at a rate of 5 percent in 2017 — up from 2.9 percent in 2016.
Still, state officials said they were encouraged by decreases in hospital admissions for pain-medication overdoses, which dropped 2.4 percent between 2016 and 2017 even as admissions for heroin overdoses spiked 12.5 percent.
"We've decreased opioid prescriptions 20 percent in two years," Levine said. "We are really working with the medical community to use these carefully and judiciously."
Farley said the increases in heroin-overdose cases were "reflective of how the entire problem has shifted."
"It started out as a prescription problem, but people are switching to heroin because it's cheaper," Farley said. He said doctors need to continue reducing opioid prescriptions "to stop people from getting addicted in the first place." But, he said, those reductions must be coupled with more accessible treatment, so that people already dependent on pills don't turn to heroin if a doctor reduces their prescription.
In Philadelphia, advocates said the statewide data dovetailed with what they have been seeing on the ground. At Prevention Point, the city's only needle exchange, which also provides medical care and access to treatment, executive director Jose Benitez said his staff had been serving more Hispanic patients.
In 2016, white non-Hispanic residents had the highest hospitalization rate for heroin overdoses in the state. But by 2017, Hispanic Pennsylvanians were being admitted to hospitals for heroin overdoses more often than white or black residents, at a rate of 19.3 patients per 100,000 residents, the PHC4 report found. That's a 48.8 percent increase over 2016.
Hispanic residents were also the only ethnic group in the state to see an increase in hospital admissions for pain-medication overdoses — a spike of 31.1 percent.
Benitez said there's a dearth of Spanish-language resources for people in addiction. "It can sometimes be difficult for people to get into drug and alcohol treatment — and then add a language barrier to that," he said. And seeking treatment is even more difficult when you're undocumented: "People who don't have the proper paperwork to be in the country — their treatment gets hugely complicated because they're more likely to wait for an urgent, urgent issue before they go in for treatment," he said.
He said the statistics released this week show providers aren't doing enough to reach Hispanic patients.
Analysts at PHC4 also highlighted stark jumps in hospital admissions among other groups.
Among black residents, there was a 34.7 percent increase in hospitalization rates for heroin overdoses. And though this group's hospitalization rates for pain medication decreased, it still had the highest rate in the state in 2017.
Hospitalization rates for heroin overdoses increased across all age groups, including among those ages 55 and up. Older residents are still the least likely in the state to be hospitalized for a heroin overdose, but their rate of hospitalization nonetheless increased by more than a third between 2016 and 2017. They also had the highest rate of hospitalization for pain-medication overdoses. Rates of heroin-overdose hospitalization among 15- to 34-year-olds remained the highest in the state, but increased by just 8.5 percent between 2016 and 2017.