Although the opioid crisis has spread throughout the country, it hits many Northeastern states the hardest. And with its combination of dense urban and remote rural populations living against a backdrop of Rust Belt economic decline, Pennsylvania has consistently ranked as one of the most devastated states in the region over the last few years.
Pennsylvania's Opioid Epidemic
Over the last decade, opioid addiction has imposed a major burden on PA's social, economic, medical, and criminal justice systems.
Overdose Deaths in Pennsylvania
Pennsylvania is currently averaging a startling 10 overdose deaths a day, with 3,505 PA residents dying of drug overdoses in 2015. In 2014, the state's overdose death rate sat at 21 per 100,000 — roughly 50% higher than the nation's average of 14.7 — before jumping to 26 in 2015. As such, there are more overdose deaths than car accidents among Pennsylvanians 25 to 64. With opioids found in 81% of PA overdose deaths, such figures are a good metric for evaluating the opioid epidemic as a whole.
Alarmingly, these estimates are conservative: A lack of mandatory, standardized overdose death reporting in PA may mask the severity of this issue. Further compounding the problem is that these data do not report opioid-related non-overdose deaths, such as accidents, suicides, and chronic health problems.
Growing Healthcare Costs
In addition to the immeasurable human toll, some researchers have made attempts at attaching a concrete price tag to the PA's opioid-related healthcare expenditures — And their findings have demonstrated an extreme strain on the PA healthcare system as a whole. While recent figures are difficult to determine, analysts have estimated that in 2007 Pennsylvanians spent nearly $874 million on opioid-related healthcare costs. What's more? Only 3.5% of this figure specifically went towards addiction treatment, prevention, and research — the rest was used to mitigate the physical and mental toll of opioid use among patients. Although more proactive public health strategies have been implemented since, the major jump in opioid use over the last decade means that the overall economic burden of this disease is even greater.
The Drugs Fueling PA's Opioid Epidemic
Most drug-overdose deaths in PA usually involve multiple substances. In 2015, toxicology reports found heroin in roughly 55% of overall overdose deaths and 79% of deaths involving at least one illicit substance, making it by far the most deadly drug in the state. Also a growing problem, fentanyl is the second most frequently identified drug, found in 27% of toxicology screens. However, these tests do not account for emerging fentanyl analogues, which are increasingly prevalent. Overlap between these two drugs is attributed to the ubiquitous presence of fentanyl-laced heroin in the area. Interestingly, the opioid epidemic may be also be boosting cocaine's popularity and mortality potential: PA overdose death toxicology screens saw a 41% increase in the presence of cocaine between 2014 and 2015.
Major Demographic Trends
With 1 in 4 families now struggling with substance abuse, the opioid epidemic is one that affects all Pennsylvanians.
Pennsylvanians Hardest Hit
While pervasive among all social groups, the 2015 prevalence of opioid addiction opioid jumped in a number of specific demographics:
As such, White men in this age group represented 15% of overdose deaths —while making up only 4.7% of the general PA population.
Trouble in Both Urban and Rural Communities
While the biggest growth in opioid usage, addiction, and overdose rates have been in rural and suburban areas — where the problem has finally been able to garner significant media and political attention — opioids continue to be a blight in PA's urban communities, especially Pittsburgh and Philadelphia. Early estimates for Philadelphia alone have predicted 1,200 opioid overdose deaths in 2017 — a significant increase from 907 last year, which was in turn a 30% boost compared to 2015's figure.
Solutions for Pennsylvania's Opioid Crisis?
After some initial lag, PA's government has produced a robust response against the opioid epidemic over the last few years. Elected in 2014, Governor Tom Wolf and his administration has consistently advocated for increased recovery resources and an end to opioid-use stigma.
Early and Ongoing Efforts
The executive arm of PA's anti-opioid addiction services is the cabinet-level Department of Drug and Alcohol Programs, which was established in 2012. At a more local level, Single County Authorities administer community substance abuse programs by helping to coordinate different providers and distribute funding for patients in need. The state has also established its own prescription drug monitoring program, arming providers and pharmacists with an online database for tracking which patients are getting prescriptions, which prescribers are writing them, and how often these addictive drugs are being prescribed.
The Opioid Overdose Reversal Act 139 of 2014 (David's Law) greatly expanded access to naloxone for PA residents. Act 139 permits first responder organizations to be able to obtain, carry, and administer the life-saving drug. Additionally, its Good Samaritan provision offers immunity from liability from administering naloxone to another person believed to be experiencing an overdose, as well as protecting them from potential arrests that might be made as consequence of contacting emergency services.
Last year, Governor Wolf signed new legislation limiting emergency room opioid prescriptions to one week, a measure designed to curb addiction potential and reduce prescription drug diversion. Additionally, PA's 2016/17 budget allocated $10 million in funding for behavioral health and $5 million for Medical Assistance (Medicaid). Among other programs, the Department of Human Services has allocated these funds to implement 45 Opioid Use Disorder Centers of Excellence. These expanded centers promise to treat 10,100 PA residents who were previously unable to access treatment. Health organizations in PA are also using these funds to focus on "warm handoffs": programs where emergency health workers directly help survivors of opioid overdoses into appropriate addiction treatment programs.
Online Public Health Resources
As part of these efforts, PA's official website has a number of opioid addiction resources that include include:
Additionally, the Pennsylvania Office of Mental Health and Substance Abuse Services (OMHSAS) established its own "PaRecovery" website with the stated goal of connecting PA residents to culturally competent mental health services.
Better Naloxone Access for Pennsylvanians
Naloxone has been available for PA residents over the counter since 2016. However, it remains expensive — Narcan nasal spray retails for over $150 without insurance — making it unlikely to become a regular feature of the average Pennsylvanian first aid kit any time soon. In the year prior, PA was one of the many states to issue a statewide "standing order" for naloxone prescription through Physician General Dr. Rachel Levine. This allowed PA residents to obtain naloxone without a prescription from a personal doctor since 2015. Although naloxone is covered under PA's Medical Assistance program, the popular brand-name auto-injector version requires prior authorization, while generic does not. Additionally, the Department of Health administers a program giving free two-dose naloxone nasal spray kits to PA public high schools with the help from industry sponsors.
Centers of Excellence
Centers of Excellence are team-based coordinated care groups that are focused on individualized whole-person treatment. Their aim is to integrate behavioral health and primary care, ensure continued follow-up and community support to reduce relapse. Among other obvious problems, opioid use relapses are a major source of mortality from accidental overdose, as a recovering patient will have a much lower tolerance than they did before. Centers of Excellence also focus on securing food, housing, and employment for those in (and out of) recovery. Ultimately, the PA Centers of Excellence are meant as a resource for patients who may have trouble navigating what can be a complicated and disjointed care system.
The Future of the PA Opioid Crisis
Despite these measures, overdose deaths in PA are continuing to climb. Looking for solutions, one recent Philadelphia opioid task force report has recommended safe injection sites. While such sites may indeed be able to save lives, their implementation is already facing harsh opposition.
To ensure continued funding for the Medical Assistance program, Governor Wolf has pushed back against Trump Administration plans to end Medicaid expansion, a funding source which he credits with providing addiction treatment to some 125,000 Pennsylvanians. Other promising strategies include further plans to transition funding focus from emergency naloxone triage to more long-term treatment and prevention programs, such as behavioral health and education. While naloxone programs are indeed crucial for preventing today's overdose deaths, these holistic approaches may work to save lives years in the future.