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Death counts rising as proposed opioid regulations under fire

There have been 51 confirmed heroin-related deaths in York County this year, according to Coroner Pam Gay.

David Weissman
717-505-5431/@DispatchDavid

A national debate over efforts to reduce painkiller prescriptions is delaying any additional regulations, as the drugs continue claiming overdose victims locally and nationally at record pace.

In this file photo, family and friends of heroin overdose victims take part in a rally on Continental Square in York to bring awareness to "Don't run, call 911," in November 2015. John A. Pavoncello photo.

The Centers for Disease Control and Prevention (CDC) was on track to finalize new prescribing guidelines for opioid painkillers in January, according to Associated Press reports. The guidelines — though not binding — would be the strongest government effort yet to reverse the rise in deadly overdoses tied to drugs including OxyContin, Vicodin and Percocet.

Under the proposed guidelines, doctors would prescribe these drugs only as a last choice for chronic pain, after non-opioid pain relievers, physical therapy and other options, according to the AP. The CDC also wants doctors to prescribe the smallest supply of the drugs possible, usually three days or less for acute pain. And doctors would only continue prescribing the drugs if patients show significant improvement.

York County Coroner Pam Gay said she thinks these are good ideas.

"It's not trying to take (painkillers) away from people who really need it," Gay said, "but we really have a problem in this country ... and must be more responsible about how we're prescribing (these drugs)."

Gay said her office has confirmed about 28 non-heroin-related drug deaths this year, and the majority of those deaths involved opioids in one way or another.

Gay also pointed out that opioid painkillers feed the heroin problem.

Deaths linked to misuse and abuse of prescription opioids climbed to 19,000 last year, the highest figure on record, according to the CDC. Heroin and opioid painkillers caused 28,650 fatal overdoses in 2014, or 61 percent of all drug-related overdose deaths.

CDC Director Dr. Tom Frieden told the Associated Press that more Americans are "primed" for heroin use because of their exposure to painkillers.

So far this year, there have been 51 heroin-related deaths in York County and nine suspected heroin-related deaths, according to Gay. There were 62 such deaths in 2014.

But the number could be far greater. Naloxone, commonly known as Narcan, is a non-addictive nasal or intravenous treatment that revives those who have overdosed. It was successfully used in York by first responders more than 80 times in 2015 as of Dec. 8, sometimes on the same person on more than one occasion.

Dr. Matt Howie, medical director for the York City Bureau of Health, said he's supportive of efforts to reduce overdoses, but isn't sure the CDC went about their process in the most effective way.

The center's highly unusual move — the CDC rarely advises physicians on medications, a job formally assigned to the Food and Drug Administration — thrust the agency into the middle of a longstanding fight over the use of opioids, a powerful but highly addictive class of pain medications that rang up over $9 billion in sales last year, according to IMS Health.

Critics complained the CDC guidelines went too far and had mostly been written behind closed doors, according to the AP. One group threatened to sue. Then earlier this month, officials from the FDA and other health agencies at a meeting of pain experts bashed the guidelines as "shortsighted," relying on "low-quality evidence." They said they planned to file a formal complaint.

"They started a hornet's nest when they did this," Howie said. "As a public health official, I think we need more evidence-based discussion. As someone who works with chronic pain patients, I think this was well intended, but misguided."

The CDC has since abandoned its January target date, instead opening the guidelines to public comment for 30 days and additional changes, according to the AP.

While in favor of additional regulations, Gay acknowledged that she's worried that making it more difficult to obtain painkillers could lead to a spike in heroin users.

As opioid painkillers have become more expensive along with additional restrictions, addicts have been turning more and more to the less expensive heroin, she said.

"I'm optimistic that (additional regulations) won't (lead to more heroin users), but I'm also realistic," she said. "We're working to educate others to make sure they're not going over to heroin. We just need to keep being proactive."

The Associated Press contributed to this article.

Reach David Weissman at dweissman@yorkdispatch.com.