Opioid-related hospital stays in York County triple the state rate in 2016-17

Logan Hullinger
York Dispatch

The annual increase in opioid-related hospitalizations in York County was more than three times the statewide average for 2016-17, according to a new report.

The percent of hospitalizations because of overdoses in York County increased 39.4 percent between 2016 and 2017, well above the statewide average of 12.7 percent, according to a Wednesday, June 13, report from the Pennsylvania Health Care Cost Containment Council (PHC4).

The statewide average was the "lowest increase in recent years," the report states.

York County isn't boasting the same results.

What's happening in the county? The York Regional Opiate Collaborative formed in 2014 as the York County Heroin Task Force to combat the opioid epidemic, but the name changed in 2016 in an attempt to formalize the group.

More:Heroin Task Force gets new name, director

More:10,000 opioid disposal kits donated to York in effort to curb epidemic

Since its formation, the collaborative has helped synchronize treatment services, organized prescription drug drop-offs and spearheaded the distribution of naloxone, a drug used to reverse the symptoms of a drug overdose, to first responders,

Matthew Howie, director of the collaborative, could not be reached for comment.

However, York County Coroner Pam Gay, also a member of the collaborative effort, hypothesized as to why the county saw such an increase in hospitalization despite local efforts.

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One possible reason is the frequency of "Narcan saves," when a person is revived using Narcan, which is the brand name for naloxone, she said. Local law enforcement started carrying Narcan in 2015, and police in York County used Narcan to save 593 people who were overdosing between 2014 and 2017, according to Pennsylvania Department of Drug and Alcohol Programs data collected by Lehigh Valley Live

From 1996 to 2014, at least 26,500 opioid overdoses in the U.S. were reversed by naloxone, according to the National Institute of Drug Abuse.

"Some of (the hospitalizations) may be because of the number of people saved by Narcan who choose to seek additional treatment," she said. "We have a very high amount of Narcan saves in York."

As a result, those revived by the drug can choose to seek hospital treatment, adding to the tally of hospitalizations that might otherwise have resulted in death or refusal to seek further treatment.

Dr. Christopher Echterling, WellSpan Health's medical director of vulnerable populations, largely focuses on addiction in his practice and agrees that the abundance of Narcan use in the county can lead to more hospital visits.

He also proposed his own theory: the abundance of addict recovery homes.

York County has a large number of addict recovery homes that are largely unregulated and don't have resources that traditional treatment centers have, he said. People come from all over the state to take advantage of the often-cheaper alternative, and they are usually in early stages of recovery.

"One thing that's always been unique in York is that it has one of the largest recovery health communities in the state," he said. "People who go to such facilities are usually early in recovery and more prone to relapse."

As a result, he said, those who relapse may opt to seek medical treatment, skewing statistics and increasing the rate of hospitalizations because of opioid use.

Still, Echterling praised the recovery houses and said they are an important resource for those trying to shake addition. The treatment methods aren't the issue, he said — the stage in addiction at which the addicts go to the facility is.

Gay and Echterling also emphasized that the number of overdoses has increased over the years as heroin and fentanyl replace previously favored prescription drugs such as OxyContin.

The power of the drugs, especially fentanyl, which is 50-100 times stronger than morphine, can more often lead to an overdose among users, they said.

Still, York is praised for its efforts to curb drug abuse in the county.

More:Heroin overdoses spike in York County

"The opioid epidemic was so strong out of the gate that there's been a lag in progress being seen," Echterling said. "However, we have a wonderful drug task force and resources in the county."

Despite its resources, the county also still sees a high number of opioid-related hospitalizations for its population compared with other areas.

York County had the eighth-most hospitalizations in 2016, with 104 total, and the sixth most in 2017, with 145. This marks a rate of 68.7 people per 100,000, ranking York County 13th in the state, according to the report.

However, statistics from 20 of the 67 counties weren't reported, potentially altering the rankings for York County.

In 2016, the county saw 123 opioid-related deaths, which increased to 162 deaths last year.

So far in 2018, the county has seen 47 opioid-related deaths, Gay said. There are 26 more that are suspected of being opioid-related but have yet to be confirmed, she added.

More:Drug, homicide deaths rise in York County in 2017

History of opioid crisis: The increasing trend of opioid addiction and deaths began in the late 1990s, when pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, according to the NIDA.

As a result, health care providers began to prescribe the medicine more frequently and provided a gateway to heroin use. About 80 percent of people who use heroin first misused prescription opioids, according to the NIDA.

In Pennsylvania, the opioid crisis has been declared a "disaster" by Gov. Tom Wolf.

Gov. Tom Wolf and newly elected Lt. Gov. running mate John Fetterman (not pictured) speak to the media at Manchester Cafe in Manchester Township, Wednesday, May 16, 2018. Dawn J. Sagert photo

Earlier this year, Wolf signed a statewide disaster declaration to improve the state response and increase access to treatment in hopes of mitigating opioid-related deaths. 

More:Pennsylvania issues disaster declaration over opioid crisis

The 90-day declaration listed 13 initiatives to be carried out by a collaboration among all state agencies, with focus on the departments of Health, Drug and Alcohol Programs, the Pennsylvania Emergency Management Agency, the Pennsylvania Commission on Crime and Delinquency and the Pennsylvania State Police.

As a result, the state has waived annual licensing requirements for high-performing drug and alcohol treatment facilities, created the Opioid Data Dashboard to help the public access information about what resources are available locally and implemented several other changes.

In April, Wolf renewed the declaration, which is scheduled to expire again in July.

York County lawsuit: Additionally, last year, York County solicitor Glenn Smith filed a 252-page complaint against 21 opioid manufacturers and distributors and four out-of-state doctors for downplaying the risks of using opioids, including OxyContin, fentanyl and Percocet.

Most of those who have died from suspected opioid overdoses in York County started taking opioids prescribed for pain before their addictions developed, Gay said. 

For the past few years, officials and advocates have tried to encourage physicians to try using alternative methods, she said, adding that certain levels of pain do not require prescription-strength medication.

Gay said she supports the county’s lawsuit against opioid producers because they should be held accountable if they used “deception and aggressive marketing” to push their products.

To handle the lawsuit, York County retained New York-based law firm Napoli Shkolnik PLLC, said Smith, who said there will be "no cost to York County taxpayers." 

The county was the fourth in the state to pursue litigation against companies profiting from the sale of opioids, joining Beaver, Delaware and Lackawanna counties.