Hospitals and health providers locally and across the commonwealth are dealing with an opioid crisis that prompted Gov. Tom Wolf to declare Jan. 10 that a public health emergency exists in Pennsylvania.
“Hospitals are acutely aware of the dangers of overprescribing opioids,” said Dr. Michael Consuelos, senior vice president of the Hospital and Healthsystem Association of Pennsylvania.
“The risk of opioid dependence is a complex issue and must often be balanced in treating patients appropriately for pain,” said Dr. Timothy H. Wong, quality committee chairman for IRMC Physician Group at Indiana Regional Medical Center.
Wolf’s declaration of an opioid crisis covered “heroin and prescription pain medications, such as morphine, codeine, methadone, oxycodone, hydrocodone, fentanyl, and hydromorphone.”
The governor said it impacted “all areas of the state, including urban, suburban and rural communities and all ages including both young people and older Pennsylvanians, and is unprejudiced in its reach and devastation.”
Wong said it is a new phenomenon and medical teams are scrambling to find solutions.
He compared it to trying to predict the stock market, or to what medical personnel found themselves doing to deal with the earliest days of the AIDS crisis in the 1980s.
“We are kind of traveling by the seat of our pants,” said Wong, who started out volunteering to work with the quality committee of the IRMC Physician Group.
He found out that insurers such as Highmark and UPMC Health Plan hold physicians responsible for certain metrics — and that metrics may not exist without evidence found in clinical trials that could go on for decades.
IRMC and other hospitals across the state seek to travel as partners with the Wolf administration in bringing an end to the crisis.
“Many aspects of the declaration impact hospitals and we are committed to being partners in finding a solution,” Consuelos said.
The annual toll of opioid deaths across the commonwealth has been increasing, to 4,627 in 2016, and a preliminary total of 5,260 in 2017 — but the toll in Indiana County dropped from 53 in 2016 to 40 in 2017.
“We had fewer opioid deaths because of more liberal use of Narcan by first responders,” Wong said.
That would include, but isn’t restricted to, prescription abuse, such as that targeted by state Attorney General Josh Shapiro, who has seen arrests for unlawful diversions of opioids rise by 72 percent over a year ago.
A day after Wolf declared the opioid emergency, Shapiro announced the arrest of Dr. Henry Dela Torre, 68, of DuBois, who allegedly over-prescribed opioids that killed a Punxsutawney-area woman and caused her brother to have an overdose that was reversed with Narcan.
Narcan is not completely foolproof. There is the so-called “elephant tranquilizer” carfentanil, which according to the federal Drug Enforcement Administration is 100 times more potent than fentanyl.
And, Wong said, carfentanil is Narcan-resistant.
Dela Torre is free on $150,000 unsecured bond pending a preliminary hearing in Punxsutawney on Feb. 21.
Wong said heroin deaths are “quite high” in Indiana County.
He said other causes of drug-related deaths locally include alcohol and polysubstance abuse, or a mixed bag that could include prescription drugs, but also alcohol, cocaine and psychoactive drugs or benzodiazepines.
That in turn includes such drugs as alprazolam, clonazepam and diazepam, also known as Valium.
Wong sees occasional spikes in opioid activity, and believes traffic from Allegheny County contributes to how bad the problem is in Indiana County. But he doesn’t see a lot of problems from Indiana University of Pennsylvania.
“Not a lot of (opioid victims) are IUP students,” Wong said, depending on anecdotal evidence. “The vast majority are local residents.”
Not long ago, The Chicago Tribune reported that physicians in many Chicago-area hospitals are trying to overturn their profession’s longstanding dependence on opioids. That paper reported that Chicago’s Rush University Medical Center has turned, over the past six months, to giving post-surgical patients Tylenol, Motrin and gabapentin, a medication used for nerve pain, with a mild opioid used just for intermittent pain spikes.
In Pennsylvania, Consuelos said, hospitals are working to reduce the quantity and duration of opioids and working with patients who may need assistance with their opioid use.
“Pennsylvania’s hospital community is committed to taking the lead to treat current patients, expand access to treatment, reduce the supply of opioids in our communities, and prevent overdoses,” the Hospital and HealthSystem Association of Pennsylvania vice president said.
Since the third quarter of 2016, Consuelos said, the number of opioid prescriptions for adults has decreased by 28 percent, while prescriptions of opioids for children have decreased by 46 percent.
Wong said IRMC works actively with ARMOT, the Addiction Recovery Mobile Outreach Team, involving the Indiana hospital and the Armstrong Indiana Clarion Drug and Alcohol Commission.
“IRMC also has psychiatrists on staff to help with consults for patients with opioid overdoses when admitted,” Wong wrote in an email.
Also, there is Suboxone, a combination of naloxone or Narcan and buprenorphine, a narcotic. Wong said an injectable Suboxone may be on the market shortly to help in the treatment of opioid addiction.
“(Patients) will come in, and get a shot that is time-released,” Wong said. “It is very hard to mess with that type of solution.”
Consuelos pointed to other efforts being done by hospitals across the commonwealth.
“‘Centers of Excellence,’ such as Allegheny Health Network’s, provide streamlined programs including prescribing guidelines, screening and clinics to improve their opioid treatment,” the Hospital and Healthsystem Association executive said.
There is OverdoseFreePA, run through the University of Pittsburgh School of Pharmacy.
“OverdoseFreePA works with government and health care associations to increase community awareness of the dangers of opioid misuse and support initiatives to decrease overdoses and deaths in the participating counties,” Consuelos said.
Also, UPMC is applying research to provide patients with a full-service addiction medicine program. Consuelos said the Pittsburgh-based hospital chain is using that program to help treat patients and establish new protocols and options.
He also referred to the South Central Pennsylvania Opioid Awareness Coalition, a partnership of regional hospitals, including UPMC Pinnacle, Penn Medicine Lancaster General Health; Penn State Health Milton S. Hershey Medical Center, Summit Health; WellSpan Health; Memorial Hospital of York; Lancaster County Pharmacists Association; Geisinger Holy Spirit; Lancaster Regional Medical Center; Physician’s Alliance, Ltd., and Hanover Hospital.