Heroin Overdoses Challenge Hospitals
California's hospitals have seen a dramatic spike over the last decade in the number of patients being treated for heroin overdoses.
New data released by the Office of Statewide Planning and Development (OSHPD) shows a nearly doubling in the number of patients overdosing on heroin being treated at hospital emergency rooms or admitted as inpatients between 2005 and the first half of last year. The numbers tend to confirm national numbers released by the U.S. Centers for Disease Control and Prevention earlier this month, and tend to suggest an epidemic of hard drug use by whites in relatively affluent parts of the state.
In 2005, the state's hospitals saw 1,284 heroin overdose cases through their ERs, and admitted 298 of them for inpatient care, OSHPD data show. By 2013, 2,449 cases were seen in hospital ERs – a nearly 92% increase -- with 541 being admitted as inpatients.
Data for the first half of 2014 indicated hospitals saw 1,325 patients and admitted 301. The former is up 11% compared to the first half of 2013 and 30% from the first half of 2012.
“It's a surprising number,” said Patrick Moody, spokesperon for Henry Mayo Memorial Hospital in Santa Clarita, just outside of Los Angeles. That 196-bed facility, which serves a mostly affluent middle-class suburban population, treated three heroin overdose patients in 2005. It treated 15 during the first half of 2014, one more than the 14 it treated in 2013.
Policy experts credit numerous reasons for the spike in heroin use, one of which has been the rise in the use of powerful opioid prescription painkillers over the past decade. That has led many patients to become dependent on Oxycodone and similar products. When they can no longer obtain pills legally, heroin is a much cheaper alternative, officials say.
“Heroin was the original addiction 20 or 25 years ago. Now it's to Vicodin and other opiates and that leads to heroin,” said Roneet Lev, M.D., director of operations at the emergency department at Scripps Mercy Medical Center in San Diego. Lev, who also chairs a prescription drug abuse medical task force in San Diego County, suggested that actions taken to curb abuse in that arena may be fueling the rise in heroin use.
Hospitals in San Diego County treated 180 heroin overdose patients in 2005. That reached 368 in 2013. Scripps Mercy saw its treatment rates jump from about 27 in 2005 to 65 in 2013. It treated 40 cases during the first half of 2014. Lev, like other ER physicans interviewed for this article, have not noticed a particularly dramatic rise in heroin overdoses – their focus has been on prescription drug issues.
Prescription drug abuse is killing more Americans these days than automobile accidents, but heroin is taking its own toll. The CDC indicated that the number of heroin-related deaths in the western U.S. doubled from 0.9 per 1,000 population in 2000 to 1.8 in 2010. It jumped 80% from 2007 to 2010 alone. The highest number of deaths was among non-Hispanic whites between the ages of 18 and 44. That's despite the widening availability of rapid antidotes such as Narcan, which can be administered via a nasal spray. Of those deaths nationwide, 16% also involved the use of prescription opioid painkillers.
According to the OSHPD data, hospitals treated 95 patients between the ages of 18 and 34 for heroin overdoses in 2005. That more than tripled in 2013, when 287 were treated. The number stood at 172 for the first half of 2014.
However, the largest number of overdoses treated occur among patients under the age of 18. They represented 1,290 patients in 2005, but that number reached 2,607 in 2013 and 1,328 through the first half of 2014.
The increases are not uniform across regions. In Los Angeles County – the state's most populous and home to roughly a third of all Californians – hospitals treated 404 heroin cases in 2005, including 315 under the age of 18. That rose to 639 cases in 2013, a jump of 59% but still less than the statewide numbers. Among those patients under the age of 18, the cases rose to 522.
Brian Johnston, M.D., who chairs the department of emergency medicine at White Memorial Medical Center in Los Angeles, noted that within the county a variety of institutions – including Kaiser Permanente, the Hospital Association of Southern California, the local chapter of the American College of Emergency Physicians and the Los Angeles County Department of Health Services – have collaborated to try and reduce prescription drug abuse. It is replicating the program to curb prescription drug abuse that originated in San Diego County.
Among the changes: ERs will prescribe painkillers in only limited amounts, and won't replace lost or stolen prescriptions for painkillers. They are also using a database known as the Controlled Substance Utilization Review and Evaluation System (CURES) to determine if patients who are seeking painkillers in hospital ERs already have existing prescriptions.
“It's a wonderful public health (tool) for doctors to be able to access that data,” Johnston said, but he added that many clinicians still have challenges being able to access the CURES database.
One of the hardest hit regions is Orange County, which Scripps' Lev has said will soon be adopting the program. Hospitals in that county treated 91 patients for heroin overdoses in 2005, including 57 patients under the age of 18. The number of cases was 385 in 2013, a more than 400% increase. Of those, 302 were under 18, a nearly six-fold increase. That epidemic among teenagers has prompted some schools in the county to place drug interventionists on staff or use drug-sniffing dogs for regular campus sweeps.
By contrast, some counties in Northern California saw either a significant drop or comparatively small increase in cases. San Francisco County hospitals treated 163 cases in 2005. That dropped to 103 in 2013. Santa Clara County treated 24 cases in 2005 and 37 in 2013, although it saw 25 patients through the first half of last year.
