Dr. Phillip Reilly

Dr. Philip Reilly, Fayette County coroner, explains why people are overdosing on prescription medication in increasing rates. According to statistics supplied by the coroner’s office, it showed that within the county, there were 41 fatal overdoses in 2011, 15 overdose deaths in 2012 and 29 lethal overdoses in 2013, with four cases pending.

This article is part of a continuing series of articles examining illegal drugs in Fayette County.

For years, many of Hollywood’s shining stars have been burning out before their time because of deadly drug overdoses.

Corey Monteith of “Glee,” Heath Ledger of “The Dark Knight” and more recently, Phillip Seymour Hoffman of “Capote” and the upcoming “Catching Fire” all passed away due to drug overdoses.

While these unfortunate incidents might seem like something that can only happen in the fast-paced world of Hollywood, the truth is the same kinds of overdoses are happening much closer to home.

Fayette County has an increasing problem with drug abuse. A problem that can be so intense, it can lead to death.

From 2009 to 2011, Pennsylvania experienced 6,206 drug-induced deaths according to the Pennsylvania Department of Health.

Fayette County had the highest rate of drug overdoses based on the population size. Following behind Fayette County was Huntingdon and Philadelphia counties respectively.

As various agencies, doctors and law enforcement officers work together to combat the problem, they look toward the science behind the addiction, the statistics of the abusers and the knowledge that has been gained to help curtail deaths from drug overdose.

The science behind addiction

Dr. Philip Reilly, Fayette County coroner, explained that one of the reasons why people are overdosing on prescription medication is because they are chasing the ultimate high.

Reilly demonstrated this principle by drawing a graph showing how various medications can overlap causing a “shingling” effect.

In short lasting drugs, pills that are to be taken every four to six hours, there is a significant high or relief from pain that is achieved from the medication. Unfortunately, sometimes the pill’s effect wears off before the recommended dosage time period. This, in turn, will prompt the person to take another dose before the time interval causing the “shingling” effect.

“In the first hour, it (the medication) will surge and then it drops in the blood level,” explained Reilly. “Wouldn’t it be wonderful if it (the intended effects of the pill) would last longer?”

Reilly said that after over-the-counter Contact was created to last 12 and 24 hours, other drug companies started to follow suit by creating medication labeled extended release (ER), long acting (LA) and slow release (SR). Because the medications are to last for a longer period of time, the person taking the medication never reaches a peak in pain relief or a high. The medication reaches a “cruising altitude” where it remains until it slowly tapers off 12 or 24 hours later.

“What he (a person abusing the drug) does is call his dealer. ‘I need a 20 (milligram) not a 10 (milligram),’” Reilly said. “They think, ‘Maybe I got a bad one (pill),’ and they take another one. You then have a tremendous lethal amount.”

Statistics of abusers

Many people might think drug overdoses occur with the usage of heroin and cocaine. However, the picture of overdosing in Fayette County is much different with many of the drugs found in the medicine cabinet.

According to a Pharmaceutical Threat Assessment developed by the Drug Enforcement Administration (DEA), Philadelphia Division, the number of prescriptions that have been given by doctors has increased significantly since 1991.

“In 1991, physicians issued 76 million opioid (psychoactive drug) prescriptions. By 2001, that number nearly doubled to 139 million. By 2010, the total nearly tripled, tallying 210 million opioid prescriptions,” stated the assessment.

The assessment also cited drug poisoning, which includes pharmaceutical controlled substances, as the leading cause of accidental death in the United States. Drug overdoses were responsible for more deaths than traffic accidents and guns in 2010, according to data from the Centers for Disease Control.

According to statistics supplied by the Fayette County coroner’s office, it showed that within the county, there were 41 fatal overdoses in 2011, 15 overdose deaths in 2012 and 29 lethal overdoses in 2013 with four cases pending.

Further information revealed that the average overdose victim is a white male between the ages of 21 and early 50s, and usually occurs with a mixture of prescription medication, illicit (illegal) drugs or alcohol.

Although the recent trend in Fayette County has shown prescription drug abuse is on the rise, trends can change over time.

Mark Reilly, deputy coroner for Fayette County, said that depending on the street cost of prescription drugs, abusers can switch to illicit drugs because they can be purchased at a much lower cost.

Knowledge is power

While drug overdoses continue to occur, there have been some strides made in the right direction.

A few years ago, a popular prescription drug that was being abused was Fentanyl. The drug was intended to be administered in patch form to provide patients with pain relief over a 72 hour time period.

“I can give you the patch. It is used to (pretty much) knock you out. It practically puts you in a comatose state. We have to breathe for you,” said Dr. Philip Reilly. “One patch lasts 72 hours. What is on the patch will be dripping into your system.”

People who were abusing the drug would cut open the patch and suck the gel-like medicine out in one gulp.

“What if you tore open the patch and sucked out the gel? You would be getting 72 hours (worth of medicine) in one dose,” explained Dr. Philip Reilly. “You would be dead before you hit the floor. We had to deal with that for six months until we got the word out (that the deaths were happening).”

“The manufacturers have modified the patches. Even if they break these open, they can’t get the full amount,” said Mark Reilly.

The importance of disseminating information hinges on doing so in a timely matter. According to Mark Reilly this is a roadblock the Fayette County coroner’s office runs into often.

“It is an area of frustration for us because we start reaching out to see, ‘Who could do a quantitative analysis (for toxicology) in two to three days?’ There was no one,” he said.

“We have been trying to come up with a way to solve this problem for the nation,” added Dr. Philip Reilly. “If we could say, ‘This was the cause of death,’ then you would have a firm backed up diagnosis.”

Both Reillys believe that being able to identify the cause of death sooner would be able to help with police investigations.

Curtailing death from overdose

While the problem of death resulting from drug overdoses seems to be on the rise in Fayette County, statewide actions are working to curtail the issue.

Currently, Pennsylvania is working to pass the Good Samaritan Law that would provide drug users who help someone who has overdosed get medical treatment with immunity.

The bill was unanimously passed by the state senate at the end of last year and is currently before the House Judiciary Committee.

Another proposed action to help lower the number of deaths by overdosing is to make Naloxone, or Narcan, an over the counter medication.

Narcan, when administered to a person who has overdosed, can almost reverse the effects of an overdose caused by opioids which include drugs such as heroin, morphine, Oxycontin, methadone, Vicodin, codeine and other prescription pain medication. The Narcan keeps the person breathing and awake.

Currently, Narcan is only available by prescription from a doctor.

Mark Reilly said those who are opposed to making Narcan readily available over the counter cites its abuse factor.

“(The abuser) would use the Narcan, get high, come down and get another high,” he said explaining the concerns of making it over the counter. “It is a bad experience coming down from Narcan.”

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