The following article is part of a continuing series of articles examining the effects of illegal drugs in Fayette County.
Hospital emergency room physicians and nurses are finding themselves at the front lines of a changing drug culture, treating more patients overdosing from heroin and prescription drugs.
“We see some aspect of how drugs affect people’s lives every day,” said Jeff Frye, an emergency room doctor at the Uniontown Hospital. “Vicodin is one of the most abused prescription drugs out there.”
In 2010, one in every 20 people in the U.S. age 12 and older — a total of 12 million people — reported using prescription painkillers non-medically, according to the National Survey on Drug Use and Health.
Based on the data from the Drug Enforcement Administration, sales of these drugs to pharmacies and health care providers have increased by more than 300 percent since 1999.
“We need to look at other ways to control pain, if we can, other than narcotics,” said Frye.
Over his last 14 years treating people at the hospital, Frye said he’s seen an increase in prescription drug and heroin abuse of those between the ages of 15 and 20. The increase has been particularly noteworthy in the last three years, Frye said.
The death toll from overdoses of prescription painkillers has more than tripled in the past decade, according to the Centers for Disease Control and Prevention (CDC).
A recent finding by the CDC shows that more than 40 people die every day from overdoses involving narcotic pain relievers like Vicodin, methadone, Oxycontin and Opana.
“Overdoses involving prescription painkillers are at epidemic levels and now kill more Americans than heroin and cocaine combined,” said CDC Director Dr. Thomas Frieden.
At UPMC Presbyterian Hospital in Pittsburgh, where Michael Lynch has been an emergency room doctor for over 10 years, the number of patients treated for acute or chronic pain complaints requesting opioids has continued to rise.
“We continue to see a steady increase in progression of opioid abuse, overdose and toxicity, and that’s a national trend, but locally as well,” said Lynch, who also serves as medical director of the Pittsburgh Poison Center.
On average, Lynch said, UPMC Presbyterian averages about six people daily treated for overdoses from prescription drugs.
Although hospitals are required by law to treat a patient’s symptoms, Frye and Lynch said a lot of drug overdoses result from people “doctor shopping” — getting controlled substances from multiple health care practitioners, none of whom knows about what the other has prescribed.
While more than three dozen states have established databases to help track opioid and narcotic drug prescriptions and refills, Pennsylvania has yet to do so.
“We know a certain number of prescribed medications we provide will probably be used inappropriately,” said Lynch.
Frye said that Uniontown has a computerized records system in place to review a patient’s medical history, while their primary care physician and pharmacy are also contacted, if necessary.
Frye added the hospital is also working to implement a pain policy that would limit the amount of prescription medication emergency room doctors prescribe to several days worth with the patient following up with their primary care doctor.
“We see the overdoses, we see the abuse and we actually see people seeking narcotics for different reasons,” said Frye. “Some are seeking them for their personal use because they are addicted and they use, but we also see people that are seeking to sell.”
Frye said some people will even go to the extent of faking an injury or pain to get prescription narcotics so they can go back on the street to sell it.
“When pain is subjective, it’s very hard to tell what’s real,” said Frye.
Frye mentioned a woman in her 40s who recently came into the emergency room complaining of back pain and wanted a prescription drug refill.
Four days earlier, Frye said, he treated the woman for a drug overdose that required naxolone or narcan, a medication that reverses the effects of an overdose on people that have stopped breathing or lose consciousness.
“How are you going to refill someone’s narcotics that just overdosed on them?” asked Frye.
According to Frye, some hospital units and surgical practices are looking at using oral narcotics such as nerve blocks and longer-acting local anesthetics, but it doesn’t really work at the pain site because some patients are resistant to it.
Frye said anti-inflammatory medications and ice can also be used instead of narcotics to help relieve pain symptoms.
“I think that where we are running into problems now in the medical culture (is by) treating pain primarily (with) opioids,” said Lynch.
“For the last decade or more, we are running into patients who are likely experiencing pain subjectively without necessarily having injury, and the way that pain has been treated is with opioids,” said Lynch.
Frieden said states, health insurers, health care providers and individuals have critical roles to play in the national effort to stop the overdose epidemic while at the same time protecting patients who need prescriptions to control pain.
“The really large prescriptions don’t come from hospital emergency departments, they come from primary care doctors and other types of physicians,” said Lynch. “I think we end up as a safety net for those that have been treated long-term.”