When public health officials recognized the scope of the danger caused by the increase in opioid addiction and overdose across the country around the year 2007, they began calling it a crisis. By that time, the dramatic increases in opioid-related public health problems had already spread to every corner of the country, including Luzerne County, Pennsylvania. Local, state, and national policymakers – alongside everyone else – quickly realized that opioid addiction, a.k.a. opioid use disorder (OUD), accidental non-fatal overdose, and accidental fatal overdose do not discriminate.
Everyone is vulnerable, and no one is immune. From rural whites in the Midwest and Western states, to non-whites in urban areas in the Northeast and all demographics in between, the crisis touched everyone. From pro athletes to white-collar professionals to middle-class families to low-income individuals, communities around the country feel the negative effects of the opioid crisis.
If you’re not familiar with the broad strokes of the crisis in the U.S., and how it developed over the past thirty years, we’ll offer a brief but comprehensive overview now. Then – as the title of this article suggests – we’ll focus our attention on the opioid crisis in Pennsylvania, with a specific focus on one Pennsylvania county, Luzerne.
The Opioid Crisis in the U.S.: An Overview
The Centers for Disease Control (CDC) identifies three phases, also called waves, that contribute to what we now call the opioid epidemic or the opioid crisis:
First Wave:
This initial wave of the crisis resulted from a dramatic surge in prescriptions for opioid painkillers that began around 1990. The increase in prescriptions caused a spike in fatal overdose nationwide by the end of the 90s, a trend that continued through 2010.
Second Wave:
This second wave started around 2010. Around the country, policymakers changed prescribing rules, which made long-term prescription opioids more difficult to obtain. An unintended consequence of this was the prescription to addiction pathway. Without access to prescription opioids, many individuals who had developed opioid use disorder turned to illicit drugs like heroin. This caused a significant spike in fatal heroin overdose nationwide.
Third Wave:
This wave began around 2012-2013. It’s different that than phases one and two because the main driver is fentanyl and other synthetic opioids. CDC data shows that just over thirty percent of fatal drug overdoses in 2016 involved synthetic opioids, and that upward trend continues
Many experts believe we’re now in Wave Four, which has not yet been officially categorized by the CDC has a new wave. However, an influx of fentanyl, which drug traffickers use to enhance amphetamines such as methamphetamine, and add to illicitly produced fake-prescription opioids and illicit opioids like heroin, alongside an array of complex factors related to COVID-19, have resulted in another surge in overdose deaths.
What is Phase Four of the Opioid Crisis?
An article published in 2021 called “The Rise of Illicit Fentanyl, Stimulants, and the Fourth Wave of the Opioid Overdose Crisis,” as well as with the article we cite above on the fourth wave of the opioid crisis, describes how wave four is different than the three preceding waves.
This new wave is characterized by:
- Increased combined use of stimulants and opioids
- Misusing two or more substances is called polysubstance abuse/misuse
- Polysubstance misuse is exacerbated by drug dealers and traffickers using fentanyl to enhance:
- Illicit fake-prescription opioids
- Other illicit opioids (heroin)
- Methamphetamine
- Cocaine
- Increased presence of co-occurring mental health disorders in people with SUD
- Treatment of individuals with polysubstance misuse that includes methamphetamine face significant challenges as a result of the consequences of long-term exposure to amphetamines and/or stimulants, which include:
- Neurological deficits
- Suicidal ideation
- Psychosis
- Hostility
- Violence
- Treatment of individuals with polysubstance misuse that includes methamphetamine face significant challenges as a result of the consequences of long-term exposure to amphetamines and/or stimulants, which include:
Here’s how a recent report describes the impact of fentanyl – a driver of the third wave and a partial driver of the new, fourth wave – on the opioid crisis:
“Fentanyl and its analogs are often used to spike other addictive drugs, including other opioids, [Ed. methamphetamine] and cocaine, creating powerful combinations of often unknown, sometimes deadly, strength. The arrival of these synthetics tended to make existing drug addictions more lethal.”
That report also includes data on the effect of the presence of fentanyl on specific geographic regions in the U.S. Of importance to this article is an increase in nine northeastern states, including Pennsylvania. Data from the report shows that while rural, mostly white areas in the Midwest experienced the most dramatic increases in fatal opioid overdose rates during waves one and two of the opioid crisis, the increases in wave three occurred primarily in the rural and urban northeast, with the largest increases in urban areas among non-whites. Experts identify the presence of fentanyl, the proximity to international points of entry, and population density as the primary causes of the increase seen in the northeast between 2015 and 2017.
We’ll examine the effect of fentanyl on the opioid crisis in Pennsylvania – Luzerne County, specifically – in just a moment. To understand the situation in Pennsylvania, it’s important to understand the big picture. We’ll start by offering the lates nationwide statistics on the opioid crisis then quickly move on to present and discuss the Pennsylvania data.
The Opioid Crisis: Facts and Figures
Here’s the latest available data on drug overdose in the U.S. These are the total fatal opioid overdoses recorded for 2019-2021, according to the CDC:
- 2019: 50,178
- 2020: 69,061
- 2021: 73,453
These are the total fatal overdoses for any/all drugs:
- 2019: 67,697
- 2020: 78,056
- 2021: 107,306
That’s where we are nationwide. Someone new to these statistics might find them astounding: a hundred thousand deaths a year from drug overdose, with close to three quarters of those deaths attributed to some kind of opioid. For perspective, in 1999, when the opioid crisis was in its nascent stages, the overdose death rate in the U.S. was 6.1 deaths per 100,000 people. In 2021, the overdose death rate is 28.3 deaths per 100,000 people.
That’s an increase of 364 percent, or an increase close to 17 percent per year for the 22 years for which we have data. That’s why public health officials and addiction treatment and awareness advocates have been raising the alarm for almost a decade now. That rate of increase has a serious, negative impact on individuals, families, and communities across the county.
Now let’s take a look at the data for Pennsylvania.
Addiction and Overdose Facts and Figures: Pennsylvania
We’ll start with the number of people in Pennsylvania diagnosed with substance use disorder (SUD) between 2016 and 2020.
Substance Use Disorder: Pennsylvania
- 2016: 295,000
- 2017: 303,000
- 2018: 293,000
- 2019: 316,000
- 2020: 299,000
With a population of around 9.3 million, the 2020 statistics show that 3.1 percent of adults in Pennsylvania have SUD. That means they need treatment – which we’ll address below. For now, let’s drill down and examine the overdose and opioid statistics in Pennsylvania. We retrieved the following data from the CDC and information published by the Pennsylvania Department of Health to identify the role of opioids in those SUD statistics.
Pennsylvania: General Opioid Overdose Data
Drug Overdose Deaths 2015-2020:
- 2015: 3,119
- 6th highest rate in nation
- 2016: 4,540
- 4th highest rate in nation
- 2017: 5,425
- 3rd highest rate in nation
- 15 overdose deaths per day/average
- 86% opioid-related
- Among those, 36% also involved a stimulant such as cocaine and/or methamphetamine
- 2018: 4,451
- 4th highest rate in nation
- 12 overdose deaths per day/average
- 84% opioid related
- Among those, 37% also involved a stimulant such as cocaine and/or methamphetamine
- 2019: 4,480
- 5th highest rate in nation
- 12 overdose deaths per day/average
- 84% opioid-related
- Among those, 42% also involved a stimulant such as cocaine and/or methamphetamine contributing to their cause of death
- That’s a 12% increase from 2018
- 2020: 5,162
- 8th highest rate in nation
- 14 people per day/average
- 85% opioid-related
- Among those, 44% also involved a stimulant such as cocaine or methamphetamine
- That’s a 22% increase from 2019
Before we get to the detailed data for Luzerne County, we’ll share some of ways the state of Pennsylvania responded to the increasing opioid overdose numbers.
The Response in Pennsylvania
In May of 2014, Governor Tom Corbett established the Heroin and Other Opioids Workgroup to examine the opioid crisis in Pennsylvania, and make recommendations that would help mitigate the harm caused by the increase in opioid-related SUD and opioid overdose fatalities. The workgroup moved quickly, and by October 2014, the Pennsylvania state legislature passed a law establishing a prescription drug monitoring program to stem the flow of opioid medication flowing into Pennsylvania communities.
Governor Tom Wolf, upon election in 2014, continued where Governor Corbet left off, and organized and all-hand-on-deck, all-of-the-above approach to the opioid epidemic in Pennsylvania. This comprehensive effort included:
- Extending the prescription drug monitoring program established by his predecessor
- Issuing a standing order prescribing the fast -acting, overdose reversing drug Naloxone for all pharmacies across the state
- This meant that beginning in 2015, anyone in the state could purchase Narcan from any pharmacy in Pennsylvania, without a prescription in their name
- Establishing The First Responder Addiction and Connection to Treatment Program
- This program trained over a thousand EMS first responders and public safety officers to support people experiencing overdose, and connect people with SUD to evidence-based treatment programs
- Between 2018-2022, this program administered 73,450 doses of naloxone in Pennsylvania communities
- Creating a drug take-back program with drug take-back boxes to help people dispose of unwanted drugs
- The program distributed 300,000 drug disposal pouches
- The program collected and destroyed 180,969 pounds of drugs from take-back pouches in 2020 alone
- Establishing this Opioid Awareness website as a one-stop online resource for information, support, and crisis services
- Created a 24/7 addiction treatment support hotline called Get Help Now: 1-800-662-HELP
- Since launching in 2016, helpline staff logged over 76,000 incoming calls
- Establishing this Opioid Data Dashboard to keep the public, as well as mental health professionals and physicians, up-to-date on the latest available opioid statistics
- Forming a warm-handoff program, wherein a health provider can connect an overdose victim – or anyone who needs support – to a substance use treatment specialist with an in-person, face-to-face introduction
- Collaborating with the Drug Enforcement Agency to locate, confiscate, and destroy 29 tons of illegal drugs between 2017-2022
- Created a 24/7 addiction treatment support hotline called Get Help Now: 1-800-662-HELP
It’s clear the state government of Pennsylvania is doing everything they can to support the individuals, families, and communities affected by the opioid crisis in Pennsylvania. These continued and ongoing efforts are critical. The current data on the crisis, and the potential of increased harm and complications from the multi-pronged fourth wave of the crisis make understanding treatment needs and expanding access to SUD support more important than ever.
To understand all of this on a local level, we’re ready to look at the data from Luzerne County, where we own and operate Hazleton Treatment Services in the town of Hazleton, PA, and Miners Medical in Ashley, PA.
The Opioid Crisis in Pennsylvania: Luzerne County
Luzerne County is located in northeast PA and has a population of just over 325,000 people, and is considered part of the Scranton–Wilkes-Barre–Hazleton Metropolitan Statistical Area, which has a population of around 500,000. It’s an industrial and mining area that boomed in the 20th century, but became part of the rust belt in the 1970s and 1980s.
Luzerne was hit hard by the first two waves of the opioid epidemic, as the data below shows. It’s also been hit hard by substance use in general. Its rate of SUD mirrors that of Pennsylvania, with about 3.1 percent of the population with a clinical diagnosis of SUD.
Let’s get to the data.
Luzerne County: Opioid Epidemic Data
- People with substance use disorder (SUD):
- 2016: 8,673
- 2017: 8,120
- 2018: 9,933
- 2019: 10,744
- 2020: 10,046
- Opioid prescription rates:
- 2015: 95 for every 100 residents
- 2016: 86 for every 100 residents
- 2017: 71 for every 100 residents
- 2018: 61.5 for every 100 residents
- 2019: 51 for every 100 residents
- 2020: 49.4 for every 100 residents
- Overdose deaths:
- 2015: 90
- 2016: 138
- 2017: 145
- Opioid related: 134
- 2018: 158
- Opioid related: 142
- 2019: 128
- 2020: 179
- 2021: 205
Let’s dissect those numbers. We’ll start with the SUD rates between 2015 and 2020. That’s an increase of 16 percent in the number of people in Luzerne who need support for SUD. Next, the prescription rates: the prescription to addiction pathway drove the first and second waves of the crisis, and this 48% reduction in opioid prescription rates shows that the statewide programs to reduce the flow of opioids into Luzerne by this pathway worked.
However, those programs didn’t stop the increase in overdose deaths over the same period of time. Fatal overdoses increased by 128 percent, driven by the third wave presence of fentanyl in the illegal drug supply. According to the Drug Enforcement Agency (DEA), Luzerne had the most overdoses for any county in PA in 2015, the 13th most in 2016, and the 9th most in 2017. In addition, available data from the state dashboard shows that in 2017 and 2018, over 90 percent of overdose deaths in Luzerne County were opioid related: 132 out of 145 in 2017, and 142 out of 148 in 2018. We do not have access to data for 2015-2016 or 2019-2021.
Luzerne County, PA: Steps to Support People with Opioid Use Disorder
We can report that in September 2019, during a statewide Naloxone distribution event, public health officials distributed 122 Naloxone kits in Luzerne County.
Events like that are a good way for public health official and treatment providers to interact with the public and spread awareness about the opioid epidemic. The first step in awareness efforts is prevention. The second step is support for people with substance use disorders, or the families of people with substance use disorder.
The data of the fourth wave of the opioid crisis, characterized by polysubstance use disorders and co-occurring mental health disorders, and complicated by the adverse mental health effects of chronic exposure to stimulants like cocaine and amphetamine, point in a specific direction with regards to treatment and support.
To meet this fourth wave, we need to prioritize integrated treatment and follow the best practices defined by the Substance Abuse and Health Services Administration (SAMHSA) publication “Substance Use Disorder Treatment for People With Co-Occurring Disorders.” To learn more about treatment for co-occurring disorders, please click here and/or read this article on our blog:
Anxiety Disorders, Substance Use Disorder, and Integrated Treatment
Those resources have all the details you need. What you can learn right now about integrated treatment – and how it can help mitigate the ongoing harm caused by the opioid crisis – is that it focuses on the whole person. It addresses all the factors that affect the lives and the recovery of people in treatment for SUD. That means co-occurring mental health disorders are addressed. Families are involved in treatment. It means the individual in need of support gets support on every level possible, including interventions targeted at reducing disparities related to the social determinants of health.
That approach can help the citizens of Luzerne County, PA, and it’s the approach we espouse and provide every day – in an outpatient capacity – at Hazleton Treatment Services and Miners Medical.
By Carl Kelley, Regional Director, Eastern Pennsylvania, Pinnacle Treatment Centers
About The Author
