By Janice Wright, MPH, LCADC, CCS, Executive Director, Mount Pocono Medical
When the COVID-19 pandemic arrived in the U.S. in March 2020, it grabbed everyone’s attention, and for good reason. The primary responsibility of public health officials at the local, state, federal level is to keep our citizens safe from anything that threatens their health, wellbeing, and safety. The COVID-19 pandemic did all that, and therefore, that’s where our attention went: to the immediate threat.
However, there was another, ongoing crisis in the U.S. in 2020. That crisis also threatened the health, wellbeing, and safety of our citizens: the opioid crisis, or opioid epidemic. In fact, 2020 was a complicated time in the overall arc of the opioid crisis.
In 2020, the general public had known about the opioid situation for five years or more. States like Pennsylvania initiated an organized response to the increase in opioid addiction and overdose death as early as 2014, when Governor Tom Corbett established the Heroin and Other Opioids Workgroup. The Pennsylvania state legislature passed a law later that year that limited the flow of opioids by establishing a prescription drug monitoring program.
That program met the moment. In 2014, the two main drivers of opioid addiction – which we now call opioid use disorder (OUD) – and fatal overdose were the prescription to addiction pathway and the influx of fentanyl into the U.S., which made the use of illicit fake-prescription opioids and illicit opioids like heroin more deadly and increased the risk of fatal overdose.
2020 was a complicated period in the opioid crisis because we were entering a new wave. This wave is characterized by an increase in overdose deaths involving the combined use of opioids and stimulants like cocaine and methamphetamine, and complicated by the presence of fentanyl. Experts say this is a fourth wave.
We’ll explain what that means now.
The Opioid Crisis 1990-2019: Three Waves
The Centers for Disease Control (CDC) describes the origin and history of the opioid crisis as occurring in three distinct phases – or waves – that occurred in a stepwise manner and led to where we are today, in 2022, at the beginning of a possible fourth wave.
Here’s how the CDC defines the first three waves of the crisis:
- Wave One began around 1990. The main driver of this wave was a significant increase in prescriptions written for opioid analgesics. The rise in opioid availability and use caused a surge in fatal overdose around the country. This upward trend continued until around 2010, when the second wave began.
- Wave Two began in 2010, when policymakers around the country altered opioid prescribing rules, which decreased the number of long-term prescriptions written for opioids. A primary driver of this wave was a phenomenon known the prescription to addiction pathway. Many people with opioid use disorder, with no more access to prescription opioids, began using illicit drugs like heroin. This caused a surge in fatal heroin overdose nationwide.
- Wave Three began around 2012. The main driver of this wave is the influx of illicit fentanyl – read the warning published by the Drug Enforcement Agency (DEA) here – and other synthetic opioids. CDC data indicates that close to one third of fatal drug overdoses in 2016 involved synthetic opioids, a trend which has not stopped.
That brings us to the beginning of the COVID-19 pandemic, when experts believe a fourth wave of the opioid crisis had already begun.
Stimulants, COVID-19, Fentanyl, and Co-Occurring Disorders: How is Wave Four Different?
Although the CDC has yet to officially declare a fourth wave of the crisis there’s a growing body of evidence to suggest that we are now in the middle of this new wave, and that it’s been exacerbated by issues related to the intervening COVID-19 pandemic.
Here are the primary features of this new wave:
- A surge in the use of cocaine and methamphetamine, alongside opioid use
- Misuse of/addiction to two or more substances is called polysubstance misuse/addiction
- A surge in the presence of co-occurring mental health disorders in people with substance use disorder (SUD)
- A surge in the presence of illicit fentanyl not only in illicit opioids, but in a wide range of illicit substances, including cocaine, methamphetamine, and illicit tranquilizers
This third wave is challenging because the treatment of individuals with opioid addiction, stimulant addiction, and a co-occurring mental health disorder creates complications above and beyond typical addiction treatment. Compared to other substances of misuse, long-term exposure to drugs like cocaine and methamphetamine can cause increased:
- Neurological deficits
- Suicidal ideation
In addition, wave four has the potential to be more deadly than the preceding waves. Here’s how a new analysis of the opioid epidemic describes the impact of fentanyl on the current state of the opioid epidemic:
“Fentanyl and its analogs are often used to spike other addictive drugs, including other opioids, and cocaine, creating powerful combinations of often unknown, sometimes deadly, strength. The arrival of these synthetics tended to make existing drug addictions more lethal.”
Wave Four in Context: The National Opioid Crisis Data
The most recent publications from the CDC show that since the end beginning of the pandemic, fatal overdoses have increased not only for opioids, but also for all other drugs:
- Opioid related: 50,178
- Any/all overdose: 67,697
- Opioids involved in 74% of all fatal overdoses
- Opioid related: 69,061
- Any/all overdose: 78,506
- Opioids involved in 88% of all fatal overdoses
- Opioid related: 73,453
- Any/all overdose: 107,306
- Opioids involved in 69% of all fatal overdoses
Let’s give that data some big-picture perspective. The overdose death rate in the U.S. in 1999 was 6.1 deaths per 100,000 people. Twenty-two years later, the overdose death rate is 28.3 deaths per 100,000 people, which is an increase of over 350%, or an annual increase of almost 17 percent.
That’s why we call it a crisis: numbers like that are unacceptable for our overall health, wellbeing, and safety. Before we look at the data for Monroe County, we examine the overall data for the state of Pennsylvania.
The Opioid Crisis in Pennsylvania: Facts and Figures
To understand the opioid crisis in the state, we’ll begin by sharing the number of people who met the clinical threshold for substance use disorder (SUD) for the last five-year period for which we have complete data.
SUD in Pennsylvania: Five-Year Trend
- 2016: 295,000
- 2017: 303,000
- 2018: 293,000
- 2019: 316,000
- 2020: 299,000
Pennsylvania has a population of 9.3 million. The numbers from 2020 show that around 3.1 percent meet the criteria for clinical SUD, which means they need professional treatment and support as soon as possible. That’s a critical part of addressing the opioid crisis: a broader acknowledgment and awareness of the prevalence of addiction and substance use disorder, and the need for reducing the barriers to treatment that many people in Pennsylvania – and across the country – experience every day.
Now we’ll take a close look at the overdose and opioid statistics in Pennsylvania, with a focus on the role of opioids. Our sources for the following data are the CDC website and the Pennsylvania Department of Health.
Pennsylvania: General Opioid Overdose Data
Overdose Fatalities, 2015-2020:
- 2015: 3,119
- Ranking: 6th in U.S.
- 2016: 4,540
- Ranking: 4th in U.S.
- 2017: 5,425
- Ranking: 3rd in U.S.
- 15 fatal overdoses every day
- 86% of deaths involved an opioid
- 36% involved cocaine and/or methamphetamine in addition to an opioid
- 2018: 4,451
- Ranking: 4th in U.S.
- 12 fatal overdoses every day
- 84% of deaths involved an opioid
- 37% involved cocaine and/or methamphetamine in addition to an opioid
- 2019: 4,480
- Ranking: 5th in the U.S.
- 12 fatal overdoses every day
- 84% of deaths involved an opioid
- 42% involved cocaine and/or methamphetamine in addition to an opioid
- Presence of cocaine and amphetamine increased 12% from 2018
- 2020: 5,162
- Ranking: 8th in the U.S.
- 14 fatal overdoses every day
- 85% opioid-related
- 44% involved cocaine or methamphetamine in addition to an opioid
- Presence of cocaine and amphetamine increased 22% from 2018
Before we get to the detailed data for Monroe County, we want you to learn how the State of Pennsylvania has responded to the opioid crisis so far. For an in-depth look at the Pennsylvania response, please read this article on our blog:
The Opioid Crisis in Pennsylvania: Spotlight on Luzerne County
The response has been robust. We encourage you to read the details in the article above. However, we’ll offer a brief summary here. The response in the PA includes:
- Prescription drug monitoring
- Enhanced, statewide access to the fast-acting, overdose reversing drug Naloxone
- A special program for EMS first responders and public safety officers on how to best support overdose victims
- A statewide drug take-back program
- This comprehensive Opioid Awareness website
- A warm-handoff program to facilitate connecting overdose victims to SUD treatment providers
To learn about the impact of the opioid crisis in Pennsylvania on a more focused, local level, we’ll now share the latest information opioid addiction and overdoses in Monroe County, where we own and operate Mount Pocono Medical in the town of Mount Pocono, PA.
The Opioid Crisis in Pennsylvania: Monroe County
Monroe County is located in northeast PA, just southeast of Luzerne County, the subject of our previous article on the opioid crisis in Pennsylvania. Monroe has a population of 169,273 people. It’s well-known for its state parks, as a stop on the Appalachian Trail, and various towns that cater to tourists visiting the Pocono Mountains. Monroe became a popular exurb during the 1990s-2010s, because of its proximity to Philadelphia, New York City, and other urban areas in nearby New Jersey.
Let’s take a look at the data from Monroe County now.
Monroe County: Opioid Epidemic Facts and Figures
- Individuals diagnosed with addiction, a.k.a. substance use disorder (SUD)
- 2016: 1,682
- 2017: 2,121
- 2018: 2,403
- 2019: 3,034
- 2020: 5,860
- Opioid prescription rates
- 2015: 83 for every 100 residents
- 2016: 76 for every 100 residents
- 2017: 65 for every 100 residents
- 2018: 57 for every 100 residents
- 2019: 32 for every 100 residents
- 2020: 30 for every 100 residents
- Overdose deaths:
- 2015: 39
- 2016: 42
- 2017: 54
- Opioid-related: 49
- 2018: 54
- Opioid-related: 51
- 2019: 59
- 2020: 83
- 2021: 67
A quick analysis of those numbers shows that in 2020, 3.4 percent of the population had an SUD, which is higher than the statewide percentage of 3.1 percent. In addition, the number of people diagnosed with SUD increased almost 250 percent between 2016 and 2020, which outpaced the average statewide increase, which was less than 2 percent.
While opioid prescription rates decreased – thanks to the proactive work of local and state authorities – the overdose death rate increased dramatically. In 2020, the overdose rate was 112 percent higher than in 2015, but 2020 showed relative improvement. Overall deaths decreased, but the overdose rate is still over 70 percent higher than in 2015.
In addition, the state dashboard shows that in 2017 and 2018, opioids accounted for most of the overdose deaths in Monroe County. In 2017, opioids were involved in 49 out of 54 overdose fatalities, or 96 percent. The following year, 2018, opioids were involved in 51 out of 54 overdose fatalities, or 94 percent.
Monroe County, PA: How to Support People with Opioid Use Disorder
To start, the Pocono United Way, in cooperation with the government of Monroe County, published this Opiate Community Resource Guide, which includes the following helpful, Monroe County-specific information, including:
- Addiction Awareness Resources
- Opioid Addiction Information and Resources
- Fact sheets on the signs of opioid overdose
- Fact sheets on the steps to take to help overdose victims
- Information on Naloxone use and access
- Crisis hotlines, including the state helpline at 1-866-824-3578
- Recovery housing resources
- Community support group resources, for programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)
- Treatment resources
Their treatment resource page also includes tips on what kind of treatment programs to look for, how to find out if the program in question is covered by Medicare or Medicaid, and how to find out if a private insurance policy covers addiction treatment.
The Monroe County resource guide is an important tool for the entire community. The sections on treatment and support are particularly valuable. This fourth wave of the opioid crisis may be the most challenging yet. All evidence shows an increase in polysubstance misuse and an increase in the prevalence of co-occurring disorders. To meet the increased and differential needs posed by this wave, as compared to the previous three, its more important than ever for treatment professionals in Monroe County to apply the principles of integrated treatment 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 integrated treatment for co-occurring disorders, please click here.
Integrated Treatment in Monroe County: Pinnacle Treatment Centers
An integrated approach to treatment means that all the factors in an individual’s life that can or may affect their addiction are addressed in a logical, comprehensive manner using the latest evidence-based treatment techniques. In an integrated treatment program:
- Individuals receive the latest SUD treatment available, including medication-assisted treatment of opioid use disorder (MAT for OUD)
- Co-occurring mental health disorders are treated alongside SUD
- Families participate in treatment
- Individuals learn how to incorporate lifestyle changes that support recovery into their daily lives, including:
- Healthy eating
- Stress management
- Relapse prevention
- Mindfulness meditation/techniques
- Individuals receive support or connection to support services for:
- Ongoing education
- Vocational training
- Personal development
Integrated treatment can reduce or prevent the harm caused by the opioid crisis by treating the whole person and preparing that person to rebuild a productive life in their family and community. When the individual thrives, the family thrives. When families thrive, communities thrive. And when communities thrive, life improves for everyone.
We know this, because provide integrated treatment for substance use disorder (SUD) and co-occurring disorders every day of the year at our outpatient treatment facility Mount Pocono Medical in the town of Mount Pocono, PA.