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Pennsylvania has made strides at cutting down the supply of prescription opiates through measures like an electronic prescription drug monitoring program and introducing new guidelines for prescribing the drugs.

However, opiate-related overdoses continue to rise, driven by an increase in heroin and synthetic opioid use.

In 2016 in Cumberland County, 66 people died of drug-related overdoses. Nearly 50 of those deaths were attributed to heroin and fentanyl, according to Cumberland County Coroner Charley Hall.

By comparison, of the 41 total overdose deaths in 2015, 19 were attributed to heroin, Hall said.

Nearly 200 doses of the overdose-reversing drug were administered by Cumberland Goodwill EMS in 2016 — a nearly 60 percent increase from the year prior.

Is there a correlation between limiting the supply of prescription opioids and the rise and lives lost to the use of heroin?

“We knew that this was going to be an issue, that we were going to push addicts in a direction that was going to be more deadly,” Holy Spirit Medical Group Medical Director Dr. Carrie DeLone said.

DeLone served as Pennsylvania’s physician general under Gov. Tom Corbett.

“... But, we also know that you have to start somewhere,” she said. “You have to understand what you’re doing. You have to regulate this. It can’t just be business as usual.”

DeLone said an influx of prescription opioids had become such a problem that it had to be dealt with in an effort to stop the number of people addicted to the drugs from growing.

“The initial problem is that we have people who are addicted and now we are not giving them as many pharmaceutical-grade painkillers, so they are moving to heroin,” she said.

When prescription opioids like OxyContin began hitting the market more than a decade ago, pharmaceutical companies touted them as being largely non-addictive, DeLone said. In 2006, Purdue Pharmaceutical, the maker of OxyContin, agreed to pay $630 million to settle federal charges that it had misrepresented the safety concerns and risks of the drugs.

A 2012 study found 86 percent of urban heroin users had abused prescription opioids first, according to the National Institute on Drug Abuse. Some of those people began with drugs they were prescribed, while others were able to get access to drugs prescribed to someone else.

Cracking down

A similar situation to Pennsylvania’s occurred in Kentucky in 2013 when efforts were made to crack down on prescription opioids, according to University of Maryland Professor of Criminology Katie Zafft.

Zafft said that when Kentucky implemented measures to limit prescription opioids there was a spike in use in drugs like Suboxone and heroin.

She said that as the markets for drugs like OxyContin began to dry up, street-level prices went up, and heroin became the cheaper alternative.

“Drug addicts are drug addicts but they’re not stupid,” Zafft said. “It’s just plain economics. If you’re not ready to grapple with your addictions, you’ll find it someway.”

Zafft said there needs to be a multifaceted approach to dealing with the current opioid problem. This includes cutting down on supply — like the prescription drug policies implemented by Pennsylvania and law enforcement efforts, but also treatment solutions that reduce demand for drugs.

She said cutting off supply can work when a drug is just emerging, but the current opioid problem is too far into its cycle for the focus to be on just that side.

“Epidemics go in cycles,” Zafft said. “... This one is established. There’s established trafficking routes. There’s established addiction. There’s a demand. There’s a good supply. When they become this entrenched in a community, we need a holistic approach to bend that curve down again.”

While Zafft said she did not believe current heroin and opioid users were ripe for it, some success has been had using coerced desistance for drug addicts as an alternative to mandated drug treatment.

Coerced desistance generally involves highly frequent — in some cases daily — or random screenings for substances.

A failed test is promptly met with punishment like a short stay in prison.

Positive results have been found for methamphetamine users in the HOPE Program in Hawaii and drunk drivers in the 24/7 Sobriety program in South Dakota, according to a study conducted by Mark A.R. Kleiman.

“It works for a lot of other drug users, but it takes the opiate addict to get into treatment to actually quit,” Zafft said. “While I’m a proponent for coerced abstinence, and I think it’s great for a lot of people ... for the people who are hooked on opiates, treatment of some kind is super important.”

DeLone highlighted the expanded use and access to Naloxone and expanded treatment options through Centers of Excellence as steps the state is taking to help combat the opiate problem.

She said that while the prescription drug policies may contribute to a rise in heroin use, the policies were necessary and should provide long-term gains by helping physicians and other medical professionals identify and prevent people who may become addicts.

“It’s not always good to be right,” she said. “Unfortunately, we have seen an increase in heroin overdose deaths since we’ve instituted some mechanisms to decrease that abuse. That doesn’t mean these weren’t the right decisions.”

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