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PA. OVERDOSE CRISIS WORSENS

The Pennsylvania State Coroner's Association recently released a report titled Report on Overdose Death Statistics - 2014, http://www.pacdaa.org/Documents/Pennsylvania%20State%20Coroners%20Association%20Drug%20Report%202014.pdf which stated there were over 2400 drug overdose deaths in Pennsylvania in 2014, an increase of about 20%.

Seven people die every day in Pennsylvania from drug related causes. Not known are the number of persons who overdose but survive.

Heroin was present in about 800 deaths and heroin and/or pain killer were present in about half of the overdoses.

In nearly 10% of all overdoses, drugs used to treat heroin addiction such as methadone or suboxone were present.

In recent years, I have seen an increase in the number of healthcare professionals using heroin. Many of these individuals were initially prescribed opiates for chronic pain; however, some of these individuals began using heroin after their access to opiates was cut off.

Last week, I spoke with a detective from the suburban Philadelphia area who advised me that in his jurisdiction, he has seen a significant increase in the amount of heroin on the street and in much large quantities than he has seen in the past.

When I asked the detective how many of the heroin users he interviewed started on opiate medication, he replied "most of them."

This past April, I wrote a blog titled Guidelines for Prescribing Opioid Analgesics, and discussed a December 3, 2014 Report from the Pennsylvania Joint State Government Commission titled Guidelines for Prescribing Opioid Analgesics. That report indicates the total opioid dosage above 100 mg/day of oral morphine or its equivalent (80 mg. of oxycodone) is not associated with improved pain control, but is associated with a significant increase in the risk of harm.

In my blog dated January 6, 2015, Issues Presented by the Use of Pain Medication for Healthcare Workers, I discuss the position paper published by the American Academy of Neurology on September 30, 2014. That article noted that, "although there is evidence for significant pain relief in the short term (average duration of trials five weeks, range 1 - 16 weeks), there is no substantial evidence for maintenance of pain relief over longer periods of time, or significant evidence for improved physical function". It also indicated that 50% of patients taking opioids for at least three months are still on opioids five years later and noted that some states have issued guidelines regarding opiate use. For instance, the State Medical Board of Ohio issued new guidelines with an 80 mg. per day trigger point.

I presently represent several healthcare professionals who were taking in excess of 120 mg. of opiates per day while they were working.

I now represent a healthcare worker who was taking in excess of 240 mg. of opiates per day for the past two years.

More and more, pain management doctors are looking for alternatives to opiate medications and I have had several patients who have been successfully weaned off opiate medications and are managing their pain through a combination of therapy and other analgesics.

If you are on chronic pain medication, you should discuss the level of pain medication with your doctor. If you are working while on pain medication, and you are reported to a state board for some issue or problem with work, your use of pain medication will come under scrutiny by the healthcare licensing board.


2014 American Academy of Neurology, Opioids for Chronic Noncancer Pain. A position paper of the American Academy of Neurology from 2014.

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