Austin Saline, BA
Asif Ilyas, MD, MBA, FACS
The first wave of the “Opioid Epidemic” was related to prescription opioids starting in 1999.
The second wave of the “Opioid Epidemic” began around 2010 related to an increase in heroin abuse.
The third wave of the “Opioid Epidemic” began approximately in 2013 with the rise of synthetic opioid abuse such as fentanyl.
Pennsylvania’s drug-related overdoses deaths were 26 per 100,00 in 2015 and rose to 43 per 100,000 in 2017.
Pennsylvania’s urban counties were found to have a higher number of drug-related overdose deaths 67% than in rural counties 53% between 2015 to 2017.
Pennsylvania’s had 3rd highest death rate from drugs in 2018 with 65% overdoses involving opioids.
From 1999-2018, nearly 450,000 people have died due to the “Opioid Epidemic.”1 (Figure 1) The CDC characterizes three notable spikes in opioid-related death over the past twenty years. The three waves occurred in 1999, 2010, and 2013. The first wave was related to the sharp rise in opioid prescribing by physicians. The second wave was due to an increase heroin abuse. The third wave was related to the advent and rise of synthetic opioid abuse such as fentanyl.2 Shockingly, the number of deaths due to synthetics were as many as heroin and natural opioids-related deaths combined.3 Despite federal and state interventions, approximately 128 people die due to opioid overdose every day.1
Figure 1. Understanding the Epidemic. Atlanta, GA: CDC, National Center for Injury Prevention and Control. March 19, 2020. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html.
Since 2010, Pennsylvania has outpaced the entire country in drug-related deaths and opioid-related hospitalizations.2 (Figure 2) These deaths can be partly attributed to the increase in opioid prescriptions. In 2012, the rate of opioids prescriptions peaked throughout the entire country, but 60% of Pennsylvania counties had a prescription rate larger than the national rate. This trend continued in the upcoming years as the state had the 6th highest opioid prescription rate in 2014 and 2015. Pennsylvania’s prescription rate did fall dramatically to 26th in 2016. Despite the reduction in prescription rate in Pennsylvania in 2016, drug-related overdoses continued to rise. Notably, fentanyl misuse attributed to 65% of drug-related overdoses between 2015 to 2017. Fentanyl contributed to an increase in drug-related deaths as PA’s drug-related overdoses deaths rose from 26 per 100,00 in 2015 and to 43 per 100,000 in 2017.5 PA had the 3rd highest death rate from drugs in 2018 with 65% of overdoses involving opioids.6
Figure 2. amfAR Opioid & Health Indicators Database. Pennsylvania Opioid Epidemic. Retrieved from https://opioid.amfar.org/PA.
Balmert et al. analyzed Pennsylvania opioid-mortality trends relative to demographics from 1979 to 2014. (Figure 3) During this time frame, five counties, Allegheny, Berks, Erie, Lehigh, and Philadelphia, had the largest number of opioid-related deaths. Since 1982, Philadelphia county has had the highest number of opioid-related deaths. Interestingly, Allegheny County almost reached as high as Philadelphia County in 2013. Philadelphia County has continued to have the highest rates of accidental poisoning in the black population, while suburban or rural Pennsylvania counties such as Bucks County and Carbon County, have had the highest rates for white population within the age range of 25-34. In addition, the investigators found that the largest rate of deaths was among those aged 25-34 in both genders and found that all age groups continued to rise.7
Figure 3. Balmert LC, Buchanich JM, Pringle JL, Williams KE, Burke DS, Marsh GM (2016) Patterns and Trends in Accidental Poisoning Deaths: Pennsylvania’s Experience 1979-2014. PLoS ONE 11(3): e0151655. doi:10.1371/journal.pone.0151655
The Joint Intelligence 2018 Report from the DEA Philadelphia Division continued to evaluate the trends found in Balmert et al. beyond 2014. (Figure 4) Their study showed a similar trend in drug-related overdose deaths among the similar counties from 2015-2017 as shown in Figure 4. They similarly found 70% drug-related overdose deaths were males to females with a similar growth in age groups 25-34 in both genders. They also found that urban counties were found to have a higher number of drug-related overdose deaths (67%) than in rural counties (53%) between 2015 to 2017.5
Figure 4. Drug-related overdose deaths among the PA counties from 2015-2017. DEA Philadelphia Division and the University of Pittsburgh. (September 2018). The Opioid Threat in Pennsylvania September 2018 Joint Intelligence Report. DEA-PHL-DIR-036-18.
In conclusion, Pennsylvania still continues to struggle with combatting the opioid epidemic. From 2010 to 2020, there has been a steady increase in opioid-related deaths. This can be attributed to a variety of factors, but synthetic opioids have played a major role in the increase in accidental overdose deaths. When looking within Pennsylvania counties, Philadelphia County still remains the highest in number of accidental poisonings. The studies still find that urban counties still show larger opioid-related deaths than rural areas. Pennsylvania still has a long road ahead in combatting this epidemic.
 Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. Available at http://wonder.cdc.gov.
 Understanding the Epidemic. Atlanta, GA: CDC, National Center for Injury Prevention and Control; March 19, 2020. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html.
 Scavette, Adam, (2019), Exploring the Economic Effects of the Opioid Epidemic, Economic Insights, 4, issue 2, p. 1-7, https://EconPapers.repec.org/RePEc:fip:fedpei:00036.
 amfAR Opioid & Health Indicators Database. Pennsylvania Opioid Epidemic. Retrieved from https://opioid.amfar.org/PA.
 DEA Philadelphia Division and the University of Pittsburgh. (September 2018). The Opioid Threat in Pennsylvania September 2018 Joint Intelligence Report. DEA-PHL-DIR-036-18.
 NIDA. "Pennsylvania: Opioid-Involved Deaths and Related Harms." National Institute on Drug Abuse, 3 Apr. 2020, https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/pennsylvania-opioid-involved-deaths-related-harms Accessed 8 Sep. 2020.
 Balmert LC, Buchanich JM, Pringle JL, Williams KE, Burke DS, Marsh GM (2016) Patterns and Trends in Accidental Poisoning Deaths: Pennsylvania’s Experience 1979-2014. PLoS ONE 11(3): e0151655. doi:10.1371/journal.pone.0151655.