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Why Here?

Factors that contributed to the opioid epidemic in Pittsburgh.

By: Sara Makin, M.S.Ed.,NCC

If you’ve been paying attention to the news media in the last two years, you’re well aware of the opioid epidemic ravaging the United States. President Trump, after dragging his feet, recently declared the drug overdose epidemic a, National Public Health Crisis, the worst drug epidemic in history that would, in his words, “Require the resolve of our entire country.” Almost nowhere are people more keenly aware of that predicament than right here in Southwestern Pennsylvania.

Last year, according to the DEA, overdoses were up 37% in Pennsylvania to the tune of approximately 13 deaths daily, and this rate is steadily increasing. Out of ten counties in PA with the highest rates of overdose per capita, nine of them are in Southwestern PA. Allegheny County and the five surrounding counties all soar above the national average for opioid related deaths. There are myriad reasons this crisis has a stranglehold on the region, and they all work in lockstep to complicate the problem.

Aside from the too frequent and often unnecessary scribbling on prescription pads, a failed war on drugs, and the overwhelming impact of cheap and powerful narcotics like fentanyl, there are factors financial, institutional, and cultural at play. And unsurprisingly, they’re very difficult to track and understand.


 

The Allegheny Department of Human Services and the Allegheny Health Department recently completed a joint study on intervention tactics and said, “Our ability to implement evidence-based strategies is limited by the fact that much about the victims is unknown.” The fact is, it’s tough to help addicts with treatments that work effectively as they need more data from those who struggle with addiction in order to modify treatment. They also mentioned that it was difficult to identify other health factors that may have contributed to the deaths of patients, and cited many deaths occur when other drugs like barbiturates are present in victims. Perhaps the most frustrating part of this ordeal is that experts say drug abuse in this region is old hat.

“Addiction in Southwestern PA is not new. When I first started working in the field in the early 80’s, heroin and other opioids were the primary drugs being used, and similar issues with overdoses were going on. Then crack cocaine displaced the opiates, and things have come back around to opiates being the primary drug being used. The difference that I have seen is the age of those who are using, and the age they are starting. Back in the 80’s those who we were seeing for heroin usage were older, in their forties, fifties, and sixties, and they had progressed through other drugs to the point of settling into heroin,” said Kevin Kordzi, Medical Education Unit Director at Resources for Human Development who directs a community residential program for individuals with mental health and substance abuse issues who are returning from prison called, Capitalizing on a Recovery Environment.

“In the late 90’s, I was working in Butler County when heroin first began sweeping through the county. The ages of people who were using changed dramatically as teenagers and young adults were the ones using heroin. And typically they started by snorting the drug with the false belief that they couldn’t get addicted if they snorted it rather than injected it. As heroin became more common, opiate-based pain pills were being prescribed much more readily, and once people got cut off by the doctors, the already established availability of heroin was an easily accessible replacement,” said Kordzi.

Abuse of narcotics is a long term problem for Southwestern PA, so, too, is the state of the economy. Experts see poverty and drug abuse going hand in hand.

“Economics seems to be the common thread within the progression of drug usage and the types of drugs being used. In the 80’s, people began avoiding needles, and crack was readily available and cheap. When heroin returned, it was cheap and highly potent, which allowed people to snort it rather than inject it, so they convinced themselves that they really weren’t addicts because they weren’t injecting. However, as the person’s addiction progressed, it was cheaper and more efficient to inject, so they did. Recently, economics again entered the picture as fentanyl in its various forms has taken over, and to a large part, displaced heroin due to cost and potency,” said Kordzi.

The infrastructure of roadways in and around Pittsburgh and Washington County and their proximity to opioid-rich areas, makes bringing drugs into the greater Pittsburgh area fairly simple. Our road systems connect us to West Virginia, Ohio, and other parts of Pennsylvania that all suffer from higher than average overdose related deaths.

“First of all, we are part of a larger region that has experienced significant problems from opioids that includes much of the Northeastern United States, West Virginia, and Ohio. But from the onset, Southwestern PA unfortunately was ahead of many of these regions, and still is, with the magnitude of the problems that we experience,” said Neil A. Capretto, Medical Director of Gateway Rehab.

“For many of the towns and communities in Southwestern Pennsylvania that were economically depressed and still trying to recover from the loss of the steel mills, these prescription opioids became a valuable commodity on the streets, and literally created an underground economy. The price of oxycodone was initially going from $.50- $1.00 per milligram, and now it is usually one dollar or more per milligram, and the average person we were treating was using 180 mg or more per day,” said Capretto.

“To make matters even worse in what I often refer to as the perfect storm, at the same time the cartels in Mexico started producing very high purity heroin, and started a very elaborate and intensive distribution system in Southwestern Pennsylvania. They knew that there were now thousands of new people addicted to prescription opioids which, at some point, would lose their access to their supplier of the prescription opioids, or would no longer be able to afford [prescription drugs] as they developed higher tolerance. Without them, they would get very sick, and dealers would offer them this new and stronger heroin that would give them the same effect at about 20-25% of the daily cost. By the thousands, people in our region switched from prescription opioids to heroin use. Probably at least 80% of all new heroin users in our region started with prescription opioids. This has unfortunately led to increasing and record numbers of overdose deaths. To make matters even worse, in the last one to two years there is a growing pattern of replacing heroin with synthetic opioids, such as fentanyl and derivatives of fentanyl, which can be 50-100 or even more times stronger than heroin. This is leading to even more record numbers of overdose deaths,” said Capretto.

There are some other factors in this region with negative impact. Before we dive into that, let’s go back to the crux of addiction: feeling a certain way, not liking it, and wanting to feel differently. The triggering emotion is negative, which leads to the question if there is anything particular in the environment in Southwestern PA that would impact our emotions negatively. There is extremely low sunlight in this area. Lack of sunlight normally leads to a Vitamin D deficiency, which can present as symptoms of depression. Another factor related to depression in lower income communities and food deserts, is poor diet and health. Nutritional deficiency leads to poor health, and its corresponding feelings of despondency. Certain chemical combinations in processed foods can lead to feelings of malaise, as well . Combine these factors with economic strain, a culture of addiction, the normalization of drug use, and an overabundance of cheap, high-quality narcotics, and the resulting situation is one where drug use can become rampant.