Pubdate: Fri, 6, Jan 2017
Source: Baltimore Sun (MD)
Copyright: 2017 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author: John Moore

OPIOID USERS FILLING MARYLAND HOSPITAL BEDS AND EMERGENCY ROOMS

Family members of those who died of opioid overdoses embrace at the "Fed
Up!" rally to end the opioid epidemic on September 18, 2016 in Washington,
DC. Some 30,000 people die each year due to addiction to heroin and other
opioids.

Family members of those who died of opioid overdoses embrace at the "Fed
Up!" rally to end the opioid epidemic on September 18, 2016 in Washington,
DC. Some 30,000 people die each year due to addiction to heroin and other
opioids. (John Moore)

Maryland has the nation's highest rate of hospitalizations for opioid use,
according to newly released federal data that illustrates the depth of the
addiction problem in a state where many people have died from overdoses of
the drugs.

Tens of thousands of people are admitted to state hospitals or visit an
emergency room each year related to opioid withdrawal, overdose or
complication, according a decade's worth of statistics provided by the
U.S. Agency for Healthcare Research and Quality.

Those numbers far eclipse the 1,259 deaths from all drug and alcohol
overdoses in Maryland in 2015 and the 1,468 fatal overdoses in the first
nine months of 2016.

"It's an epidemic, and it's only increasing in numbers," said Dr. Chirag
Chaudhari, chair of the emergency department at the University of Maryland
Baltimore Washington Medical Center in Glen Burnie. "As more and more
attention is paid to it and resources become available, we hope to see
declines."

The rate of hospital admissions in Maryland was 362 for every 100,000
residents in 2014, the most recent year for which the federal data is
available, far exceeding the national average of 225. Maryland's rate was
eight times Iowa's rate of 44.

Drug overdoses now kill far more Marylanders and Americans than car
crashes and homicides, and officials already know 2016 will be far worse
than the year before.

There were 1,468 fatal overdoses statewide through September of this year,
eclipsing the 1,259 deaths for all of 2015, Maryland's health...

Drug overdoses now kill far more Marylanders and Americans than car
crashes and homicides, and officials already know 2016 will be far worse
than the year before.

There were 1,468 fatal overdoses statewide through September of this year,
eclipsing the 1,259 deaths for all of 2015, Maryland's health... (Meredith
Cohn)

The ranking didn't surprise health officials who know that prescription
painkillers and heroin have had a long-standing grip in Maryland and
particularly Baltimore. But several said Maryland's numbers may be higher
because of the state's comprehensive hospital reporting standards.

The state's Health Services Cost Review Commission collects wide-ranging
hospital data from billing records and uses it to help set hospital
prices, an unusual arrangement that requires thorough accounting. As a
result, Maryland looks worse compared with the other 46 states and
Washington, D.C., that voluntarily report billing data to the federal
agency.

The federal data shows that the rate of emergency room visits in Maryland
was 288 per 100,000 residents, exceeding the national average of almost
178.

The data also show that the epidemic affects men and women and people of
all ages and backgrounds in Maryland.

Rural and suburban areas had rates of opioid-related emergency visits
above the national averages, but the heavy concentration in the Baltimore
area stunned federal researchers. Many other states showed opioid
addiction growing more rapidly or at least more evenly in non-urban areas.

"It's a much bigger disparity than anywhere else," said Anne Elixhauser, a
senior research scientist at the Agency for Healthcare Research and
Quality.

The rate of emergency visits in Baltimore, the state's only large
metropolitan area, was 977 per every 100,000 residents. Nationally, it was
177 for big-city regions.

Dr. Gentry Wilkerson, an emergency room doctor at the University of
Maryland Medical Center in Baltimore, said there was nothing different
about patients in Baltimore or Maryland compared with other states.

Baltimore, however, seemed to have a "culture" of heroin that has endured
when other drugs like cocaine came into fashion elsewhere, said Wilkerson,
also an assistant professor in emergency medicine at the University of
Maryland School of Medicine. The relationship, he added, continues to
grow.

He counted one person coming to his emergency room every other day for
opioid overdose in 2015. In 2016, it increased to an average 1.2 people a
day. That doesn't count those with other complications from opioid use.

"It is a ton of visits," he said, and likely fueled most recently by
illicit fentanyl, a powerful opioid mixed into heroin unbeknownst to users
that say it hit them "like a ton of bricks."

The admission rate in Maryland has long been high. However, it was one of
four states that logged a slight drop in the rate of overall hospital
admissions, potentially reflecting how patients are now treated, emergency
room doctors say.

For example, Maryland's Medicaid health program, which covers low-income
residents, no longer allows patients suffering withdrawal symptoms from
opioids to be admitted after an emergency department visit. Maryland
hospitals also operate under a unique agreement with federal regulators
that switches their emphasis to health outcomes from fee-for-service,
eliminating the incentive to admit patients who may not need it.

Many opioid abusers no longer need to be admitted, said Dr. Michael
Fingerhood, chief of the division of chemical dependence at Johns Hopkins
Bayview Medical Center.

The widespread use of naloxone, an opioid overdose antidote that has few
lingering effects, and buprenorphine, a treatment drug that can mitigate
harsh withdrawal symptoms and cravings, has made hospital admissions less
necessary, Fingerhood said.

Those who are admitted must have some kind of complication or other
disorder, including alcohol withdrawal that can be fatal, he said.

He said other states could see drops in admissions for opioid use in
coming years as they adopt emergency room treatments and change their
models of care, even if emergency room visits remain high, he said.

The epidemic has so far proven stubborn to control.

"A huge number of people aren't in treatment," Fingerhood said.

Hopkins, the University of Maryland Medical System and other hospital
systems that have long directed opioid-addicted patients to treatment
programs outside their facilities are now becoming more aggressive in
directly addressing the issue. They have launched or plan to begin efforts
to train the patients to use naloxone for revival from an overdose and
start them on buprenorphine-based treatment while they are in the
emergency rooms.

The programs will target all comers.

"I'm thankful that we at least have the potential to reduce the problem,"
said Wilkerson of the University of Maryland Medical Center.
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