Pa. behind N.J. in tackling drug overdoses

July 01--When 24-year-old Gregory Humes overdosed on heroin on May 19, 2012, the people he was with drove him to Chester County Hospital and left him outside in his car without alerting anyone. They likely feared arrest.

An increasing number of states grant immunity in such cases, to encourage calls to 911. They also allow first responders as well as friends and family to carry the overdose-reversal medication Narcan.

Pennsylvania does neither. New Jersey does both.

"When I went to pick up my son's belongings," David Humes said, "the detective said, 'If we had a 911 Good Samaritan law or a Narcan law here, your son might still be alive.' "

Pennsylvania, with the nation's seventh-highest drug death rate in 2011, also lacks a database that would help doctors limit excess narcotics prescriptions, which sometimes lead to use of street heroin. And workers compensation patients in Pennsylvania receive twice as many painkillers as those in New Jersey, where fatal overdoses are well below the national average.

New Jersey has moved faster and more forcefully to save lives threatened by soaring use of pharmaceuticals.

"I don't understand it," said Corey Davis, a North Carolina-based attorney with the National Health Law Program who studied databases around the country that allow physicians to check whether patients are "doctor-shopping" for prescriptions, a sure sign of abuse. "Forty-eight of those states have programs that are -- I don't know how to say it -- more modern than Pennsylvania," he said.

That could change soon. The Assembly may approve a monitoring program for physicians this week, three years after legislation was first introduced. Bills that would encourage calls to 911 and expand use of overdose-reversal medication are also on the agenda.

Naloxone (brand name Narcan) can be safely administered by non-medically trained people in an overdose situation, when every minute counts. Monitoring programs have been found to sharply reduce doctor-shopping, although limiting prescriptions for people who are addicted could push some to use heroin to avoid withdrawal sickness.

"It must be done in tandem with increased access to treatment and increased access to naloxone," said Alice Bell, coordinator of the Overdose Prevention Project in Allegheny County. "It's like squeezing the balloon in one place and its coming out somewhere else."

There was a small increase in heroin overdoses when Florida cracked down on pill mills a few years ago, said Len Paulozzi, an epidemiologist at the Centers for Disease Control and Prevention, but that "was dwarfed by the decline in opioid analgesics."

Gov. Christie publicly embraced the issue last year, signing a bill to protect drug users from prosecution when reporting an overdose with the rock star Jon Bon Jovi at his side. The bill also made it easier to distribute overdose medication to laypeople. Last month Christie expanded statewide a pilot program to equip police and first responders.

Gov. Corbett has held news conferences to launch a statewide drug take-back program convene a working group on opioid addiction and overdose. A task force he appointed last July to promote safe prescribing guidelines is expected to report this month.

"It is a very challenging situation when there are many patients" -- particularly cancer patients -- "that need to be treated with these medications and yet we know that there is this potential for addiction and diversion," said Carrie DeLone, a task force cochair and state physician general.

Medical use of prescription painkillers has risen by a factor of 10 nationwide since 1990.

Yet "in general, narcotics have not been found to be very successful in treating chronic pain," DeLone said.

You wouldn't know that from workers comp.

An injured worker out more than seven days without surgery in Pennsylvania typically is prescribed twice the amount of narcotics as one in New Jersey, according to a recent report by the Workers Compensation Research Institute.

The Cambridge, Mass.-based nonprofit found that the average morphine equivalent per claim in Pennsylvania (2,745 mg) was third-highest of the 25 states that account for most workers comp benefits. New Jersey's (1,316 mg) was fourth-lowest.

"What that means is that an injured worker in Pennsylvania receives a 5 mg Vicodin every four hours for three months," said Vennela Thumula, a policy analyst and coauthor.

The reason is suggested by the focus of another institute report. Doctors in Pennsylvania can dispense directly to patients. Workers comp will pay a percentage above whatever is designated as the average wholesale price. Commercial insurance, Medicaid, and Medicare will not.

Many of the medications are provided by companies that buy in bulk and repackage them in different quantities with new wholesale prices. They openly market their services to doctors as an income multiplier.

Physician-dispensed ibuprofen costs workers comp 73 cents per pill in Pennsylvania, vs. 26 cents from a pharmacy. Generic Percocet costs $3.11 vs. 64 cents.

New Jersey limits physician dispensing to a seven-day supply. The portion of workers comp payments that went for physician-dispensed prescriptions there increased from 9 percent in 2008-09 to 12 percent in 2011-12, the institute found. In Pennsylvania, it rose from 18 percent to 38 percent.

In workers comp, "you don't see a co-pay and you don't see a bill," said Rep. Marguerite Quinn (R., Bucks), sponsor of a bill that would limit physician dispensing to 15 days.

It passed the House unanimously in April but faces opposition from repackaging companies and orthopedists, who do much of the physician dispensing.

The bill had been scheduled for a vote last week in the Senate Labor and Industry Committee but was pulled from the agenda.

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