Pennsylvania leads the nation - New Jersey is fourth - in drug overdose deaths among young adult men, according to a new analysis, raising the local level of urgency about an epidemic that over the last decade has killed more than twice as many Americans as homicide.
Bucks and Gloucester Counties led their respective states in overdose fatality rates among males ages 19 to 25 - each of them nearly three times Philadelphia's rate. In the eight-county region, more than 100 young men a year are dying from overdoses of both illicit and legal drugs.
The state numbers are included in a report on teen substance abuse released Thursday by the Trust for America's Health. The public health nonprofit examined federal statistics for 2011-13 filtered by age and sex. An Inquirer analysis did the same at the county level.
Pennsylvania, with 30.3 deaths per 100,000 young-adult male residents, was less than one-tenth of a point higher than No. 2 New Mexico.
But when all ages and genders are combined, Pennsylvania ranks ninth, with a death rate that is two-thirds that of the worst state, West Virginia. New Jersey's overall rate is below the national average.
The difference has to do with the far-higher overdose rates in middle age. But state-by-state variations depend on numerous factors, including occupation. For instance, West Virginia disability-claims records suggest many coal miners were prescribed addictive painkillers.
The new report focuses on teens and young adults, to make the point that stepped-up prevention efforts when youngsters are still in high school could have a major impact on deaths later on. Overdose fatality rates for ages 12 to 18 are one-tenth those of young adults.
"The opportunity to do prevention work is when they are still in school, that captive audience," Jeffrey Levi, the foundation's executive director, said in an interview.
Patterns of drug use as teens transition into adulthood are not well understood, Brian Bumbarger, a founding director of the EPISCenter at Pennsylvania State University, said Thursday.
The report praised the work of Bumbarger's center (the acronym stands for Evidence-based Prevention and Intervention Support), a statewide collaboration of several agencies and efforts. It also scored states on how many of 10 recommended policies they had adopted, from bullying prevention to mental-health funding. New Jersey was one of only two states with a perfect 10; Pennsylvania was above average with seven.
The indicators mainly seemed to indicate how little is known about teen addiction.
But why would young adults in Pennsylvania be any different from those elsewhere? And what explains the higher rates in the suburbs? Bucks, Montgomery, and Delaware Counties all have much higher fatality rates than Philadelphia (Chester County is also lower). Gloucester, Camden, and Burlington Counties are above the New Jersey average.
Jeanine M. Buchanich, who studies overdose data at the University of Pittsburgh's Graduate School of Public Health, said that patterns in some parts of Pennsylvania seem to be an extension of neighboring Appalachian states, where prescription painkiller addiction is greatest.
Over the last decade, painkillers have become a major gateway to heroin. Some people who are addicted to synthetic prescription opioids move on to the substance derived from opium poppies to avoid withdrawal sickness when they can no longer afford the pricier pain pills.
Buchanich cited a couple of reasons for the suburban death rates. One is essentially the result of "competing risk": Philadelphia loses so many young men through homicide that overdose rates are lower.
The other, which she attributed to research by the journalist Sam Quinones for his recent book Dreamland: The True Tale of America's Opiate Epidemic, is that Mexican drug importers years ago targeted suburban areas, where painkiller use was already high, in an effort to avoid urban drug gangs.
Overdose deaths have leveled off in some parts of the country in recent years. "Unfortunately, Pennsylvania is not one of those places so far," said Buchanich, who has seen more recent data than what were used for the new report on teens and young adults.
A separate, just-released Drug Enforcement Administration analysis of overdose fatalities in Pennsylvania noted that some of the cheapest and purest heroin in the nation passes through Philadelphia. Extremely potent heroin can be snorted or taken orally.
Roland Lamb, director of Philadelphia's Office of Addiction Services, pointed to a report that "heroin tablets" disguised as the prescription opioid oxycodone, complete with similar markings, had been seized in New Jersey last year.
"The idea is that with swallowing, you have less of an aversion" compared with injecting it, he said.
A decade ago, Mike Pelone started taking OxyContin and Percocet that he purchased on the street while living in Bucks and Montgomery Counties.
A 2005 graduate of Wissahickon High School, he went through rehab three times. In August 2010, after 90 days of sobriety, "he scored some heroin, got high, and died," said his father, Michael J. Pelone. He was 23.
Despite the tragic end to a five-year struggle, Pelone said, Mike's family had learned to accept his addiction as a form of chronic disease, as the medical profession has in recent decades. He wishes everybody would.
"There are no annual parades or ribbons to wear for them," Pelone said. "Just a robust stigma remains, with plenty of 'what ifs' and 'whys' from the folks who know so little of drug addiction."
Inquirer staff writer Chris Palmer contributed to this story.
Several Moves This Week Aimed at Drug Overdoses
Thursday's report, "Reducing Teen Substance Misuse: What Really Works," comes amid a flurry of activity to combat overdoses.
The Food and Drug Administration on Wednesday approved a nasal-spray version of the opioid overdose-reversal medication naloxone, which is increasingly being carried by police and other first responders. It is sold under the brand name Narcan.
The Pennsylvania Health Department recently announced a "standing order" for the medication, essentially meaning that pharmacies can provide it without a prescription to families and friends of people who are at risk of overdose. New Jersey allows this as well.
The American Medical Association on Tuesday called for a ban on direct-to-consumer advertising for prescription drugs and implantable medical devices, arguing that they are a factor in increasing health-care costs and encouraging patient demands for inappropriate treatment. Research shows that prescription pain relievers are not effective for chronic pain, but they are heavily advertised and frequently prescribed by doctors.
Federal advertising restrictions were loosened in 1997, and drug sales soared over the next decade. New Zealand is the only other country that allows prescription medication commercials on television with minimal regulation.
Also on Tuesday, the Obama administration released its 2015 National Drug Control Strategy. It encourages Congress to permit Medicare to review and restrict inappropriate prescribing. Private insurance companies and state Medicaid programs have used such reviews for years to reduce the use of addictive drugs. - Don Sapatkin