Fastest rise in Pa. overdose deaths: White women

Accidental drug deaths among whites, women, and people ages 35 to 44 are much higher and rising far faster in Pennsylvania than nationally, according to a detailed analysis released Thursday that covers more than three decades.

The examination by researchers at the University of Pittsburgh goes well beyond the already worrisome data showing that the state's overdose fatality rates have exceeded the national average by more than 50 percent in recent years. Between 1979 and 2014, for example, U.S. death rates rose sixfold, data from the National Center for Health Statistics show.

Yet in Pennsylvania, these deaths increased by a factor of 14. (New Jersey's fatal overdoses went up slightly more than the national average.) White Pennsylvanians? Up 16 times. The state's women? Up 17 times.

The paper, published in the open-access journal PLoS ONE, did not address reasons for the differences. What's happening in Pennsylvania may simply reflect national trends, but amplified. Overdose fatalities everywhere are trending toward younger people and whites, who often live in the suburbs, as more prescriptions for potentially addictive pain pills are written there. Women are more likely to be prescribed opioids for pain.

About 5 percent of those who abuse prescription drugs move on to heroin to avoid withdrawal sickness, other research has found.

And Pennsylvania has unusually cheap, pure, and easy-to-find heroin, Jeanine M. Buchanich, a coauthor of the new study and a research assistant professor of biostatistics at Pitt's Graduate School of Public Health, said in an interview.

Overdose risk is especially high when tolerance has declined - typically when someone is released from jail or rehab, or returns to a group of old friends after a period of abstinence.

That apparently is what happened to Jennifer Rose Werstler, who had been living in a halfway house in Florida following her release from rehab in West Palm Beach.

A judge in Chester County insisted that the former manager of a burger place in Newtown Square return home for a hearing on drug paraphernalia possession charges. Her parents, who live in the house where she grew up in East Goshen Township, said they pleaded for understanding, fearful that she would meet up with old friends.

The judge turned down the request, so Werstler flew home and went to court. She went out the next night to celebrate her birthday with friends, who scored some heroin in Philadelphia. A video camera captured her two friends leaving a KFC restaurant. Werstler was found unconscious by an employee in a bathroom stall.

She died in the emergency room on May 9, 2014. It was her 20th birthday.

Release from rehabilitation is a dangerous time because addiction affects the brain's "ability to make a decision and impulse control," said Beverly J. Haberle, executive director of the Council of Southeast Pennsylvania, the regional affiliate of the National Council on Alcoholism and Drug Dependence. When a substance abuser returns to familiar surroundings - and users - "the automatic response to that kind of feeling is to use," she said.

The federal data used for the new study have been around for years but independent researchers have not published analyses that went this deep or back so many years for any state, said Buchanich. The paper examined accidental drug poisonings for ages 15 to 64 in various demographic groups beginning in 1979; earlier data are not comparable.

When it comes to drugs, 1979 seems like another world. It would be nearly two decades before the government permitted prescription drug advertising on TV, considered a key driver in the demand for opioid painkillers once reserved for cancer pain.

In 1979, four black women died of accidental overdoses throughout Pennsylvania; in 2014, there were 101 deaths among black women. For white women, 34 in 1979 and 719 in 2014. Chester, Burlington, and Camden Counties recorded three deaths apiece in 1979; their respective totals for 2014 were 71, 64, and 62. Even in Philadelphia, there were just 17 overdose deaths in 1979, compared with 480 recorded 35 years later.

Among black men statewide, death rates peaked among 55- to-64-year-olds. For white males, it was ages 25 to 34.

Buchanich speculated that those differences were due to choice of drugs. African Americans are more likely to use crack and cocaine, and "they are living longer as drug users," she said, while prescription pain pills and heroin may cause "a more rapid acceleration in whites to accidental overdose death."

Men die at far higher rates than women locally and nationally. But women are narrowing the gap, especially in Pennsylvania. For women who are white and ages 35 to 44, the 2014 overdose fatality rate was 141 times greater than in 1979.

Although it was unclear why women would be worse off in Pennsylvania, "women in general are more likely to pursue health care and they are more likely to be prescribed these therapies" - opioid painkillers - "for a medical reason," said Cynthia Reilly, a pharmacist and director of the Pew Charitable Trusts' Prescription Drug Abuse Project.

She said that women also are more likely to be prescribed benzodiazepines like Valium, which make overdoses more likely when used in combination with opioids.

Women also move on to more potent painkillers more rapidly than men, Buchanich said, a process known as telescoping.

While death rates have plateaued or declined in some states, "my sense in Pennsylvania is that we haven't reached our peak yet," she said, noting that the state's overall fatality rate increased an average of 8.3 percent annually over the last 35 years.

Caleb Alexander, a physician and pharmacoepidemiologist at Johns Hopkins Bloomberg School of Public Health, didn't see much positive news in the study.

"At the end of the day, things are getting worse for everybody, but they are getting much worse for certain groups," Alexander said.

dsapatkin@phillynews.com

215-854-2617

@DonSapatkin