CHICAGO — Illinois emergency rooms experienced a 66 percent jump in opioid overdose visits last year, according to a new report that suggests the epidemic of heroin and prescription painkiller abuse continues to worsen in some states.
The federal Centers for Disease Control and Prevention released state emergency room data Tuesday in a report that encourages hospitals and health departments to do more to combat outbreaks and prevent repeat overdoses.
The report found there were more than 142,000 ER visits for suspected opioid overdoses between July 2016 and September 2017 in 45 states, which represented a 30 percent increase from the third quarter of 2016 to the third quarter of 2017. In 16 states hard-hit by the opioid epidemic, ER visits from overdoses rose 35 percent during that time.
The increase was worst in the Midwest and in large metropolitan areas.
In the Midwest, Wisconsin saw a 109 percent jump in suspected opioid overdose visits. Visits rose 35 percent in Indiana, 28 percent in Ohio and 21 percent in Missouri.
Data from ER visits, rather than overdose deaths, is useful because they show when and where people are overdosing, information states can use to identify where resources are needed, said Dr. Anne Schuchat, acting CDC director, in a conference call Tuesday with reporters. An ER visit also is a time when people can get help before their drug use kills them.
"We don't have to wait until it's too late," Schuchat said.
The report found that urban centers saw a greater increase in overdose visits than rural areas, which have traditionally been seen as the hardest hit by the nation's opioid epidemic.
Schuchat said that could reflect changes in the drug supply in urban centers like Chicago, where the practice of cutting heroin with fentanyl has exacerbated drug toxicity. But it could also be a statistical anomaly since that data was collected from just 16 states.
Dr. Nirav D. Shah, director of the Illinois Department of Public Health, said the rise in overdoses in the state is not unexpected given the upsurge in fentanyl-laced heroin across the state.
"This increase reinforces the need for us to work together: government, health care, behavioral health, community-based organizations, substance use disorder treatment programs, clinicians, pharmacists, law enforcement, and others, to implement strategies to help reverse the growing epidemic," Shah said in an emailed statement.
Among the solutions is increasing access to medication-assisted treatment, which combines behavioral therapy with medication to reduce withdrawal symptoms, Shah said. He also calls for increasing the availability of naloxone, which reverses the effects of overdoses, and working with law enforcement.
At Loretto Hospital in Chicago's Austin neighborhood, there has been a steady increase in opioid-related admissions over the past year, said Dr. Sandeep Mellacheruvu, director of behavioral health. It is typical to see overdose increases at the start of the month, when many people get their paychecks, but the spikes could also be due to growing fentanyl use, he said.
Loretto is expanding its program to include medication-assisted treatment, Mellacheruvu said. It also is increasing community outreach efforts to nursing homes to help address prescription opioid addiction among the elderly.
The crisis is gripping Illinois' urban and suburban communities alike.
Dr. Thomas Eiseman, an addiction medicine specialist at Northwestern Medicine Central DuPage Hospital in west suburban Winfield, said there has been a noticeable increase in opioid-related visits over the last six months to a year, both among bored, disaffected youths and middle-aged users.
Increasingly, users are shifting from heroin to stronger synthetic opioids such as fentanyl, and recently Central DuPage Hospital experienced its first death from carfentanil, which is 100 times as potent as fentanyl and 5,000 times as potent as heroin.
"It's the scariest thing I've ever seen in my career," Eiseman said.
Central DuPage recently added seven beds, for a total of 20, to its adult inpatient detox and residential program, and is offering several new patient education groups on overdose prevention and withdrawal-reduction drugs. It is also extending medication-assisted treatment to outpatients, and Eiseman emphasizes the importance of behavioral therapy to help patients work through the life issues that led them to abuse drugs in the first place.
After the Midwest, where opioid overdose visits rose an average of 70 percent, the largest regional increase was in the West, where the rise was 40 percent.
In the Northeast, opioid overdose emergency room visits rose by 105 percent in Delaware and 81 percent in Pennsylvania. But some states that historically have had the worst opioid problems, including West Virginia, Massachusetts, New Hampshire and Rhode Island, experienced small decreases in overdose visits.
In the Southeast, which at 14 percent had the lowest regional increase in overdose visits, Kentucky reported a statistically significant decrease of 15 percent.
It isn't clear if that's because those hard-hit states have been devoting resources to tackle the problem for longer and are seeing success, or because their rates were so high that they couldn't get higher, Schuchat said.
Chicago-area hospitals cut back on opioids to battle addiction epidemic »
"We hope that it's a positive sign that will persist," she said. But, she later added, "whether we are seeing real, true persistent declines or they are statistic fluctuations, we just don't know yet."
At Mount Sinai Hospital in the North Lawndale neighborhood, medical director Dr. Jaime Moreno said he sees so many heroin-related problems in his ER that it is hard to tell if there has been an increase. Overdose visits alone don't capture the severity of the problem. Many more people come in with infections, withdrawal symptoms and complications from missing routine appointments like dialysis because they were busy getting high, he said.
But the hospital does little more than ensure patients are medically stable before discharging them with referral phone numbers to rehab services, Moreno said.
Moreno said he has started conversations with community clinics about beginning medication-assisted treatment in Sinai's ER and then handing patients off for further rehab. That would involve training hospital physicians to administer the first dose of medications that reduce patients' opioid withdrawal symptoms so that they aren't sent out into the city without any defense against the itch for their next fix.
"There's a lot more we can do," he said.