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PHILADELPHIA, PA - JULY 20: Art Gutierrez, 42, holds an orange container, "trash can," filled with heroin powder, that he bought on Thursday, July 20, 2017, in Philadelphia, PA. Gutierrez who grew up in California, has been using heroin for two year and during that these two years he has contracted HIV and Hep C. (Photo by Salwan Georges/The Washington Post via Getty Images)

Deaths during opioid-driven hospital stays have quadrupled

Opioid-driven deaths during hospital stays in the United States quadrupled between 1993 and 2014, according to a new study released Monday.

The rate of opioid dependence diagnoses tapered during this period, according to the study, though the rate of opioid or heroin poisoning diagnoses climbed steadily.

Zirui Song, an assistant professor of health care policy at Harvard Medical School and a physician at Massachusetts General Hospital, launched the study in 2016 as a way to better understand the patients he treated. He analyzed nearly 385,000 hospital stays involving patients who were admitted for opioid use with data from the National Inpatient Sample of the Healthcare Cost and Utilization Project, a national database compiled by the Agency for Healthcare Research Quality.

Song’s research shows that by 2014, four times as many patients were dying from opioid-related causes in the hospital, rising from 0.43 percent before 2000 to 2.02 percent, the study said.

“That was a striking finding,” Song said.

The study found that patients admitted to the hospital for opioid use skewed young — 39 years old on average — and white. From 1993 to 2014, the number of black and Hispanic patients admitted to hospitals for opioid or heroin poisoning remained fairly stable. But that rate among white patients doubled between 2007 and 2013; with about 30,000 cases, they were the “largest and fastest-growing share of hospitalizations” in recent years, according to the study published Monday in the journal Health Affairs.

Why are people dying with opioids in their bodies after they arrive at the hospital? Song said the data alone can’t answer that question, but he offered a few possible explanations.

The presence of fentanyl and heroin nationwide is growing in communities across the country, often at prices that are cheaper than prescription opioids, such as oxycodone, he said. And efforts to treat people where they are — in the field, or at clinics or urgent care facilities — could mean that hospitals tend to admit patients who “are higher risk and more severe,” he said.

Song said the study is intended to raise awareness of the need for better strategies for hospitals when patients are admitted for using opioids, in addition to continuing and improving public health and community strategies already underway.

Michael Botticelli, who served as drug czar during the Obama administration and currently directs the Grayken Center for Addiction at Boston Medical Center, said the study makes the case for more hospitals to adopt intervention and treatment programs to combat the nation’s ongoing opioid epidemic and rising number of overdose deaths.

In 2016, an estimated 64,000 died from drug overdoses nationwide, according to preliminary data from the Centers for Disease Control and Prevention. Of those, 20,000 were linked to use of synthetic opioids, including fentanyl; another 15,000 people fatally overdosed on heroin.

President Donald Trump declared the opioid epidemic a public health crisis, which called for action but dedicated no new money to the cause. A commission established by Trump and chaired by New Jersey Gov. Chris Christie issued 56 recommendations for how the country could better fight the crisis, including a mandate for ongoing training for physicians, dentists and health professionals before they can write an opioid prescription and more funding and research into alternative pain management therapies.

“It’s really important that we continue and that the federal government continues to pour much-needed resources into fighting this epidemic,” Botticelli said.

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