Hospitalizations for opioid overdoses are increasing among Black and Hispanic Pennsylvanians, study finds

Although Pennsylvania is seeing fewer people hospitalized for heroin and opioid painkiller overdoses, the racial divide in those affected is widening, a new research brief has found.

Black and Hispanic people in Pennsylvania are increasingly being hospitalized for heroin and opioid painkiller overdoses, even as white Pennsylvanians are ending up in hospitals for overdoses less often, according to an analysis by an independent state agency that reviews trends around health-care costs.

The research shows that overall, hospitalizations for opioid overdoses in the state decreased by 27% between 2016 and 2021. And most of the drop was due to a decrease in heroin overdose admissions, while hospital admissions for prescription painkiller overdoses stayed mostly steady.

The increases in hospitalization among Black and Hispanic residents are in line with similar increases in the overdose death rate in those communities — a sign of the growing racial disparities in Pennsylvania’s opioid crisis.

» READ MORE: Decades into the opioid epidemic, Black Philadelphians are dying of overdoses at the same rates as white residents, and the death toll is breaking records.

The analysis of data collected from medical diagnostic codes during hospital admissions by the Pennsylvania Health Care Cost Containment Council (PHC4) found:

However, PHC4′s data likely do not present the full picture of hospitalizations for overdoses in the state, said Jeanmarie Perrone, an emergency medicine physician at the University of Pennsylvania, and the school’s director of the Division of Medical Toxicology and Addiction Medicine Initiatives.

The report does not include emergency-room visits for opioid overdoses, but rather shows only people admitted to the hospital for more serious complications after an overdose.

And hospital admissions for fentanyl overdoses were not broken out as a unique category in PHC4′s hospital admission data until the last quarter of 2020. (Fentanyl is a synthetic opioid, significantly more potent than heroin, which has replaced much of Philadelphia’s heroin supply in recent years.)

People hospitalized for a fentanyl overdose between 2016 and the first three quarters of 2020 were categorized under the diagnostic codes for a painkiller overdose, the agency said.

In 2021, the first full year for which fentanyl overdose hospitalization data is available, the agency found that about 18% of all opioid overdose hospitalizations involved fentanyl. And among hospitalizations for overdose where the patient died, 34% were for fentanyl overdose.

In Philadelphia, many people who survive an opioid overdose are revived by friends, outreach workers, or bystanders and don’t go to the hospital, Perrone said. The number of overdose victims admitted for a hospital stay from the emergency room is also relatively small compared with the total number of overdoses she treats.

“Many opioid overdoses don’t get admitted, or even get transported to the hospital much of the time,” she said. “It doesn’t really reflect what’s happening in the trenches.”

Jen Smith, the secretary of the state Department of Drug and Alcohol Programs, said the findings underscore why the state must conduct better outreach in communities of color, which appear to be less equipped to handle the recent influx of fentanyl in the drug supply.

“I think a lot has been done in the space around educating people about naloxone — getting it into communities, getting it into households, but I’m not sure we did a great job of getting it into Black communities,” she said.

She noted that even the limited data on hospital admissions are in line with trends that state officials have been observing.

An analysis by The Inquirer of federal data on overdoses found that deaths among Black Philadelphians have risen by 70% since 2018, and deaths among white residents have declined slightly, by 9%. The rest of Pennsylvania has seen the rate of Black deaths double over the same period.

Black Pennsylvanians outside Philadelphia have been far likelier to die of overdoses than their white counterparts for about three years.

This article has been updated to include information about how fentanyl overdoses were categorized in hospital discharge data before the fourth quarter of 2020.