As the number of drug overdoses continues to climb in Butler County, law enforcement officers and ambulance crews are saving people's lives.

But those life-saving miracles come with a cost that is straining the local health care system.

The cost of the opioid antidote naloxone that saves lives is just one part of the problem.

In Butler County, 74 lives were lost in 2016, and as of last week, there were 39 confirmed fatal overdoses this year.

Many others have overdosed, but have been saved by a timely application of naloxone — often called by its brand name Narcan.

Each dose of naloxone has a cost, each ambulance dispatch for an overdose has a cost and each autopsy performed on a person who died from a drug overdose also has a cost.

In some cases, these costs are covered directly with taxpayer money, while in other cases the costs put a strain on privately owned ambulance services and nonprofit medical providers.

Naloxone

When a person overdoses on an opioid, which includes prescription painkillers like morphine and street drugs such as heroin, their breathing is slow and irregular and they typically become non-responsive.

One or two doses of naloxone, which can be administered intravenously, intramuscularly or with an easy-to-use nasal spray, is usually able to return the patient's breathing to normal and the patient retains consciousness in a couple of minutes. The drug has few side effects.

Dr. Rachel Levine, Pennsylvania's physician general, on March 1, 2016, issued a standing order making naloxone available to the general public at pharmacies and billable to health insurance without a prescription.

The drug usually costs between $30 and $40 per dose for hospitals and emergency services and two-packs are sold at pharmacies range in price from $65 up to $150.

Naloxone is carried by ambulances, many police officers and firefighters, and is being found in more and more places. Some school districts in Butler County approved policies allowing school nurses to have naloxone stocked. Both Butler County Community College and Slippery Rock University have naloxone on their campuses.

Butler County Drug and Alcohol in June bought 540 Narcan kits, which contain two doses and cost about $75 each, to distribute to various agencies that work with people who may overdose. The county commissioners last year approved a policy that required more than 600 county employees to get trained in administering naloxone.

Ambulance services

Gene Troyan, director of operations for Butler Ambulance Service, said that for the past year the service has seen an average of one overdose call per day for its coverage area, which includes Butler Township, the city of Butler and numerous other townships in the central part of the county.

The calls seem to come in waves. Troyan said that the ambulance service can sometimes go several days without responding to an overdose, but then get dispatched to more than one in a day. Earlier this summer the service responded to five overdose calls in a 24-hour period, he said.

In nearly every case, an overdose patient who is revived with naloxone and is awake and alert will sign a patient refusal form, declining an ambulance ride to the hospital.

In the case of Butler Ambulance, it costs about $240 — not including the cost of naloxone — to have a two-person crew, one paramedic and one emergency medical technician, get in an ambulance and respond to an overdose call, Troyan said. That figure includes gasoline and maintenance for the vehicle, wages and supplies that are used on each call such as rubber gloves and a bag-valve mask to assist breathing.

Butler Ambulance will send a bill for about $240 to its overdose patients, though those bills are rarely paid, Troyan said.

“Very seldom do we recoup that, because it's noninsurance,” he said. Health insurance only covers ambulance transports and hospitalizations, he said.

The other effect of the frequent overdose calls is that it ties up emergency responders.

“If we are out on two overdose calls at one time that limits the number of vehicles we have available. That could delay response time to another emergency,” he said.

Butler Ambulance is a for-profit service, though many of its rates are fixed either by law or by insurance companies, meaning it can't charge more for some services to cover the costs of non-transport calls.HospitalsButler Health System pays its supplier about $30 for each dose of naloxone.Health system officials estimate that it will spend between $7,000 and $9,000 this year on naloxone alone, said Dr. David Rottinghaus, emergency department director. Most of that cost is not reimbursed and is considered a donation from the health system.The antidote is used frequently in the emergency room and BHS also supplies it to numerous nearby emergency service providers. The ambulance services that it supplies include Butler, Chicora, Petrolia and Slippery Rock.Since 2015, BHS has also provided naloxone to the Bruin, Butler city, Chicora, North Washington, Slippery Rock and Unionville fire departments. It has given out 172 kits to police and fire units during that time, said John Spryn, Butler Health System EMS Coordinator.The health system is also working on partnering with more agencies including police departments in the northern part of the county, Spryn said.UPMC has a similar arrangement to supply naloxone for free to some emergency service providers in the county including Cranberry Township EMS, Harmony EMS, Quality EMS, and the Cranberry Township volunteer fire and police departments. The naloxone is replaced on a one for one basis and UPMC provides free training, said Ashley Trentrock, UPMC spokeswoman.In some cases an overdose patient is brought to the hospital emergency room by a friend or relative where they can be revived by naloxone, though they may not get admitted for more treatment.Some do get hospitalized or seek further treatment after an overdose. The number hospitalizations for heroin overdoses have been “skyrocketing” across the state, according to a recent report by the Pennsylvania Health Care Cost Containment Council.According to the report, there were 1,524 hospital admissions in Pennsylvania for heroin overdoses in 2016, an increase of 66 percent from 2014. Overdose hospitalizations for pain medication and heroin cost public and private insurance plans $27 million in the state in 2016, the report said.While the problem can be discussed in terms of dollars, the effect on the community is even bigger, Rottinghaus said.“The biggest cost is the human tragedy and the cost of the individual who overdoses. Everything else pales in comparison to that. The tragedies are everyday,” he said.PolicePolice officers are notified and also called to the scene of many overdoses. Overdosing is not a crime, though possession of drugs or drug paraphernalia are typically misdemeanor offenses.Nearly every police officer in Butler County is equipped with naloxone and trained in how to administer it to a person who has overdosed.Around the country, the antidote is now considered a part of an officer's standard issue gear, along with flashlight and handcuffs, said Mark Peffer, chief deputy sheriff.“They sometimes get to the scene five to 10 minutes before the ambulance and if they see this is an active overdose, they administer naloxone,” he said.The Butler County Sheriff's Office has been distributing naloxone at no cost to municipal departments since 2015, when the county got a state grant. The cost of the grant was paid by the Pennsylvania Chiefs of Police Association.The county has a batch of naloxone through the grant that will expire March 2018, though it has also added to its supply with donations from Butler Health System.County grant writer Sean Pew is seeking another grant or funding source to continue the program, Peffer said.Most of the municipal police departments either get naloxone through the county program or have a relationship with a health care provider.Buffalo Township police is the only department that does not carry naloxone. Lt. Tim Derringer, officer in charge for the department, said that carrying naloxone is not off the table, but he needs to discuss it with the township supervisors.County coronerRecord numbers of people dying from drug overdoses means the county coroner's office has been especially busy. When a person dies from an injury or illness in a hospital or medical facility, a death certificate is typically issued and signed by an attending physician.When a person dies in their home, in a traffic accident or under suspicious circumstances such as a suspected drug overdose, the coroner or one of his two deputies is called and an autopsy is usually ordered, County Coroner William Young III said.“I always tried to budget for 100 (autopsies) and once we got up near 90, I told them we needed to budget for 125, because the drugs have gotten more prevalent,” Young said.Butler County paid for 120 autopsies in 2016, 74 of which were confirmed as fatal overdoses, and spent a total of $194,495 on post-mortem expenses, County Controller Ben Holland said.Young said he has several forensic pathologists who are contracted to perform autopsies, but the coroner or a deputy has to sit in on the procedure.The county also paid $87,075 to Young Funeral Home last year, which functions as the county's morgue and facility for autopsies to be performed.In 2015, the county had 89 autopsies and $135,494 in post-mortem expenses and in 2012, it had 71 autopsies and paid $114,340 in expenses.Some of the fees are set by statute, though several of the fees this year are set to be increased by the county commissioners for the first time since 2011.The more autopsies needed, the more money the county is obligated to pay, Holland said.“It heavily weighs on our budget because we are contracting out a lot of those services,” he said.Holland said that a county-run morgue or medical examiner's office could potentially be more efficient, but the county has not done a cost-benefit analysis or seriously considered making such a change.Young said he is hopeful that the tide is turning in the county thanks to the increased availability of naloxone and the efforts law enforcement making heroin harder to get.He noted that after seeing about 30 overdose deaths through the first three months of this year, the rate has slowed dramatically in the last three months.“My hat is off to all the police departments and DA's office,” he said. “Last year was overwhelming, so far the second half of this year hasn't been bad at all.”