Dr. Walter Hofman: Coroner addresses local heroin deaths


Montgomery County, with almost 800,000 inhabitants, is the 3rd largest population in the Commonwealth of Pennsylvania. In 2014, the deaths of 161 citizens were reported by the Montgomery County Coroner due to overdoses of prescription and /or non-prescription drugs. The manner of death was predominantly accidental but some were suicidal…

These drugs are all too easy to obtain. In almost 100 percent of the cases, patients go to multiple doctors for the same ailment, receive a number of prescriptions for the same drug, and fill them all at one neighborhood pharmacy…

In 100 percent of cases, are these patients paying cash?  Because paying cash for multiple doctors and prescriptions for the same drug is very expensive.  And insurance doesn’t cover the same service multiple times in the same day or month.

Who are these patients who can afford such costs? Are they drug dealers from the street or from Wall Street?  Are they pain patients hoarding medications out of fear? Are patients taking these large amounts by themselves and not selling any?

It may come as a surprise to many, but the majority of the overdose cases we examine are not facilitated by shady transactions with a drug dealer in a dark alley, but filled by prescription at local pharmacies.

A legal drug dealer, out in the open, in public, filling prescriptions for legal drugs.  Why is one transaction shady and the other isn’t?  They’re selling the same products. But one dealer paid the government for a license and is selling government-approved drugs, while the street dealer doesn’t have the money or connections to do the same. Plus, the street dealer’s customers — unlike the pharmacy’s — usually don’t have insurance.

Even though more people now have insurance, there are still millions who don’t have any. And even with insurance, there will still be plenty of patients who can’t afford to regularly see a doctor. The cost of seeing a doctor is added to the cost of every prescription, which is one of the reasons it’s cheaper to buy drugs on the street.

Fentanyl is a drug 10-20 times stronger than heroin and is most often prescribed for pain. When scraping the fentanyl patches or crushing lozenges, and then mixing with heroin, an even more dangerous situation occurs…  Other opioid analgesics that are being used with heroin are hydromorphone, levophanol, meperidine, methadone, morphine, oxycodone and oxymorphone…

Finally, it has been stated that “some people who use large amounts of drugs often and long enough become addicted.” Not always true. Using a drug for a short time is adequate to become “hooked,” and sometimes only requires one use…

Dr. Walter Hofman is a board-certified Forensic Pathologist and cororner of Montgomery County

Sometimes only requires one use…  “Sometimes” is pretty vague, but I’d say the more accurate description is that addiction rarely happens with a single use of a drug.


On October 27, 2014, Pennsylvania passed a law that will modernize our prescription drug monitoring program and undoubtedly save lives. However, implementation will be even more complex than the lengthy legislative process we’ve already seen. We’ll continue to share information about our PDMP as the program gets off the ground. Look for further blog posts about the role of prescription monitoring as part of a public health effort to reduce overdose, address risky substance use and addiction, and most importantly, to improve the quality of care that all patients receive.

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