State taking opioid epidemic head on
CRANBERRY TWP — State and federal public health and law enforcement officials were in Cranberry Township on Wednesday, where they spoke about ongoing efforts to curb opioid abuse and overdose deaths in the commonwealth.
The state Department of Health will begin working with doctors and hospitals to reduce prescribing opioids for pain relief and to get overdose patients into treatment programs.
Dr. Rachel Levine, acting secretary of health and physician general, outlined the state's latest efforts in the battle against overdose deaths at the Western Pennsylvania Opioid Education Conference at the Regional Learning Alliance Learning and Conference Center in the township Wednesday.
“We have been overprescribing opioids for relatively minor pain,” Levine said. “We have to learn to use opioids more carefully; more judiciously.”
Opioids are needed for treatment of post surgery pain, cancer treatment pain and other medical issues, she said.
However, a prescription for 30 days worth of opioids can be too much because addiction can occur after taking the drug for as few as five days, Levine said.
She compared opioids to antibiotics, saying overuse led to viruses becoming significantly resistant to the medication.
“People develop a tolerance of opioids,” Levine said. That tolerance leads to patients seeking more of the drug, she said.
The department is working with a task force of medical school deans to develop a new curriculum for assessment and treatment of pain, Levine said.
New guidelines for prescribing opioids are also being developed for treating children and adolescents, emergency room treatment, dentists and chronic non-cancer pain treatment. The guidelines suggest when therapy, exercise and other treatments that don't involve medication can be prescribed, she said.
Pennsylvania has already adopted a prescription drug monitoring program that allows doctors to track prescriptions and identify patients becoming dependent on opioids, Levine said.
The program has been in place in Pennsylvania for a year and has helped reduce opioid prescriptions by 8 percent and overdose deaths by 12 percent, Levine said.
In 2015, the drug poisoning death rate was 26.3 people for every 100,000 people in the state. The rate rose to 36.5 in 2017. The national rate was 16.3 in 2015, Levine said.
Act 139, which became law in 2014, and a standing order from the department have liberalized the use and dispensation of naloxone, also known as Narcan, which Levine credited with reviving nearly 4,000 overdose patients.
The measures allow doctors to write Narcan prescriptions for third parties, such as a family member of an addict, and provide Narcan to schools for free, and Levine is writing a standing prescription that will allow anyone to purchase it.
Levine said the state recently signed a $5 million contract to provide Narcan to first responders.“Everybody deserves a chance at life. Everybody deserves a chance at recovery,” Levine said. “It's impossible to go into recovery if you're dead.”The state received a $5.7 million federal grant to expand the use of methadone, suboxone and other medication-assisted recovery treatments, but case management is needed, she said.Many hospitals have obtained grants to start “warm hand off” programs in which emergency room doctors contact their county drug and alcohol commissions when treating overdose patients to convince those patients to enter treatment and recovery programs, Levine said.Jeffrey Kelly, Cranberry Township EMS executive director and chief, raised an issue that Levine said should be explored.Paramedics treating an overdose patient are supposed to administer enough Narcan to stabilize the patient and then take him or her to a hospital, he said.But other first responders sometimes administer Narcan before the ambulance arrives and revive the patient, who then refuses further treatment and leaves, he said.It's a “catch 22” situation because the ambulance can respond to other calls after the overdose patient leaves, but ambulance services don't get paid unless they take the patient to the hospital, Kelly said.Ambulance services also don't get paid for many overdose patients they take to hospitals because the patients don't have health insurance, he said.The fee for a township ambulance to respond is $686 and the average bill is $950, Kelly said.The township EMS and Karns City Communities that Care received $5,000 grants at the conference from Magellan Health, which hosted the event.Kelly said the ambulance service will use its grant to create a team of law enforcement, drug treatment case managers and paramedics to try to convince overdose patients to go to a hospital or enter a rehabilitation program.“If we don't get them to the hospital we're not dealing with the problem,” Kelly said.Karns City Communities that Care operates drug, alcohol and tobacco programs in schools and for families.Many people who end up using heroin, fentanyl and carfentanil — an extremely potent synthetic drug designed to immobilize elephants — first become addicted to prescription medications found in homes, said Joseph Moses, a supervisory agent at the U.S. Drug Enforcement Agency's Pittsburgh office.He said 5 percent of the world's population lives in the United States, but the country accounts for 99 percent of hydrocodone use and 85 percent of oxycodone use. Eighty percent of heroin users first became addicted to opioids,The 475 million doses of opioids prescribed in Pennsylvania in 2015 was enough to give every state resident 37 pills, Moses said.He described doctors who illegally provide opioids as “drug dealers in white coats.”Heroin is the drug of primary concern to the DEA, he said.Dealers will lace heroin with fentanyl making a strong mixture designed to out compete rival dealers, he said.“Deaths will actually increase business,” Moses said.Agents conducted a series of traffic stops in one area following a rash of overdose deaths and learned from the people they stopped that they came to the area to buy the heroin that caused the deaths because they heard it was “good,” he said.Heroin in the county is smuggled from Mexico by ruthless cartels, he said.“They are very smart, but ruthless,” Moses said.
