One year after declaring state of emergency, Pa. officials assess progress on opioid battle

Just under a year after Gov. Tom Wolf declared an emergency over Pennsylvania’s opioid epidemic, state officials on Monday highlighted programs they say have been touted as national models, while acknowledging there’s much work to be done to address one of the worst overdose crises in the country.

The state has gotten more people into treatment, they said, and lowered a key barrier that has long kept people with addiction from medication-assisted treatment, the “gold standard” of addiction treatment. It’s also begun, slowly, to expand access to those treatments to the state’s inmates, who are particularly vulnerable to substance-use disorder, and relapse and overdose upon their release.

Pennsylvania remains in a state of emergency over the crisis. In 2017, 5,546 people died of overdoses in the state, 1,217 of them in Philadelphia. Wolf extended his emergency declaration for 90 more days in December, and programs to help overdose survivors seek treatment from their hospital beds are not widespread enough, state officials said.

Even amid progress, the breadth of the crisis is staggering. At Monday’s news conference, officials touted the success of the state’s drug treatment hotline (1-800-662-HELP). More than 15,000 people called the line last year seeking treatment for themselves or a loved one, and 45 percent were then connected directly to treatment. But in Philadelphia alone, city officials have estimated, between 50,000 and 70,000 people are addicted to opioids.

Here are some takeaways from Monday’s news conference:

Ending prior authorizations. On Monday morning, the American Medical Association called Pennsylvania’s efforts to end prior authorizations for addiction treatment medicines a “breakthrough” in the battle against the opioid crisis. Under prior authorization, patients with addiction would wait days to receive medication-assisted treatments (MAT). But people in active opioid addiction experience such intense withdrawal pain, they are much more likely to relapse than those who receive MAT. Days in withdrawal, waiting for a prior authorization to come in, are enough to persuade some patients to turn to street drugs for relief.

Advocates have long complained that prior authorization is an unnecessary barrier to needed treatments. Last year, Pennsylvania’s Medicaid system stopped requiring prior authorizations for MAT; in October, the state’s seven major insurers agreed to do the same. At Monday’s news conference, state officials cited this change as a major accomplishment after years of unprecedented numbers of overdose deaths.

More treatment sought. Over the last two years, the state has opened 45 facilities to coordinate care for Medicaid recipients with opioid-use disorder. Before these “centers of excellence” opened, about 48 percent of such patients were receiving addiction treatment. Now, 70 percent of that population has sought addiction treatment, and 60 percent stayed in treatment past 30 days.

State officials couldn’t immediately say how many people with private insurance are receiving treatment; a 2016 U.S. surgeon general’s report suggested only one in 10 people with a substance use disorder gets treatment.

Treatment in prisons. The state Department of Corrections (DOC) launched a pilot buprenorphine program at its women’s prison, the State Correctional Institution at Muncy. About 20 people are participating in the medication-assisted therapy and have been prescribed an injectable form of the drug, said Daniel McIntyre, the director of the Bureau of Community Corrections.

The move comes after buprenorphine played a role in this summer’s decision by the department to ban book donations and mail-order deliveries to inmates, after corrections workers were mysteriously sickened in a drug-exposure scare. (Toxicologists said their symptoms may have been a collective hysteria over fears of being exposed to an unknown drug.) The ban was aimed primarily at curbing smuggled doses of the synthetic cannabinoid K2. But in defending the ban, the department tweeted a photo of a book used to smuggle strips of buprenorphine into a prison. The ban has since been relaxed.

The DOC is moving slowly toward prescribing inmates addiction-treatment drugs, despite years of controversy surrounding their presence in prison health care. Pennsylvania prisons have been offering Vivitrol, an opioid blocker, to inmates since 2014, but opioid-based treatment medications like buprenorphine and methadone are especially stigmatized in the correctional system, state officials say.

Still, attitudes are slowly changing: after a pilot program at their own women’s prison, Philadelphia prisons began offering buprenorphine to inmates systemwide in the fall. In November, a federal judge in Massachusetts ruled that prisons were required to offer methadone to inmates who need it. State officials said that that ruling hasn’t influenced their decision to offer medication-assisted treatments — the state was gearing up to do so when the ruling came down — but that it has helped increase awareness on the issue.

Warm handoffs. At state officials' urging, at least one hospital in every Pennsylvania county has launched some form of a warm-handoff program, in which emergency-room patients revived from overdoses are offered immediate access to treatment, facilitated by certified recovery specialists who themselves have overcome addiction.

But access can vary among hospitals. Jennifer Smith, director of the state Department of Drug and Alcohol Programs, said at least two Philadelphia hospitals — Temple University Hospital and Penn Presbyterian Medical Center — have fully implemented warm-handoff programs, and the city health department is working with another half-dozen that offer some form of them.

Smith said some hospitals around the state have found program logistics challenging. Some counties opted to contract with agencies that send certified recovery specialists to hospitals when an overdose victim arrives, rather than having a full-time specialist on staff. But “there is some liability issue in having an outside entity coming into the hospital to deliver services and advising on potential treatment options when they’re not an employee of that hospital,” Smith said.

Expanding the warm-handoff program is crucial in the year ahead, she said. So is helping people who’ve been through treatment transition into a new life.

“We attack the opioid crisis in stages,” Smith said. “First, it was, what can we do to keep people alive? Then, what do we do now that we’re keeping them alive?

“Now, we’re starting to transition into what we’ll call the next phase: Once individuals have received treatment, how do we ensure that they’ve sustained recovery? In Philadelphia, the most immediate need is the warm handoff and connection to treatment, followed by recovery supports.”