Health Policy$ense

Pennsylvania Declares a State of Emergency for the Opioid Epidemic

Physicians on the front lines respond

Last week Pennsylvania became the sixth state in the country to declare a state of emergency for the heroin and opioid epidemic. With over 4,600 drug overdose deaths in 2016 alone, and over 5,000 deaths estimated for 2017, this declaration comes at a critical time for Pennsylvanians. It also presents opportunities for health care providers to innovate in their approaches to identifying and treating substance use disorder patients.

Governor Wolf stated this move allows him to “waive statutory regulations that create barriers to treatment and prevention, prevent first responders and others from saving lives, and reduce efficiency of our response.” The specific initiatives the state will pursue fall into three areas of focus:

  1. Enhancing coordination and data collection to bolster state and local response, including expanded access to Prescription Drug Monitoring Program (PDMP) data

  2. Improving tools for families, first responders, and others to save lives – through increased access to naloxone

  3. Speeding up and expanding access to treatment

The response among policymakers, advocates, police, and providers has been optimistic, but cautious.  To combat the epidemic, the University of Pennsylvania Health System (UPHS) has already assembled a task force that aims to: improve opioid stewardship, improve treatment of chronic noncancer pain, improve access to high quality addiction services, and improve education related to pain, the use of opioids, and the diagnosis and treatment of addiction. We asked LDI Senior Fellows, physicians on the front lines of the epidemic, to share their insights on the impact of declaration and what could mean for the work currently taking place at UPHS. 

Michael Ashburn, MD, MPH, MBA, an anesthesiologist who currently serves on the Pennsylvania House Advisory Committee on Opioid Addiction and the Pennsylvania State Task Force on Prescription Drug Abuse, voiced his approval, and his hope that the declaration would facilitate and support UPHS efforts. “I am delighted Governor Wolf took this step, as it clearly states that we are in a public health crisis.” He continued:

With regard to the declaration, addiction treatment services are highly regulated at the state and federal level. I am hopeful that the declaration will allow us to have facilitated discussions with state regulatory bodies to allow us to move forward with some of the innovative solutions we hope to put into place to improve addiction treatment services. 

In addition, we do have ongoing projects in partnership with state to enhance access to PDMP data, and this declaration will likely make it easier for the state to continue to move these projects forward. 

Jeanmarie Perrone, MD, an emergency medicine physician and member of the Philadelphia Mayor's Task Force to Combat the Opioid Epidemic, also noted the opportunity for increased access to PDMP data, as well as her hopes that the declaration would improve surveillance systems in Philadelphia and reduce “roadblocks” to getting patients into treatment:

Improved funding and reporting requirements for opioid overdose may bring improved screening and testing for various opioid analogues that may be contributing to overdose or fatalities. More rapid toxicology testing and reporting of overdoses with better granularity of toxicology results would help improve surveillance in the city to help determine where the most potent and dangerous opioids are coming from.

Additionally, we can gain more insights by studying data that is being entered into the Prescription Drug Monitoring Program for Pennsylvania. A research mandate to make that data available (even if anonymized) could help inform escalating prescribing patterns and trials of interventions that may be feasible to improve safer prescribing efforts and many other potential interventions.

I hope that this can mitigate some of the administrative and insurance roadblocks we have encountered in our efforts to bridge more patients into treatment. Although we have tried to be innovative in our outreach approach, we have stumbled into numerous hurdles that prevent patients from having more open doors to engage in treatment whenever they may be ready.

…[G]etting people into treatment and allowing them to continue in treatment, even if interrupted by relapse or hospitalization, is a challenge hindered by insurance and the roadblocks of prescribing buprenorphine. The ability to continue "emergency doses" of buprenorphine would be an important new treatment avenue.

Zachary Meisel, MD, MPH, MSHP, also an emergency medicine physician who served on the Mayor’s opioid task force, applauded the declaration and pointed to a number of provisions that could have tangible effects:

Allowing EMTs (Emergency Medical Technicians) to dispense/leave naloxone at the scene…this is important as it will increase the availability of the lifesaving drug and is very cool – since bureaucratic inertia makes it very hard for non-pharmacists to dispense any medication.

Allowing some providers like emergency physicians to be able to prescribe medication-assisted treatment on short-term basis (as a bridge), without formal waiver requirements, will make a big difference.

Getting rid of birth certificate requirements for patients (who may be affected by homelessness etc.) is key to reducing socio-demographic disparities in treatment.

All in all—reducing bureaucratic barriers and advancing efforts to destigmatize prevention and treatment will go a long way to improving the chances of this state digging out of the epidemic.