Drug overdoses are increasing rapidly throughout the nation, including right here in Pennsylvania. Therefore, it is no surprise that overdose touches our friends, family, and community. The Department of Drug and Alcohol Programs (DDAP) is focused on addressing the overdose problem in Pennsylvania, while ensuring that our prevention programs are robust, well-resourced and evidence-based, and that all Pennsylvanians struggling with the disease of drug and alcohol addiction can get the level and duration of treatment and recovery supports they need to live a healthy and productive life.
The department, in partnership with the Department of Health, established a warm hand-off process to help overdose survivors who appear in emergency departments (ED) to receive counseling and a doctor’s referral to be transferred directly from the ED to a drug treatment facility. The department has incorporated contractual changes with the Single County Authorities (SCAs) in its 2015-2020 grant agreement that establishes the overdose survivor as a priority population and requires each SCA to create a process for the direct referral from the ED. In February 2017, DDAP, DOH, and the Pennsylvania chapter of the College of Emergency Physicians released guidelines and protocols for doctors to implement ED warm handoffs:
Pennsylvania Drug Take-Back Box Program
The department has spearheaded a greatly-expanded prescription drug take-back box availability in late 2013. Many young people who abuse prescription drugs are stealing them from medicine cabinets. Keeping unused opioids or other common drugs of abuse in a medicine cabinet is no longer safe or responsible. The department, working in partnership with Pennsylvania Commission on Crime and Delinquency (PCCD) the Pennsylvania District Attorney's Association (PDAA), the Attorney General’s (AG) office and the National Guard, designed a process that has increased the number of permanent prescription drug take-back boxes across the Commonwealth, with the goal of reducing the amount of prescription drugs available for potential misuse/abuse. Since the expanded program started in January 2014, approximately 317,088 pounds of prescription drugs have been collected and properly destroyed. In 2016, approximately 124,336 pounds of prescription drugs were collected and destroyed. As of September 2017, there are 681 take-back boxes placed across all 67 counties.
To locate a drug take-back location near you, please visit the Get Help Now application.
Overdose Task Force (OTF)
The department established OTF in July 2013. It is comprised of representatives from the national, state, county and local levels and continues to meet approximately quarterly. The initial goal of the OTF was to develop a rapid response mechanism to break down information silos so that law enforcement and emergency medical services could have real-time trends information more readily available to them.
Given the nature of this public health crisis, in June 2015, the OTF expanded its leadership to include Physician General Rachel Levine, MD, as co-chair of the group and simultaneously expanded its focus from its initial rapid response goal to include: 1) informing and driving public policy on the issue of overdose; 2) informing overdose response; and 3) strategizing and planning robust responses to the crisis.
The Departments of Drug and Alcohol Programs and Health are co-chairing the Prescribing Practices initiative with the purpose of reducing prescription drug abuse and overdoses while maintaining effective pain management. The group includes representation from all medical professionals, as well as their professional associations and regulatory agencies.
The focus of this group is to identify and find consensus on best and safest prescribing and pain management practices and to identify ways that the stakeholders at the table (representing various state departments and private organizations) can most effectively promote those practices.
After the group’s first meeting, there appears to be a strong consensus in the group that the existing “Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain,” adopted by the Federation of State Medical Boards of the United States in July 2013, was the policy which this group should adopt and promote. This policy has been accepted by the American Pain Society and the American Academy of Pain Medicine. We are also working with the SAMHSA Regional Director, who has been putting us in touch with some of the stronger prescriber and dispenser training programs in our region.
Another goal of this group is to ensure not only that prescribers and dispensers are not only trained in best pain medicine practices, but that they also are trained in identifying drug abuse and addiction problems in their patients, and that they know where to refer them for treatment. At a minimum, prescribers and dispensers should have training in SBIRT (screening, brief intervention, referral to treatment), an evidence-based practice proving to be effective in reducing alcohol abuse and showing great promise with respect to drug abuse as well. View the Pennsylvania Prescribing Guidelines.
Continuing Medical Education (CME)
DDAP has been working collaboratively with the Department of Health to implement training with CMEs for prescribers. The trainings for prescribing guidelines and naloxone are now available. The trainings for warm handoff and the PDMP will be available in the near future. To access the trainings, please visit the Pennsylvania Medical Society.
Prescription Drug Monitoring Program
The Department is working with health care providers to educate them on identifying those with substance use disorder through PDMP and effectively directing them to treatment. For more information on the Prescription Drug Monitoring Program please visit the Department of Health PDMP web page.
Law Enforcement/First Responder Initiative
The Department led efforts to equip law enforcement and others with naloxone. Act 139, also known as “David’s Law,” made naloxone available to police, firefighters and family members and friends of those at risk of heroin or other opioid overdoses. Naloxone rapidly reverses overdoses and has saved thousands of lives. As of August 2016, more than 430 municipal police departments across the Commonwealth were equipped with naloxone through DDAP’s efforts. Over 1300 overdoses have been reversed. Additionally, 1,200 State Police patrol cars are equipped with naloxone in every county. Under DDAP’s leadership, district attorneys and municipal police chiefs have developed naloxone programs. The Department has initiated and continues to oversee several initiatives to provide training, technical support, and funding, as well as closely track those efforts, including the number of departments carrying naloxone and the number of overdoses reversed.
On March 1, 2016, Lt. Gov. Mike Stack, along with then DDAP Secretary Gary Tennis, Physician General Dr. Rachel Levine, Pennsylvania lawmakers, and representatives from the Pennsylvania District Attorneys Association (PDAA), Pennsylvania Chiefs of Police Association (PCPA), Pennsylvania State Police (PSP), and health insurance providers recognized more than 300 municipal police departments, PSP and hundreds of individual police officers for their life-saving work resulting from the use of naloxone.
The impact in lives saved has been immense and has made it possible for hundreds of people to have a second chance at life and the treatment necessary to obtain recovery.
Given the number of times that police respond to the scene of an overdose first, Departments who are not currently engaged in using naloxone are urged to do so. Technical assistance in getting started is available through DDAP and funds are available to support the purchase of naloxone.
Police Intervention Efforts
The department is researching various national police-assisted referral to treatment models to develop a Pennsylvania model. Once the model is complete, the department will work with various interested police departments to encourage impentation.
Treatment Bed Capacity
Under guidance from OTF, the department is reviewing treatment bed availability and a process for tracking it across the Commonwealth in real time. While this process is still underway, some initial barriers and strategies to remediate these concerns have been identified. The department has also engaged partners, including the Hospital and Health System Association of Pennsylvania (HAP) to identify solutions.