Earlier this year, Gov. Wolf declared the "opioid and heroin epidemic" a "statewide disaster emergency." Under the emergency declaration, the governor established an opioid command center and waived regulations related to treatment, among other measures. On April 10, the declaration would have expired, however the governor renewed the emergency for another 90 days. The current crisis has been years in the making and we should not tackle it 90 days at a time. There are measures that our commonwealth can and should take if we're serious about making progress.
Although Pennsylvania has two successful syringe exchange programs (one in Philadelphia and one in Allegheny County), state law prohibits the distribution of "drug paraphernalia" (including syringes and needles). The current exchanges operate under legal authority granted by the city/county in which they are situated. Unlike 19 states that explicitly give legal authority to exchanges in their law, Pennsylvania is not acting. It is time that the state acts and gives explicit authority to syringe exchanges in state law.
Safe injection sites save lives. While Philadelphia city officials announced that they encourage private entities to pursue safe injection sites, other cities across the nation are taking action. From a legal point of view, safe injection sites can be done the hard way — opened under legal ambiguity with a potential challenge of their legality, as they did in Vancouver in the 1990s; or the easy way, with clear legal authority from the state before the first one opens, as they did in Toronto after approval from the ministry of health. It is probable that Pennsylvania will have a safe injection site in the near future. The commonwealth should ensure that when it opens, the users and the workers are protected under the law.
Pennsylvania was one of the states with the greatest increase in its overdose death rate between 2015 to 2017. During about the same time period (2014-16), the proportion of drugs seized in Allegheny County that contained fentanyl increased eightfold. Some attribute the spike in mortality to fentanyl. Testing drugs for fentanyl is cheap and quick — $1 test strips produce accurate results. A study found that users are concerned about fentanyl in their drugs. Most users said that if given the opportunity they would test their drugs and modify their behavior (not use the drugs, use them slower, or use with naloxone nearby) if fentanyl was present.
Pennsylvania should start a statewide fentanyl testing program. The program should distribute testing strips to users and organizations that conduct outreach (such as syringe exchange programs). Further, the state should collect data on fentanyl and provide a safe way to dispose of fentanyl-laced drugs when the user chooses to do so.
The gold standard of opioid addiction treatment is the use of medications to satisfy the chemical dependence of the body to opioids. One medication that has proven its efficacy is buprenorphine. However, to prescribe it, physicians, nurse practitioners, and physician assistants need a special license from the Drug Enforcement Administration that can be obtained following training. Only 4 percent of all physicians in the United States are licensed to prescribe buprenorphine. In more than half of counties in Pennsylvania, there are fewer than 10 licensed physicians, and in six counties there are none. All that is standing between the unlicensed physicians and the waiver is an eight-hour online training.
Ironically, these same unlicensed physicians are allowed to prescribe opioids (even buprenorphine) for pain because they meet the state's licensing requirements and are registered with the DEA. Pennsylvania should amend the Board of Medicine's licensing requirements to include the buprenorphine training. If a provider is unwilling to treat addiction, or even have the option to do so, they shouldn't prescribe controlled substances.
To tackle the current crisis we must look not only to the future but also the past. Of the almost 50,000 inmates in Pennsylvania state prisons, 28 percent are incarcerated for drug offenses. In a time of rising compassion to drug users, and understanding that by definition addiction is "characterized by compulsive drug seeking and use, despite harmful consequences," we must rethink the circumstances of many of those drug offenses and pardon those incarcerated.
This is also a racial justice issue: America transitioned from viewing drug use as a criminal justice issue to a public health issue, as those dying transitioned from being black to white. If we are to talk about recovery, that must include making amends for the mistakes of the past.
None of the solutions above will end the current opioid crisis overnight, nor are they the only solutions. To systematically change the trajectory of the drug epidemic we need to invest in housing, health care, education, and jobs. As we work toward systemic change, we must pursue policies that give people the opportunity to stay alive, seek treatment, and go through the journey of recovery.