This is a brief synopsis...
PA Act 139
In November 2014, Pennsylvania’s Act 139 went into effect. Designed to prevent overdose deaths, it focused primarily on increasing access to naloxone, a medication that reverses overdose caused by prescription opioid pain relievers and heroin. In simple terms, Act 139 does three things:
This bill is currently in the works. Representative Gainey is the co-chairman of the HOPE Caucus (PA HEROIN, OPIOID PREVENTION & EDUCATION CAUCUS (PA-HOPE)) with Rep. Kaufer. It would provide additional funding for treatment defined as “licensed long-term residential addiction treatment facilities, including licensed halfway houses;" funding for purchase of naloxone for local police and first responders and the provision of training on the use of naloxone; drug and alcohol addiction counseling in county jails; costs to the criminal justice system related to drugs and alcohol addiction; establishment and maintenance of procedures to ensure the transition of overdose survivors to addiction treatment programs; fund prescription drug monitoring.
I and other community activists would also like to see opioid replacement therapy and naloxone for distribution through community programs for people at risk of opioid overdose themselves. It would be so good for our patients if all hospitals in PA provide actual inpt and/or oupt substance use treatment services (not just smoking cessation) or linkage to substance use counseling and referral 24/7, on-demand. Where will we get the funding for this you ask? These programs will pay off in the long run, not just in addressing overdose deaths but also ED visits, hospital admissions, health care utilization and other related consequences of addiction to our communities.
There is a very interesting legislation proposed by Maryland delegate Dan Morhaim (HB 908) . For a wide variety of reasons, hospitals are an excellent location to initiate treatment. This bill requires acute care hospitals to have an addiction treatment counselor available or on-call 24/7 to patients in emergency rooms and in-hospital and to have defined arrangements for transfer to appropriate detoxification and rehabilitation care services. The bill also calls for the State’s hospital regulatory agency (HSCRC) to develop cost-effective strategies to support hospital capital and operating expenses. He also proposes the Safe Consumption and Poly-Morphone Programs but these are considered too radical for the US (have been implemented in other countries). You can read more http://www.huffingtonpost.com/entry/dan-morhaim-heroin_us_56b3c342e4b08069c7a69b86
I need a little inspiration to resuscitate this blog. Our group is hard at work "addressing the social determinants of health." We are working on curriculum, talks, posters, workshop, etc. But it is usually some sort of patient encounter that prompted me to act...I recently admitted a very young woman with a hand infection due to injection drug use. She was studying to be nurse a one point, had less than ideal childhood and family circumstances, literally homeless but she wanted to quit. She did well on buprenorphine for 2 years, lost her insurance recently (you name it). She wanted to go to a nearby hospital for detox and rehab but we just could not get her in. Luckily she did not have bacteremia or endocarditis and she was also resourceful; she knew various treatment programs in the community. She had friends whom she knew she would quickly relapse if she went to stay with them. She found a friend who was in recovery who was willing to let her stay on his couch for 1-2 weeks until her hand got better. The inability to provide ready access to addiction treatment has always been so infuriating to me. Her story is not unique. As a primary care provider, I see a lot of intersection between pain and addiction. I'm concerned that in our war on drugs and in the efforts to curb the opioid abuse epidemic, we have overlooked pain treatment. Yes, of course, there are "physical" pain and "emotional" pain and all shades in between but they are all pain, pain managed with physical therapy, talking therapy, alternative therapy, anti-depressant/anti-anxiety medications and yes even opioids. There is also pain that comes from the lack of opportunities in our society, pain from inequality, social injustice, social isolation and a culture that thrives on financial success, individualism and personal responsibility. Is there a medication for that? In the next segment, I will summarize legislation that tries to address this issue.
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"