Fighting PA's Opioid Crisis
The Pennsylvania House of Representatives is taking swift and determined action to combat the opioid crisis in Pennsylvania.

The Scope of the Crisis
In 2014, according to the federal Drug Enforcement Agency (DEA), approximately 2,500 Pennsylvanians died from overdose of opioid drugs. The victims came from every corner of the state.  According to the Pennsylvania Health Care Cost Containment Council (PHC4), opioid overuse and abuse cost the Commonwealth more than $12.2 million in hospitalization costs annually as of 2012.

There is broad consensus the opioid issue affects all groups of Pennsylvanians – not differentiating by race, region, religion, income or any other factor.  Beyond the public health toll, opioids are straining prisons (70 to 80 percent of all jail sentences) and are costly (nationwide, more than $50 billion annually in treatment and lost productivity). 

What Are Opioids?

Opioids are a class of drugs derived from or pharmacologically similar to opiates. While these analgesics are the most effective pharmaceuticals for killing pain, they carry with them a significant risk of addiction. Some data suggest that 60 percent of prescription opioid deaths occur in patients with no history of substance abuse and who are only prescribed an opioid by one health care practitioner.

What's Been Done to Help?
This issue and problem is not new; the General Assembly has been working to deal with this latest drug threat. The drug problem is not partisan, and the House has been attacking it in a non-partisan manner.

Through a resolution authored by Rep. Doyle Heffley, the House created a task force in 2014 which produced a report with recommendations, the HR659 Task Force and Advisory Committee on Opioid Prescription Drug Proliferation. Those recommendations have been drafted, introduced and voted… with the final bills to be voted this week in the House. The House reviewed the report and acted on the recommendations

New Laws To Fight the Opioid Crisis
•    Opioid Prescriptions (Act 122 of 2016, formerly HB 1699): Prohibits a health care practitioner from prescribing more than seven days of an opioid drug product in a hospital emergency department or urgent care facility unless certain medical conditions warrant more than a seven-day supply.
•    Reduce Prescription Drug Abuse (Act 123 of 2016, formerly HB 1737): Allows for the proper disposal of unused prescriptions and over-the-counter medications.
•    Prescription, Addiction Education (Act 124 of 2016, formerly SB 1202): Amends the Achieving Better Care by Monitoring All Prescriptions Program Act to require prescribers and dispensers to obtain education in pain management, identification of addiction, and the use of opioids, and require system queries when prescribing or dispensing an opioid benzodiazepine drug.
•    Prescriptions for Minors (Act 125 of 2016, formerly SB 1367): Prohibits prescribing an opioid to a minor, with certain limitations, for more than seven days and requires all prescribers to receive written consent from a minor’s parent or legal guardian in order to prescribe a medical treatment containing opioids as well as discuss the risks of addiction and overdose associated with the medication.
•    Opioid Curriculum (Act 126 of 2016, formerly SB 1368): Requires licensing boards create a safe opioid prescribing curriculum to be offered in medical schools and establishes a patient voluntary non-opioid directive.
•    Addiction Treatment Access (HR 590 – passed House): Urges the Department of Drug and Alcohol Programs to establish and administer a task force on access to addiction treatment through health plans and other resources.

HR 659 Task Force Report Administration Actions
•    Easily accessible information. A new hyperlink was created for webpages with prescribing guidelines to help viewers easily find more information.  
•    Specific online training modules for risk, treatment and referral.  Further, the Department of Drug and Alcohol Programs (DDAP) is collaborating with the Department of State, so that the selected modules will be accepted for CME credits.
•    Department of Human Services is continuing efforts to develop a multi-agency approach to substance abuse disorder services through participation in CMS Medicaid Innovation Accelerator Program.  
•    Stronger Enforcement. While slower than it should be, the Pennsylvania Insurance Department is enforcing statutes that require parity of coverage for behavioral health services, which include addiction treatment and rehabilitation.  
•    Prescription “take-back” programs to be sustained and expanded to help reduce the sheer amount of excess prescription opioids in people’s homes.
•    Guidance. The DDAP is providing guidance on how prescribers can refer patients to Single County Authorities and local service providers. 

In a strong bipartisan showing, members of the House Republican and Democratic Caucuses, along with Gov. Tom Wolf, discuss what's been accomplished and what lies ahead in combatting the opioid crisis in Pennsylvania.

What Legislative Action Has Already Been Taken?
•    Act 191 of 2014 (formerly SB 1180) – Act 191 created, for the first time, a program to ensure that information on potentially harmful prescription opioids could be collected and monitored by appropriate authorities, giving physicians and dispensers the tools need to ensure that patients are not being over-prescribed.  The law also allows law enforcement to monitor physicians who may be over-prescribing.
•    Act 139 of 2014 (formerly SB 1164) – This critical legislation allowed law enforcement and first-responders to carry and administer naloxone – the life-saving drug that can reverse ongoing opioid overdoses.
-    Act 139 also grants so-called “good Samaritan” protection, which provides immunity from prosecution to persons responding to and reporting overdoses.
-    880 overdoses have been reversed by naloxone in Pennsylvania since November 2014, according to the Pennsylvania Department of Drug and Alcohol Programs.
•    Act 80 of 2015 (formerly SB 524)– This law created a pilot program within the state Department of Corrections to provide grants to correctional facilities that can be used for addiction treatment, with the aim of avoiding relapse when offenders are released.
-    Act 80’s pilot program began in April 2015 and runs through September 2016.  The pilot involves 175 inmates in four counties.
•    Act 37 of 2016 (formerly HB 608) — Allows the Secretary of Health to add substances to the controlled substances list of the “Drug Act” to keep pace with the designer drug trade.
•    HR 893 (Readshaw) calls on the Joint State Government Commission to study benefits, costs and drawbacks of treatment modalities for substance abuse disorder and also the feasibility of using state hospital facilities for addiction treatment.

House Bills Awaiting Senate Action*
•    HB 1295 (DiGirolamo) – This bill (passed unanimously May 16, 2016, and awaiting Senate action) adds buprenorphine to the Methadone Death and Incident Review Act. It would include deaths and incidents attributable to the use and misuse of Suboxone as part of the Methadone Death and Incident Review Team. Buprenorphine is diverted and misused quite frequently.  In fact, some doctors in Philadelphia were recently arrested for more than $5 million worth of prescriptions that were just being abused.
•    HB 1601 (Vereb) – Restores mandatory minimum sentences for heroin (and other things too). The mandatory minimums were held unconstitutional in how the statutes were written; this is the remedy. In passed the House 143-54 in October and currently awaits Senate Judiciary Committee action.

Pending House Bills (related)*
•    HB 988 (Murt) – Increases penalties for drug trafficking offenses.
•    HB 1511 (DiGirolamo) – Creates an emergency addiction treatment fund by taxing the sales of opioids in Pennsylvania.
•    HB 1568 (DiGirolamo) – Requires protective services workers to receive training in addiction and how to make appropriate referrals for assessment and treatment
•    HB 1294 (DiGirolamo) – Requires prescribers to check the PMP Database before writing a prescription for buprenorphine.  
•    HB 1692 (Readshaw) – Outlines involuntary treatment requirements and procedures for individuals suffering from alcohol and other drug abuse.
•    HB 1748 (Mahoney) – Outlines requirements for a K-12 course of study on drug and alcohol abuse and requires instructors to be trained to better recognize students who may be using or abusing alcohol, drugs or other dangerous controlled substances.  
•    HB 2128 (Heffley) – Requires placement of Narcan in recovery residences.  

Senate Legislation*
•    SB 1305 (Yaw) – Companion bill to HB 1698, now in the Senate Committee.
•    SB 1228 (Yaw) – Companion bill to HB 1699, now in the Senate Committee.
•    SB 532 (Eichelberger) – Addresses methadone clinics and safety standards, now in the Senate Public Health and Welfare Committee.

Related Action

House HOPE Caucus
The House has also established the PA Heroin, Opioid Prevention and Education (PA-HOPE) Caucus. This bipartisan group of legislators is chaired by Rep. Aaron Kaufer and Rep. Ed Gainey.

Joint Policy Committee Hearings
As opioid crisis legislation falls under the jurisdiction of at least three standing committees, and in order to help prepare bills for the fall session, joint hearings were held across the Commonwealth in July, August and September by the House Republican and House Democratic Policy Committees. The Policy Committees will act as coordinators and work with the various committee chairs to plan the topics and hearings.

Special Session Information

Under Article IV, Section 4, of the Pennsylvania Constitution, the governor can call the General Assembly into special session to address an issue of unique importance to the Commonwealth as proclaimed by the governor. (A majority of legislators may also sign a petition to the governor to call a special session; regardless, the governor makes the call.)

The value of a special session is to focus on a single issue. When the General Assembly is convened in a special session, its members can only consider legislation on those subjects designated in the governor's proclamation. Just 34 such sessions have been called in Pennsylvania history.

* at conclusion of 2015-16 Legislative Session