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
According to the federal Drug Enforcement Agency (DEA), more than 4,642 people died from drug overdoses in 2016.  That equates to about 13 people a day in Pennsylvania with 85% of those deaths being attributed to prescriptions or illicit opioids like heroin.  According to the Pennsylvania Health Care Cost Containment Council (PHC4), in 2016 heroin overdose admissions alone cost the Commonwealth more than $13.9 million while pain medication overdoses cost $13.2 million.  For every 100,000 residents, 31 were admitted for an opioid overdose. 

This is not an urban problem or a rural problem, it is a Pennsylvania problem. Pennsylvania now leads the nation in drug overdoses among men ages 12 to 25 and is ninth in the country across the general population. The number of overdose deaths exceeds those caused by car crashes and guns combined.  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.We all recognize that prevention, treatment and recovery are the efforts needed to overcome this crisis.

This session, a number of bills have been drafted, introduced and passed in the House to combat opioid abuse. This follows the passage of several bills last session that were a product of a task force in 2014 which produced a report with recommendations, the HR659 Task Force and Advisory Committee on Opioid Prescription Drug Proliferation.

Opioid-Related Legislation Passed by the PA House in the 2017-18 Session
•    Consent to Treatment (House Bill 17- now law: Act 47): Clarifies that a parent or legal guardian can provide consent, over the objection of a minor, to providing medical care or counseling related to diagnosis or treatment of substance abuse.
•    Drug and Alcohol Programs (House Bill 119- awaiting Senate action): Requires the Department of Drug and Alcohol Programs to certify drug and alcohol recovery houses which receive public funding.
•    Opioid Abuse Prevention Education (House Bill 121- awaiting Senate action): Updates alcohol, chemical and tobacco abuse curricula to include opioid abuse prevention education.  (*included in the Public School Code bill- House Bill 178)
•    Impact on Infants, Children (House Bill 235- awaiting Senate action): Establishes a task force to examine the opioid abuse epidemic’s impact on infants and children.
•    Electronic Prescriptions (House Bill 353- awaiting Senate action): Aims to reduce the diversion of controlled substance into the wrong hands by requiring electronic prescriptions of Schedule II, III and IV controlled substances.
•    Pain Management Clinics (House Bill 1043- awaiting Senate action):  Requires pain management clinics to register with the Department of Health.
•    Mandatory Minimums for Certain Drug Offenders (House Bill 741- awaiting Senate action):  Because the Supreme Court struck down most mandatory minimum sentences, this legislation is the remedy to restore mandatory minimum sentences for numerous dangerous crimes including those about selling drugs to minors, in school zones and elsewhere, and possession of large quantities of drugs.
•    Act 20 of 2017- Drug and Alcohol Detoxification Program (included in the Administrative Code Bill House Bill 118):  Encourages licensed health care facilities to convert beds to provide detoxification to ensure emergency detoxification services are available.

Previous House Action
•    HR 659 of 2013-14 – Created a task force to study the opioid abuse issue in Pennsylvania.  The task force in 2015 produced The Report of the Task Force and Advisory Committee on Opioid Prescription Drug Proliferation.  The report produced several recommendations which have since become legislative proposals. (more details below)
•    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.
o    Act 139 also grants so-called “good Samaritan” protection, which provides immunity from prosecution to persons responding to and reporting overdoses.
o    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.
o    Act 80’s pilot program began in April 2015 and ran through September 2016.  The pilot involved 175 inmates in four counties.
•    Act 1-A (HB 1801) – The Supplemental General Appropriation Act of 2015 provided a $3.5 million increase in the Department of Drug and Alcohol Program’s Assistance to Drug and Alcohol appropriation to expand substance use disorder treatment services provided through the Single County Authorities.
•    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.
•    Act 16-A of 2016 (formerly SB 1073) – The General Appropriations Act of 2016 provided $15 million in state funds ($20 million total funds) in the Department of Human Services to establish 45 Centers of Excellence to expand narcotic treatment programs to include Suboxone treatment at facilities and to increase the capacity and quality of care provided to individuals seeking treatment for substance use disorder. 
•    HR 893  (Readshaw)- Called 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.  The Commission issued a report in response to HR 893 on June 27, 2017.

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.

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.