 Hello and welcome to this special Facebook Town Hall. Today we'll be focusing exclusively on the opioid crisis here in Pennsylvania and how Governor Wolf's administration is working with legislators, local officials and other advocates to address this public health threat head-on. Most importantly, he is fighting for $34 million in new funding as part of the final 2016-17 budget to implement 50 centers of excellence that will treat more than 11,000 people that currently are not able to access treatment. So joining us today to talk about how this funding will directly address the crisis is Ted Dallas, Secretary of the Department of Human Services, Gary Tennis, Secretary of the Department of Drug and Alcohol Programs, Dr. Karen Murphy, Secretary of the Department of Health and Dr. Rachel Levine, Pennsylvania's physician general. Thank you all so much for being here. Thank you. It's nice to be here with you. Yeah. And before we get to our Facebook viewer questions, we just would like to have each of you go around quickly and talk about how your department is working to help combat this crisis. So my department, the Department of Human Services, we run the Medicaid program for low-income individuals. It's health insurance for low-income individuals. The Centers for Excellence that you mentioned are part of the Medicaid program. So for us, first the good news is the Medicaid expansion that the governor championed expanded drug and alcohol treatment to over 62,000 Pennsylvanians. Most of them accessed that treatment in the first two months of the Medicaid expansion, so those were likely folks who didn't have any insurance prior to the Medicaid expansion. Now the not-so-good news is the effectiveness of the treatment that we're able to provide now. Substance use disorder, or an SUD, particularly for opiates, is very hard to treat. And if you look at some of the numbers that we have in Pennsylvania, about 48 percent of the folks who we know have an SUD in the Medicaid program, only 48 percent, I should say, only 48 percent of them are in treatment. After 30 days of being aware that they have an SUD, that number drops to about 33 percent. Similarly, for folks who show up in the emergency room, these are Medicaid folks, only 10 percent of them enter treatment even after being in the emergency room for an overdose. That number goes up slightly to just 15 percent after 30 days. But what you really see is there's an effectiveness gap in the treatment we provide. The Centers for Excellence are an opportunity to try to change that to address the whole person. So a lot of folks who have a substance use disorder may have a co-occurring behavioral health issue. They may have chronic pain or a physical health problem that caused them to start using opiates in the first place. So the Centers for Excellence is an effort to try to coordinate that care, make sure we treat the whole person and we don't just treat the SUD, but we also treat the underlying causes of that substance use disorder. Thank you, Secretary Dallas. Secretary Tennis. Yes. The Department of Drug and Alcohol Programs was just created by the General Assembly and was raised from a bureau to a cabinet-level department in July of 2012. The General Assembly raised it to that level because of its desire to make sure we could carry out the function of a single-state authority, which is to coordinate drug and alcohol policies across agencies. So we work with almost every agency in the state to find ways to strengthen and coordinate and streamline drug and alcohol policy. We also administer the federal and the state substance abuse prevention and treatment block grants. So we get about 60% of our funds from the federal government, about 40% from the state, and that money goes out to our counties, and they administer these dollars to do strong prevention programs, strong treatment programs. And we, like I said, we coordinate with all of the agencies. We'll go into that a little bit more. But our job is to really make sure what Ted was talking about, which is we really make sure that when folks get drug and alcohol treatment that they're getting the full continuum of care based on a good individualized clinical assessment that would be handled in a clinically sound manner. Wonderful. Dr. Murphy. So the Department of Health is responsible for improving the health of all Pennsylvanians. And we also, in doing so, we look at public health as a main function of the department. When we look at this crisis, it is the worst crisis that we've ever experienced in Pennsylvanian as a country. So the Department of Health works alongside of other agencies in state government on education. Also, we are getting ready to launch our prescription drug monitoring program, which hopefully will identify those in need so that we can get them to treatment faster than we were able to before. And Dr. Levine. Good afternoon. So I'm the physician general in Pennsylvania. And so my role in that position is to advise the governor and the administration and the secretary of health on medical issues and public health issues. And as Secretary Murphy mentioned, the opioid crisis is really the worst public health crisis that we're facing. One thing that I've been able to do as physician general under governables leadership was to write a standing order prescription for naloxone. Naloxone is a medication that is an antidote to an opioid overdose. And under Act 139, I was able to write two standing order prescriptions. The first was for first responders to carry naloxone, such as the Pennsylvania State Police and municipal police departments. In the last year and a half, they have saved over a thousand lives in Pennsylvania. And Secretary Tennis had an event last week about that. I also signed a standing order prescription actually for anyone in Pennsylvania to be able to obtain naloxone from a pharmacy so that in case a loved one might be addicted to prescription opioids or to heroin, that an overdose can be reversed with that medication saving their life and then getting into the treatment that they need. Wonderful. So just as a reminder, these are questions that we've gotten from our viewers to Governor Wolff's Facebook page over the last day or so here. And we're going to get to just as many as we can. I'd like to start with Secretary Tennis. Barbara from Eastern Pennsylvania unfortunately shared with us that her daughter had passed away. And so she wants to know when will Pennsylvania develop effective treatment plans for addicts? You bet. Well, first of all, the first thing I want to say to Barbara is I am just so, so terribly sorry to her loss as a parent of four kids. I just can't imagine anything worse than it seems like every week or two I'm meeting with another parent who's lost their child overdose and it's a shattering, terrible problem. We know at last count we lost 2,500 Pennsylvanians to overdose right now in America. We're losing about 1,000 Americans a week. So we have a terrible crisis. We are working aggressively to ensure that addiction treatment is provided at the clinically correct level of care. The overall context of treatment right now is that over the past 10 years the federal government has cut funding to drug and alcohol treatment by 25% in real dollars. We already were underfunded. The state government, up until Governor Wolf tick off, the state funding for drug and alcohol treatment was steadily cut year after year as well. What that resulted in is treatment that had been successful, that had had the right level of care, the right length of stay, got cut back further and further and further until pretty soon. People just couldn't get long enough time in or if they did get in the kind of wraparound services that Secretary Dallas is talking about, that deals with the whole person, our treatment programs used to be able to do that. But as they had to stretch those dollars more and more thin, then they were less able to do that. The federal government states that we as a nation fund enough treatment to treat 10% of the need, so that's caused our programs to go on the cheap and you just can't do that. You have to make sure you fund them, as you said, to treat the whole person like they used to. So I just really mostly want to thank Governor Wolf because what has happened in the last year and a half, this reversal of this steady, steady cuts, primarily in Medicaid expansion but also even in funding for treatment through our agency, is really historic and it's the first time that we've had leadership that really recognizes that this has to be on the front burner. Thank you. Dr. Murphy, we'll go to you next. Sandy from Colville asks, what do you have in mind for rural areas that do not have the treatment facilities readily available? So we are very concerned about rural areas. The statistics actually are much higher in rural Pennsylvania as compared to our urban counterparts. So when we look at even the outcomes, there's been a 315% increase in hospitalizations for heroin overdose compared to 143% in the urban areas. So the problem is definitely much, considerably worse in the rural area. So what we plan on doing is working with our rural health systems, our rural health clinics, at ways that we can better restructure the healthcare delivery system in those areas so that we can address this issue. Also with the Centers of Excellence that Secretary Tennis is speaking of, hopefully some of those will go to the rural areas as well. So rural Pennsylvania is a focus for the Department of Health as well as all of us, and we will be taking specific action in those two areas to address this. I would just add, Karen, that for the Centers of Excellence we received 116 proposals. They were in 48 of the 67 counties, so many of the proposals were in rural areas as well. Dr. Levine, Sharon from Johnsonburg says that her question is in regards to holding doctors accountable for overprescribing, and she says why is it nearly impossible to file charges for negligence? So overprescribing has been an issue, and in terms of what's led to this crisis, one aspect has been the significant prescriptions, amount of prescriptions for opioid pain medications. So we are working on that in an interagency way. So we are working with the medical school deans for a better education for medical students about this topic. We also have continuing medical education that we've been working with for physicians as well as other medical providers who prescribe these medications to educate them better, and that's part of the requirements for their license. And finally, we are working on specialty-specific prescribing guidelines on opioids for many different providers in the state, including dentists and pharmacists and physicians, and we're continuing to work on those to help them prescribe less opioids for different types of pain. Those guidelines are going to be taken to the Board of Medicine and other specialty boards for their acceptance and affirmation. So we are absolutely working on that problem. Secretary Dallas, Joshua asks, and this is a rather long one, but I'm going to read it, is the state moving to a system of suspending Medicaid enrollment for individuals who are incarcerated rather than the current system that terminates enrollment. If so, how long until this is available to the state and county correction systems? So the short answer is yes, we are moving in that direction. The federal government requires a termination of benefits. What we are looking at, and we have a lot of support in the General Assembly for this as well, is making some changes to our IT systems so that when folks enter the correctional system, we suspend their benefit rather than terminating their eligibility. So that way, when they leave the correctional system, we'll be able to turn it back on. In the interim, we're also working with a less high-tech approach on that as we're working through that solution. We have folks, some of our county assistance workers, who determine eligibility. They go out to, for example, we're piloting in Greater First State Prison in Montgomery County. They're going out to the state correctional institution there, and they're working with the folks who are going to be leaving that month to make sure that if they're eligible for Medicaid, they're enrolled and we're ready to make them eligible the day they leave so that the moment they leave prison, if they're getting drug treatment while they're in prison, they'll be able to get drug treatment as soon as they leave as well. We're trying that also with some county-level jails in Montgomery County. We're also looking in the western part of the state to do a similar pilot. But ultimately, the solution will be making that IT change that we're working on with the legislature. If I could throw in on that. There's been a really great partnership between DDAP and DHS with the county jails. We're now up to over 50 counties that actually we have case managers going into the county jail. They do the assessment. If the person needs drug and alcohol treatment, they hook up with their county assistance offices. And we're closing in on getting every county now covered so that when somebody comes out of county jail, the moment they step foot out, their Medicaid's turned on, there's a van waiting them to take them right to treatment. That's going to not only create greater public health in our communities, but that's going to create greater public safety because those individuals are at very high risk of recidivism. And it's an example of the kind of partnership that DHS and DDAP has had, working with our county stakeholders as well, our county jails, district attorneys, judges, and probation and parole. We'll stick with you, Secretary Tennis. Amy asks, studies have shown that most of those affected by opioid abuse and heroin addiction are over the age of 30. What is being done to educate this demographic? Lots of resources are used for in-school and education, but what about adults? Well, first of all, I would love to do a lot more resources for our students and kids. We think more is needed there, but as for those over 30, there are a number of things we're doing. We know that four out of five Pennsylvanians who are on heroin today started on prescription opioids. So really the genesis of this problem has to do with the overprescribing of opioids. We've started a PR campaign. We've actually got some nonprofit funding to do the P.A. Stop campaign, which involves both a combination of putting posters and billboards all over the state. You might have seen them around. It's addiction can affect anyone, and it has kind of the faces of every demographic you could possibly imagine on the poster, just to let everybody know that this is no longer an issue that we can say that's those people over there. This is us. Anybody can get addicted to opioids, anyone, and if you do, you're at risk of moving to heroin. There are also PSAs that are part of that that we've been running, and I don't know if they're still running on the radio, but people would tell me they heard them. I never heard them, but we've been doing those. We are training Dr. Levine, Secretary Murphy, and I have an aggressive campaign with the prescribing guidelines to train our doctors both in medical school. We're meeting with the medical school deans. This is a collaborative project. And with the medical society and other healthcare provider groups to do continuing medical education for training physicians, because really in the doctor's office is a good place for someone who's at risk to be taught, this is risky for you. You have to identify when there's a problem and nip it in the bud before it gets going. And finally, we're doing a regional project with SAMHSA and about five surrounding states, West Virginia, Maryland, Ohio, and the District of Columbia to do a PR campaign and really to pool our resources to get greater efficiencies and hit the whole region at once on a PR campaign to do exactly what your questioner was asking about. It is the direction we need to go. Dr. Levine, Tom from Glassport asks, why can't your primary care physician write treatment prescriptions? This would make it easier and less costly to get treatment, no? It's a very good question. So there are different ways to treat patients who are addicted to opioids. One way, as Secretary Tennis was alluding to, is rehab. And you would need to have patients in long enough rehab to get off their drug addiction and to work towards recovery. There's another method that can be used for patients with opioid use drug addiction, and that's using what is called medication-assisted treatment. And there certainly has been a pivot in the federal government for medication-assisted treatment, which can be very useful for many patients. So that includes methadone, a medicine called Suboxone, and another medicine called Vivitrol. And they all work kind of differently. Methadone has been around for many years and can be very effective for selected patients. Those really, that methadone for addiction has to be prescribed through methadone clinics. And actually, they're regulated through Secretary Tennis's department. So your family physician would not be prescribing that for an addiction. Suboxone, however, is prescribed by physicians. Your physician has to take extra training, which is available through the federal government, about eight to 10 hours of extra training in the use of that. And family physicians, internists, et cetera, can prescribe Suboxone. Vivitrol is a different type of medication. It's a shot, which also can be very effective, and your physician can prescribe that. It's important to emphasize that medication-assisted treatment, the medicine assists the treatment. So there's no miracle cure here. The idea is the medicine can assist recovery, but all of those patients need to be in therapy and counseling in what's called wraparound services, where the medicine can assist the substance abuse treatment that can lead a person to that type of recovery. So actually, if your physician takes the extra training, they can prescribe Suboxone. Great. Thank you for that. Let's go to Secretary Dallas. Diane is asking, who is paying the tab for these folks to go get their medications to stay off opioids? So the answer is that depends. If you have private insurance, there are cases where your private insurance will pay for that. For low-income folks who are on the Medicaid program, they can get funding for treatment through the Medicaid program that's split between the state and the federal government. And then there are some folks who can't afford private insurance and may not qualify for the Medicaid program and they're forced to go out of pocket or through some other method. Ultimately, though, it's important to note when you look at treatment, particularly treatment that's provided as Rachel was talking about medication-assisted therapy, that allows a lot of folks to continue working even while they're getting treatment. So while they're getting treatment and some of that's taxpayer-funded treatment, it helps them continue working, providing for their children. It's less expensive than some of the consequences of not getting treatment. And ultimately, if you wind up in the criminal justice system, you're incarcerated, or if you haven't forbid you pass away, you can leave children behind that then another part of my department might have to take care of. So when you look at the cost of it, a lot of times it's private insurance, sometimes it's Medicaid, sometimes it's out of pocket. But ultimately, too, you need to look at those costs in terms of what the cost might otherwise be if we don't make that intervention. I think there's a fair amount of research on that and review the research and what Secretary Dallas is saying is exactly right. The research actually shows that every dollar spent on treatment, including the medication, returns about $7 to taxpayers and reduced criminal justice costs, children and youth services costs, HIV, hepatitis C cure costs. There's just a litany of costs that's spent off if we don't take care of the problem. It's much cheaper to treat people and get them into recovery than it is to allow the disease to deteriorate and to go on. And Secretary Tennis, Bob from State College says since prior treatment programs have had little effect on reducing addiction, he says, what new programs will be put in place to afford the addict a better outcome? Well, the one thing I want to say is people in recovery stay anonymous in terms of whether programs work if they are allowed to do the right level of care in the right length of stay, whether medication or not medication, although actually all programs do use medication pretty much in varying levels, at least during detox. But if they are allowed to do the right length of care, we get tremendous success, like 60 to 70% rate for people with severe addiction, for people with lesser addiction. It's even higher and you don't have to spend as much money doing the treatment. You don't have to provide as much, just like any other disease. We are, what we're really doing is we're working on identifying when medications are going to be best or not. We're working with our programs to make sure they get the right level of care in the right length of stay, and it's actually the funders. I think most of the programs want to do it if they can get funded. And I guess the big thing I want to say is we have 23 million Americans in recovery. Most of those people got better in treatment. So you don't necessarily hear them, because of the anonymity around the disease, because of the stigma, you don't hear them talking about it. But people do get better from this disease all the time. Those who have suffered where they've lost loved ones, that's little consolation to hear about those 23 million. And we understand that, and we're going to continue to work together and look at the best technologies for getting people better. But treatment ultimately does work. I think that's part of the rationale behind the governor's proposal to fund or hopefully able to fund. They will be folks who have proposed us and have come up with innovative ways for approaches that we think might work even better than the processes we have now by, again, by treating that whole person and looking at different ways of doing things. So I think the governor's proposal is a way to try to make the treatment we have even better than we have today. And that highlights the importance of naloxone. So naloxone reverses an overdose. You can't get addicted from naloxone. You can't abuse naloxone. You can't run your business for the rest of the life. You can't use it for every person. You can't use it for a person's whole life and gives them the chance to get the treatment that the other secretaries are talking about in a chance for recovery. Everyone deserves a chance for life and for recovery. And we've seen more and more police departments stocking their arsenal. Every day we're getting more police departments. Every day they're getting more and more. Every day, every single day lives are being saved right now with naloxone warm handoff and by warm handoff I mean getting a recovery specialist or case manager to intervene with the individual either at the overdose site and go with them to the emergency department or in the emergency department and we're actually started we've given these requirements to our counties you've got to have these strong procedures in place by the end of the year some of them are already getting amazing results as you said what is it about 10% and emergency departments get to treatment in Berks County now they're getting two out of three overdose survivors into treatment those are the best outcomes I've heard anymore in the nation we have some innovative programs here in Dauphin County and in Washington County where they're actually when the 911 call comes in on overdose they have the recovery specialist often somebody in recovery often somebody who's overdosed out to the overdose scene and they actually start engaging that individual right at the overdose scene accompanying them to the emergency department and then basically we don't really ask these people or try to talk them into treatment we basically treat them like somebody with a massive coronary we say okay we've kept you alive now we're gonna start your treatment we know that doctors orders have no legal authority even somebody with a massive heart attack is free to walk out on the sidewalk and drop over dead of a heart attack but the truth is we follow doctors orders and we really want to encourage a shift in the paradigm so that it's a muscular warm handoff to treatment and because otherwise they're at risk of over overdosing again we have time for one more and Dr. Murphy I'd like to direct this at you this is another question from Sandy who asked your prior question and it's a big one she says how do you think we can overcome the stigma attached to addiction so that people can get help so that is a great question and it is one that we believe is critical to addressing this public health crisis so what is this stigma associated with drug addiction out in the public people think that this this issue is in one particular segment as secretary tennis said it has faces of all so these are mothers fathers brothers sisters people we know I'm sure if we pull people in the room we would have those that have suffered I think the most important reason for us as leading this initiative to try to address this crisis the most important reason for us to address the stigma is because it's delaying people from getting into treatment so parents don't want to admit that their children have a problem we have husbands and wives that don't want to come out and say that there is a problem so we have to work together to really educate the public is that this public health crisis is not this is there is no one that is immune and that we need to get people into treatment to save lives we have seven we're losing seven Pennsylvanians every day I can think of no other disease that we would ever not intervene to get people help as quickly as possible so stigma is very important for us to address and we will work to address it diligently so that we are effective in in getting people to treatment faster others we think we look at folks with drug and alcohol addiction say well they're choosing they made bad choices most diseases have bad choices involved those with heart disease often have made bad choices in terms of their you know poor eating choices lack of exercise to kind of point the finger is really is a deadly deadly practice because as Secretary Murphy said it not only keeps people from admitting that they have the disease and seeking help it also drives what I call stigma stigmatized policy what other disease would we tolerate at a national level funding only 10% of the need instead we pay seven times more to wait till people deteriorate into the criminal justice system and then we pay far far more so or we wait until they die of an overdose so the policy of cages and coffins as a treatment or as a response to any disease it's not a civilized response we really truly need to take stigma on we all deserve it we could have much healthier communities we could have much safer communities if we finally kind of move into the light and understand this truly is a disease dr. Benjamin Rush 240 years ago one of the signers of Declaration of Independence said we need to stop looking at this as a moral failing and we need to start looking at it as a sickness so it's 240 years later many many lives lost later it's time we finally get it you've all been wonderful advocates for this cause and I truly appreciate you all joining us here today and we are at a time but I want to thank each of you for being here today to address just some of the questions that have hit Governor Wolf's Facebook page I also want to thank everyone who tuned into our discussion here and encourage you to like the governor's Facebook page and follow him on Twitter in order to stay up-to-date on everything the administration is doing to combat opioid addiction here in Pennsylvania thank you so much