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National opioid forum held in Lower Swatara; Pennsylvania No. 2 in U.S. for OD deaths

By Dan Miller

Posted 3/20/18

Pennsylvania picked as site because it’s No. 2 in U.S. for OD deaths

Some Pennsylvania employers have jobs to offer, but can’t fill them because they can’t find enough people who …

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National opioid forum held in Lower Swatara; Pennsylvania No. 2 in U.S. for OD deaths


Pennsylvania picked as site because it’s No. 2
in U.S. for OD deaths

Some Pennsylvania employers have jobs to offer, but can’t fill them because they can’t find enough people who can pass a drug test.

That is one of many ways the opioid and heroin epidemic is affecting Pennsylvania, especially rural Pennsylvania, according to participants in a forum on the epidemic that was held in the Lower Swatara Township Fire Hall on March 14.

The forum was the first of five roundtables on opioid misuse in rural America being held over the next few months across the country by the U.S. Department of Agriculture.

“Pennsylvania was No. 2 last year in the number of overdose deaths” nationwide, USDA Assistant to the Secretary for Rural Development Anne Hazlett, who presided over the forum, told the Press & Journal about why federal officials chose to hold the first roundtable here.

The four other roundtables are being held between now and July 11 in Utah, Kentucky, Oklahoma and Maine.

“We wanted to see how rural communities are being impacted and what is working in some of these places that we can look at replicating elsewhere,” Hazlett said. “We can best then look at our own programs to see what specific initiatives we might be able to develop within our own programs, as well as helping link communities between each other with best practices.”

The March 14 event brought to Lower Swatara elected officials including state House members, county commissioners and county coroners; representatives of law enforcement, emergency responders, and those who provide drug and alcohol treatment and counseling; victims of the epidemic who have started support groups in memory of loved ones who have died; and people in recovery who shared their own harrowing tale of addiction and abuse.

Every available parking space at the fire hall was filled.

One of those spaces — inside a fire hall bay — was occupied by a recreational vehicle pulled by a pickup truck that brings monthly injections of Vivitrol to recovering addicts in remote rural areas.

Vivitrol is the brand name for naltrexone, a non-narcotic  medication released in 2006 that takes away the craving for heroin and other opioids, said Amanda Cope, a panelist at the forum who in 2015 launched Positive Recovery Solutions.

She said Vivitrol is covered by insurance, but many people in rural areas who need it can’t get to providers who have it.

“We have a lot of patients driving hours to our brick-and-mortar location in order to get a follow-up injection,” said Cope, a registered nurse and recovering addict who will be sober 12 years as of May 6. “I decided I was going to create a mobile entity that took this medication and made it accessible to anybody who wanted access to it, regardless of their location. … This is a company literally created by addicts for addicts.”

Started in Blair County, PRS now operates in 28 Pennsylvania counties.

“We are now pushing over 400 injections a month” and the company is expanding into Ohio, Kentucky, Maryland, Indiana, Florida and West Virginia. PRS also provides Vivitrol to inmates coming out of state prisons and some county jails.

Specialty courts

The panel heard from Michael J. Barrasse, a Lackawanna County Court judge who has been praised for his role in developing specialty treatment courts like drug courts.

“Often our county prisons, our state prisons, end up being our detox our drug rehab and our mental health hospital, all at the same time,” he said. “We can’t Narcan, we can’t arrest our way out of the problem. (Yet) one of the problems that we are facing today is that the arrest ends up being the only way that we are often able to get these individuals into treatment.”

Mapping overdoses

In Adams County, emergency medical service providers rely on a mapping system developed by the University of Pittsburgh to track where overdoses are occurring in the county. That way EMS can position its ambulances “where they are going to be the most useful,” said Eric Zaney of the Adams County Regional EMS.

“We are chasing patients,” many of whom are overdosing “over and over again multiple times,” he added. “It begins to wear on EMS crews. You don’t have the avenues to get them into recovery — none. When we revive them with Narcan we end up getting a patient refusal. We do our best to spend an extended amount of time on scene to get those folks to go to the hospital because that’s our only option. The minute they refuse we are going to be out there (again), and we know it.”

Rural communities

The impact the opioid and heroin epidemic is having on rural communities in Pennsylvania was illustrated in stark terms by Jim Barbour, a farmer in Susquehanna County.

The county has just 42,000 people and “everybody knows everybody, yet we have one of the highest rates of suicide and drug overdose in the state,” Barbour said.

He sees the epidemic as tied to the economic decline of the family farm and the changes that brings about.

“For the next generation it’s too much work and not enough money to stay. That makes it difficult. In a rural area there are not a lot of other jobs,” he said.

While mining and Marcellus Shale have brought “a lot of good jobs to the area,” many of these employers can’t find people to fill the positions.

“We have so many people that are addicted and are not clean that they cannot find a job,” Barbour said. This is contributing to rising crime rates, especially burglaries, that are themselves changing the culture of life in Susquehanna County.

“It used to be everything was unlocked and everybody was neighborly. Now because of the high cost of addiction” people have to protect their farm equipment, garages and tools from those who steal these items to support their habit.

Barbour said one thing he wasn’t hearing at the forum was talk of reducing the supply of heroin coming in. Susquehanna County is along the interstate “pipelines of supply” of heroin and other illegal drugs, he added.

“If we can figure out how to slow down the supply, we might have less to do on the backend of trying to do the treatment and trying to get people back into a viable place in our society.”

Losing loved ones

Several speakers told of losing their own friends and loved ones to a heroin overdose.

But there were also stories from those who have overcome their own addiction to lead productive lives, such as Alexis Johnson.

Johnson is nearing her three-year anniversary in recovery, but it took seven trips to prison. She overdosed seven times — including twice in four hours in 2012. She flat-lined twice and considers herself fortunate to be alive.

“It doesn’t matter how many times you have fallen, it’s how we give you the tools to get you back up,” Johnson said. “I just quit my six-figure a year job to pursue motivational speaking. I have dedicated my life to this. I lost 16 friends to heroin. I do this day and night and I’m not going to stop until we find a solution, because there is one.”

Addiction is a disease and should be treated that way, said Dr. Kent Vrana, chairman of the pharmacology department at the Penn State College of Medicine.

“If someone makes some bad choices and ends up with high cholesterol and hardening of the arteries and has a heart attack, we don’t say you made bad choices we aren’t going to treat that high blood pressure. We treat the individual,” Vrana said.

While much of the fight is focused on the individual —  such as providing Narcan and improving access to treatment — overcoming the epidemic means addressing the socioeconomic challenges affecting not just rural America but elsewhere, said Shannon Monnat, a researcher and associate professor of sociology at Syracuse University.

“Are we trying to save lives now by getting a tourniquet on this problem, or are we interested in dealing with the underlying causes that got us here in the first place?” she said. “Drug overdose rates just as with alcohol and suicide are higher in places that exhibit more economic and social distress. Importantly though these are also places that have higher rates of obesity, they have higher rates of low self-rated health, higher rates of smoking. There is nothing particularly unique about opioids except they are contributing to younger and faster deaths.”

Three programs from USDA

Hazlett after the forum said that USDA has three main programs to help rural communities deal with the opioid and heroin epidemic.

The agency can assist in building bricks-and-mortar facilities such as transitional housing, treatment clinics, hospitals and other types of medical facilities.

USDA also has a distance learning and telemedicine program that can assist in bringing services to remote areas where there might not be a treatment provider nearby. USDA also offers a grant program for youth preventative efforts.

“I think there is a lot of partnership going on at the local level,” Hazlett said, citing the example of a faith-based program in Lancaster County presented at the forum that works to engage congregations in fighting the epidemic. “There was a lot of partnership and collaboration opportunity to learn from today and I look forward to taking that back and putting it into practice.”