Lawmakers held a public hearing in Harrisburg Thursday to brief officials on the continued impact of the state’s opioid crisis in rural communities.
Addiction specialists, treatment providers and law enforcement gave testimony in front of the bicameral Center for Rural Pennsylvania, a legislative agency that acts as a policy resource for members of the statehouse.
In 2020, 3.4 million residents — or just over a quarter of Pennsylvania’s total population — lived in rural counties, according to the nonpartisan organization.
Speaking virtually, Melissa Ferris, executive director of the Fayette County Drug and Alcohol Commission, told the Center’s board of directors that while overdose fatalities in Pennsylvania declined slightly in the first part of 2022, they have continued to rise in Fayette County.
Ferris said, for many of the county’s residents, finding transportation to get to treatment services is a challenge.
The majority of people housed at the county’s jail in Uniontown, an hour south of Pittsburgh, have substance use disorders, she continued.
“When an individual leaves the jail they’re at very high risk of overdose,” Ferris added. “They may go back to using a substance and thinking they can use ‘x’ amount of bags of heroin — or now it’s actually fentanyl — and they overdose.”
The commission will use its share of the state’s 2021 opioid settlement payout to bring medication-assisted treatment to the prison, Ferris said, as well as bolster its community addiction support team. The grant-funded program sends support workers out with EMTs responding to reports of an overdose.
That way, once the person overdosing has been revived with naloxone, the commission’s staff is there to help them navigate services, offer them resources and leave them with more doses of naloxone.
Over 18 years, the Commonwealth will receive nearly $1.07 billion from opioid manufacturers and distributors to address the overdose crisis, as dictated in the settlement.
Jeremiah Daley with the federal High Intensity Drug Trafficking Area program told lawmakers that Pennsylvania continues to have a disproportionate share of drug overdose deaths nationally.
Roughly 5,343 people died of a drug overdose in 2021, according to the state’s opioid data dashboard. While finalized numbers are typically delayed by three to six months, lawmakers estimate there were more than 3,000 fatal overdoses in 2022.
“So there's a great deal of urgency to address these issues in a unified and collaborative way,” he said.
The legislature passed a bill last year requiring law enforcement to report all fatal and non-fatal overdoses into a shared database so that public officials statewide could leverage that information to aid their communities.
That mandate, however, must be expanded to first responders and other medical professionals, Daley stressed.
“Key to this is consistent and continuous data collection and sharing by all the responsible agencies and disciplines to report both fatal and non-fatal overdoses as close to the time of occurrence as possible,” he said.
Staffing shortages compound bureaucratic barriers
Labor shortages, too, have limited drug and alcohol treatment providers’ ability to meet the demand for care.
Jason Snyder with the Rehabilitation and Community Providers Association explained the problem is twofold: employees are leaving the sector to find better pay elsewhere, and state regulations that dictate staff-to-client ratios at treatment facilities are exacerbating the workforce crisis.
Residential, non-hospital treatment and rehabilitation programs must have one full-time or equivalent counselor for every eight clients, and one full-time counselor for every six adolescent clients, according to regulatory standards adopted in 1996.
While that ratio is slightly lower for hospital-based treatment centers, full-time counselors at outpatient programs may not have more than 35 patients at one time.
“Effectively, what we are saying is in the midst of an overdose death crisis, we'll take the risk that you might die on the street rather than go outside a staff-to-patient ratio that was seemingly pulled out of thin air decades ago,” Snyder said.
“Our problem today is not capacity-related. In other words, we have treatment slots available at every level of care,” he continued.
Justin Wolford, director of outpatient services at CenClear, which provides treatment in 10 counties across central Pennsylvania, said four staff vacancies — paired with the ratio requirements — have precluded specialists from seeing an additional 140 patients they have the capacity to treat.
“I want to be clear that those four vacancies are bare minimum positions that need to be filled,” Wolford said. “That's without consideration for the volume of new services that are needed, and the demand is quite genuinely insatiable.”
Wolford said his staff is also overburdened by documentation and licensure requirements that limit their ability to hire qualified candidates.
Speakers urged lawmakers to push the Department of Drug and Alcohol Programs to revise its policies.
"The amount of opportunity that we're missing is mind-blowing,” Snyder said.
