Addressing the Opioid Epidemic in Western Pennsylvaniaiop.pitt.edu/sites/default/files/Events/Westmoreland... · 2018-01-12 · experience in the mental health field as a residential

Presented by:

Wednesday January 17, 2018

8:00 am – 4:00 pm

Science Hall, Westmoreland County Community College

Addressing the Opioid Epidemic

in Western Pennsylvania: Bridging Public Health and Public Safety

Photo by AndreCarrotflower

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University of Pittsburgh Institute of Politics,

the University of Pittsburgh School of Pharmacy

Program Evaluation and Research Unit Technical Assistance Center,

Westmoreland Drug and Alcohol Commission,

and the U.S. Drug Enforcement Administration

presents

Addressing the Opioid Crisis in Southwestern Pennsylvania:

Bridging Public Health and Public Safety


8:00 am – 4:00 pm


PROGRAM AGENDA

8:00 – 8:30 am Registration and Continental Breakfast

8:30 – 9:00 Welcome and Introductions by Mark Nordenberg, Chancellor Emeritus, University and Pittsburgh, and Chair, Institute of Politics, with a special welcome from Gina Cerilli, Commissioner and Chair, Westmoreland County

9:00 – 9:30 Recovery is Possible Panel moderated by Jana Kyle, Executive Director, Fayette County Drug and Alcohol Commission, Inc., featuring:

Mary Phillips

Austin Hixson, Certified Recovery Specialist, Southwestern Pennsylvania Human Services, Inc.

9:30 – 9:45 Open Discussion moderated by Jana Kyle

9:45 – 10:35 Fentanyl and Emergent Threats: Partnering Prosecution and Public Health, featuring:

Cheryl Andrews, Executive Director, Washington Drug and Alcohol Commission, Inc.

Soo Song, First Assistant U.S. Attorney for the Western District of Pennsylvania

Eugene Vittone, District Attorney, Washington County

Brian Dempsey, Intelligence Specialist, DEA

10:35 – 11:00 Open Discussion

11:00 – 11:15 Break

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11:15 – 11:45 Coordination of Tactical Diversion, featuring:

Kate Lowery, Single County Authority Administrator, Beaver County Behavioral Health Drug and Alcohol Program

David Lozier, District Attorney, Beaver County

James Higgins, Special Agent, DEA

John DeLuca, Chief of Police, City of Beaver Falls

11:45 – 12:00 pm Open Discussion

12:00 – 12:20 Community Paramedicine and the Opioid Crisis: First Responder Warm Handoff Program by Christie Hempfling, Emed Health and CONNECT Community Paramedic Program, Community Health Team Manager, The Center for Emergency Medicine


12:30 – 1:30 Lunch and Addiction as a Disease by Dr. Mitchell West, Medical Director for Addiction Medicine, Allegheny Health Network

1:30 – 2:00 Recovery is Possible Encore Panel moderated by Jana Kyle, featuring:

Kendra DiLascio, Case Manager, Southwestern Pennsylvania Human Services, Inc.

Ashley Potts, Licensed Social Worker, Allegheny Health Network


2:15 – 2:45 Substance Use Disorder Treatment: Roles for Single County Authorities and Centers of Excellence, featuring:

Colleen Hughes, Executive Director, Westmoreland Drug & Alcohol Commission

Elizabeth Comer, Director, Clinical and Case Management Services, Westmoreland Drug & Alcohol Commission

Cheryld Emala, Executive for Innovation and Strategic Alignment, Southwestern Pennsylvania Human Services Center of Excellence


3:00 – 3:45 Keynote Address by Josh Shapiro, Attorney General, Commonwealth of Pennsylvania

3:45 – 4:00 Next Steps and Closing Remarks by David Battiste, Special Agent in Charge, DEA

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Table of Contents

Presenter Biographies ................................................................................................................................... 5

Increasing Access to Treatment .................................................................................................................. 10

Overview ................................................................................................................................................. 10

Medication Assisted Treatment .............................................................................................................. 12

Warm Hand-Offs: Protocols for Emergency Departments and First Responders ...................................... 15

Overview ................................................................................................................................................. 15

Excela Warm Hand Procedure Provided by Ms. Colleen Hughes ........................................................... 20

Help for Overdose Survivors – Fayette County Drug & Alcohol Commission ............................................. 22

Opioid Epidemic: Best Practices in Prescribing ........................................................................................... 24

Pennsylvania’s Prescription Drug Monitoring Program (PDMP) ................................................................ 26

Operation Trojan Horse Fact Sheet ............................................................................................................ 29

Suspected Overdose Incident Report ......................................................................................................... 30

Carfentanil in Pennsylvania ......................................................................................................................... 32

How to Properly Dispose of Your Unused Medicines ................................................................................. 34

Treatment for Drug Use and the Need for Paid Family and Medical Leave ............................................... 35

Moving Forward and Next Steps ................................................................................................................. 37

How to Use This Manual ......................................................................................................................... 39

Why a Coalition? ..................................................................................................................................... 42

Describing Your Community ................................................................................................................... 43

Obtaining Your Data ................................................................................................................................ 43

Determining Your Community’s Readiness to Have an Impact on Overdose Deaths ................................ 44

Selecting Your Coalition Members .......................................................................................................... 45

Developing Your Coalition Vision Statement .......................................................................................... 46

Selecting Your Coalition Leadership ....................................................................................................... 46

Conducting Productive Meetings ............................................................................................................ 46

Assessing Your Coalition’s Health ........................................................................................................... 46

County Overdose Elimination Framework .............................................................................................. 47

Selecting Your Evidence-Based Interventional Strategies ...................................................................... 47

Naloxone Availability .......................................................................................................................... 47

Medication Assisted Treatment (MAT) ............................................................................................... 47

Opioid Prescribing Practices ............................................................................................................... 48

Prescription Drug Monitoring Programs (PDMP) ................................................................................... 48

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Building an Impact Model ....................................................................................................................... 48

Developing and Using a Strategic Plan ................................................................................................... 49

Developing an Evaluation Plan................................................................................................................ 50

Finding Evaluation Assistance ................................................................................................................. 50

Current Situation Assessment ................................................................................................................. 50

County Dashboard Framework ............................................................................................................... 50

Sustainability: Developing a Grant Application ...................................................................................... 50

Reasons Applicants Do Not Get Funded ................................................................................................. 53

Potential Sources of Grant Funding ........................................................................................................ 53

How the TAC Can Help ............................................................................................................................ 53

Glossary ....................................................................................................................................................... 54

References .................................................................................................................................................. 58

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Presenter Biographies

Cheryl Andrews

Cheryl Andrews is Executive Director for the Washington Drug and Alcohol Commission. Ms. Andrews

has 15 years of experience working in the drug and alcohol field; specifically, with the Single County

Authority. During her five-year tenure with the Commission, she has worked collaboratively in

developing and implementing innovative programs within the criminal justice system; including, the

correctional facility and the court system, Children and Youth Services, local hospitals, and the faith-

based community. Ms. Andrews works closely with the Washington County District Attorney to provide

education and distribution of naloxone to first responders and community members. Ms. Andrews

serves on the U.S. Attorney of Western PA’s working group on drug overdose and addiction and is the

co-chair of the prevention and education committee.

David Battiste

Mr. Battiste has been DEA Assistant Special Agent in Charge Pittsburgh District since June 2015. His

employment history includes Public Safety officer-Department of Public Safety Dallas/Fort Worth Airport

1989 – 1990 and Police Officer in Jennings, La from 1981 to 1989; attained the rank of Sergeant. Mr.

Battiste has a BS in Criminal Justice from McNeese State University (Lake Charles, LA) received in 1988

and Masters in Management from Webster University (Santa Teresa, NM) received in 2003.

Elizabeth Comer

Elizabeth Comer is the Director of Clinical and Case Management Services for the Westmoreland Drug

and Alcohol Commission (WeDAC). She has a Bachelor of Science in Criminal Justice and a Master of

Social Work Degree from California University of Pennsylvania. Elizabeth’s work history includes

experience in the mental health field as a residential counselor, experience in the medical field as a

medical social worker/case manager, and experience working in the Drug and Alcohol Field for over 11

years. In her current position she provides oversight to treatment services and WeDAC’s subcontracted

Drug and Alcohol Case Management Unit.

Kendra DiLascio

Kendra DiLascio a 35 year old, mother of two that lives in Westmoreland County, and has been in

recovery for five years. Kendra has been employed at SPHS in Greensburg for 2 years starting as a

Certified Recovery Specialist and currently working as a Case Manager. She graduated with her

Bachelor’s degree from Kaplan University with a degree in Psychology with an emphasis in Substance

Abuse Counseling and will complete her Master’s Degree in April 2018 with a major in Psychology with

an emphasis in addictions. Kendra is a Narcan survivor, Narcan trainer and advocate for recovery.

Cheryld Emala

Cheryld Emala is the Executive for Innovation and Strategic Alignment at Southwestern Pennsylvania

Human Services, Inc. (SPHS). She is a graduate of the University of Pittsburgh with a Master’s Degree in

Social Work and is a Licensed Clinical Social Worker. Cheryld is responsible for staff development across

the SPHS system, as well as program planning and design. Her work covers an array of human services

throughout the southwestern Pennsylvania region. Her current focus at SPHS is the development and

implementation of the Center of Excellence for opioid use disorders for Mon Valley Community Services

Primary Care, and The CARE Center.

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She has extensive experience in the area of trauma and was trained through The Trauma Center of JRI to

obtain the credential of Certified Trauma Specialist. She has been treating individuals who have

experienced complex trauma for over 14 years and provides consultation for complex cases.

Christie Hempfling

Christie Hempfling currently serves as the Community Health Team Manager for Emed Health and the

CONNECT Community Paramedic Program as well as an adjunct faculty member of the University of

Pittsburgh. Emed Health is one of the longest running Community Paramedic Programs in the Country.

Ms. Hempfling is a certified EMT and also has a Bachelor’s degree in Rehab Science with a concentration

in Athletic Training. She has been working with Emed Health since 2007 and the CONNECT Program

since 2012 and received an award from the Emergency Medical Services Institute of Pennsylvania in

2013 in recognition of her pioneering work in the field of Community Paramedicine.

James Higgins

James Higgins is the Supervisory Special Agent with the Pittsburgh Tactical Diversion Squad of the U.S.

Drug Enforcement Administration (DEA). Prior to his current role, James served as a DEA special agent

with the San Diego Violent Trafficker Team. Before joining the DEA in 2004, he was a police officer with

the Las Vegas Metropolitan Police Department and served for four years in the U.S. Marine Corps. James

graduated from the University of Pittsburgh with a bachelor’s degree in Administration of Justice.

Austin Hixson

Austin Hixson is 28 years old and from West Newton, Pennsylvania, and has been in recovery for seven

years. He works in the drug and alcohol field as a Certified Recovery Specialist with SPHS in Greensburg.

He attended the University of Pittsburgh for two and a half years as a psychology major, and intends to

finish and get his bachelor’s degree and beyond in the coming years. After struggling for over 6 years

with a heroin addiction that began at a very young age, and going through multiple unsuccessful

attempts at sobriety through different treatment methods, he found lasting recovery through a

methadone-maintenance program. His experience has led him to become an advocate for methadone

treatment programs and other forms of medically-assisted treatment, and he considers it a personal

mission of his to work to eliminate the stigma of MAT and that of addiction as a whole.

Colleen Hughes

Colleen D. Hughes is the Executive Director at Westmoreland Drug and Alcohol Commission, Inc.

(WeDAC). She holds a MS degree in Business and Industry Counseling, as well as being a Certified

Advanced Alcohol and Drug Counselor. Ms. Hughes’ position involves overseeing the development and

implementation of necessary operational activities in regard to the planning, organization direction and

administration of the Drug and Alcohol service delivery system. This system includes intervention,

prevention, treatment, case management and recovery support services. She also supervises the use of

all funds for the administration and provision of services under the authority of the Single County

Authority (SCA).

She is a member of the PA Association of County Drug and Alcohol Administrators (PACDAA). Ms.

Hughes is also on the board of directors and serves as the president for Southwest Behavioral Health

Management, Inc. Her experience includes Deputy Director of WeDAC for three years, Deputy Director

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and Director of Washington Drug and Alcohol Commission, as well as ten years of experience in

substance abuse treatment.

Kate Lowery

Kate Lowery has served for over 11 years as the Single County Authority Administrator at the Beaver

County Behavioral Health Drug and Alcohol Program. Within her role, Ms. Lowery oversees the SCA’s

patient assessment, level of care determination, and placement. She also manages the SCA’s intensive

care management and patient referrals for prevention, intervention, and treatment services. Before her

role with the SCA, she worked at Beaver County Psychiatric Services and Western Psychiatric Institute

and Clinic – UPMC. Ms. Lowery has a Master’s of Science in Counseling from Gannon University.

David Lozier

David J. Lozier was elected Beaver County District Attorney on November 3, 2015 and will serve a four-

year term from January 2016-December 2019. For 27 years David J. Lozier has represented clients in

complex court cases in over 20 counties throughout Western Pennsylvania, Ohio and West Virginia. He

has earned a reputation for honest and fair representation, and has been listed in Best Lawyers in

America since 2007.

David J. Lozier has lived a life of service to his community. He is a 12-year Veteran US Army Infantry

Officer and Helicopter pilot, 12-year member of Patterson Heights Borough Council with 10 years as

Borough Council President, 20-year Sunday School Teacher and church Youth Leader, and has both led

and volunteered on church mission trips in Beaver County, Appalachia and storm-torn Louisiana.

David J. Lozier earned his undergraduate and law degrees from the College of William and Mary in

Williamsburg, VA. He began his litigation career as an associate at the law firm of Buchanan Ingersoll in

1988, and then worked with prominent personal injury attorneys including Frank Conflenti and Harry S

Cohen and Associates until 2012 when he established his own law office in Chippewa. He has lived in

Beaver County for 25 years, been married to his wife Beth for 24 years, and together they have raised 2

college-aged daughters.

Mark Nordenberg

Mark A. Nordenberg joined the faculty of Pitt’s School of Law in 1977. Earlier in his career, he served as

Dean of the School of Law and as Interim Provost of the University. In 1995, he was elected Interim

Chancellor by the University’s Board of Trustees, and the next year, following a national search, he was

elected Chancellor. Nordenberg served in that office for nineteen years and led Pitt through one of the

most impressive periods of progress in its 229-year history.

Throughout his career, Nordenberg has been very active in civic affairs and has received many important

forms of recognition. Among them, he has been named Pittsburgh’s Person of the Year by Pittsburgh

Magazine and a History Maker by the Senator John Heinz History Center. Reflecting his role as a regional

leader in higher education, he has been awarded honorary degrees by Carnegie Mellon University, the

Community College of Allegheny County, Duquesne University, LaRoche College and Thiel College.

In 2014, Nordenberg and Jared Cohon, President Emeritus of Carnegie Mellon, received the Elsie Hilliard

Hillman Lifetime Achievement Award for Excellence in Public Service from the Institute of Politics. After

stepping down as Chancellor, he joined the Institute as its Chair and has been particularly involved in its

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incarceration and opioid initiatives. He serves on the boards of Bank of New York Mellon, BNY Mellon’s

Southwestern Pennsylvania Foundation, Manchester Bidwell and UPMC.

Josh Shapiro

Josh Shapiro serves as Pennsylvania’s Attorney General to combat crime, uphold individual rights and

protect consumers. He is the sixth person elected to the office, and was sworn in on January 17, 2017 as

the Commonwealth’s top lawyer and chief law enforcement officer with a mandate to ensure integrity

and be the people’s Attorney General.

Throughout his career as a public servant, Josh has risen above politics and taken on the status quo to

protect Pennsylvanians.

Some of his top priorities include protecting seniors, veterans, small businesses and consumers from

scams and fraud; implementing a comprehensive integrity agenda to ensure people from across the

Commonwealth are heard and have faith in the justice system; and directing an aggressive fight against

the heroin and opioid epidemic, including treatment for those suffering from addiction.

Josh’s work has earned him a national reputation as a rising progressive leader and bipartisan consensus

builder.

As the Chairman of the Pennsylvania Commission on Crime and Delinquency, his work on behalf of

victims and for criminal justice reform earned him the trust of law enforcement leaders from across the

ideological spectrum.

As Chairman of the Montgomery County Board of Commissioners Josh led an historic fiscal turnaround,

helped the first LGBT couples in Pennsylvania marry, protected voting rights and fired Wall Street money

managers to protect pensions and save retirees millions. As State Representative for Pennsylvania's

153rd House District he passed some of the toughest ethics laws in state history.

Josh Shapiro graduated magna cum laude from the University of Rochester and earned his law degree at

night from Georgetown University Law Center. He was in private practice for over a decade and is a

member of the Pennsylvania Bar. Josh was raised in Montgomery County, where he met his high school

sweetheart, Lori, and where they are raising their four children.

Soo Song

As First Assistant United States Attorney for the Western District of Pennsylvania, Ms. Song has

overseen all criminal prosecution and civil and appellate litigation pursued on behalf of the United

States in the 25 counties that comprise the Western District of Pennsylvania.

From November 2016 through December 21, 2017, Ms. Song served as the Acting United States

Attorney for the Western District of Pennsylvania. Ms. Song served on the National Heroin Task Force

and strengthened protocols for crime victim notification, advocacy and restitution in federal court,

including victims of cyber intrusions. Ms. Song helped to establish the Veterans Treatment Court for the

Western District of Pennsylvania, one of the first federal courts of its kind. As a federal prosecutor, Ms.

Song principally prosecutes cybercrimes and crimes against children.

Prior to joining the Western District of Pennsylvania in 2004, Ms. Song was an Assistant United States

Attorney in the District of Arizona. In Arizona, she prosecuted child sexual assaults and homicides that

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occurred within federal jurisdiction on the Navajo Indian reservation, and was also assigned to the

Arizona Joint Terrorism Task Force. Ms. Song also previously served as Deputy Director of the Office of

Tribal Justice at the United States Department of Justice in Washington, D.C. where she advised

Attorney General Janet Reno.

Ms. Song obtained a B.A. from Yale University and a J.D. from George Washington Law School.

Eugene Vittone

Eugene A. Vittone is the elected District Attorney of Washington County, Pennsylvania. He began his

term on January 3, 2012 after serving twelve years as an Assistant District Attorney in the county. While

an Assistant District Attorney, Vittone handled juvenile court, several trial lists and handled felony

criminal trials. Vittone also initiated the Drug Treatment Court in the county and oversaw white collar

prosecutions within the county.

District Attorney Vittone is a Washington County native. He graduated from Peters Township High

School in 1977 where he participated in Track and was an original member of the Fighting Indians

Marching Band. He attended the University of Pittsburgh, graduating in 1981 with a B.S. in Biological

Sciences. He then obtained his Master's in Business Administration and Masters in health Administration

from the University of Pittsburgh. In 1997, he earned his law degree with honors from Duquesne

University. He was a member of the Law Review and the Manderino Honor Society in advocacy. Prior to

attending law school, District Attorney Vittone managed a large EMS agency in Washington County and

worked throughout law school as a paramedic. Vittone has maintained his paramedic certification to

this date.

District Attorney Vittone is a member of many different Washington County organizations. He enjoys

singing with the Washington Festival Chorale and is a member of the parish choirs of Ave Maria Parish in

Bentleyville and Immaculate Conception in Washington, PA. He is also privileged to act as an Assistant

Scout Leader for Troop 1419 in Bentleyville. Vittone coaches baseball every spring for the Bentworth

Baseball Association. He is a member of the Pennsylvania District attorneys Association, the National

District Attorneys Association, the Pennsylvania Narcotic Officers Association and the International

Association of Financial Crimes Investigators.

District Attorney Vittone frequently lectures on topics related to criminal investigation, prosecution and

crime prevention for law enforcement, prosecutors and community groups.

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Increasing Access to Treatment

Overview

Access to appropriate treatment is an important concern for those with SUD.

Pennsylvania Client Placement Criteria (PCPC) outlines principles of treatment, levels of care and

placement criteria.

Barriers to obtaining treatment include:

o Limited capacity of treatment facilities;

o Lack of transportation;

o Lack of child care;

o Work concerns;

The American Disabilities Act (ADA) protects a person in MAT from

discrimination by the government for its benefits programs, including resources

such as welfare and child care assistance and other forms of financial assistance.

Furthermore, when MAT involves take-home medication, it enables patients to

engage in employment, education, child care, or other important aspects of life

that enhance the individual’s rehabilitation process.

Patients involved in MAT face unique employment challenges, especially as

employers increasingly impose pre-employment drug testing and patients must

wrestle with whether or not to disclose their status. Vocational training

provided throughout the MAT process should include basic education about

drug testing, including the fact that methadone may be detected.

o Financial concerns/insurance issues; and

The cost of different medications used in MAT varies, and this may need to be

taken into account when considering treatment options.

The Affordable Care Act now requires most insurers to cover addiction

treatment benefits. In addition, the Mental Health Parity and Addiction Equity

Act (MHPAEA) of 2008 requires health insurers and group health plans to

provide the same level of benefits for behavioral health services that they do for

primary care.

Not all insurance plans cover every available addiction treatment medication,

and some plans cap the number of dosages and prescription refills covered for a

MAT patient (SAMHSA; SAMHSA).

o Lack of connections from intercept points to treatment facilities;

“Warm hand-off” is an approach which involves individuals being referred to

SUD treatment when they contact an intercept point in the community such as

a hospital ED, law enforcement officer, SUD treatment provider, correctional

facility, or primary care provider.

Emergency departments can facilitate connections to treatment after overdose

patients are treated in the emergency room. Many projects include the use of

Certified Recovery Specialists (CRS) who stay with an overdose patient until he

or she can be taken directly to a treatment facility.

In the case of law enforcement, this involves the coordination of substance use

treatment without penalizing the individual for their substance use/addiction

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(see “Frameworks for Law Enforcement Warm Hand-offs” below for more

detail).

o There are several ways in which law enforcement entities can facilitate the referral to

treatment process for individuals who struggle with substance use:

o Assist with navigating prevention/treatment system.

o Link to the treatment provider/recovery community.

o Individualized screening, assessment, and referral to an appropriate level of care which

includes appropriate length of stay (Morrison, 2016).

Physicians available to treat/prescribe:

o Office Based Opioid Treatment (OBOT) is the treatment of opiate addiction with a

medication in a physicians' office and outside of the clinic system. Two medications are

available: methadone and buprenorphine. Each medication has specific requirements

and regulations before it can be dispensed.

o Treatment should be combined with psychosocial counseling to be most effective.

o Some unscrupulous providers are known as “pill-mills” (NAMA, 2016).

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Medication Assisted Treatment

What is Medication Assisted Treatment?

Medication Assisted Treatment (MAT) combines behavioral therapy and medications to treat

SUDs.

MAT does not replace therapy; it is an adjunct to therapy, helping individuals to deal with the

psychosocial issue of addiction.

Including medication in treatment is one of the best choices for opioid addiction.

When a person suffers from addiction, certain medications enable them to return to their

normal state of mind, no longer experiencing drug-induced highs and lows.

MAT alleviates the person’s constant thoughts about the drug.

MAT can also decrease issues related to withdrawal and cravings. These changes allow the

person to think about and focus on lifestyle changes enabling them to return to a healthy life.

MAT treats opioid addiction in the same way certain medications are taken to treat heart

disease or other illnesses.

It is safe for people to use MAT specific medications for long periods of time, such as months,

years, or even over a lifetime.

When used appropriately, the use of medication in treating SUDs will not result in a new

addiction. MAT is intended to aid people in managing their addiction, enabling them to maintain

the benefits experienced through recovery (SAMHSA, 2016b).

Medications used:

o Methadone: Prevents withdrawal by making the person feel like they are still using the

drug, minus the highs and lows. Instead, the person feels normal and does not

experience any discomfort. This medication is a narcotic pain reliever. Methadone is

available in liquid, wafer and pill form.

o Buprenorphine: Similar to methadone, buprenorphine eases cravings for and

withdrawal from the drug. It comes in the form of a pill or sublingual film that is placed

under the tongue.

o Subutex®, Suboxone® (includes naloxone): Suboxone® contains a combination of

buprenorphine and naloxone. Naloxone blocks the effects of opioid medication,

including pain relief or feelings of well-being that can lead to opioid dependence

(Indivior Inc., 2015).

o Naltrexone, Vivitrol® (injectable), Revia® (oral): Naltrexone works differently than

methadone and buprenorphine in that it blocks the rewards that usually result from

taking the drugs and getting high, such as the euphoric and sedative effects. Naltrexone

comes in pill form, such as Revia® and Depade®, and in an injectable form, trade name

Vivitrol®. A healthcare provider must administer the injectable form (SAMHSA; U.S.

Department of Health and Human Services, 2008).

MAT and diversion from criminal justice system:

o Refer to treatment: Many individuals entering the criminal justice system are using

illegal drugs at the time of their arrest and/or have substance use problems. Further,

many commit property crimes to obtain money to buy drugs, and participation in drug-

dealing organizations often places individuals in situations where other crimes are likely

to occur. For this reason, it is important that law enforcement entities play an

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instrumental role in facilitating and connecting individuals to the appropriate treatment

that they need.

o Drug courts/alternate sentencing: An “alternative to incarceration” is any kind of

punishment other than time in prison or jail that can be given to a person who commits

a crime. Punishments other than prison or jail time place serious demands on offenders

and provide them with intensive court and community supervision. Alternatives to

incarceration can repair harms suffered by victims, provide benefits to the community,

save money, and rehabilitate offenders (FAMM; SAMHSA, 2016a).

MAT for justice-involved individuals (correctional facilities, jails, prisons, community

corrections):

o Prior to re-entry: Medication-assisted treatment (MAT) is currently underutilized in the

treatment of drug-dependent, criminal justice populations. MAT use is largely limited to

detoxification and maintenance of pregnant women in criminal justice settings.

o During re-entry/probation/parole: MAT use prior to the community reentry period is

minimal, but the period immediately following release from incarceration has a higher

risk of overdose.

o Pennsylvania has an MAT Pilot project underway to connect individuals to treatment

upon release from a correctional facility (Belenko, Hiller, & Hamilton, 2014; Friedmann

et al., 2012; Miller, 2013; SAMHSA, 2016a).

MAT during pregnancy

o Detox: Methadone is a pure opioid-agonist with a long half-life (24 hours) which allows

for daily dosing. Methadone is the medication of choice for treatment during pregnancy,

because there are more data regarding neonatal outcomes following in utero exposure.

It is a pregnancy category C drug and is not specifically approved for treatment of opioid

dependence during pregnancy by the FDA, despite widespread recommendations as the

medication of choice in pregnancy. Initiating or switching treatment to methadone

should be offered to all opiate dependent pregnant patients. Methadone for the

treatment of opioid dependence is available only through opioid treatment programs

(OTPs).

o Induction: Guidelines for introducing pregnant patients to methadone have been well-

established. Providers must ensure the patient is not concurrently using other drugs

that could increase the risk of over-sedation. Care should also be taken to avoid

increasing the dose too quickly or slowly to minimize overdosing and to forestall

potential premature termination from treatment due to the inability of the medication

to alleviate withdrawal, respectively. The quality of the therapeutic alliance with the

health care providers initially established during assessment can help with retention.

o Maintenance: Opioid addiction is a chronic, relapsing disease. Acute opioid withdrawal

is physiologically stressful, characterized by profound activation of the sympathetic

nervous system with hypertension, tachycardia, and gastrointestinal symptoms. In the

1970s, a series of case reports and animal studies reported stillbirth and meconium

aspiration when patients presented late in gestation in acute opioid withdrawal.

Coincident with these reports, randomized trials in the general opioid dependent

population demonstrated that methadone maintenance decreased opioid craving and

allowed rehabilitation more effectively than acute withdrawal. As methadone

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maintenance for the treatment of opioid dependence became accepted as appropriate

medical therapy, the use of methadone during pregnancy to prevent maternal (and

fetal) withdrawal was examined. Methadone maintenance during pregnancy improved

prenatal care, reduced illicit drug use, and minimized the risk of fetal in utero

withdrawal. These demonstrated benefits led to the current recommendation for opioid

agonist maintenance for opioid dependent women during pregnancy (DDAP, 2016;

Dowell, Haegerich, & Chou, 2016; VCHIP)

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Warm Hand-Offs: Protocols for Emergency Departments and First Responders

Overview

“Warm hand-off” is an approach which involves individuals being referred to SUD treatment

when they contact an intercept point in the community such as a hospital ED, law enforcement

officer, SUD treatment provider, correctional facility, or primary care provider.

Emergency departments can facilitate connections to treatment after overdose patients are

treated in the emergency room. Many projects include the use of Certified Recovery Specialists

(CRS) who stay with an overdose patient until he or she can be taken directly to a treatment

facility.

In the case of law enforcement, this involves the coordination of substance use treatment

without penalizing the individual for their substance use/addiction (see “Frameworks for Law

Enforcement Warm Hand-offs” below for more detail).

There are several ways in which law enforcement entities can facilitate the referral to treatment

process for individuals who struggle with substance use:





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Excela Warm Hand Procedure Provided by Ms. Colleen Hughes

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What is D&A Mobile Case Management and what can it do for you?

Drug and Alcohol Assessments to determine the appropriate level of care

Facilitate referrals to outpatient and/or inpatient drug and alcohol treatment services

Facilitates referrals to Certified Recovery Specialist Services (CRS)

Provides Coordination of Services (assists patients with non-treatment needs, i.e. employment,

physical health care follow up).

Provides Narcan training to patients and family members of overdose survivors

Why is D&A Case Management in the hospital?

The Department of Drug and Alcohol Programs (DDAP) is mandating that “the warm hand off”

process is implemented.

The warm hand off consists of a direct transfer of overdose survivors from the hospital

emergency department directly to drug and alcohol treatment (instead of giving patients a

phone number to call or scheduling a subsequent appointment for 1-2 days later).

The warm hand off is an evidence based approach that allows patient engagement into drug and

alcohol treatment services while meeting them where they present for care

What if people refuse?

If the patient is not in agreement with pursuing D&A Treatment Services, please document this

in the patient’s electronic file and provide them with the Mobile Case Management Brochure

and D&A Treatment Resource Packet.

Goals

Reduce the county’s overdose epidemic

Facilitate referrals to treatment services which will also assist with reducing the re-admission

rate when a patient receives the appropriate clinical support for their substance use disorder

Increase access to treatment and recovery support services for individuals in our county

Other available services

Patients are also eligible to receive Certified Recovery Specialist (CRS) services to further their

engagement into treatment services. This free service allows patients to increase their chances

of long term recovery by working with a peer mentor who has ‘walked in their shoes’. Patients

can sign up for these services by calling 1-800-220-1810.

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Help for Overdose Survivors – Fayette County Drug & Alcohol Commission

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Opioid Epidemic: Best Practices in Prescribing

Retrieved from: Centers for Disease Control and Prevention

(www.cdc.gov/drugoverdose/prescribing/guideline.html)

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Links to Pennsylvania Prescribing Guidelines

The Use of Opioid to Treat Chronic Noncancer Pain:

https://www.pamedsoc.org/PAMED_Downloads/PAGuidelinesonOpioids.pdf?utm_source=PDF

&utm_medium=web&utm_campaign=OpioidGuidelinesNonCancer

Emergency Department Pain Treatment Guidelines:

https://www.pamedsoc.org/PAMED_Downloads/PA%20ED%20Guidelines%20Opioids.pdf?utm_

source=PDF&utm_medium=web&utm_campaign=OpioidGuidelinesED

Opioid in Dental Practice:

https://www.pamedsoc.org/PAMED_Downloads/opioid_dental_prescribing_guidelines3_13_15.

pdf?utm_source=PDF&utm_medium=web&utm_campaign=DentalGuidelines

Opioid Dispensing Guidelines:

https://www.pamedsoc.org/PAMED_Downloads/PA%20Guidelines%2c%20on%20the%20Dispe

nsing%20of%20Opioids.pdf?utm_source=PDF&utm_medium=web&utm_campaign=PharmacyO

pioidGuidelines

Obstetrics and Gynecology Pain Treatment:

https://www.pamedsoc.org/PAMED_Downloads/OpioidGuidelinesOBGYN.pdf?utm_source=PDF

&utm_medium=web&utm_campaign=OBGYNGuidelines

Geriatric Pain Opioid Use and Safe Prescribing:

https://www.pamedsoc.org/PAMED_Downloads/OpioidGuidelinesGeriatrics.pdf?utm_source=P

DF&utm_medium=web&utm_campaign=GeriatricsGuidelines

The Safe Prescribing of Opioid in Orthopedics and Sports Medicine:

https://www.pamedsoc.org/PAMED_Downloads/Orthopedics%20and%20Sports%20Medicine%

20Guidelines%20FINAL.pdf

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Pennsylvania’s Prescription Drug Monitoring Program (PDMP)

Information retrieved from Pennsylvania Department of Health

http://www.health.pa.gov/Your-Department-of-

Health/Offices%20and%20Bureaus/PaPrescriptionDrugMonitoringProgram/Pages/GeneralInfo.aspx#pre

scribers

Overview of PDMP

Q: What is a Prescription Drug Monitoring Program (PDMP)?

A: The PDMP is a statewide program that collects information about controlled substance prescription drugs that are dispensed to patients within the state.

Q: Why does Pennsylvania have a PDMP?

A: The Office of the Attorney General (OAG) operated the former PDMP. Previously, the PDMP required the reporting of Schedule II controlled substances only. The legislature passed a new law, Act 191 of 2014, which requires monitoring Schedule II through Schedule V controlled substances. The Pennsylvania Department of Health is responsible for the development and the day-to-day operations of the new system.

Q: Do other states have PDMPs?

A: 49 states, including Pennsylvania, have an operational prescription drug monitoring program or have enacted legislation to establish a PDMP and are in the process of creating one.

Q: What is the purpose of the new PDMP?

A: The purpose of the PDMP established by Act 191 of 2014 is two-fold:

To be used as a tool to increase the quality of patient care by giving prescribers and dispensers access to a patient's controlled substance prescription medication history, which will alert medical professionals to potential dangers for purposes of making treatment determinations; and

To aid regulatory and law enforcement agencies in the detection and prevention of fraud, drug abuse and the criminal diversion of controlled substances.

Q: How does the PDMP work?

A: As of January 1, 2017, dispensers are required to collect and submit this information to the PDMP no later than the close of the subsequent business day. The PDMP stores the information in a secure database and makes it available to healthcare professionals and others as authorized by law.

Q: When will prescribers and dispensers have access to the PA PDMP database?

A: Registration for PA PDMP program is open and the system is available for query.

Q: What are controlled substances?

http://www.health.pa.gov/Your-Department-of-Health/Offices%20and%20Bureaus/PaPrescriptionDrugMonitoringProgram/Pages/GeneralInfo.aspx#prescribers



27 | P a g e

A: Controlled substances are drugs that have varying degrees of potential for abuse or dependence. Drugs and other substances that are considered controlled substances under the Controlled Substances Act (CSA) are divided into five schedules. Substances are placed in their respective schedules based on whether they have a currently accepted medical use in treatment in the United States, their relative abuse potential, and likelihood of causing dependence when abused. The following are examples of Schedule II through Schedule V controlled substances:

Schedule II - drugs with acceptable medical use, but with a high abuse potential that lead to dependence (morphine, methadone, oxycodone).

Schedule III - drugs with less abuse potential and a moderate risk of abuse potential (aspirin/codeine combinations, buprenorphine).

Schedule IV - drugs with a lower abuse potential (alprazolam, clonazepam, diazepam).

Schedule V - drugs with less abuse potential than other schedule drugs and contain limited quantities of a controlled substance (robitussin AC, phenergan with codeine).

Q: Will there be a training program for dispensers and prescribers to utilize the new system?

A: Yes, all PDF tutorials on how to register, search and use the system are available on the PDMP Portal section of the website.

Q: What is required of dispensers?

A: As of January 1, 2017, all Schedule II-V dispensed prescriptions must be reported to the system no later than the close of the subsequent business day.

For example, if your pharmacy is open Monday to Friday, from 8:30 a.m. to 9:00 p.m. the dispensation data from Monday must be submitted by Tuesday before 9:00 p.m. The dispensation data from Friday must be submitted by the following Monday before 9:00 p.m.

Note: The PMP Clearinghouse can accept dispensation data every day including weekends.

Q: Will the new PDMP system be "real-time"?

A: Dispensers, prescribers and their delegates will have "real-time" access to the data stored by the PDMP at any given time. However, beginning January 1, 2017, dispensers have up to the close of the subsequent business day to submit data after dispensing a scheduled prescription drug.

Q: Do dispensers or prescribers have to pay anything for the program?

A: A dispenser or prescriber shall not be required to pay a fee or tax specifically dedicated to the establishment, operation or maintenance of the program.

Q: Will the PDMP offer any kind of referrals to treatment programs for patients suspected to have the disease of addiction?

A: The PDMP provides data to healthcare professionals to enable them to make more informed decisions about prescribing and dispensing monitored prescription drugs to their patients or potential patients. Healthcare professionals are encouraged to use the data obtained from the PDMP to improve their treatment of patients, including referring patients to substance abuse

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treatment. Information regarding drug and alcohol treatment services is available on the Pennsylvania Department of Drug and Alcohol Programs website.

Q: Would prescription dispensation data from Methadone Assisted Treatment (MAT) Programs or Narcotics Treatment Programs (NTP) in Pennsylvania be included into the PA PDMP system?

A: Licensed health care facilities, including MATs/NTPs, that distribute controlled substances for the purpose of administration in the licensed health care facility are not required to submit data to the PA PDMP system. Furthermore, MATs/NTPs are covered under the confidentiality regulation 42 CFR Part 2, Subpart C, which does not allow medical professionals in MATs/NTPs to share any controlled substances dispensation information to the PA PDMP system.

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University of Pittsburgh Institute of Politics,

the University of Pittsburgh School of Pharmacy

Program Evaluation and Research Unit Technical Assistance Center,

Westmoreland Drug and Alcohol Commission,

and the U.S. Drug Enforcement Administration

presents

Addressing the Opioid Crisis in Southwestern Pennsylvania:

Bridging Public Health and Public Safety


8:00 am – 4:00 pm


PROGRAM AGENDA

8:00 – 8:30 am Registration and Continental Breakfast

8:30 – 9:00 Welcome and Introductions by Mark Nordenberg, Chancellor Emeritus, University and Pittsburgh, and Chair, Institute of Politics, with a special welcome from Gina Cerilli, Commissioner and Chair, Westmoreland County

9:00 – 9:30 Recovery is Possible Panel moderated by Jana Kyle, Executive Director, Fayette County Drug and Alcohol Commission, Inc., featuring:

Mary Phillips

Austin Hixson


9:45 – 10:35 Fentanyl and Emergent Threats: Partnering Prosecution and Public Health, featuring:

Cheryl Andrews, Executive Director, Washington Drug and Alcohol Commission, Inc.

Soo Song, First Assistant U.S. Attorney for the Western District of Pennsylvania

Eugene Vittone, District Attorney, Washington County

Brian Dempsey, Intelligence Specialist, DEA


11:00 – 11:15 Break

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11:15 – 11:45 Coordination of Tactical Diversion, featuring:

Kate Lowery, Single County Authority Administrator, Beaver County Behavioral Health Drug and Alcohol Program

David Lozier, District Attorney, Beaver County

James Higgins, Special Agent, DEA

John DeLuca, Chief of Police, City of Beaver Falls

11:45 – 12:00 pm Open Discussion

12:00 – 12:20 Community Paramedicine and the Opioid Crisis: First Responder Warm Handoff Program by Christie Hempfling, Emed Health and CONNECT Community Paramedic Program, Community Health Team Manager, The Center for Emergency Medicine


12:30 – 1:30 Lunch and Addiction as a Disease by Dr. Mitchell West, Medical Director for Addiction Medicine, Allegheny Health Network

1:30 – 2:00 Recovery is Possible Encore Panel moderated by Jana Kyle, featuring:

Kendra DiLascio

Ashley Potts


2:15 – 2:45 Substance Use Disorder Treatment: Roles for Single County Authorities and Centers of Excellence, featuring:

Colleen Hughes, Executive Director, Westmoreland Drug & Alcohol Commission

Elizabeth Comer, Director, Clinical and Case Management Services, Westmoreland Drug & Alcohol Commission

Cheryld Emala, Executive for Innovation and Strategic Alignment, Southwestern Pennsylvania Human Services Center of Excellence


3:00 – 3:45 Keynote Address by Josh Shapiro, Attorney General, Commonwealth of Pennsylvania

3:45 – 4:00 Next Steps and Closing Remarks by David Battiste, Special Agent in Charge, DEA

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Table of Contents

Presenter Biographies ................................................................................................................................... 5

Increasing Access to Treatment .................................................................................................................. 10

Overview ................................................................................................................................................. 10

Medication Assisted Treatment .............................................................................................................. 12

Warm Hand-Offs: Protocols for Emergency Departments and First Responders ...................................... 15

Overview ................................................................................................................................................. 15

Excela Warm Hand Procedure Provided by Ms. Colleen Hughes ........................................................... 20

Help for Individuals or Family Members Struggling with Addiction ........................................................... 22

Drug and Alcohol Services – Provider Contact List ..................................................................................... 24

Help for Overdose Survivors – Fayette County Drug & Alcohol Commission ............................................. 26

Opioid Epidemic: Best Practices in Prescribing ........................................................................................... 28

Pennsylvania’s Prescription Drug Monitoring Program (PDMP) ................................................................ 30

Operation Trojan Horse Fact Sheet ............................................................................................................ 33

Suspected Overdose Incident Report ......................................................................................................... 34

Carfentanil in Pennsylvania ......................................................................................................................... 36

How to Properly Dispose of Your Unused Medicines ................................................................................. 38

Treatment for Drug Use and the Need for Paid Family and Medical Leave ............................................... 39

Moving Forward and Next Steps ................................................................................................................. 41

How to Use This Manual ......................................................................................................................... 43

Why a Coalition? ..................................................................................................................................... 46

Describing Your Community ................................................................................................................... 47

Obtaining Your Data ................................................................................................................................ 47

Determining Your Community’s Readiness to Have an Impact on Overdose Deaths ................................ 48

Selecting Your Coalition Members .......................................................................................................... 49

Developing Your Coalition Vision Statement .......................................................................................... 50

Selecting Your Coalition Leadership ....................................................................................................... 50

Conducting Productive Meetings ............................................................................................................ 50

Assessing Your Coalition’s Health ........................................................................................................... 50

County Overdose Elimination Framework .............................................................................................. 51

Selecting Your Evidence-Based Interventional Strategies ...................................................................... 51

Naloxone Availability .......................................................................................................................... 51

Medication Assisted Treatment (MAT) ............................................................................................... 51

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Opioid Prescribing Practices ............................................................................................................... 52

Prescription Drug Monitoring Programs (PDMP) ................................................................................... 52

Building an Impact Model ....................................................................................................................... 52

Developing and Using a Strategic Plan ................................................................................................... 53

Developing an Evaluation Plan................................................................................................................ 54

Finding Evaluation Assistance ................................................................................................................. 54

Current Situation Assessment ................................................................................................................. 54

County Dashboard Framework ............................................................................................................... 54

Sustainability: Developing a Grant Application ...................................................................................... 54

Reasons Applicants Do Not Get Funded ................................................................................................. 57

Potential Sources of Grant Funding ........................................................................................................ 57

How the TAC Can Help ............................................................................................................................ 57

Glossary ....................................................................................................................................................... 58

References .................................................................................................................................................. 62

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Presenter Biographies

Cheryl Andrews

Cheryl Andrews is Executive Director for the Washington Drug and Alcohol Commission. Ms. Andrews

has 15 years of experience working in the drug and alcohol field; specifically, with the Single County

Authority. During her five-year tenure with the Commission, she has worked collaboratively in

developing and implementing innovative programs within the criminal justice system; including, the

correctional facility and the court system, Children and Youth Services, local hospitals, and the faith-

based community. Ms. Andrews works closely with the Washington County District Attorney to provide

education and distribution of naloxone to first responders and community members. Ms. Andrews

serves on the U.S. Attorney of Western PA’s working group on drug overdose and addiction and is the

co-chair of the prevention and education committee.

David Battiste

Mr. Battiste has been DEA Assistant Special Agent in Charge Pittsburgh District since June 2015. His

employment history includes Public Safety officer-Department of Public Safety Dallas/Fort Worth Airport

1989 – 1990 and Police Officer in Jennings, La from 1981 to 1989; attained the rank of Sergeant. Mr.

Battiste has a BS in Criminal Justice from McNeese State University (Lake Charles, LA) received in 1988

and Masters in Management from Webster University (Santa Teresa, NM) received in 2003.

Elizabeth Comer

Elizabeth Comer is the Director of Clinical and Case Management Services for the Westmoreland Drug

and Alcohol Commission (WeDAC). She has a Bachelor of Science in Criminal Justice and a Master of

Social Work Degree from California University of Pennsylvania. Elizabeth’s work history includes

experience in the mental health field as a residential counselor, experience in the medical field as a

medical social worker/case manager, and experience working in the Drug and Alcohol Field for over 11

years. In her current position she provides oversight to treatment services and WeDAC’s subcontracted

Drug and Alcohol Case Management Unit.

Kendra DiLascio

Kendra DiLascio a 35 year old, mother of two that lives in Westmoreland County, and has been in

recovery for five years. Kendra has been employed at SPHS in Greensburg for 2 years starting as a

Certified Recovery Specialist and currently working as a Case Manager. She graduated with her

Bachelor’s degree from Kaplan University with a degree in Psychology with an emphasis in Substance

Abuse Counseling and will complete her Master’s Degree in April 2018 with a major in Psychology with

an emphasis in addictions. Kendra is a Narcan survivor, Narcan trainer and advocate for recovery.

Cheryld Emala

Cheryld Emala is the Executive for Innovation and Strategic Alignment at Southwestern Pennsylvania

Human Services, Inc. (SPHS). She is a graduate of the University of Pittsburgh with a Master’s Degree in

Social Work and is a Licensed Clinical Social Worker. Cheryld is responsible for staff development across

the SPHS system, as well as program planning and design. Her work covers an array of human services

throughout the southwestern Pennsylvania region. Her current focus at SPHS is the development and

implementation of the Center of Excellence for opioid use disorders for Mon Valley Community Services

Primary Care, and The CARE Center.

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She has extensive experience in the area of trauma and was trained through The Trauma Center of JRI to

obtain the credential of Certified Trauma Specialist. She has been treating individuals who have

experienced complex trauma for over 14 years and provides consultation for complex cases.

James Higgins

James Higgins is the Supervisory Special Agent with the Pittsburgh Tactical Diversion Squad of the U.S.

Drug Enforcement Administration (DEA). Prior to his current role, James served as a DEA special agent

with the San Diego Violent Trafficker Team. Before joining the DEA in 2004, he was a police officer with

the Las Vegas Metropolitan Police Department and served for four years in the U.S. Marine Corps. James

graduated from the University of Pittsburgh with a bachelor’s degree in Administration of Justice.

Colleen Hughes

Colleen D. Hughes is the Executive Director at Westmoreland Drug and Alcohol Commission, Inc.

(WeDAC). She holds a MS degree in Business and Industry Counseling, as well as being a Certified

Advanced Alcohol and Drug Counselor. Ms. Hughes’ position involves overseeing the development and

implementation of necessary operational activities in regard to the planning, organization direction and

administration of the Drug and Alcohol service delivery system. This system includes intervention,

prevention, treatment, case management and recovery support services. She also supervises the use of

all funds for the administration and provision of services under the authority of the Single County

Authority (SCA).

She is a member of the PA Association of County Drug and Alcohol Administrators (PACDAA). Ms.

Hughes is also on the board of directors and serves as the president for Southwest Behavioral Health

Management, Inc. Her experience includes Deputy Director of WeDAC for three years, Deputy Director

and Director of Washington Drug and Alcohol Commission, as well as ten years of experience in

substance abuse treatment.

Kate Lowery

Kate Lowery has served for over 11 years as the Single County Authority Administrator at the Beaver

County Behavioral Health Drug and Alcohol Program. Within her role, Ms. Lowery oversees the SCA’s

patient assessment, level of care determination, and placement. She also manages the SCA’s intensive

care management and patient referrals for prevention, intervention, and treatment services. Before her

role with the SCA, she worked at Beaver County Psychiatric Services and Western Psychiatric Institute

and Clinic – UPMC. Ms. Lowery has a Master’s of Science in Counseling from Gannon University.

David Lozier

David J. Lozier was elected Beaver County District Attorney on November 3, 2015 and will serve a four-

year term from January 2016-December 2019. For 27 years David J. Lozier has represented clients in

complex court cases in over 20 counties throughout Western Pennsylvania, Ohio and West Virginia. He

has earned a reputation for honest and fair representation, and has been listed in Best Lawyers in

America since 2007.

David J. Lozier has lived a life of service to his community. He is a 12-year Veteran US Army Infantry

Officer and Helicopter pilot, 12-year member of Patterson Heights Borough Council with 10 years as

Borough Council President, 20-year Sunday School Teacher and church Youth Leader, and has both led

and volunteered on church mission trips in Beaver County, Appalachia and storm-torn Louisiana.

7 | P a g e

David J. Lozier earned his undergraduate and law degrees from the College of William and Mary in

Williamsburg, VA. He began his litigation career as an associate at the law firm of Buchanan Ingersoll in

1988, and then worked with prominent personal injury attorneys including Frank Conflenti and Harry S

Cohen and Associates until 2012 when he established his own law office in Chippewa. He has lived in

Beaver County for 25 years, been married to his wife Beth for 24 years, and together they have raised 2

college-aged daughters.

Mark Nordenberg

Mark A. Nordenberg joined the faculty of Pitt’s School of Law in 1977. Earlier in his career, he served as

Dean of the School of Law and as Interim Provost of the University. In 1995, he was elected Interim

Chancellor by the University’s Board of Trustees, and the next year, following a national search, he was

elected Chancellor. Nordenberg served in that office for nineteen years and led Pitt through one of the

most impressive periods of progress in its 229-year history.

Throughout his career, Nordenberg has been very active in civic affairs and has received many important

forms of recognition. Among them, he has been named Pittsburgh’s Person of the Year by Pittsburgh

Magazine and a History Maker by the Senator John Heinz History Center. Reflecting his role as a regional

leader in higher education, he has been awarded honorary degrees by Carnegie Mellon University, the

Community College of Allegheny County, Duquesne University, LaRoche College and Thiel College.

In 2014, Nordenberg and Jared Cohon, President Emeritus of Carnegie Mellon, received the Elsie Hilliard

Hillman Lifetime Achievement Award for Excellence in Public Service from the Institute of Politics. After

stepping down as Chancellor, he joined the Institute as its Chair and has been particularly involved in its

incarceration and opioid initiatives. He serves on the boards of Bank of New York Mellon, BNY Mellon’s

Southwestern Pennsylvania Foundation, Manchester Bidwell and UPMC.

Josh Shapiro

Josh Shapiro serves as Pennsylvania’s Attorney General to combat crime, uphold individual rights and

protect consumers. He is the sixth person elected to the office, and was sworn in on January 17, 2017 as

the Commonwealth’s top lawyer and chief law enforcement officer with a mandate to ensure integrity

and be the people’s Attorney General.

Throughout his career as a public servant, Josh has risen above politics and taken on the status quo to

protect Pennsylvanians.

Some of his top priorities include protecting seniors, veterans, small businesses and consumers from

scams and fraud; implementing a comprehensive integrity agenda to ensure people from across the

Commonwealth are heard and have faith in the justice system; and directing an aggressive fight against

the heroin and opioid epidemic, including treatment for those suffering from addiction.

Josh’s work has earned him a national reputation as a rising progressive leader and bipartisan consensus

builder.

As the Chairman of the Pennsylvania Commission on Crime and Delinquency, his work on behalf of

victims and for criminal justice reform earned him the trust of law enforcement leaders from across the

ideological spectrum.

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As Chairman of the Montgomery County Board of Commissioners Josh led an historic fiscal turnaround,

helped the first LGBT couples in Pennsylvania marry, protected voting rights and fired Wall Street money

managers to protect pensions and save retirees millions. As State Representative for Pennsylvania's

153rd House District he passed some of the toughest ethics laws in state history.

Josh Shapiro graduated magna cum laude from the University of Rochester and earned his law degree at

night from Georgetown University Law Center. He was in private practice for over a decade and is a

member of the Pennsylvania Bar. Josh was raised in Montgomery County, where he met his high school

sweetheart, Lori, and where they are raising their four children.

Soo Song

As First Assistant United States Attorney for the Western District of Pennsylvania, Ms. Song has

overseen all criminal prosecution and civil and appellate litigation pursued on behalf of the United

States in the 25 counties that comprise the Western District of Pennsylvania.

From November 2016 through December 21, 2017, Ms. Song served as the Acting United States

Attorney for the Western District of Pennsylvania. Ms. Song served on the National Heroin Task Force

and strengthened protocols for crime victim notification, advocacy and restitution in federal court,

including victims of cyber intrusions. Ms. Song helped to establish the Veterans Treatment Court for the

Western District of Pennsylvania, one of the first federal courts of its kind. As a federal prosecutor, Ms.

Song principally prosecutes cybercrimes and crimes against children.

Prior to joining the Western District of Pennsylvania in 2004, Ms. Song was an Assistant United States

Attorney in the District of Arizona. In Arizona, she prosecuted child sexual assaults and homicides that

occurred within federal jurisdiction on the Navajo Indian reservation, and was also assigned to the

Arizona Joint Terrorism Task Force. Ms. Song also previously served as Deputy Director of the Office of

Tribal Justice at the United States Department of Justice in Washington, D.C. where she advised

Attorney General Janet Reno.

Ms. Song obtained a B.A. from Yale University and a J.D. from George Washington Law School.

Eugene Vittone

Eugene A. Vittone is the elected District Attorney of Washington County, Pennsylvania. He began his

term on January 3, 2012 after serving twelve years as an Assistant District Attorney in the county. While

an Assistant District Attorney, Vittone handled juvenile court, several trial lists and handled felony

criminal trials. Vittone also initiated the Drug Treatment Court in the county and oversaw white collar

prosecutions within the county.

District Attorney Vittone is a Washington County native. He graduated from Peters Township High

School in 1977 where he participated in Track and was an original member of the Fighting Indians

Marching Band. He attended the University of Pittsburgh, graduating in 1981 with a B.S. in Biological

Sciences. He then obtained his Master's in Business Administration and Masters in health Administration

from the University of Pittsburgh. In 1997, he earned his law degree with honors from Duquesne

University. He was a member of the Law Review and the Manderino Honor Society in advocacy. Prior to

attending law school, District Attorney Vittone managed a large EMS agency in Washington County and

worked throughout law school as a paramedic. Vittone has maintained his paramedic certification to

this date.

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District Attorney Vittone is a member of many different Washington County organizations. He enjoys

singing with the Washington Festival Chorale and is a member of the parish choirs of Ave Maria Parish in

Bentleyville and Immaculate Conception in Washington, PA. He is also privileged to act as an Assistant

Scout Leader for Troop 1419 in Bentleyville. Vittone coaches baseball every spring for the Bentworth

Baseball Association. He is a member of the Pennsylvania District attorneys Association, the National

District Attorneys Association, the Pennsylvania Narcotic Officers Association and the International

Association of Financial Crimes Investigators.

District Attorney Vittone frequently lectures on topics related to criminal investigation, prosecution and

crime prevention for law enforcement, prosecutors and community groups.

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Increasing Access to Treatment

Overview

Access to appropriate treatment is an important concern for those with SUD.

Pennsylvania Client Placement Criteria (PCPC) outlines principles of treatment, levels of care and

placement criteria.

Barriers to obtaining treatment include:

o Limited capacity of treatment facilities;

o Lack of transportation;

o Lack of child care;

o Work concerns;

The American Disabilities Act (ADA) protects a person in MAT from

discrimination by the government for its benefits programs, including resources

such as welfare and child care assistance and other forms of financial assistance.

Furthermore, when MAT involves take-home medication, it enables patients to

engage in employment, education, child care, or other important aspects of life

that enhance the individual’s rehabilitation process.

Patients involved in MAT face unique employment challenges, especially as

employers increasingly impose pre-employment drug testing and patients must

wrestle with whether or not to disclose their status. Vocational training

provided throughout the MAT process should include basic education about

drug testing, including the fact that methadone may be detected.

o Financial concerns/insurance issues; and

The cost of different medications used in MAT varies, and this may need to be

taken into account when considering treatment options.

The Affordable Care Act now requires most insurers to cover addiction

treatment benefits. In addition, the Mental Health Parity and Addiction Equity

Act (MHPAEA) of 2008 requires health insurers and group health plans to

provide the same level of benefits for behavioral health services that they do for

primary care.

Not all insurance plans cover every available addiction treatment medication,

and some plans cap the number of dosages and prescription refills covered for a

MAT patient (SAMHSA; SAMHSA).

o Lack of connections from intercept points to treatment facilities;

“Warm hand-off” is an approach which involves individuals being referred to

SUD treatment when they contact an intercept point in the community such as

a hospital ED, law enforcement officer, SUD treatment provider, correctional

facility, or primary care provider.

Emergency departments can facilitate connections to treatment after overdose

patients are treated in the emergency room. Many projects include the use of

Certified Recovery Specialists (CRS) who stay with an overdose patient until he

or she can be taken directly to a treatment facility.

In the case of law enforcement, this involves the coordination of substance use

treatment without penalizing the individual for their substance use/addiction

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(see “Frameworks for Law Enforcement Warm Hand-offs” below for more

detail).

o There are several ways in which law enforcement entities can facilitate the referral to

treatment process for individuals who struggle with substance use:





Physicians available to treat/prescribe:

o Office Based Opioid Treatment (OBOT) is the treatment of opiate addiction with a

medication in a physicians' office and outside of the clinic system. Two medications are

available: methadone and buprenorphine. Each medication has specific requirements

and regulations before it can be dispensed.

o Treatment should be combined with psychosocial counseling to be most effective.

o Some unscrupulous providers are known as “pill-mills” (NAMA, 2016).

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Medication Assisted Treatment

What is Medication Assisted Treatment?

Medication Assisted Treatment (MAT) combines behavioral therapy and medications to treat

SUDs.

MAT does not replace therapy; it is an adjunct to therapy, helping individuals to deal with the

psychosocial issue of addiction.

Including medication in treatment is one of the best choices for opioid addiction.

When a person suffers from addiction, certain medications enable them to return to their

normal state of mind, no longer experiencing drug-induced highs and lows.

MAT alleviates the person’s constant thoughts about the drug.

MAT can also decrease issues related to withdrawal and cravings. These changes allow the

person to think about and focus on lifestyle changes enabling them to return to a healthy life.

MAT treats opioid addiction in the same way certain medications are taken to treat heart

disease or other illnesses.

It is safe for people to use MAT specific medications for long periods of time, such as months,

years, or even over a lifetime.

When used appropriately, the use of medication in treating SUDs will not result in a new

addiction. MAT is intended to aid people in managing their addiction, enabling them to maintain

the benefits experienced through recovery (SAMHSA, 2016b).

Medications used:

o Methadone: Prevents withdrawal by making the person feel like they are still using the

drug, minus the highs and lows. Instead, the person feels normal and does not

experience any discomfort. This medication is a narcotic pain reliever. Methadone is

available in liquid, wafer and pill form.

o Buprenorphine: Similar to methadone, buprenorphine eases cravings for and

withdrawal from the drug. It comes in the form of a pill or sublingual film that is placed

under the tongue.

o Subutex®, Suboxone® (includes naloxone): Suboxone® contains a combination of

buprenorphine and naloxone. Naloxone blocks the effects of opioid medication,

including pain relief or feelings of well-being that can lead to opioid dependence

(Indivior Inc., 2015).

o Naltrexone, Vivitrol® (injectable), Revia® (oral): Naltrexone works differently than

methadone and buprenorphine in that it blocks the rewards that usually result from

taking the drugs and getting high, such as the euphoric and sedative effects. Naltrexone

comes in pill form, such as Revia® and Depade®, and in an injectable form, trade name

Vivitrol®. A healthcare provider must administer the injectable form (SAMHSA; U.S.

Department of Health and Human Services, 2008).

MAT and diversion from criminal justice system:

o Refer to treatment: Many individuals entering the criminal justice system are using

illegal drugs at the time of their arrest and/or have substance use problems. Further,

many commit property crimes to obtain money to buy drugs, and participation in drug-

dealing organizations often places individuals in situations where other crimes are likely

to occur. For this reason, it is important that law enforcement entities play an

13 | P a g e

instrumental role in facilitating and connecting individuals to the appropriate treatment

that they need.

o Drug courts/alternate sentencing: An “alternative to incarceration” is any kind of

punishment other than time in prison or jail that can be given to a person who commits

a crime. Punishments other than prison or jail time place serious demands on offenders

and provide them with intensive court and community supervision. Alternatives to

incarceration can repair harms suffered by victims, provide benefits to the community,

save money, and rehabilitate offenders (FAMM; SAMHSA, 2016a).

MAT for justice-involved individuals (correctional facilities, jails, prisons, community

corrections):

o Prior to re-entry: Medication-assisted treatment (MAT) is currently underutilized in the

treatment of drug-dependent, criminal justice populations. MAT use is largely limited to

detoxification and maintenance of pregnant women in criminal justice settings.

o During re-entry/probation/parole: MAT use prior to the community reentry period is

minimal, but the period immediately following release from incarceration has a higher

risk of overdose.

o Pennsylvania has an MAT Pilot project underway to connect individuals to treatment

upon release from a correctional facility (Belenko, Hiller, & Hamilton, 2014; Friedmann

et al., 2012; Miller, 2013; SAMHSA, 2016a).

MAT during pregnancy

o Detox: Methadone is a pure opioid-agonist with a long half-life (24 hours) which allows

for daily dosing. Methadone is the medication of choice for treatment during pregnancy,

because there are more data regarding neonatal outcomes following in utero exposure.

It is a pregnancy category C drug and is not specifically approved for treatment of opioid

dependence during pregnancy by the FDA, despite widespread recommendations as the

medication of choice in pregnancy. Initiating or switching treatment to methadone

should be offered to all opiate dependent pregnant patients. Methadone for the

treatment of opioid dependence is available only through opioid treatment programs

(OTPs).

o Induction: Guidelines for introducing pregnant patients to methadone have been well-

established. Providers must ensure the patient is not concurrently using other drugs

that could increase the risk of over-sedation. Care should also be taken to avoid

increasing the dose too quickly or slowly to minimize overdosing and to forestall

potential premature termination from treatment due to the inability of the medication

to alleviate withdrawal, respectively. The quality of the therapeutic alliance with the

health care providers initially established during assessment can help with retention.

o Maintenance: Opioid addiction is a chronic, relapsing disease. Acute opioid withdrawal

is physiologically stressful, characterized by profound activation of the sympathetic

nervous system with hypertension, tachycardia, and gastrointestinal symptoms. In the

1970s, a series of case reports and animal studies reported stillbirth and meconium

aspiration when patients presented late in gestation in acute opioid withdrawal.

Coincident with these reports, randomized trials in the general opioid dependent

population demonstrated that methadone maintenance decreased opioid craving and

allowed rehabilitation more effectively than acute withdrawal. As methadone

14 | P a g e

maintenance for the treatment of opioid dependence became accepted as appropriate

medical therapy, the use of methadone during pregnancy to prevent maternal (and

fetal) withdrawal was examined. Methadone maintenance during pregnancy improved

prenatal care, reduced illicit drug use, and minimized the risk of fetal in utero

withdrawal. These demonstrated benefits led to the current recommendation for opioid

agonist maintenance for opioid dependent women during pregnancy (DDAP, 2016;

Dowell, Haegerich, & Chou, 2016; VCHIP)

15 | P a g e

Warm Hand-Offs: Protocols for Emergency Departments and First Responders

Overview

“Warm hand-off” is an approach which involves individuals being referred to SUD treatment

when they contact an intercept point in the community such as a hospital ED, law enforcement

officer, SUD treatment provider, correctional facility, or primary care provider.

Emergency departments can facilitate connections to treatment after overdose patients are

treated in the emergency room. Many projects include the use of Certified Recovery Specialists

(CRS) who stay with an overdose patient until he or she can be taken directly to a treatment

facility.

In the case of law enforcement, this involves the coordination of substance use treatment

without penalizing the individual for their substance use/addiction (see “Frameworks for Law

Enforcement Warm Hand-offs” below for more detail).

There are several ways in which law enforcement entities can facilitate the referral to treatment

process for individuals who struggle with substance use:





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Excela Warm Hand Procedure Provided by Ms. Colleen Hughes

21 | P a g e

What is D&A Mobile Case Management and what can it do for you?

Drug and Alcohol Assessments to determine the appropriate level of care

Facilitate referrals to outpatient and/or inpatient drug and alcohol treatment services

Facilitates referrals to Certified Recovery Specialist Services (CRS)

Provides Coordination of Services (assists patients with non-treatment needs, i.e. employment,

physical health care follow up).

Provides Narcan training to patients and family members of overdose survivors

Why is D&A Case Management in the hospital?

The Department of Drug and Alcohol Programs (DDAP) is mandating that “the warm hand off”

process is implemented.

The warm hand off consists of a direct transfer of overdose survivors from the hospital

emergency department directly to drug and alcohol treatment (instead of giving patients a

phone number to call or scheduling a subsequent appointment for 1-2 days later).

The warm hand off is an evidence based approach that allows patient engagement into drug and

alcohol treatment services while meeting them where they present for care

What if people refuse?

If the patient is not in agreement with pursuing D&A Treatment Services, please document this

in the patient’s electronic file and provide them with the Mobile Case Management Brochure

and D&A Treatment Resource Packet.

Goals

Reduce the county’s overdose epidemic

Facilitate referrals to treatment services which will also assist with reducing the re-admission

rate when a patient receives the appropriate clinical support for their substance use disorder

Increase access to treatment and recovery support services for individuals in our county

Other available services

Patients are also eligible to receive Certified Recovery Specialist (CRS) services to further their

engagement into treatment services. This free service allows patients to increase their chances

of long term recovery by working with a peer mentor who has ‘walked in their shoes’. Patients

can sign up for these services by calling 1-800-220-1810.

1200

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ite 300

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A 150

62 724-243-2220

ww

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cinc.org

Dru

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Alcoh

ol S

ervicesP

rovider C

ontact

List

SPHS Behavioral Health, Greensburg203 South M

aple AvenueGreensburg, PA 15601724-834-0420www.sphs.org

SPHS Behavioral Health, Mon Valley

2 Eastgate Ave.M

onessen, PA 15062724-684-6489www.sphs.org

Detoxification and Non Hospital RehabilitationGateway Rehabilitation CenterM

o�et Run RoadAliquippa, PA 15001724-378-4461www.gatewayrehab.org

Gateway Rehabilitation Center208 South Church Street Suite 201M

t. Pleasant, PA 15666724-365-4020www.gatewayrehab.org Greenbriar Treatm

ent Center800 M

anor DriveW

ashington, PA 15301724-225-97001-800-637-hopewww.greenbriar.net Twin Lakes CenterP.O. Box 909Som

erset, PA 15501814-443-3639www.twinlakescenter.org Arc M

anor200 Oak AvenueKittanning, PA 16201724-548-7607www.arcm

amor.org

Pyramid Pittsburgh

306 Penn AvenuePittsburgh, PA 152211-888-694-9996www.pyram

idhealthcarepa.com

Pyramid Healthcare

1894 Old Route 220, Box 967Duncansville, PA 166351-888-694-9996www.pyram

idhealthcarepa.com

Conewago Indiana2275 W

arren RoadIndiana, PA 157011-888-347-3873www.firetree.com

Cove Forge CharterNew Beginnings RoadW

illiamsburg, PA 16693

1-800-873-2131

Adolescent Detoxification and/or RehabilitationGateway Rehabilitation CenterM

o�et Run RoadAliquippa, PA 15001724-378-4461www.gatewayrehab.org

Pyramid Ridgeview

4447 Gibsonia RoadGibsonia, PA 150441-888-694-9996www.pyram

idhealthcarepa.com

Adolescent Rehabilitation for Adjudicatedand Delinquent M

alesOutside In School of Experiential Education, Inc.1050 Ft. Palm

er RoadBolivar, PA 15923724-238-8441www.outsideinschool.com

Adelphoi Village Inc., Monastery Run

1108 Village Way

Latrobe, PA 15650724-520-1111www.adelphoivillage.org

Screening/Assessment/Case M

anagement

Individuals who are uninsured, underinsured, or are not eligible for m

edical assistance should contact the SPHS Case M

anagement Unit for a level of care assessm

ent and referral for services.

SPHS D&A Case Managem

ent203 South M

aple Avenue, Greensburg, PA 15601

800-220-1810 724-832-5880www.sphs.org

Individuals who have private health insurance, including medical

assistance, can access services by contacting any treatment

facility and scheduling an assessment.

Outpatient/Intensive Outpatient/PartialAllied Addiction Recovery766 East Pittsburgh Street Suite 101Greensburg, PA 15601412-246-8965www.alliedaddictionrecovery.com

Axiom Fam

ily Counseling Services, Inc.225 M

argaret Avenue Suite 3Jeannette PA 15644724-522-5456www.axiom

familycounseling.com

Gateway Greensburg212 Outlet W

ay, Suite 1Greensburg, PA 15601724-853-7300www.gatewayrehab.org

Gateway Monroeville

4327 Northern PikeM

onroeville, PA 15146(412) 373-2234www.gatewayrehab.org

Greenbriar Monroeville

400 Penn Center Boulevard St. 707Pittsburgh, PA 15235www.greenbriar.net

Greenbriar New Kensington701 Fourth Ave.New Kensington, PA 15068724-339-7180www.greenbriar.net

MedM

ark 1037 Com

pass CircleGreensburg, PA 15601724-834-1144

New Freedom Recovery Center

2000 Comm

erce LoopSuite 2200North Huntingdon, PA 15642724-382-4628www.newfreedom

recovery.org

Outside In School of Experiential Education, Inc.905 East Pittsburgh StreetGreenburg, PA 15601724-837-1518www.outsideinschool.com

SPHS Behavioral Health, Greensburg203 South M

aple AvenueGreensburg, PA 15601724-834-0420www.sphs.org

SPHS Behavioral Health, Latrobe1100 Ligonier StreetLatrobe PA 15650724-532-1700www.sphs.org

SPHS Behavioral Health, Mon Valley

2 Eastgate Ave.M

onessen, PA 15062724-684-6489www.sphs.org

SPHS Behavioral Health, New Kensington408 8th Street, Suite 1New Kensington, PA 15068724-339-6860www.sphs.org

Strive Health of Greensburg101 North M

ain Street, Suite 200Greensburg, PA 15601724-302-0804www.strivecares.com

Medicated Assisted Treatm

entAllied Addiction Recovery766 East Pittsburgh Street Suite 101Greensburg, PA 15601412-246-8965www.alliedaddictionrecovery.com

Axiom Fam

ily Counseling Services, Inc.225 M

argaret Avenue Suite 3Jeannette PA 15644724-522-5456www.axiom

familycounseling.com

Gateway Greensburg212 Outlet W

ay, Suite 1Greensburg, PA 15601724-853-7300www.gatewayrehab.org

JADE Wellness Center

4105 Monroeville Blvd.

Monroeville, PA 15146

412-380-0100www.m

yjadewellness.com

MedM

ark 1037 Com

pass CircleGreensburg, PA 15601724-834-1144

RHJ Medical Center, Inc., Hunker

1005 Old State, Rt. 119Hunker, PA 15639724-696-9600www.rhjm

edical.com

RHJ Medical Center, Inc., Vandergrift

2994 River RoadVandergrift, PA 15690724-696-9600www.rhjm

edical.com

E�ective 1/5/2018

26 | P a g e

Help for Overdose Survivors – Fayette County Drug & Alcohol Commission

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Opioid Epidemic: Best Practices in Prescribing

Retrieved from: Centers for Disease Control and Prevention

(www.cdc.gov/drugoverdose/prescribing/guideline.html)

29 | P a g e

Links to Pennsylvania Prescribing Guidelines

The Use of Opioid to Treat Chronic Noncancer Pain:

https://www.pamedsoc.org/PAMED_Downloads/PAGuidelinesonOpioids.pdf?utm_source=PDF

&utm_medium=web&utm_campaign=OpioidGuidelinesNonCancer

Emergency Department Pain Treatment Guidelines:

https://www.pamedsoc.org/PAMED_Downloads/PA%20ED%20Guidelines%20Opioids.pdf?utm_

source=PDF&utm_medium=web&utm_campaign=OpioidGuidelinesED

Opioid in Dental Practice:

https://www.pamedsoc.org/PAMED_Downloads/opioid_dental_prescribing_guidelines3_13_15.

pdf?utm_source=PDF&utm_medium=web&utm_campaign=DentalGuidelines

Opioid Dispensing Guidelines:

https://www.pamedsoc.org/PAMED_Downloads/PA%20Guidelines%2c%20on%20the%20Dispe

nsing%20of%20Opioids.pdf?utm_source=PDF&utm_medium=web&utm_campaign=PharmacyO

pioidGuidelines

Obstetrics and Gynecology Pain Treatment:

https://www.pamedsoc.org/PAMED_Downloads/OpioidGuidelinesOBGYN.pdf?utm_source=PDF

&utm_medium=web&utm_campaign=OBGYNGuidelines

Geriatric Pain Opioid Use and Safe Prescribing:

https://www.pamedsoc.org/PAMED_Downloads/OpioidGuidelinesGeriatrics.pdf?utm_source=P

DF&utm_medium=web&utm_campaign=GeriatricsGuidelines

The Safe Prescribing of Opioid in Orthopedics and Sports Medicine:

https://www.pamedsoc.org/PAMED_Downloads/Orthopedics%20and%20Sports%20Medicine%

20Guidelines%20FINAL.pdf

30 | P a g e

Pennsylvania’s Prescription Drug Monitoring Program (PDMP)

Information retrieved from Pennsylvania Department of Health

http://www.health.pa.gov/Your-Department-of-

Health/Offices%20and%20Bureaus/PaPrescriptionDrugMonitoringProgram/Pages/GeneralInfo.aspx#pre

scribers

Overview of PDMP

Q: What is a Prescription Drug Monitoring Program (PDMP)?

A: The PDMP is a statewide program that collects information about controlled substance prescription drugs that are dispensed to patients within the state.

Q: Why does Pennsylvania have a PDMP?

A: The Office of the Attorney General (OAG) operated the former PDMP. Previously, the PDMP required the reporting of Schedule II controlled substances only. The legislature passed a new law, Act 191 of 2014, which requires monitoring Schedule II through Schedule V controlled substances. The Pennsylvania Department of Health is responsible for the development and the day-to-day operations of the new system.

Q: Do other states have PDMPs?

A: 49 states, including Pennsylvania, have an operational prescription drug monitoring program or have enacted legislation to establish a PDMP and are in the process of creating one.

Q: What is the purpose of the new PDMP?

A: The purpose of the PDMP established by Act 191 of 2014 is two-fold:

To be used as a tool to increase the quality of patient care by giving prescribers and dispensers access to a patient's controlled substance prescription medication history, which will alert medical professionals to potential dangers for purposes of making treatment determinations; and

To aid regulatory and law enforcement agencies in the detection and prevention of fraud, drug abuse and the criminal diversion of controlled substances.

Q: How does the PDMP work?

A: As of January 1, 2017, dispensers are required to collect and submit this information to the PDMP no later than the close of the subsequent business day. The PDMP stores the information in a secure database and makes it available to healthcare professionals and others as authorized by law.

Q: When will prescribers and dispensers have access to the PA PDMP database?

A: Registration for PA PDMP program is open and the system is available for query.

Q: What are controlled substances?




31 | P a g e

A: Controlled substances are drugs that have varying degrees of potential for abuse or dependence. Drugs and other substances that are considered controlled substances under the Controlled Substances Act (CSA) are divided into five schedules. Substances are placed in their respective schedules based on whether they have a currently accepted medical use in treatment in the United States, their relative abuse potential, and likelihood of causing dependence when abused. The following are examples of Schedule II through Schedule V controlled substances:

Schedule II - drugs with acceptable medical use, but with a high abuse potential that lead to dependence (morphine, methadone, oxycodone).

Schedule III - drugs with less abuse potential and a moderate risk of abuse potential (aspirin/codeine combinations, buprenorphine).

Schedule IV - drugs with a lower abuse potential (alprazolam, clonazepam, diazepam).

Schedule V - drugs with less abuse potential than other schedule drugs and contain limited quantities of a controlled substance (robitussin AC, phenergan with codeine).

Q: Will there be a training program for dispensers and prescribers to utilize the new system?

A: Yes, all PDF tutorials on how to register, search and use the system are available on the PDMP Portal section of the website.

Q: What is required of dispensers?

A: As of January 1, 2017, all Schedule II-V dispensed prescriptions must be reported to the system no later than the close of the subsequent business day.

For example, if your pharmacy is open Monday to Friday, from 8:30 a.m. to 9:00 p.m. the dispensation data from Monday must be submitted by Tuesday before 9:00 p.m. The dispensation data from Friday must be submitted by the following Monday before 9:00 p.m.

Note: The PMP Clearinghouse can accept dispensation data every day including weekends.

Q: Will the new PDMP system be "real-time"?

A: Dispensers, prescribers and their delegates will have "real-time" access to the data stored by the PDMP at any given time. However, beginning January 1, 2017, dispensers have up to the close of the subsequent business day to submit data after dispensing a scheduled prescription drug.

Q: Do dispensers or prescribers have to pay anything for the program?

A: A dispenser or prescriber shall not be required to pay a fee or tax specifically dedicated to the establishment, operation or maintenance of the program.

Q: Will the PDMP offer any kind of referrals to treatment programs for patients suspected to have the disease of addiction?

A: The PDMP provides data to healthcare professionals to enable them to make more informed decisions about prescribing and dispensing monitored prescription drugs to their patients or potential patients. Healthcare professionals are encouraged to use the data obtained from the PDMP to improve their treatment of patients, including referring patients to substance abuse

32 | P a g e

treatment. Information regarding drug and alcohol treatment services is available on the Pennsylvania Department of Drug and Alcohol Programs website.

Q: Would prescription dispensation data from Methadone Assisted Treatment (MAT) Programs or Narcotics Treatment Programs (NTP) in Pennsylvania be included into the PA PDMP system?

A: Licensed health care facilities, including MATs/NTPs, that distribute controlled substances for the purpose of administration in the licensed health care facility are not required to submit data to the PA PDMP system. Furthermore, MATs/NTPs are covered under the confidentiality regulation 42 CFR Part 2, Subpart C, which does not allow medical professionals in MATs/NTPs to share any controlled substances dispensation information to the PA PDMP system.

DEA Philadelphia Field Division, 600 Arch Street, Suite 10224, Philadelphia, PA 19106

OPERATION TROJAN HORSE

FACT SHEET

What is Operation Trojan Horse?

Operation Trojan Horse is a coordinated effort between DEA and state and local law enforcement to combat the epidemic of heroin and opioid overdoses

in Pennsylvania and Delaware. Trojan Horse offers intelligence resources, funding, and training with the goal of identifying illicit narcotic sources of

supply in a timely manner.

I am a police officer, what is my role?

DEA is collecting information gathered from fatal and non-fatal overdose scenes, to include telephone numbers, stamp bag logos, names of victims and identified sources of supply, pill bottles, etc. This information can be submitted

on the attached Suspected Overdose Reporting form.

What will DEA do with the information that is submitted?

DEA will query all of the provided information through DEA databases, open sources, law enforcement systems, telecommunications providers, etc.

What will I get back and how will it help my department?

The goal of Trojan Horse is to provide state and local law enforcement with information on sources of supply and co-conspirators for further investigation.

The submitting agency will be provided with all of the results of the DEA queries for their own investigative follow-up.

How does my department participate?

Operation Trojan Horse training is available upon request. DEA trainers will provide instruction on collecting and submitting the requested information.

Please contact Division Training Coordinator

Patrick Moynihan at 267-745-4698 or [email protected] or Field Intelligence Manager Laura Hendrick at 215-861-3258 or

[email protected]

Op

erat

ion

Tro

jan

Ho

rse

SUSPECTED OVERDOSE

INCIDENT REPORT

LAW ENFORCEMENT USE ONLY

Officer's Name

Officer's Contact Number

Officer's Email Address

Department Name

Case/Incident #

Date of Incident

Overdose Type Fatal Non-Fatal

Incident Street, City, Zip

Victim Full Name

Victim DOB Victim SSN

Victim Residence Street,

City, Zip

Victim's Phone Seized or

Identified

Yes

No

Identified Phone #(s)

Phone(s) Forensically

Examined (Cellebrite)?

Yes

No

If no, will phone(s) be

forensically examined?

Yes

No

Supplier Information

(Name, Nickname, Phone

#, Address, etc., if known)

Drugs Seized at Scene Yes

No

Drugs

Tested?

Yes

No

If yes, results of drug

test:

Stamp Identified

(attach photo if available)

Yes No

Stamp Name or

Description

Prescription Bottle At

Scene

Yes

No

If Yes,

Doctor's

Name,

Medication

Police Report Available

(attach if available)

Yes

No

Case Status Open

Closed

Request for DEA

Assistance

Nothing further at this time

Subscriber for identified phones

Toll records for identified phones

Cellebrite Assistance

Other

Other LE Agencies

Involved

Yes

No

Other LE Agencies

Names

Please fax this report to 215-861-1787 or email to

[email protected] within 72 hours of the incident.

You will receive a confirmation email upon receipt.

LAW ENFORCEMENT USE ONLY

UNCLASSIFIED

UNCLASSIFIED

Event

(U) The Drug Enforcement Administration (DEA) Philadelphia Field Division (PFD) conducted an analysis of drug seizure and fatal overdose data as an indicator of carfentanil in Pennsylvania. Carfentanil is a Schedule II synthetic opioid, typically used as an analgesic for large mammals, and is approximately 10,000 times more potent than morphine and 100 times more potent than fentanyl.1

Significance

(U) Carfentanil was first identified in Pennsylvania’s illicit drug supply in 2016 after being found in both drug seizures and overdose deaths. Carfentanil and other fentanyl-related substances (FRSs) have emerged as a significant drug threat in Pennsylvania, with sharp increases in overdose deaths associated since 2015. This analysis was based on data obtained from the National Forensic Lab Information System (NFLIS) 2, originally reported by seven law enforcement laboratories in Pennsylvania.

Details

(U) Carfentanil was first identified in Pennsylvania during drug seizure analysis conducted in September 2016. Since that time, a total of 97 exhibits have been analyzed and reported to NFLIS by Pennsylvania law enforcement laboratories. Of these exhibits, approximately 45 percent were submitted for analysis during the months of June and July 2017. Additional analysis of carfentanil exhibits may be pending, as there is a time lag between seizure, submission, analysis, and reporting.

(U) In terms of composition, 25 percent of the submitted exhibits were found to contain carfentanil with no additional substances. Fentanyl was found in 41 percent of the exhibits, heroin was found in 38 percent of the exhibits, and 12 percent contained both heroin and fentanyl. Carfentanil seizures have been identified in 22 Pennsylvania counties (see Figure 1). __________________ 1 Information is from the DEA National Drug Threat Assessment, 2017

2 The DEA NFLIS collects results from drug chemistry analyses conducted by state, local, and federal

forensic laboratories across the country. NFLIS provides analytical results of drugs seized by law enforcement and is a source of information for monitoring and drug trafficking in the United States. The State of Pennsylvania currently has nine local laboratories submitting to NFLIS.

(U) Carfentanil in Pennsylvania

This DEA Bulletin is based on preliminary reporting and may be subject to updating as additional information becomes available.

DEA-PHL-BUL-042-18 DECEMBER 2017

Page | 2

(U) Figure 1. Number of Carfentanil Exhibits Submitted by Pennsylvania Counties, 2016-17.

Source: National Forensic Lab Information System

(U) In addition, two exhibits contained carfentanil with cocaine, and three exhibits contained carfentanil with cocaine and heroin. This may be indicative of a poly-drug organization and, potentially, several separate sources of supply. Additional separate combinations included carfentanil mixed with p-fluoroisobutyryl fentanyl; furanyl fentanyl, and acetyl fentanyl.

(U) Carfentanil typically arrives into the United States via mail services from source countries such as China. It has been identified in powder, pill, and liquid form. In Pennsylvania, the majority of carfentanil exhibits were in powder form (62 percent).

(U) In addition, more than 85 carfentanil-positive overdose deaths have been reported in 13 Pennsylvania counties in 2017 (Allegheny, Beaver, Butler, Centre, Chester, Crawford, Dauphin, Erie, Fayette, Lehigh, Montgomery, Philadelphia, and Somerset).3 It is possible that additional carfentanil-related deaths have occurred in Pennsylvania but were not identified due to insufficient toxicology testing.

(U) The introduction of carfentanil into the illicit drug supply presents an increased danger to drug users and first responders. _________________ 3 Data received from the Allegheny County Office of the Medical Examiner, Philadelphia Medical Examiner’s

Office, and NMS Labs.

(U) This product was prepared by the DEA Philadelphia Field Division. Comments and questions may be addressed

to the Chief, Analysis and Production Section at [email protected].

mailto:[email protected]

Additional Tips • Scratch out all identifying information on the prescription

drug to make it unreadable. This will help to protect your identity and the privacy of your personal health information.

• You must not share your prescription drugs – they were prescribed to you.

Can I Flush Medicine Down the Sink or Toilet? If the abovementioned disposal options are not readily available, one option is to flush the medicines down the sink or toilet as soon as they are no longer needed. Some communities may prohibit this practice out of concern over the trace levels of drug residues found in rivers, lakes, and community drinking water supplies.

Do not flush medicines down the sink or toilet unless the prescription drug labeling or patient information that accompanied the medicine specifically instructs you to do so. Please also ensure you are compliant with your community’s laws and regulations prior to taking such action.

Drug Disposal Guidelines If no disposal instructions are given on the prescription drug labeling and no prescription drug take-back program is available in your area, then follow these simple steps to throw the drugs in the household trash:

1. Remove the medicine from its original container and mix it with an undesirable substance, such as used coffee grounds or kitty litter.

2. Place the mixture in a sealable bag, empty bag, or other container to prevent medicine from leaking or breaking out of a garbage bag.

Visit the Drug Enforcement Administration’s (DEA) Diversion Control Division website (go.usa.gov/xNVXt) or call (800) 882-9539 for more information and to find an authorized collector in your community. The site also provides valuable information about DEA’s National Take-Back Initiative.

Resources For more information on preventing prescription drug misuse, go to the following websites: • www.dea.gov • www.getsmartaboutdrugs.com • www.justthinktwice.com • www.campusdrugprevention.gov

For more information on the safe disposal of pharmaceuticals, go to the following websites: Environmental Protection Agency • How to Dispose of Medicines Properly

go.usa.gov/xNwXc Food and Drug Administration • Disposal of Unused Medicines: What You Should Know

go.usa.gov/xNw9z • How to Dispose of Unused Medicines

go.usa.gov/xNw9S

Sources: Environmental Protection Agency, How to Dispose of Medicines Properly, 2011; Food and Drug Administration, Disposal of Unused Medicines: What You Should Know, 2017.

HOW TO PROPERLY DISPOSE OF YOUR UNUSED MEDICINES

Unused or expired prescription medications are a public safety issue, leading to potential accidental poisoning, misuse, and overdose. Proper disposal of unused drugs saves lives and protects the environment.

https://www.dea.gov

https://www.getsmartaboutdrugs.com

https://www.justthinktwice.com

https://www.campusdrugprevention.gov

https://go.usa.gov/xNVXt

https://go.usa.gov/xNwXc

https://go.usa.gov/xNw9z

https://go.usa.gov/xNw9S

TREATMENT FOR DRUG USE AND THE NEED FORPAID FAMILY AND MEDICAL LEAVE

Drug use and dependence take a terrible toll on many of America’s families. The growing opioid epidemic is only the latest in a series of crises that have had devastating effects on vulnerable communities. Treatment programs and the support of family caregivers often aid the recovery of people with substance use disorders – but too many people do not have the supportive workplace policies they need to make ends meet while seeking treatment or providing care for a family member dealing with a drug use disorder. A state paid family and medical leave insurance plan would help provide economic security for working people who need time away from their jobs for a range of serious family and medical needs, including seeking or providing care related to drug use and dependence. Paid leave could also facilitate cost-effective treatments that help prevent job loss or incarceration for people with drug use disorders.

Millions of People Need Time Away From Their Jobs to Seek Treatment for Drug Use Disorders or to Provide Care• Many people with substance use disorders are employed and

need time away from their jobs for effective treatment. More than two-thirds (68 percent) of adults who report using illicit drugs were working in 2012. A recent survey found that more than 70 percent of employers say they have been affected by prescription drug use among their employees.Treatments for prescription opioid use disorder have proven successful in enabling patients to recover and manage their disorders long term. Treatments are also cost-effective and can reduce criminal behavior.

• People with drug use disorders need time away from work in order to seek the treatment they need to improve their health, keep their jobs and remain productive employees.

• Family caregivers also need time away from their paying jobs to help with substance use disorder treatment and recovery. Family members can play a key role in the care and recovery of people with substance use disorders by helping loved ones with health care arrangements, treatment and financial assistance.

• Paid family and medical leave would benefit family caregivers and people seeking treatment for substance use disorders, yet few workers have access to it. Just 14 percent of people in the U.S. workforce have access to paid family leave through their employers, and fewer than 40 percent have employer-provided short-term disability insurance.

“My son had to attend outpatient groups daily. As he had no car, he needed someone to take him to his appointments and monitor his day-to-day recovery. In our area, buses are five miles away and he would have to make three to four transfers just to get to the outpa-tient clinic. Had I had the paid time off, I could have helped him. I am the sole provider of our home. I needed to work to pay the bills. I have worked at my current job for over 30 years and had an extended leave bank of over 100 hours, but as it was my son and not me, I wasn't allowed to tap into that ac-count. It was extremely frustrating.”

— MomsRising member, California

Ensuring People With Drug Use Disorders and Their Family Caregivers Have Paid Leave Would Benefit the Whole CountryAddressing the opioid epidemic and the nation’s drug crisis generally requires a comprehensive range of interventions, including providing people with paid time away from their jobs for care and recovery. Paid family and medical leave enables working people to seek medical treatment related to a substance use disorder, or to care for a family member with one, without the threat of financial hardship. This essential support strengthens workforce participation and retention, reduces health care costs and boosts the economy – with lasting, widespread benefits for the nation.

It is well past time for national paid family and medical leave in the United States. Until that happens, several states have successfully established state paid family and medical leave insurance funds, a business friendly way to ensure all workers have access to paid family and medical leave. State paid family and medical leave insurance programs help all workers and family caregivers take paid leave to address serious family and medical needs, including serious health issues related to cost-saving, life-saving treatment for drug use. A responsibly funded, shared-cost system would mean that employers would not bear the full cost of leave and workers would be covered no matter where they live, their employers or their jobs. For more information, visit www.PaidLeaveForPa.org

Drug Use Disorders Create Costly Health and Economic Burdens for Individuals and Their Families• People caring for family members with drug use disorders also experience compounding economic

effects. Family caregivers often contribute financially to their family members’ treatment and recovery from substance use disorders, which can cost thousands of dollars per year.

• Without paid leave, these caregivers can lose income or their jobs altogether, creating an even greater economic burden that can have devastating and widespread consequences.

This fact sheet was created by the National Partnership for Women and Families, and distributed by the Women and Girls Foundation as part of their Paid Family Leave campaign.

www.nationalpartnership.org www.wgfpa.org

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Moving Forward and Next Steps

Technical Assistance Center (TAC)

Manual

(Updated April 2017)

Janice L. Pringle, PhD

University of Pittsburgh

School of Pharmacy

Program Evaluation and Research Unit (PERU)

In collaboration with

The Pennsylvania Commission on Crime and Delinquency

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Introduction: What is the Technical Assistance Center and How Can It Help Your Community Fight

Overdose?

Mission: The Pennsylvania Opioid Overdose Reduction Technical Assistance Center (TAC) will be the first

ever resource and technical assistance hub for all counties within the Commonwealth of Pennsylvania.

Based out of the Program Evaluation and Research Unit (PERU) at the University of Pittsburgh School of

Pharmacy, the TAC will assist counties and communities in planning, developing, implementing, and

sustaining community-based initiatives for reducing overdose throughout Pennsylvania.

Activities: Through the TAC, PERU will continue to develop and expand the OverdoseFreePA.org

website, which contains a wealth of information regarding overdose prevention strategies,

interventions, data, and resources. The website includes a growing database of overdose death data

within Pennsylvania, which will expand to cover all 67 counties in Pennsylvania. This data provides

insight into the causes and populations affected by overdose and is sortable to provide relevant

information to interested audiences.

The TAC staff will coordinate with county and community representatives to conduct assessments of

current strengths and liabilities for addressing overdose in each community using a systems focused

framework they have developed and tested. Results of this assessment will guide the development of a

customized evidence-based strategic plan to address the community’s current state of overdose and

overdose deaths. Technical assistance will continue to each community as they implement and sustain

their efforts to reduce overdose deaths.

Finally, TAC staff will assist the PCCD with developing Requests for Proposals (RFPs) and evaluating

applicants for funding awards to support the above efforts toward reducing overdoses and overdose

deaths.

For more information or to request technical assistance, please complete the TAC Request Form

available at http://overdosefreepa.org, use the form on the next page, or contact us at:

Pennsylvania Opioid Overdose Reduction Technical Assistance Center (TAC) University of Pittsburgh School of Pharmacy

5607 Baum Boulevard, Room 302 Pittsburgh, PA 15206

412-383-2073 [email protected]

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How to Use This Manual

This manual has two functions. First, it provides background information regarding what is known about

how to prevent overdoses and how to organize that knowledge. Second, it provides questionnaires,

worksheets, checklists, and guiding principles that can be used to apply this knowledge towards the

development of a community-specific strategic plan that could effectively guide a community towards

reducing overdoses and overdose deaths.

Please note that the TAC staff will provide your community with ongoing technical assistance regarding

how to use the information in this manual.

This manual will guide your group to develop or enhance a coalition to reduce overdose deaths within

your community. Because each community has unique characteristics, no single coalition will look the

same. The resources in this manual will help your group to understand the current overdose

phenomena in your community and the most effective people, resources, and strategies to enlist in the

fight against overdose deaths. Worksheets and resource links will assist you as you assess your

community, use available data resources to identify the scope of the overdose issue, form or develop

your coalition and leadership, select your evidence-based strategy or strategies, and evaluate your

coalition’s effectiveness.

The processes for guiding your community towards reducing overdose deaths is based both on

SAMHSA’s Strategic Prevention Framework, shown in Figure 1 (SAMHSA, n.d.) and a Framework for

Guiding System Transformation, Figure 2, (Diamond, 2015) developed at the Program Evaluation and

Research Unit (PERU). The System Transformation Framework is used to develop and enhance the

effectiveness of an organization in order to maximize its ability to achieve its selected purpose. The

Framework is intended to provide a guide to system transformation around one domain: the vision or

greater purpose of the organization. This domain influences four other domains regarding the function

of the organization: (1) culture or employee/members’ values, beliefs and assumptions about their

work; (2) behavior or how employees/members’ handle relationships, power, decision-making, conflict,

and learning; (3) structure or how the organization is designed so lines of communication in the

organization can facilitate decisions and innovations; and (4) the use of performance measurements for

system improvement. Ultimately, these domains are continually managed by the facility leadership and

are influenced by external learning (methods to provide learning and skills development to the

workforce) and internal learning (systematic processes used to improve organizational functioning),

which can continuously transform the organization toward its intended vision.

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Figure 1. SAMHSA Strategic Prevention Framework

Figure 2. System Transformation Framework

The manual walks your community through how to apply both of these processes and worksheets

(available upon request) to assess your community, obtain data to guide your selection of evidence-

based practices (EBPs) which are best matched to the data, select and implement strategies to address

overdose deaths, and maintain a healthy coalition.

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Table 1: Worksheets (available upon request)

Stage Resources and Worksheets

Supplemental County Overdose Elimination Framework Current Situation Assessment County Dashboard Framework

Assessment Describing Your Community and Community Factors Checklist Data Available to Your Community Community Readiness Assessment

Capacity Potential Coalition Members and Roles Creating a Vision Statement (and a Greater Purpose) Leadership Questionnaire Coalition Health Assessment Ascertain Available Resources and Support Determine Community Activation Level

Planning Identify Potential Evidence-Based Intervention Strategies Develop Impact Model Develop a Strategic Plan

Implementation Determine Relevant Community Connections Develop an Effective Communication Plan Implement Strategies Supporting Continuous Quality and Fidelity

Evaluation Develop an Evaluation Plan Measure Progress

Sustainability Secure Funding Resources Develop a Sustainability Plan Obtain Continued Community Support

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Figure 3. TAC Implementation Diagram

Why a Coalition?

A coalition is a group of individuals or organizations who work together to address a problem in the

community (Center for Prevention Research and Development, 2006). The coalition may include existing

organizations such as social service agencies, government agencies, or community groups, or may be

formed by individuals who share a common concern. Research on overdose prevention strategies shows

that community coalitions can be very effective at implementing changes that promote health in the

community (Albert et al., 2011). One of the strongest effects of a coalition approach is the ability to

change the environment in the community by increasing awareness of overdose-related issues that also

result in changes in the community’s attitudes and beliefs regarding overdose. This evolution then yields

targeted changes in community systems that are needed to support the application of specific evidence-

based practices to reduce overdose. In summary, coalitions help to form links between organizations

and individuals at various levels in the community to leverage their resources toward reducing overdose

deaths (University of Kansas Work Group for Community Health and Development, 2015).

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Describing Your Community

Identifying characteristics of your community helps you to understand factors which will influence your

ability to affect change within your community. The composition of your coalition, strategy selection,

collaboration opportunities, and selection of evidence-based practices are enhanced when you choose

them with the overall character of the community in mind.

Your coalition should represent views of the various stakeholders affected by overdose issues and

provide opportunities for participation to as broad a section of your population as possible. Consider

demographic, cultural, economic, and social factors in your community to ensure that your strategy is

inclusive and represents the community as a whole. Size, population, urban or rural location, and

resource availability are factors which will influence your approach. Also, consider any specific

subpopulations within your community (age, gender, race and ethnicity, religion, veteran status, etc.)

You will need to identify where, when, and in which population segments overdose is more of a risk.

Use the Describing Your Community and Community Factors Checklist to characterize your community.

Obtaining Your Data

Data about the incidence and prevalence of drug use, overdose, and overdose deaths in your

community will help you understand the scope of the problem and identify possible solutions.

The TAC collects data on overdose deaths in Pennsylvania through the OverdoseFreePA.org Overdose

Death Data registry. County coroners or medical examiners submit case information through a secure

access website to provide an almost real time picture of overdose deaths by county. Information

includes age group, race, gender, type(s) of drug(s) contributing to death, and zip codes of incidence and

residence (if available). This information helps community members to know who is affected by

overdose in their community. Single County Authorities (SCAs), coroners, and medical examiners should

contact the TAC for guidance on how to submit overdose data.

Other data sources for information on the scope of overdose deaths include national and state data sets

and local data sources such as law enforcement agencies, healthcare facilities, or emergency medical

services (EMS) agencies. Identifying the types of healthcare practitioners, hospitals and clinics, human

service agencies, substance use disorder (SUD) treatment facilities, recovery support groups, education

resources, and criminal justice facilities in your community will help you to obtain information about

available resources and identify gaps in existing services or unmet needs.

Data on non-fatal overdoses can help you identify risk factors or intervening variables for overdose, but

it is not always easy to obtain. You may be able to acquire this information from local law enforcement,

healthcare, or EMS agencies to help provide a total picture of overdose risk in your community, but

standard data collection methods remain a challenge.

Use the Data Available to Your Community and Potential Sources of Data worksheets to identify what

data on overdoses is currently available for your community and potential sources for this data. Utilize

resources such as contact lists for state or county organizations or individuals which can help provide

additional data or sources for your coalition.

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Determining Your Community’s Readiness to Have an Impact on Overdose

Deaths

“Readiness” refers to your community’s capacity to initiate and implement change. Some groups or

segments of your community may not be aware that overdose is an issue. Other groups may deny that

this problem exists or that it doesn’t need to be solved (because it is not severe enough, or because they

believe time and resources could be better spent elsewhere). Even if the community is aware and wants

to take action, views about the appropriate interventions and solutions to your overdose problem will

also vary (University of Kansas Work Group for Community Health and Development, 2015).

Conducting a readiness assessment helps you to determine how likely it is for a social change initiative

to be successful based on your community’s current status (Substance Abuse and Mental Health

Services Administration, 2015). If your community is not ready to effectively conduct overdose

prevention and intervention efforts, you may need to complete preparatory work to enhance awareness

and receptiveness in your community before you attempt to develop your prevention and intervention

plan. When preparing to implement overdose reduction efforts, it is always best to consider roadblocks

which may interfere with your efforts and try to plan ways to remove these obstacles before you begin

implementation (Substance Abuse and Mental Health Services Administration, 2015).

Complete the Community Readiness Assessment worksheet to assess your community readiness, then

compare your community’s readiness to the stages below in Table 2.

If your Community Readiness Assessment indicates that your community has little to no awareness of its

overdose death risk, you may need to conduct awareness enhancement efforts in your community

before you begin to choose intervention strategies. There are many evidence-based strategies for

increasing community awareness regarding public health threats such as overdose. The TAC can provide

you with some of these strategies and guide you in their implementation.

If you find your levels in one readiness area (see table below) are much lower than another area, you

will want to focus on increasing capability in that area. Again, the TAC can provide you with support on

how to apply effective strategies to increase readiness in specific areas. All readiness areas should be

fairly consistent before you begin your work. If they are not, work on those with the lowest readiness

levels first.

After you complete the Community Readiness Assessment worksheet, compare your community’s stage

in each domain to the levels shown in Table 2 to determine where your coalition should start its efforts.

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Table 2: Stages of Community Readiness

Stage Goal

No awareness Increase awareness about the issue of overdose

Denial Increase awareness that the problem exists in your community

Vague awareness Increase awareness that the community can do something

Pre-planning Increase awareness with ideas to address the problem

Preparation Gather information and begin to plan

Initiation Identify and implement evidence-based programs

Stabilization Evaluate and improve programs

Confirmation Expand services

Professionalization Maintain momentum and continue growth

Selecting Your Coalition Members

As you build your coalition, carefully think about who should be involved and what viewpoints these

individuals represent. Questions to consider include: which potential coalition members represent the

composition of your community; and which potential members advocate for people with SUDs? Your

first step should be to contact your county’s SCA for Drug and Alcohol Programs for assistance if they are

not already involved with your coalition. If there is an existing coalition working to address overdoses, it

is preferable that you don’t duplicate the efforts made by this coalition or compete against it. Instead,

you may be able to enhance the existing coalition’s efforts rather than starting a new group.

Carefully consider those who hold positions of influence within your community or its various

subgroups. These individuals can make systems and resources accessible that are otherwise unavailable.

These individuals and their resources may be required to implement strategies that can effectively

reduce overdoses. Social service providers, healthcare providers, SUD treatment professionals, law

enforcement officers, EMS providers, school leaders, religious leaders, government officials, and media

personnel are all examples of possible coalition members.

Also consider members who more completely represent your community and permit inclusion of people

from different backgrounds and viewpoints. Refer to the Describing Your Community worksheet to

ensure that your coalition is as inclusive and diverse as possible. Consider the technical skills your

coalition will need such as administrative, fiscal, public relations, and management skills. Try to identify

potential members or volunteers with expertise in as many of these areas as possible as you get started.

Begin with a smaller, core group of individuals (typically no more than ten) committed to reducing

overdose and expand your membership as you develop and implement your strategy.

Complete the Potential Coalition Members and Roles worksheet to identify potential coalition

participants in your community.

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Developing Your Coalition Vision Statement

Your coalition leadership will need to develop a Vision and Greater Purpose to guide your group as you

proceed. The Vision and Greater Purpose are extremely important to your Coalition’s work and guide

the activities and priorities of all members. The Vision should be short, clear, inspirational, and

inarguable and should set a goal that is ambitious and idealized. Refer to the Creating a Vision

Statement worksheet to develop a Vision Statement and Greater Purpose for your coalition.

Selecting Your Coalition Leadership

When selecting coalition leadership, consider the background and experience of potential leaders.

Choose a leader who has experience leading community-based efforts to improve health. Good coalition

leaders are respected in the community, have access to community leaders, and have some

understanding of overdose and evidence-based prevention, intervention, and treatment strategies.

Complete the Leadership Questionnaire to evaluate potential leaders for your coalition.

Conducting Productive Meetings

As your coalition forms, you will need to hold meetings to discuss issues and determine strategies and

action steps. Your coalition leadership will need to identify someone to facilitate meetings, both of the

entire group or any subgroups. You may be able to access a meeting room through one of your coalition

groups, a local library, community center, coffee shop or restaurant. Good meeting facilitation requires

confidence and interpersonal skills. It is important to provide a forum for all stakeholders to be heard in

a constructive manner. Below are some tips for conducting a good meeting:

1. Have a written agenda with enough copies for attendees;

2. Have a sign-in sheet to document participants/update contact info;

3. Have a plan for what to accomplish;

4. Begin and end on time;

5. Make people feel welcome and introduce selves;

6. Agree as a group on the rules of meetings;

7. Encourage and allow participation;

8. Treat all participants with respect;

9. Keep routine reports brief;

10. Provide more time for planning of new activities/initiatives;

11. Assign responsibility and a timeframe for all action items and document in minutes;

12. Defer an item if necessary; and

13. Summarize key points to ensure accurate understanding.

Assessing Your Coalition’s Health

If your coalition is already established, you should conduct an evaluation of your organization health to

understand where your coalition currently stands. If your coalition is new, you should conduct an

evaluation of your organizational health within one month of beginning your coalition. All coalitions

should conduct annual coalition health assessments to make sure they are operating as efficiently and

effectively as possible. The TAC will provide you with a method for conducting this assessment.

Analyzing the relationships between your coalition’s mission, vision, objectives, and organizational

culture and behavior can help you to optimize performance towards reducing overdose.

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Complete the Coalition Health Assessment worksheet.

County Overdose Elimination Framework

Refer to the County Overdose Elimination Framework to see how a county or community coalition can

implement strategies to prevent overdose deaths. The framework uses a population health approach to

target interventions based on the risk level of SUDs or overdoses for various populations. The

framework illustrates the importance of a comprehensive strategy to prevent overdoses which

incorporates health promotion and supply reduction strategies, consideration of risk and protective

factors involved in prevention, intervention strategies at the point of overdose, and treatment and

aftercare availability. To be effective in preventing deaths, coalitions need to adopt a comprehensive

view of their community and of where to direct their efforts.

Selecting Your Evidence-Based Interventional Strategies

Based on the circumstances and resources in your community, you should select your interventional

strategies from the following four EBPs to reduce overdoses (US Department of Health and Human

Services ASPE, 2015). Be sure to consider conceptual fit (does the strategy address the problem you

identified) and practical fit (is the strategy a good match for your community’s characteristics). Some

subsidiary strategies fit under these main areas.

Naloxone Availability

Naloxone (also known as Narcan™) is a medication that reverses opioid and opioid overdose effects and

can be administered by healthcare professionals, emergency responders, family members, friends, or

bystanders. Naloxone is available in several forms with the most common being an auto-injector (Ev-

Zio™) or a nasal spray. Pennsylvania has a standing order which permits individuals to purchase

naloxone without a prescription and administer it to someone they suspect is having an overdose.

Naloxone is safe and effective and will not harm the person in the event that the individual is not

actually experiencing an opioid overdose.

Common placements for naloxone include: those prescribed an opioid medication, first responders such

as EMS and law enforcement, jail or correctional facilities, or family and friends of people at high risk of

overdose. Pharmacies that stock and dispense naloxone are increasing, but many are unaware of the

need. Your coalition may choose strategies to increase awareness and availability of naloxone in your

community, particularly at intervention points where people are at high risk of overdose.

Medication Assisted Treatment (MAT)

Medication Assisted Treatment (MAT) uses FDA-approved medications as part of an overall treatment

program, which includes counseling and behavioral therapy, to treat SUDs and prevent overdose.

Prescribed medication helps to normalize brain chemistry, block the euphoric effects of alcohol or

opioid drugs, relieve physiological cravings, and normalize body functions without the harmful effects of

the drug.

Medications used for MAT of opioid dependence include methadone, buprenorphine, and naltrexone.

All of these require medical oversight and must be used in conjunction with counseling and behavioral

therapy. MAT may be safely used for long periods of time, even months or years, under appropriate

medical supervision and as part of a holistic treatment program that includes psychosocial counseling.

Many people achieve full and sustained recovery using MAT (National Institute on Drug Abuse, January

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2016). Possible treatment settings include hospitals, clinics, or physician offices. Access to treatment is a

significant component of the recovery process.

Opioid Prescribing Practices

Pennsylvania is among the many states with disproportionately high opioid prescribing rates. Educating

prescribers on the correct indications for opioid painkillers and the risks of overprescribing can reduce

the risk of overdose deaths. The Pennsylvania Medical Society has recently developed Prescribing

Guidelines for several specialty areas (Pennsylvania Department of Health, 2016) and some physicians

have begun to implement screening methods such as SBIRT (Screening, Brief Intervention and Referral

to Treatment) to identify people at risk of overdose from prescription opioids. Your coalition may

choose to work with physicians in your community to make sure they are aware of and follow these

Prescribing Guidelines and use these screening methods (PA Medical Society, 2014b). Your coalition may

also work with pharmacists to make sure they are following appropriate dispensing guidelines for opioid

medications (PA Medical Society, 2014a).

Prescription Drug Monitoring Programs (PDMP)

Pennsylvania is in the process of implementing a prescription drug monitoring program, ABC-MAP. This

program will allow doctors and pharmacists to check the prescribing history of patients to ensure that

they are not seeking multiple opioid prescriptions or are at risk of diverting medications. Practitioners

will be able to check records from over 30 participating states to reduce inappropriate opioid

prescriptions. Your coalition may choose strategies to increase awareness of the PDMP program in your

community, especially among medical professionals such as physicians and pharmacists.

Use the Selecting Your Evidence-Based Strategies worksheet to identify strategies appropriate for your

community.

Building an Impact Model

An impact model (sometimes called a logic model) will guide you and your group in your efforts to

reduce overdose deaths. It outlines the course of action you will take in your initiatives and helps you

with strategic planning and evaluating your progress. The impact model provides a visual map of the

work you plan to do and how you expect it to affect your community. This model can help you to think

through the process and evaluate how well a particular intervention fits your community and coalition.

First, you must consider the problem you are trying to address (the Situation). Next, Part One of your

Impact Model (Inputs and Activities) are the planned work of your coalition. Finally, Part Two (Outputs,

Outcomes, and Impacts) are the intended results of your coalition’s work in your community.

Impact Model: Situation

Part One: Work of Coalition Part Two: Results within Community

Inputs Activities Outputs Outcomes Impact

Figure 4. Impact Model

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The Situation refers to the current condition that you are trying to address in your community, in this

case overdose deaths.

1. Inputs include the people and resources available to your coalition and the characteristics of

your community. You need to consider what strategies will fit your community and capabilities,

what resources are available to you, and what barriers may stand in the way of a particular

initiative. Some strategies may not be right for your community now and would be frustrating to

attempt.

2. Activities are the actions and tools you use to implement your program. Products, services and

activities you have or can obtain to use in your efforts would be included here.

3. Outputs are the products of your coalition efforts, such as types, levels, and targets for your

activities. Examples include number of treatment centers available, people who participated in

program activities, hours of programming, etc.

4. Outcomes are the specific, measurable behavior changes in knowledge, skills, or attitudes of the

people whom your program affects. These can be changes in awareness, practices, knowledge,

or relationships. Outcomes can be measured on a short-term, medium-term, or long-term basis.

5. Impact is the longer-term change (usually over several years or more) that occurs in your

community as a result of your coalition’s efforts. Examples would be policy changes or improved

conditions which reduce overdose.

Use the Develop Impact Model worksheet to develop your own impact models for the problems you

want to address in your community. Use a separate sheet for each Situation you want to address.

Developing and Using a Strategic Plan

The goal of the TAC is to reduce or eliminate overdose deaths in Pennsylvania. How your coalition will

address this goal will vary based on your community’s profile and needs. You will need to select

interventions which are realistically possible to be successfully implemented in your community.

Using data on overdoses for your community, you should identify who is affected, which substances

contribute most to overdoses, when and where overdose deaths are occurring, and what strategies will

reduce deaths based on this information. The strategies you select need to be evidence-based as well as

good conceptual and practical fits for your community.

Based on the work you have done so far, you are now ready to develop your strategic plan. You will

create objectives to address overdose in your community. You will want to record the current

conditions, so you can measure your progress when you conduct evaluations. Develop objectives to

reduce overdose by using the “SMART” framework:

1. Specific – how much of a change you expect (%, number, etc.) based upon your community

readiness, resources, and coalition influence;

2. Measurable - data is available and will show effects;

3. Achievable – objectives are possible and your coalition can accomplish them;

4. Relevant – objectives fit your group, community and the issue you are targeting; and

5. Time-oriented – you have a timeline for when objectives will be achieved.

Example: We intend to provide training and supply naloxone to all officers from 6 police departments in

our county within the next year.

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Use the Develop a Strategic Plan worksheet to begin developing your goals, objectives and action steps.

Developing an Evaluation Plan

An evaluation plan is important to your project because it helps you assess your efforts and identify gaps

between goals and accomplishments, and actual versus expected outcomes. You may need to adjust

your program, goals, or methods based upon evaluation results. Evaluations can be conducted while the

project is ongoing or at the completion of a project period. Many funding agencies focus on results or

outcomes and will require you to report evaluations of your progress against the goals you set.

Evaluation should be done on both a short-term and long-term basis. You will measure your

accomplishments against the objectives, milestones and goals you established in your Impact Model and

your Strategic Plan.

Use the Develop an Evaluation Plan worksheet to build an evaluation plan for your coalition.

Finding Evaluation Assistance

Your project may need to have an outside evaluator because the funder requires it. You may also need

an outside evaluator because you do not have the current staff or resources available to conduct

specialized analyses in-house. Evaluators may be available from local colleges or universities (faculty

members or graduate students), hospitals, government agencies, or private companies, which provide

these services. Graduate students in public health or social science programs might be available to

provide evaluation services as part of a course project or internship at little to no cost to your coalition.

One potential resource for evaluators is the American Evaluation Association Evaluator Finder available

online at: http://tools.eval.org/find_an_evaluator/evaluator_search.asp.

Current Situation Assessment

Both your strategic plan and evaluation plan will be more effective if you have a baseline measure of the

current conditions influencing overdoses in your community. Your coalition will be better able to

identify issues and gaps in treatment as well as measure progress toward reducing overdose deaths. The

Current Situation Assessment Survey provides a mechanism to obtain a full-circle view of conditions in

your community. Your coalition can complete the assessment with assistance from local agencies,

particularly your county SCA, as well as TAC staff. Understanding the current conditions and resources

available will enhance your ability to select and implement effective overdose reduction strategies.

County Dashboard Framework

The County Dashboard Framework provides a mechanism to highlight important results from your

Current Situation Assessment. You may change the indicators shown in the model, but you should use

the template to illustrate how your community ranks for important interventions against overdose or

exceptionally high or low capacities. TAC staff can assist in compiling the dashboard indicators and

interpreting results from your survey.

Sustainability: Developing a Grant Application

You will need to secure adequate financial resources to develop and sustain your coalition. One of the

more common ways coalitions obtain funding is through grants awarded by organizations such as

government agencies (federal, state or local), corporate or business donations, or foundation sponsors.

There may be varying levels of complexity in the application process for these funders, with some

http://tools.eval.org/find_an_evaluator/evaluator_search.asp

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requiring only a simple letter or application and others requiring a complex proposal with a specific

format and requirements.

The background work in obtaining grants is to make sure you have a well-defined understanding of the

issue(s) you are trying to address, a well thought out plan to intervene, and a plan to measure or

evaluate your success. Look for a good match between the project you are planning and potential

funders. Look at previous projects they have funded to see if yours is similar in focus, scope, and target

audience.

Plan plenty of time ahead of any deadlines – some grant applications require support letters or

documentation that will take time to acquire. Read the requirements for the application carefully and

completely – particularly page limits, format requirements, what types of organizations are eligible, and

deadlines. Also, consider whether your organization has the capacity to complete the project you

describe in your grant application.

Make sure your application is written with proper grammar and follows a logical path. Use plain

language and define any acronyms or “jargon”, so the reviewers understand them. If you have multiple

people contribute to the writing, make sure the application sounds consistent in style and tone when

these sections are compiled. Using spell check, proofreaders, and reading the application out loud can

help find errors and inconsistencies. Make sure to address every item identified in the proposal and

include all information requested as specified by the funding entity, so your application is not rejected

for technical issues. Assume the funding agency doesn’t know anything about your issue – don’t leave

out information because you assume they know something.

Most grants will require some form of the following sections:

1. Narrative:

a. Introduce your organization. Include your history, participant organizations or

individuals, mission, purpose, and guiding principles. Discuss current programs,

activities, or services your organization conducts. How is your organization unique?

b. State the problem to be addressed, the causes, and solutions that have been attempted.

Use “who, what, when, where, why, how, and how much” descriptions of the problem

and your plan to address it. Use credible data and sources to support your position.

c. Identify your target population. What geographic area, groups, individuals, or

populations do you serve or plan to serve? What is the incidence of the issue in this

population? How will your project impact this issue?

d. Describe why the problem should be addressed. Include information on severity,

number of people affected, costs to the community, what will happen if it is not

addressed, etc. Reference relevant literature or similar projects that have been

successful.

e. Describe why your organization is the right one to address the problem. What specific

strengths or capabilities does your organization have? How are you different (better)

than other organizations or initiatives?

2. Goals and Objectives:

a. Use or adapt the goals that you developed in your impact model. Describe what you

want to accomplish and how it will impact your target population.

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b. Use the SMART objectives you developed as part of your strategic plan to describe the

steps you will take toward achieving your goals. Be realistic or even conservative in

describing your objectives – these will be used later to evaluate your progress.

3. Methods:

a. What activities, services, or programs will you provide? How do these relate to your

goals and objectives?

b. Who will do the work? Describe the type of staff, volunteers, or consultants you have. If

you need staff, describe how you will acquire them – hire new staff, volunteers, sub-

contract an outside organization, etc.

c. Who will administer and monitor the project? You may need to choose a lead

organization or individual from your member agencies.

d. What other resources, equipment or supplies will be used? How will you obtain these?

e. What is the project timeline? Include milestones and checkpoints to measure progress.

4. Evaluation Plan:

Use or adapt the evaluation items you identified in the evaluation component of your plan.

Evaluate both products (items tied to your objectives) and processes (items tied to methods and

activities). You can then develop metrics which relate to the evaluation questions you formed.

Some funders and applications will require you to evaluate and report on specific metrics. Make

sure you know what these metrics are and that you specify how and when you will collect,

analyze, and report the data for each of these metrics. These funders will typically also allow you

to supplement the required metrics with your own. This is a good way to include those product

and process measures that may only be relevant to your particular initiative.

If your project, or its evaluation, requires working with and collecting personal, private, or

medical data from patients or “human subjects”, you will most likely be required to outline how

you will protect the privacy and confidentiality of the individuals who participate in your project

and their information. You may be required to adhere to strict guidelines for obtaining

participant consent and maintaining confidentiality of data provided. You may need to have

secure servers or special software to protect participant data stored on computers. Your staff

may need to complete special certifications for working with human subjects and human

subjects’ data. If your project is funded, it may need to undergo Institutional Review Board

approval to ensure that your evaluation plan adheres to ethical guidelines.

Typically, if you partner with an outside organization or evaluator that regularly works on

projects that involve human subjects, the organization will already have the appropriate staff,

certifications, resources, and familiarity with these procedures. Your partnering organization can

help clarify and expedite this process. While this level of security may not be required for every

initiative you implement, it is important that you know and understand the security measures

your funding agency requires. Failure to show that you understand these processes and can fulfil

these requirements can damage your opportunity to get funded. The TAC has familiarity

conducting projects with human subjects and will be able to provide support and clarify these

processes if needed.

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Reasons Applicants Do Not Get Funded

Understanding reasons that applicants do not get funded can help you avoid problems when writing a

grant. Here are some of the more common pitfalls in grant writing:

1. Not following directions. This could be logistics such as page limits, missing required sections, or

applicant eligibility. Your application could also be missing relevant data, program descriptions,

or letters of support.

2. Proposal is too vague. Your application doesn’t fit the funder’s objectives, or doesn’t clearly tie

the proposed activities to the expected outcomes.

3. Proposal is too narrow. It may not be inclusive enough or may have too narrow a focus for the

funding organization to support.

4. Proposal is too broad. Your goals may be too unrealistic or poorly linked to your activity plan.

5. Your organization is not well established. Your coalition may need to have some structure, and

credibility or track record to demonstrate your capability to achieve your stated goals.

6. Your evaluation plan isn’t clear. Your evaluation plan needs to show that you have objectives

and methods to measure your progress in achieving your goals. You need to have a tracking plan

to document your progress and accountability measures for the funds you receive.

7. Circumstances beyond your control. Funders may change their priorities, a state budget may be

delayed, or other such circumstances could change the availability of expected funds.

Potential Sources of Grant Funding

Here are some possible sources of grant funding for your coalition:

1. PA Commission on Crime & Delinquency www.pccd.pa.gov 2. Federal Government Grants www.grants.gov 3. Foundation Center Find Funders www.foundationcenter.org/findfunders 4. Council on Foundations www.cof.org 5. Local Human Service Agencies Specific to your county 6. Local corporations and organizations Specific to your county

How the TAC Can Help

Staff from the TAC can assist you as you form your coalition, develop your effort, and implement

strategies to address overdose deaths in your community. We provide training and technical assistance

at all points throughout the process, including grant assistance. Please contact us as early as possible in

the grant process using the form in the front of this manual.

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Glossary

Abstinence: Nonuse of alcohol or any illicit drugs, as well as non-illicit of medications normally obtained

by prescription or over the counter.

Addiction: A chronic, relapsing disease characterized by compulsive drug seeking and use, despite

serious adverse consequences, and by long-lasting changes in the brain.

Agonist: A chemical entity that binds to a receptor and activates it, mimicking the action of the natural

substance that binds there.

Antagonist: A chemical entity that binds to a receptor and blocks its activation. Antagonists prevent the

natural substance from activating its receptor.

Benzodiazepines: Group of medications having a common molecular structure and similar

pharmacological activity, including anti-anxiety sedative, hypnotic, amnestic, anticonvulsant and muscle-

relaxing effects. Benzodiazepines are among the most widely prescribed medications (e.g. diazepam,

clonazepam, alprazolam, lorazepam, etc.)

Buprenorphine: Partial opioid agonist approved by FDA for use in detoxification or maintenance

treatment of opioid addiction and marketed under the trade names Subutex and Suboxone (the latter

also containing naloxone).

Criminal Justice Advisory Board (CJAB): Local (usually county-level) planning and problem solving

groups which collaborate on criminal justice issues within Pennsylvania.

Cold turkey: Term used when quitting drugs on one’s own with no medical help. Abruptly discontinuing

drug use in an effort to quit long-term.

Comorbidity: The occurrence of two disorders or illnesses in the same person, also referred to as co-

occurring conditions or dual diagnosis.

Compulsive: The type of behavior a person exhibits that is overpowering, repeated, and often irrational.

Counseling: In Medication Assisted Treatment, behavioral therapy which is provided by a trained

counselor along with medication to treat substance use disorders.

Craving: Powerful desire for a substance that cannot be ignored. Unnaturally strong desire/urge for a

substance. An overpowering urge that people are ill-equipped to control through will.

CSAT: The Center for Substance Abuse Treatment (CSAT) of SAMHSA, within the U.S. Department of

Health and Human Services (HHS), promotes the quality and availability of community-based substance

use disorder treatment services for individuals and families who need them

Department of Drug & Alcohol Programs (DDAP): The state agency which leads efforts to reduce drug,

alcohol, and gambling addiction and promote recovery in Pennsylvania.

D.E.A.: Drug Enforcement Administration. Website: www.dea.gov

D.O.C. (DOC): Drug of Choice. A favored illicit substance for an individual or group at a specific point in

time; can also refer to the pharmaceutical that is favored among healthcare professionals to treat a

particular condition or disease.

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Denial: A common reaction of people with substance use disorders who, when confronted with the

existence of those disorders, deny that they have a substance use problem and/or have lost control of it.

Dependence: State of physical adaptation that is manifested by a drug class-specific withdrawal

syndrome that can be produced by abrupt cessation, rapid dose reduction, and/or administration of an

antagonist.

Detoxification: A process in which the body rids itself of a drug (or its metabolites). During this period,

withdrawal symptoms can emerge that may require medical treatment. This is often the first step in

substance use treatment.

Disease: A condition that results in medically significant symptoms in a human; a disorder with

recognizable signs and often having a known cause. In the context of addiction, some people reject the

fact that addiction is a disease, despite corroboration from top medical organizations.

Dopamine: A brain chemical, classified as a neurotransmitter, found in regions that regulate movement,

emotion, motivation, and pleasure.

Drug Collection Box/Take-Back Event: Mechanisms to remove unused medications from the community

through a secure collection location or event.

DSM-IV: The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), published by the

American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the

United States.

Enabling: As it applies to the disease of addiction, can be defined as doing for someone, in an attempt to

help, those things they could or should be doing for themselves, thus actually making it easier for them

to continue in the progression of the disease.

Evidence-Based Practices (EBPs): Scientifically validated approaches.

FDA: Food and Drug Administration. Website: www.FDA.gov.

Harm Reduction: Refers to policies, programs and practices that aim primarily to reduce the adverse

health, social and economic consequences of the use of legal and illegal psychoactive drugs without

necessarily reducing drug consumption.

Heroin: Heroin (diacetylmorphine) is an opioid drug that is synthesized from morphine, a naturally

occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin is a full opioid

agonist.

HIPAA: Health Insurance Portability and Accountability Act. Website: www.HIPAA.gov.

Medication Assisted Treatment (MAT): The use of medications, combined with other forms of therapy

such as counseling, in order to provide an inclusive approach to the treatment of SUDs.

Methadone: A long-acting synthetic opioid medication that is used in maintenance therapy for those

individuals dependent on opioids.

Naloxone: Also known as Narcan™. An opioid antagonist that blocks opioid receptors in the brain,

thereby blocking the effects of opioid agonists (e.g., heroin, morphine). Naloxone is a life-saving drug

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that can immediately reverse an opioid overdose. In Pennsylvania, anyone can get a prescription for

naloxone from their healthcare provider or through a standing order.

Naltrexone: Also known as Vivitrol™. A medication used in MAT for opioid addiction.

Off-label use: When a drug is used in a way that is different from that described in the FDA-approved

drug label.

Office-based opioid treatment (OBOT): office and outside of the clinic system. Each medication has

specific requirements and regulations to be dispensed.

Opioid: A compound or drug that binds to receptors in the brain involved in the control of pain and

other functions (e.g., morphine, heroin, hydrocodone, oxycodone).

Opioid Treatment Program (OTP): OTPs provide MAT for people diagnosed with an opioid-use disorder.

MAT patients also must receive counseling, which can include different forms of behavioral therapy.

Overdose Education and Naloxone Distribution (OEND): A program providing naloxone kits and training

on recognition and response to suspected overdose (administering naloxone).

Patient Review & Restriction Programs (PRRs): Strategy to reduce prescription drug use by those at

high-risk by limiting the pharmacies or physicians through which they can obtain controlled substances.

Painkillers: Analgesic substances that relieve pain. Painkillers come in two classes: opioid and non-

opioid. The non-opioid analgesics come in over the counter and prescription forms, while opioid

analgesics are only available through prescription and are potentially addictive.

Peer Support: Structured relationship in which people meet in order to provide or exchange emotional

support with others facing similar challenges. The group does not necessarily need to have healthcare

providers among its members. Alcoholic Anonymous (AA) is an example of a peer support group.

Pennsylvania Commission on Crime and Delinquency (PCCD): Entity which supports programs,

practices, and collaboration to enhance the effectiveness of the criminal justice system components in

Pennsylvania.

Polysubstance Use: The use of two or more drugs at the same time, such as CNS depressants and

alcohol or opioids and benzodiazepines.

Prescription Drug Nonmedical Use: The use of a medication without a prescription, in a way other than

as prescribed, or for the experience of feeling elicited.

Relapse: Breakdown or setback in a person’s attempt to change or modify a particular behavior; an

unfolding process in which the resumption of compulsive substance use is the last event in a series of

maladaptive responses to internal or external stressors or stimuli.

Remission: A period of time in which the signs and symptoms of the addiction have disappeared.

Respiratory Depression: Slowing of respiration (breathing) that results in the reduced availability of

oxygen to vital organs. A common symptom of overdose that can lead to death.

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SBIRT: Screening, Brief Intervention, and Referral to Treatment. A method to identify, reduce, and

prevent problematic use and dependence on alcohol and illicit drugs.

Single County Authority (SCA): The entity which administers drug and alcohol treatment programs in

each county in Pennsylvania.

Screening: Process of identifying whether a prospective patient may have a substance use disorder

before admission to treatment. Screening usually involves use of one or more standardized techniques,

most of which include a questionnaire or a structured interview.

Side effect: Consequence (especially an adverse result) other than that for which a drug is used—

especially the result produced on a tissue or organ system other than that being targeted.

Standing Order: A written prescription by an authorized prescriber to make a medication available to

those who meet pre-described conditions. In Pennsylvania, there is a standing order signed by the

Physician General to make naloxone available to first responders and general public.

Stigma: Negative association attached to an activity or condition; a cause of shame or embarrassment.

Stigma is commonly associated with opioid addiction and MAT.

Substance Abuse and Mental Health Services Administration (SAMHSA): A division of the US

Department of Health & Human Services that leads public health efforts to advance the behavioral

health of the nation. SAMHSA's mission is to reduce the impact of harmful substance use and mental

illness on America's communities. Website: http://www.samhsa.gov.

Substance Use disorder (SUD): A broad term that includes dependence on drugs and/or alcohol or using

drugs in ways outside of their intended purpose.

Suboxone®: FDA approved in October 2002, Suboxone is a medication for the treatment of opiate

dependence (addiction). Contains the active ingredient, buprenorphine hydrochloride, which works to

reduce the symptoms of opiate dependence.

Supply reduction: A general term used to refer to policies aiming to interdict the production and

distribution of drugs, particularly law enforcement strategies for reducing the supply of illicit drugs.

Tapering Phase: Phase of MAT in which patients receiving medication maintenance attempt to gradually

eliminate their treatment medication (e.g., methadone) while remaining abstinent from illicit

substances.

Tolerance: A condition in which higher doses of a drug are required to produce the same effect achieved

during initial use; often associated with physical dependence.

Withdrawal: Symptoms that occur after chronic use of a drug is reduced abruptly or stopped.

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References

Albert, S., Brason, I., Fred, W., Sanford, C. K., Dasgupta, N., Graham, J., & Lovette, B. (2011). Project

Lazarus: community‐based overdose prevention in rural North Carolina. Pain Medicine, 12(s2),

S77-S85.

National Institute on Drug Abuse. (January 2016). DrugFacts: Treatment Approaches for Drug Addiction

PA Medical Society. (2014a). Guidelines for ED Opioid. Retrieved from

https://www.pamedsoc.org/PAMED_Downloads/PA%20ED%20Guidelines%20Opioids.pdf

PA Medical Society. (2014b). PA Guidelines on The Use of Opiods to Treat Chronic Noncancer Pain.

Pennsylvania Department of Health. (2016). Opiod Dispensing Guidelines. Retrieved from

http://www.health.pa.gov/My%20Health/Diseases%20and%20Conditions/A-

D/Documents/PA%20Guidelines,%20on%20the%20Dispensing%20of%20Opioids.pdf

Substance Abuse and Mental Health Services Administration. (2015, 9/24/15). Stages of Community

Readiness. Retrieved from http://www.samhsa.gov/capt/tools-learning-resources/stages-

community-readiness

University of Kansas Work Group for Community Health and Development. (2015). The Community Tool

Box. Retrieved from http://ctb.ku.edu/en/toolkits

US Department of Health and Human Services ASPE. (2015). Issue Brief: Opioid abuse in the US and HHS

actions to address opioid drug-related overdoses and deaths. Retrieved from

https://aspe.hhs.gov/sites/default/files/pdf/107956/ib_OpioidInitiative.pdf