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Reason for hope: AMA lauds Pennsylvania’s steps to combat opioids

Wednesday, January 16, 2019  
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Pittsburgh Post-Gazette 

Reason for hope: AMA lauds Pennsylvania’s steps to combat opioids

The American Medical Association last week hailed Pennsylvania’s multi-agency, multi-pronged fight against opioids as a model for the rest of the country.

That was welcome praise, given Pennsylvania’s reputation as a national laggard as recently as 2016.

There’s no denying that the state has upended the treatment and insurance landscape since then. The AMA’s report lists some of the measures the state has taken, such as working with insurers to waive pre-authorization requirements for medication- assisted addiction treatment, extensive distribution of the emergency reversal drug naloxone and coordination of treatment through 45 Centers of Excellence statewide. The report omitted mention of other important steps, such as new state laws limiting when and how opiods may be prescribed.

However, while the state and its partners can take pride in what they have done, the jury is still out on how effective those steps have been. In 2017, as some of the measures lauded by the AMA were under way or already in place, the number of drug-related deaths in Pennsylvania and Allegheny County continued to increase. The statewide total, 5,456, was 64 percent higher than in 2015. The fatal overdose numbers for 2018 will provide insight on whether the treatment and insurance paradigms require further restructuring.

People often get hooked on opioids when recovering from injuries. When they no longer can get the painkillers legally, they try to get them illegally or switch to heroin or synthetic opioids that are available on the street.

Therein lines one of the great paradoxes — and challenges — of the fight against opoids. Deaths have gone up, even as prescriptions have gone down, partly because drug trafficking networks have moved to fill the void. According to a Drug Enforcement Administration report issued in September, Mexican cartels are a big exporter of heroin and synthetic opoids to Pennsylvania. But mail-order supplies from China are a problem, too.

All of which means that no matter how successful Pennsylvania has been in increasing access to treatment, the state still has to focus more on the underlying issues that position some people for opioid addiction.

Alternative pain management techniques may help some patients avoid opioids altogether. But one look at where the epidemic has taken its greatest toll — the hollowed-out small towns of Pennsylvania and other states — shows the need to address the hopelessness, unemployment and anomie that send some Pennsylvanians down the rabbit hole of drugs or rob them of the will to get clean. Addressing the demand for drugs is the thornier, longer-term problem.

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