Pennsylvania Physician General Discusses State, PAMED, and Other Stakeholder Response to Addressing Opioid Abuse Crisis in PA

On Aug. 11, 2015, Pennsylvania Physician General Rachel Levine, MD, spoke to the Pennsylvania Medical Society’s Specialty Leadership Cabinet (PAMED’s SLC) about the opioid abuse crisis in Pennsylvania and the Pennsylvania Department of Health’s (DOH’s) response, in collaboration with other stakeholders like PAMED.

“It hits the headlines every day, and it is a crisis in our midst,” said Dr. Levine. “This is a crisis both in Pennsylvania and nationally.”

The statistics are staggering, both in Pennsylvania and nationwide:

  • In Pennsylvania, drug overdoses accounted for 2,400 deaths in 2014, which is an average of seven people a day. This is an underestimated number because some counties didn’t report data to the Pennsylvania State Coroners Association.
  • In the U.S., more people die of drug overdoses than in car accidents.
  • Nationally, heroin-related deaths nearly quadrupled from 2002-2013.
  • There has been an increase in the use of opioids across all demographics.
  • The use of heroin has more than doubled in young adults ages 18-25.
  • 45 percent of people who use heroin are also addicted to prescription opioid painkillers.
  • In 2010, enough prescription painkillers were prescribed to medicate every American adult around-the-clock for a month.

The Wolf administration, along with several stakeholders like PAMED, are actively engaged in a coordinated response to prevent addiction, better treat those who are opioid dependent, and prevent overdose deaths. At the state level, this engagement spans many departments, including the Departments of Health, Drug and Alcohol Programs, Insurance, and Aging, said Dr. Levine.

There are several prongs to this coordinated approach, including:

    • Voluntary prescribing guidelines for prescribers, developed by the state, PAMED, and other stakeholders including the Pennsylvania College of Emergency Physicians and the Pennsylvania Dental Association for:
      • Chronic non-cancer pain
      • Emergency departments
      • Dental practices

These guidelines, along with other resources for Pennsylvania physicians, can be downloaded at

Dr. Levine said that, in the next several months, the state is working with several stakeholder groups to also develop opioid prescribing guidelines for OB/GYNs and geriatric providers. As part of the process to create prescribing guidelines for OB/GYNs, there are three workgroups that are focusing on the treatment of pain in the pregnant woman, post-partum pain, and how to treat the opioid-addicted woman during her pregnancy.

Dr. Levine also said the plan is to issue more opioid prescribing guidelines next year, including orthopedics and sports medicine, neurology (focusing on migraines), pediatrics, and more.

      • Education for providers, in close collaboration with PAMED – This will be an educational series of four online courses at low or no cost on the opioid prescribing guidelines, naloxone, the “warm hand off” (assessment of substance abuse and a facilitated referral), and the ABC-MAP prescription drug monitoring program/controlled substances database.
      • Expanding access for naloxone, including:
        • A standing order for first responders written by Dr. Levine earlier this year. Dr. Levine said that the state is working hard to get it distributed to all first responders who might come across the scene.
        • Third-party prescribing – Pennsylvania law allows physicians to prescribe naloxone to individuals, such as friends or family members, in a position to assist a person at risk of experiencing an opioid-related overdose. There are also liability protections in the law.
        • Two types of naloxone are via auto-injector (some insurers will cover) and nasal (most insurers will cover).

Dr. Levine said, though it’s not an official state recommendation, physicians should also consider writing a prescription for naloxone when writing a prescription for the extended use of an opioid.

She also said that “the warm hand off” is important when someone is administering naloxone. “With the right techniques, which will be in the provider education being developed, you can really facilitate someone’s referral into treatment,” she said.

      • A law that will create a statewide, controlled substances database – Dr. Levine said that the state is working actively on getting the database up and running, and is currently looking at vendors. She said that the database will be up and running sometime in 2016.

“Hopefully, with all of these measures, and all of your [physicians] help, we’ll start to tackle this problem and save lives in Pennsylvania,” said Dr. Levine. “This does not have an easy solution. It’s a very complex problem and you all [physicians] are one of the major stakeholders in helping us as a commonwealth overcome this problem.”

Dr. Levine also said that the state is working with medical schools to increase education on opioid prescribing and opioid use and abuse, and expanding drug prevention education with high school students.

Five Things Pennsylvania Physicians Can Do to Increase Their Confidence with Managing Opioid Therapy

      1. Increase your comfort level by familiarizing yourself with voluntary guidelines for opioids prescribers in Pennsylvania:
      2. Get involved with grassroots advocacy and initiatives:
        • Have a discussion with the physicians in your county or region—A July 7 PAMED and Potter County Medical Society event—at which Scot Chadwick, PAMED’s legislative counsel, spoke—addressed the prescription drug crisis. Mr. Chadwick is available to talk to your county medical society about this important topic. If you are interested, email him at
      3. Have a conversation with your chronic pain patients using PAMED’s Opioid Prescription Checklist that can help facilitate the pain management discussion.
      4. Take advantage of PAMED education on opioids:
        • Complete PAMED’s six-part online course designed to educate physicians and other health care providers on the appropriate use of long-acting and extended-release opioids. Online courses are approved for CME.
        • Get patient safety and risk management CME with PAMED’s Managing Risk publication “Risks Associated with Chronic Pain Management”
      5. Attend PAMED ’s Annual Education Conference this October 23 – 24, which includes an Oct. 24 course on addressing the opioid abuse crisis in Pennsylvania. These sessions are free to members.

The prescription drug abuse crisis has been a focus of attention for PAMED, and efforts to ensure the well-being of patients in Pennsylvania are ongoing. Stay up to date on the latest news and tools.