Even with state disaster declarations, combating opioid epidemic is uphill battle

Jan. 12--With his declaration Wednesday of a statewide disaster over the opioid abuse epidemic, Gov. Tom Wolf made Pennsylvania the eighth state in the country to take such a step.

The examples of the other states that declared statewide emergencies show some promise of easing the immediate problem, but cutting red tape and improving agency collaboration are only the first steps in a long-term effort to get the crisis under control, their experiences show.

Take, for instance, Virginia, where state Health Commissioner Marissa J. Levine announced a public health emergency about 14 months ago.

That drove the state Legislature to pass bills to expand the availability of naloxone, the drug used to rapidly reverse an opioid overdose, and to make needle-exchange programs possible, said Dr. Hughes Melton, chief deputy commissioner of the Virginia Health Department. A lack of political resistance to the bills, he said, was partly because of the declaration.

But the higher profile attention has not stemmed the crisis in the state. Melton said the best Virginia can say is that the growth in the opioid overdose death rate has slowed.

Fatal overdoses increased 35 percent to 1,268, according to state data for 2016. With data still being collected for 2017, the increase over 2016 should be around 10 percent, he said.

The health emergency effort, Melton said, is slowing down "the rate of worsening of the crisis."

Likewise, in Maryland, overdoses and opioid-related deaths continue to rise, despite the state of emergency announced March 1, said Clay Stamp, executive director of the state's Opioid Operational Command Center.

Besides coordinating the various state agencies, authorities were challenged to undo the stigma associated with opioid addiction -- not just in the public, but among state and local governments, Stamp said.

A strong message from the governor, he said, sends a message to the entire bureaucracy that it needs to address the crisis cooperatively. Before the declaration, law enforcement would see the crisis as a problem of not enough money for police, just as the treatment community would argue it's a crisis of insufficient inpatient and outpatient resources, he said.

Gov. Larry Hogan understood that the state needed a "neutral" structure -- the state's emergency management apparatus -- to break down barriers and focus attention at the state and local levels, including the business and faith-based communities.

It has paid off, Stamp said: "From a year ago to today is like night and day when it comes to engagement in the community."

Stamp, who has a decadeslong career in emergency management, lauded Wolf for also putting the Pennsylvania Emergency Management Agency at the head of the state's crisis response team.

"In the months to come as they mature their system of coordination, they're going to see more effective programs in the streets of Pennsylvania that will translate into lives saved," he said.

But Maryland had something Pennsylvania does not: additional money. Hogan pledged $50 million more over five years to fight the crisis.

With an already-stressed budget, Wolf added no money to a declaration that will waive 13 regulations or protocols so that Pennsylvania can put more resources into an epidemic that in 2016 killed more than 4,000 people across the state, including 238 in the Lehigh Valley.

Florida's emergency order last May 3 allowed that state to start spending $27 million in federal grant money that otherwise would have taken months to tap, Gov. Rick Scott's office said at the time of his announcement.

States should put more money into the fight if they really believe the crisis requires the emergency declaration, said Georges Benjamin, executive director of the American Public Health Association.

"You have to put some oomph into it," Benjamin said. "If you think it's an emergency, you have to put some funding behind it."

The Trump administration's federal emergency declaration over the opioid crisis is an example of a largely toothless action, he said. Individual agencies such as the Centers for Disease Control and Prevention and the Food and Drug Administration have devoted many resources to the crisis, but the administration, he said, has failed to articulate a strategic plan. Nationwide, opioids killed more than 42,000 people in 2016, more than any year on record, the CDC reported.

Empty bank accounts are forcing states to get creative. In Alaska, for example, when there was no money to buy deactivation pouches for people to dispose of unneeded painkillers, the state was able to persuade a supplier to provide 25,000 free pouches, said Andy Jones, deputy incident commander for Alaska's opioid response team.

Like the other states with emergency declarations, Alaska also took steps to give pharmacies permission to dispense naloxone. It created regional overdose response programs, trained people to administer the opioid antidote, distributed 8,000 kits and so far saved at least 100 lives, Jones said.

Alaska, which has been operating under the emergency declaration for close to a year, now is working on a longer-term strategic plan, Jones said.

"In our first year, we were just trying to save lives," he said, saying he anticipates the declaration will be extended for another year.

States also have put an emphasis on law enforcement, as the crisis shifts from abuse of legally prescribed drugs to illicit opioids such as heroin and unprescribed fentanyl, Stamp said.

The states' efforts in various ways also touch on treatment and have a long-term goal of preventing people from turning to opioids in the first place.

Prevention is the only way to get the crisis under control using a public health emergency model, said Michael R. Fraser, executive director of the Association of State and Territorial Health Officials.

"You don't treat your way out of Zika or Ebola," he said. Opioid addiction is "a chronic disease of the brain."

Arizona and South Carolina also recently declared states of emergency.

The first state to do so was Massachusetts. In November 2014, then-Gov. Deval Patrick's administration declared a public health emergency and used additional funding from the Legislature to create a task force charged with developing a comprehensive strategy. Following its recommendations, the state sank additional money into 128 new acute treatment beds, and provided more money for community health centers, education and treatment services for people in recovery, according to the state Department of Health and Human Services.

The effort may be paying off. There, opioid overdose deaths dropped by about 10 percent in the first three quarters of 2017 compared with the same period in 2016, according to the Massachusetts Department of Public Health. It was the second consecutive quarterly report estimating an overall decline in opioid-related deaths.

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