How to turn the tide of the opioid epidemic

“300 people a day. A jetliner a day.”

That’s how Madeleine Dean, U.S. representative from Pennsylvania’s 4th District, describes the record height of drug overdose deaths in the United States last year. Despite the staggering numbers, Dean noted that it’s possible to find recovery — as her middle son did a decade ago — and that there’s reason to be hopeful.

On Dec. 16, Dean participated in the University of Pittsburgh-hosted “Turning the Tide on Opioid Addiction,” a virtual discussion about the current state of the opioid epidemic and work being done to solve the crisis. Organized by Pitt’s Bernard J. Costello, associate vice chancellor for health science integration, the discussion included Dean; Rahul Gupta, director of the Office of National Drug Control Policy for the Biden administration; Art Haywood, Democratic Pennsylvania state senator, 4th District; Jennifer Smith, Pennsylvania secretary of Drug and Alcohol Programs; Jim Struzzi, Republican Pennsylvania state representative, 62nd District; and Bill Flanagan, host and producer of WPXI-TV’s “Our Region’s Business” and chief corporate relations officer for the Allegheny Conference on Community Development.

Though the participants belong to different parts of the commonwealth and political parties, they have often worked across the aisle on this and other issues for the greater good. Like Dean, the opioid epidemic has affected most of them personally — from Struzzi, who lost his brother to overdose, to Gupta, who has treated patients with substance use disorder. The participants emphasized that the opioid epidemic devastates families and economies and can affect anyone — at any age, from any socioeconomic background, racial or ethnic community, or political affiliation.

The COVID-19 pandemic has only worsened the opioid epidemic, according to Gupta. Isolation and disruption in treatment caused by the pandemic exacerbated an epidemic that was further fueled by a significant shift from organic to synthetic drugs.

Gupta noted that “it has been a tough time, but we have responded as a nation.” He also said early data shows a 2% decline in overdose deaths in 2022 and that his department’s goal is to reduce overdose deaths by 13% over the next three years.

Costello, also former dean of Pitt’s School of Dental Medicine, is one of the health care providers who responded to the exploding opioid epidemic. He helped to develop the Pain Care Pledge, guidelines for providers for responsible pain management that involves using opioids only as a last resort.

“I’m interested in pushing this culture change in prescribing across the country in any way possible because of the enormity of this problem,” he said.

Smith said services for those with substance use disorder need long-term support, and Pennsylvania needs to be ready for that challenge.

“Addiction itself is a disease, and, by definition, it is a chronic, relapsing brain disease,” said Smith. “Once you go to treatment and enter recovery, it doesn’t mean that’s easy sailing for the rest of your life. … It’s not as simple as saying we need to end addiction. That’s like someone saying we’re going to end cancer. What we need to do is worry about addressing it from lots of different angles.”

[A researcher in Pitt's School of Public Health is using data to fight the opioid epidemic.]

The participants emphasized that supporting treatment and recovery means addressing some existing challenges.

“We need to look at all of those issues — transportation, funding, resources, availability of treatment — and make sure people realize help is available,” said Struzzi. “A lot of people don’t see a way out, and unless you can show them that there is a light at the end of the tunnel, they’re not going to find it on their own.”

Struzzi had recent success in the fight against overdose deaths in Pennsylvania. Gov. Tom Wolf signed into law Struzzi’s legislation decriminalizing the sale and distribution of fentanyl strips. Fentanyl is a powerful synthetic drug that is often added to other drugs without users’ knowledge to make them cheaper and stronger. The strips are a simple tool to test for the presence of fentanyl, which supporters say can help prevent overdoses in users who would otherwise be unaware they’re ingesting the often deadly drug.

Helping people who are struggling to find their way out of addiction needs to be a priority for state lawmakers, said Haywood.

“In order to get counseling services, we have to pay counselors. In order to have more mental health treatment, we have to pay for more mental health treatment. From a patient-delivery system, our core challenge is getting services to individuals, and that means we’ve got to pay for them,” he said.

The lawmakers expect much-needed funding for Pennsylvania will come over the next 18 years from its $1.2 billion allotment of the $26 billion agreement with the nation’s three major pharmaceutical distributors — Cardinal, McKesson and AmerisourceBergen — and manufacturer Johnson & Johnson over the companies’ role in creating and sustaining the opioid crisis. Smith said 70% of those funds are being allocated directly to counties, 15% is designated for the Pennsylvania General Assembly to appropriate and the remaining 15% is allocated to political subdivisions that dropped their individual lawsuits to join the statewide lawsuit. Smith said Pennsylvania is ahead of the game in getting that money out quickly and has already made one distribution to counties, with another expected in the next couple of weeks.

“We’re in a marathon struggle, so knowing we have money over the years is part of the solution,” said Haywood.

At the national level, Dean said that even with the grim statistics, a lot of progress has been made. A national bipartisan task force addresses mental health and addiction. In the American Rescue Plan, $30 million is earmarked for harm-reduction services, and more than $5 billion will fund the U.S. Department of Health and Human Services’ efforts to expand access to mental health and addiction services.

“These are extraordinary changes in policies — putting our money where our mouth is,” said Dean.

Working within Pitt and the health care industry, Costello said he hopes to continue the work started before and during the pandemic at Pitt.

“We’re building the ship as we’re sailing it, just as we did during the COVID-19 pandemic,” he said. “We’ve proven to folks who said that government and/or universities can’t be nimble that we are.”

Costello said Pitt is a great place to dig deep and learn what is working in coping with the opioid epidemic. He envisions the University continuing to educate health sciences students about how to tackle the substance-use problem; working with Pitt’s Community Engagement Centers and public health experts to make changes in culture and policy; and building an interprofessional educational program across the health sciences to enable them to work together seamlessly in pharmacology, medicine, psychiatry and other areas.

Hope was the common thread in the discussion, and each participant reiterated that help is available to anyone struggling with a substance use disorder.

Haywood made a direct plea from the roundtable: “People on this panel want to help you. There is hope, and if you can get yourself to a position to reach out, there are thousands who will reach back.”

1-800-662-HELP (4357) is the Substance Abuse and Mental Health Services Administration’s national helpline — a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

 — Maureen Passmore, photography by Getty