Legal Prescription

ALRT's Exploration of Addiction, Law, and Medicine

May Advocate of the Month: Dr. Daniel Ventricelli

[Each month, the Addiction Legal Resource Team at Penn State’s Dickinson Law recognizes an exceptional individual for their contributions to the addiction treatment community. The individual recognized as Advocate of the Month for the month of May is Dr. Daniel Ventricelli, an Assistant Professor for Clinical Pharmacy at the Philadelphia College of Pharmacy at the University of the Sciences. Professor Daniel Ventricelli’s research focuses on policy to destigmatize substance use disorders and to better understand the interdisciplinary role of healthcare professionals in treating people with substance use disorders through evidence-based treatment and harm reduction methods. His teaching focuses on training future pharmacists to embrace harm-reduction methods and to be advocates for their patients and their profession. We are thankful for inspiration from our honored advocates and from Dickinson Law’s Inside Entrepreneurship Blog.]

By Travis Murray

When I first contacted Dr. Daniel Ventricelli in early February of 2020, the world was a much different place. There was only a handful of COVID-19 positive Americans domestically and the cases were far away on the West Coast. Dr. Ventricelli is an Assistant Professor of Clinical Pharmacy at my alma mater and I was excited to meet with him in person in Philadelphia in late March at my former campus. We planned on meeting with another one of my professors, Dr. George Downs, and talking over lunch from my favorite food cart when I was a student, Linda’s Cart. However, like many people in America and around the globe, we were forced to change our plans as COVID-19 quickly turned into a pandemic, forcing most colleges to switch to remote learning. I may not have gotten the chance to return to Philadelphia and to taste a bacon, egg, and cheese with fried onions on an everything bagel from Linda’s Cart, but we were able to improvise and conduct our meeting through everybody’s new tool to stay connected – Zoom.

After some initial minor technical difficulties, we were able to get our meeting underway from the comforts of our own homes. Dr. Ventricelli has an extensive history of education and post-graduate training and my first question was to ask him about it and how he first became interested in substance use disorders. He explained that after earning his Doctor of Pharmacy (Pharm.D.) degree from the University of Connecticut School of Pharmacy, he completed a Post-Graduate Year One (PGY1) community pharmacy residency in West Virginia through West Virginia University School of Pharmacy and Kroger Pharmacy. During his residency, he worked at a dual-diagnostics addiction treatment unit at a behavioral health hospital. It was during his rounds with the interdisciplinary team that he was asked questions about improving relationships with community pharmacists and ensuring that when patients leave the facility, they would have access to medications like buprenorphine. This led to his ultimate research question that he continues to study – what is the role of the community pharmacist in substance use disorders and addiction? He wanted to hone in on his research skills to answer this question, and matriculated on to a community practice research fellowship focused on “prescription drug abuse and misuse.” [As we discussed later, these terms have fallen out of favor for their implicit biases and stigmatizing nature.]

He accepted a two-year fellowship at East Tennessee State University and collaborated with a research team that included people with backgrounds in public health, behavioral science, and medicine. He also earned his Masters in Public Health along the way. During his fellowship, he engaged in qualitative research with providers to determine why the relationship between providers and community pharmacists were strained and how this relationship impacted patient care. More recently, he completed a statewide survey of community pharmacists to get their perspective about their behavioral intentions to dispense buprenorphine for the treatment of opioid use disorder (OUD). In his capacity as a clinical professor at the Philadelphia College of Pharmacy, he works with the University’s Substance Use Disorder Institute and works on SBIRT training for pharmacy students. SBIRT is a method of identifying and referring people to treatment by Screening patients, providing a Brief Intervention, and if appropriate, Referring to Treatment. SBIRT is an evidence-based method of delivering early intervention to patients that is embraced by the Substance Abuse and Mental Health Services Administration (SAMHSA), and a tool that Dr. Ventricelli believes that community pharmacists can use in their own practice.

Dr. Ventricelli is also based in community organizations and coalitions, especially in the southeastern Pennsylvania (SEPA) region. In particular, he is involved in the Regional Overdose Prevention Coalition (ROPC). The coalition, composed of community advocates, public health workers, and healthcare professionals, meets throughout the year to address concerns and share helpful information from their respective communities. The mission of the ROPC is to bring together stakeholders to work as regional partners to reduce the harms of substance use. The ROPC allows the region to collaborate and to address various aspects of the epidemic in the SEPA community, including naloxone access, data sharing, safer pain medication prescribing, and legislative responses. He has been with the coalition since its inception and now serves as a member on its executive board.

He is also involved at the state level in the Pennsylvania Pharmacists Association to work on continuing education programs for pharmacists and at the national level through the profession’s largest advocacy group, the American Pharmacists Association, in the Pain, Palliative Care, and Addiction Special Interest Group. Dr. Ventricelli says that in his capacity as a professor, he has become very involved with the American Association of Colleges of Pharmacy and is the Chair-Elect for their Substance Use Disorder special interest group.

Just as you are starting to think that there could not possibly be more time in the day to do anything else, he is a regular member of the Addiction Medication Quarterly Partnership Summit of Philadelphia Medical Schools. This Summit strives to develop the curriculum for medical students regarding substance use and addiction training and he has been a presenter for treatment pathways and health policies. His expertise and involvement within the SEPA community has also led him to present to Pennsylvania legislators about medications for opioid use disorder.

I then asked him about medication-assisted treatment in Pennsylvania and why medications with FDA-approved indications for treating opioid use disorder are not dispensed to patients who need them at the frequency that they should. There are many regulatory restrictions at the federal and state levels, especially surrounding buprenorphine, that do not exist for many other medications and other disease states. The question is, “why?” The answer, at least partially, is “stigma within the community” and “misunderstanding of the goals of treatment,” said Dr. Ventricelli.

Medications used for opioid use disorder, though they may need to be individualized for each patient, have such profound success on patients that even the term, “medication-assisted treatment” is falling out of favor. This is a term that I use frequently as a licensed pharmacist myself, and it made perfect sense when he explained why it is not the best term to use for medications like buprenorphine. The term inherently implies that the medication is secondary to other treatment, but data tends to indicate that access to consistent medication to treat OUD in a “medication first” approach has resounding success in preventing opioid overdose deaths. I learned to use the phrase “medication for opioid use disorder” instead from Dr. Ventricelli. Using appropriate terminology and less stigmatizing terms, such as, “a person with substance use disorder” versus “a drug abuser” or “an addict,” results in less punitive recommendations from providers. “The words we use have an impact on the care that our patients receive,” said Dr. Ventricelli.

Reflecting on what we just discussed, I then wanted to get his preliminary observations regarding the challenges that people who have substance use disorder are experiencing during the COVID-19 pandemic and closures of many facilities and resources by the states. He once again pointed out something that I never even thought about, which is the severe respiratory effects of the virus and how dangerous that it could be when coupled with the use of opioids, which cause respiratory depression. He reasonably speculates and worries that “it further complicates the likelihood that [someone who overdosed] will likely be revived with naloxone.” Besides opioid use disorder, at the time of our interview, Pennsylvania closed its state liquor store, which could have a profound impact on people who are dependent on alcohol or have an alcohol use disorder. Alcohol withdrawal can result in seizures, delirium tremens, and in the most severe cases – death. However, despite these emerging issues, there have been some positive changes. For example, SAMSHA has removed many restrictions to receiving buprenorphine and now allow patients to have appointments with providers over the telephone to obtain a prescription. Transportation to formerly-required in-person consultations was a major hardship for some patients. Prescriptions can also now be dispensed in larger quantities for longer durations of therapy. Lack of access to consistent treatment has been a major concern for patients with OUD.

While we were forced to conduct our interview over Zoom, it made me wonder, what do people who rely on group meetings, such as Alcoholics Anonymous and Narcotics Anonymous, do to continue their meetings and routines when large gatherings and shelter-in-place restrictions have been put in place? The answer, to no surprise, is a rise in virtual meetings using Zoom!

I then wanted to open it up and ask Dr. Ventricelli to describe interests and observations that he has found in his research and information that would be helpful to pharmacists and others. He said that pharmacists play an evolving role in harm reduction. Pharmacists can participate in harm reduction at the community level by providing sterile syringes. “There is a lot of really strong evidence, from years, and years, and years already about the public health benefits from providing access to sterile syringes and sterile supplies.” He went on to say, “first and foremost, one of the easiest things that [community pharmacists] could do is provide access to medications. Make sure we have naloxone in stock and ready to go – for anybody who needs it and anybody can get it. It’s not just for somebody who’s using an opioid. It’s great for somebody who might be around somebody else so they can protect their community and loved ones.” He also said to make sure that buprenorphine is available in the pharmacy. This way when a patient has made the decision to use this evidence-based medication and presents to the pharmacy, they don’t have to wait days for the medication to come in or have to go pharmacy to pharmacy looking for one that carries it. Getting trained in SBIRT is another method that community pharmacists should embrace and to engage in preventative services such as vaccines like those for hepatitis B.

These harm reduction strategies seem easy enough to do on paper, but a theme throughout our discussion is the need to break down stigmas and to educate the profession and others to embrace them fully. Dr. Ventricelli is determined to do just that. When I was a pharmacy student, Substance Use Disorders was an elective. Now, it is fully integrated throughout the pharmacy curriculum with Dr. Ventricelli at the helm with some of my other past professors, including Dr. Downs, Dr. Peterson and Dr. Koffer. Knowing this leads me to believe that the future graduates of the Philadelphia College of Pharmacy are in great hands and determined to be fierce advocates for the profession and harm reduction.

We ended our conversation talking about all the changes happening at the college since I graduated and I became even more excited to return to campus once all the travel restrictions are lifted. I work as a per diem hospital pharmacist and I left this conversation more determined to be conscientious of the phrases and terminology that I use to avoid stigmatization of patients in my own practice of pharmacy and to support harm reduction methods in our communities. Dr. Ventricelli exemplifies the type of advocates that we have for health policies that achieve better outcomes for people with substance use disorders and is a deserving Advocate of the Month.

April Advocate of the Month: Paul Polensky

[Each month, the Addiction Legal Resource Team at Penn State’s Dickinson Law recognizes an exceptional individual for their contributions to the addiction treatment community. The individual recognized as Advocate of the Month for the month of April is the Coordinator of Specialty Courts for Cumberland County, Pennsylvania. As Coordinator, Mr. Polensky oversees TOM’S Court, which specializes in mental health, Drug Treatment Court, as well as the revolutionary Opioid Intervention Court. We are thankful for inspiration from our honored advocates and from Dickinson Law’s Inside Entrepreneurship Blog.]

By: Evan Marmie

The day was warm and the setting familiar. Slowly, I drove through the sleepy town of Carlisle. The early afternoon saw the sun looming over head and a few people bustling between different lunch spots. Luckily, I found a place to park on the town’s main stretch and stepped out in front of a former bakery before I walked up the street. There was a faint breeze as cars whizzed by and I could hear birds chirping as I looked for the building where I would meet with Paul.

Sandwiched between two buildings and rising above them stood the Marion building. Roman pillars stood as tall as the roofs of the buildings beside it and inside stood two guards with a metal detector. I sighed and resigned to take off my belt and jacket as I stepped inside. I walked into the elevator to the left of the detector as I reaffixed my belt and jacket. The elevator itself was like a step into the past: wood paneling and a faint quiver as it slowly trudged up to the third floor. I stepped out facing a window looking into a more modern office space and wound my way down the hallway to a reception desk where I spoke to a receptionist who directed me to Paul’s office. 

He was warm in his greeting and shook my hand as I stepped in. The room was sparse but welcoming enough. There was a small table and chairs where I set up my computer next to a jar of candy and lowered myself into the plush seat before I turned to Paul. His desk was neat and orderly. On the back wall hanging over Pauk’s seat was a large drawing of different airships with an Air Force slogan and atop his desk’s upper shelving were a number of knickknacks clearly from times past. It was a place tucked away from the public eye, much like the important work Paul himself does on a daily basis. 

“The whole idea of the problem-solving courts is to marry the treatment piece with the judicial piece,” he remarked. He made hand gestures as he continued and was emphatic in conversation, “We deal with people in the criminal justice system. People who usually have substance use disorder or mental health disorders. There’s a lot of different kind of problem-solving courts,” he continued on, “we deal with people who do low level crimes like DUI’s where they have resources and usually do not reoffend,” he explained, “we also deal with more high risk people who usually are addicted to heroin or fentanyl or something. They usually commit crimes like theft or something else adjacent to their addiction. In both cases, we try to get them into treatment. We do our best to get them into long term treatment.” 

Speaking more directly on his role, Paul started with a pause, “I’m trying to put it in a nutshell,” he said with a chuckle before another brief pause. He looked up and to the right for a moment as he thought on his answer, “I make sure that the program, the treatment court or whatever else it is, is running the way we want it to operate and is achieving the outcomes we desire,” he continues, “I am the front end of the program and the back end of the program…I collect the data and analyze the data…I am the budget guy who makes sure our money is spent where it needs to be spent,” he explained. 

When we moved into what got him into the position, it was clear that a bit of serendipity and a lot of hard work played a role in where he is today. An Air Force veteran, Paul moved often as part of his service. After retirement, he found himself looking for opportunity anywhere. Pennsylvania ended up being where he chose to come in part for the opportunities but also because they “didn’t tax his Air Force retirement,” he joked. It was at this point he began his work in Central Pennsylvania working for the District Attorney’s Association as a training coordinator. Eventually his experience with the association helped lead him to move into working at the Cumberland County Courthouse where he began as a drug tester for the treatment courts. Through diligent effort and time, he saw promotion after promotion until he eventually became the coordinator. 

“I wanted to do something that directly affects the community,” he said with a smile, “And everything we do here kind of…scratches that itch,” he chuckled. I asked him if his path was intentional and he made it clear that it was not, “It’s all accidental. My life has always been…I never really had a lot of aspirations with that kind of thing. I’ve just always been kind of fortunate that what I’ve done has always lead to something else…the skills I’ve learned and everything I’ve developed has always related to something I’ve done,” he shrugged, “When I first got out of the Air Force, I was just burnt out. I didn’t want anything with a lot of responsibility, so I’ve, in a way, become everything I didn’t want to be,” he joked with a laugh, “I am just, y’know, very grateful with how everything has worked out. This is just such a great thing to be a part of.”

There was a brief pause before we spoke about Treatment Courts, “When I heard about the program…I just thought wow, this really makes sense. I didn’t know that wasn’t always the consensus,” he shrugged, “Problem solving courts are not always popular…there is a punishment model out there and there’s a lot of people who feel that way and that the participants are getting out of something. They lose sight of…if the punishment model worked, we wouldn’t keep sending people to jail over and over and over,” he explained further, “There is enough data and evidence to show this model works and fantastically to get the outcomes that we want. It makes people productive and reduces crimes. So, my mindset is…it’s a process improvement.”

I then asked him about the hard parts of his job. A long pause came after my question and his brow furrowed in effort as he tried to think, “Wow…hmmm, I think…I guess “herding the cats.” When we decide certain things are going to happen or when we think certain people are going to do things. Just getting the whole team to see what’s going to happen,” he shrugs, “The most enjoyable is court. My end of things is very much numbers and it becomes easy to look at someone as a statistic…court lets you see what good you get and what you’re doing really has an impact.”

Discussing the courts lead to how society sees the program at large. Treatment courts are a new advent, having been developed in the past 20 years mostly in response to high amounts of recidivism particularly for crimes involving drugs, poverty, and mental health. However, the program does not necessarily provide understanding for the community. Paul spoke on community perceptions, “We deal with people who mostly are suffering from mental disorders like substance use disorder…we ran the numbers and most of the people in our programs have suffered from abuse in the past,” He paused, “You can’t change what people think all the time…they’re looking from the outside in. They don’t understand…it’s something that the court could do more of.”

We moved onto the essential components of what makes a coordinator successful. For people who want to do what Paul does, his biggest advice is hard work, “Most of these hire up, so just getting started at the bottom is a good way to get to the top,” he recommended. As for skills, organization and patience are most important, “It helps to be a numbers person. It helps to understand program improvements. It helps to understand team dynamics,” he continued, “We’re lucky at treatment court to have worked together for a long time. We’re a mature team that gets each other. That helps.” 

As the interview ended, I packed up my computer and gave Paul a firm handshake. Riding down in the elevator, I thought of how many people there were in his relatively unknown office. As I stepped out onto the street, I similarly began to wonder how many people walked past the massive building in which he was housed without ever realizing how important the workers inside were to the every day lives of vulnerable people. I looked up at the pillars lining the façade and then to my car down the street. When I got in my car and drove past the building again, I looked at it briefly before turning my eyes forward at the signal. It turned out, even the biggest and most impressive things can seem invisible when not paying attention. 

February Advocate of the Month: Dr. Bethany Hall-Long

[Each month, the Addiction Legal Resource Team at Penn State’s Dickinson Law recognizes an exceptional individual for their contributions to the addiction treatment community. The individual recognized as Advocate of the Month for the month of February is Lt. Gov. Dr. Bethany Hall-Long, Lieutenant Governor of Delaware.  Lt. Gov. Hall-Long has served as Lieutenant Governor since January 2017. She currently serves as chair of the Delaware Behavioral Health Consortium, which was created to improve addiction and mental health in Delaware. Before her current position, she served at a state representative from 2002-2017, fellow for U.S. Dept. of Health and Human Services, and postpartum and neo-natal nurse.  During her political career, she has continued to work as a nurse, professor, and community advocate. We are thankful for inspiration from our honored advocates and from Dickinson Law’s Inside Entrepreneurship Blog.]

By: Ryan Kingshill

Often, occupying a lofty governmental position involves a certain level of detachment. The intense obligations of the role may consume the official. Isolated in a bureaucratic bubble, executive officials can fail to directly observe and abate the issues they are working to solve. The official may lose their personal connection to their constituents.

Lieutenant Governor Dr. Bethany Hall-Long artfully avoids this trap. Her early career allowed her to witness the daily struggles encountered by individuals suffering from Substance Use Disorder (SUD). As Lieutenant Governor she continues to work directly with the vulnerable populations she strives to serve, strengthening her relationship with her community. Further, her direct involvement allows her to grasp the full scope of the issues facing Delaware. Specifically, Lt. Gov Hall-Long uses her ground level work to improve the lives of those suffering from Mental Health disorders and SUD in Delaware.

The thread of practical, ground level field work weaves its way through Lt. Gov. Hall-Long’s life and career. Even at a young age. Lt. Gov. Hall-Long told me she “always had a passion to help others.” She discovered her passion through experience-specifically, taking care of family members with health issues. This sparked an interest in nursing, leading to Lt. Gov. Hall-Long obtaining a degree in Nursing Administration from Thomas Jefferson University.

While working as a post-partum and neo-natal nurse, Lt. Gov. Hall-Long observed the real-world consequences of the systemic barriers afflicting her patients. She felt particularly moved by the plight of homeless and mentally ill veterans. Her observations fueled her desire to effectuate change, driving her to obtain a PhD in health policy and nursing administration from George Mason University.

However, Lt. Gov Hall Long’s direct community involvement did not stop during her graduate studies. She continued to work as a nurse, nurse advocate, and fellow for the U.S. Dept. of Health and Human Services. When I asked why she continued to work so closely with the population while she started her political career, Lt. Gov. Hall-Long cited her mentor and advisor Dr. Hazel Johnson-Brown. Dr. Johnson-Brown encouraged Lt. Gov. Hall-Long to “Get to the table and not merely be on the outside.”

For Lt. Gov. Hall-Long, effective political leaders must “get to the table” by engaging in activities that directly assist their community. Direct involvement allows Lt. Gov. Hall-Long to see the full problem, speak to all stakeholders, and discover solutions.

Upon returning to Delaware, Dr. Hall-Long’s political career blossomed. After a setback in 2000, Lt. Gov. Hall-Long served from 2002-2017 in the Delaware legislature in both the House of Representatives and the Senate, serving as the chair of the Health and Social Services Committee from 2013-2015. In January 2017, Dr. Hall-Long was sworn in as Lieutenant Governor.

Dr. Hall-Long’s political advancement did not stop her direct community action. Remarkably, as both a member of the Delaware Legislature and Lieutenant Governor, Dr. Hall-Long continued as a member of the University of Delaware Nursing Faculty. As a professor of over twenty years, her research focuses on the populations she vowed to serve as a nurse, including pregnant teens, homeless, and individuals suffering from mental illness and SUD.

I asked Lt. Gov. Hall-Long why she continues to work as a professor despite her responsibilities as Lieutenant Governor. To answer, she described some of her work. As part of her field research, Lt. Gov. Hall-Long distributed naloxone in a homeless encampment in the woods near University of Delaware. Seeing the realities of the opioid crisis keeps her “grounded and real.” She explained her work “allows me to be in the field and keep in touch with people on the ground.” Additionally, Lt. Gov. Hall-Long’s academic work allows her to be “at the table” by listening to problems faced by the homeless at the encampment.

Our conversation naturally pivoted to the work Lt. Gov. Hall-Long has engaged in as Lieutenant Governor to mitigate the problems she witnessed. Lt. Gov. Hall-Long’s premier achievement is her work as chair of the Delaware Behavioral Health Consortium. The Consortium brought together physicians, addiction specialists, community advocates, healthcare professionals, community members and more to formulate an action plan to tackle the Behavioral Health Crisis in Delaware. Lt. Gov Hall-Long, who was integral in creating the Consortium, emphasized the importance of “including all stakeholders” in creating a plan of action. Lt. Gov. Hall-Long stated the goal of the Consortium is three-fold: “First, to save lives; second, to promote sustainable recovery; third, to promote transition back into the workforce.”

The Consortium created an action plan with multiple recommendations to strengthen Delaware’s behavioral health system. Lt. Gov Hall-Long has helped implement many of these recommendations, along with other improvements.

Perhaps the most impactful improvement enacted as part of the Consortium’s work is Delaware’s overdose system of care, the first overdose system of care in the United States. The overdose system of care establishes stabilization centers that patients can go to after release from hospitals or first responders. The centers will provide immediate treatment following an overdose to prevent relapse and readmission. The system also encourages universal sharing of Health Information to prevent individuals from “falling through the cracks.”

Other improvements Lt. Gov. Hall-Long has championed include the Division of Substance Abuse and Mental Health partnering with Shatterproof to create a rehabilitation rating system, forming a mortality overdose taskforce, encouraging adoption of the ANGEL and HERO HELP programs for police and first responders to help the transition to treatment, partnering with pew charitable trusts to analyze Delaware’s current behavioral health system, and partnering with Google to increase access to addiction resources.

To choose which actions to pursue, Lt. Gov. Hall-Long again circles back to her direct field experience. As a nurse, Lt. Gov. Hall-Long learned how to be a “consensus builder”. By incorporating all stakeholders in the Consortium, including individuals encountered during Lt. Gov. Hall-Long’s field work, Lt. Gov. Hall-Long brings all interested parties together to produce a consensus that leads to the best outcomes. In Delaware, all stakeholders pointed back to the fractured behavioral health system- precisely what these reforms seek to address.

When I asked what Lt. Gov. Hall-Long is most proud of, she pointed to Delaware’s legislative and regulatory change during her term. Lt. Gov. Hall-Long hopes the Behavioral Health Consortium and Delaware’s other efforts can spark change across the nation. She hopes Delaware can be a “model to the nation” on how to tackle the opioid crisis.

Through a unique mixture of political action and practical field work, Lt. Gov. Hall-Long works to improve the lives of those suffering from SUD in Delaware. We at Dickinson Law’s Addiction Legal Resource Team are uplifted by her efforts, and we hope others will be encouraged to “get to the table” to discover innovative solutions for the opioid crisis.

January Advocate of the Month: Senator Gene Yaw

[Each month, the Addiction Legal Resource Team at Penn State’s Dickinson Law recognizes an exceptional individual for his or her contributions in addressing substance use disorder. The individual recognized as Advocate of the Month for the month of January is Senator Gene Yaw, a state senator from Pennsylvania who has been representing the 23rd Senatorial District since 2009. Senator Yaw serves as Chairman of the Environmental Resources and Energy Committee. He is also a member of the Appropriations, Judiciary, Law and Justice, Agriculture and Rural Affairs, Banking and Insurance, and the Majority Policy Committee. Senator Yaw also serves as Chairman of the Board of Directors of the Center for Rural PA, a bipartisan, bicameral legislative agency that serves as a resource for rural policy within the Pennsylvania General Assembly. We are thankful for inspiration from our honored advocates and from Dickinson Law’s Inside Entrepreneurship Blog.]

By Cole Gordner

It was a simple request – could he utilize his position as Chairman of the Center for Rural Pennsylvania to spread awareness of the substance use crisis to rural areas of the state? As it turns out, this would be the catalyst for Senator Gene Yaw to become the de facto spearhead of legislation coming out of the Pennsylvania Senate relating to opioids and the substance use crisis.

From the moment I walked into Senator Yaw’s office, it was apparent that he is very passionate about his work and proud of what he accomplished during his time in office. Various awards, both from his time as a Senator and as Chairman for the Board of Penn College, lined his desk and the walls. At one point during our interview, Senator Yaw had to leave briefly to attend another meeting and was gracious enough to allow me to wait in his office until he returned. During this time, I was able to inspect a number of bills he had hanging near his doorway, obviously some of his proudest legislative achievements. Two of the four bills pertained to the substance use crisis: SB 1202 (Regular Session 2015-2016) which enhanced the Prescription Drug Monitoring Program, and SB 1367 (Regular Session 2015-2016) which provided opioid prescribing guidelines for minors, limited prescriptions, and imposed new penalties on prescribers who violate these guidelines.

Senator Yaw rose from humble beginnings. He grew up in the small town of Montoursville, PA and enlisted in the United States Army for 4 years before becoming a first-generation college student. After graduating from Lycoming College, Senator Yaw chose to pursue a career in law and attended the American University School of Law. After earning his J.D, Senator Yaw began a lifelong career of giving back to his community. He served as the Lycoming County Solicitor for 18 years, clerked for the President Judge of Lycoming County, and served as the General Counsel to the PA College of Technology, a public college in Williamsport, PA of which he is now the Chairman of the Board of Directors. In 2008, Senator Yaw decided to run for state senator of PA’s 23rd Senatorial District, a seat that he won and remains in today.

In 2011, Senator Yaw became the Chairman of the Board of Directors of the Center for Rural Pennsylvania, a bipartisan, bicameral legislative agency that serves to maximize resources and strategies for PA’s 3.4 million rural residents. Senator Yaw says that his election as Chairman and the aforementioned proposition were pivotal to his now passionate dedication to relieving the devastating impact the substance use crisis has had on Pennsylvania.

The initiative started out modestly. Senator Yaw decided to hold a number of hearings through the Center with the goal of simply raising awareness of the opioid problem. The first hearing was held in Lycoming County. It was slated to only last for 3 hours, but due to an overwhelming turnout, it ended up running nearly twice as long. At this moment, Senator Yaw realized the gravity of the issue; the opioid crisis is not just a rural issue or an urban issue, it is something that has the potential to affect everybody regardless of background. The Center for Rural Pennsylvania ended up holding 16 hearings on the substance use crisis across the state and issued two reports based on their findings. These hearings can be found here, and the reports can be found here.

Senator Yaw believes that the momentum that arose from those hearings resulted in more legislation than any other single issue that PA has had in recent history. Considering the legislative output since the hearings began, this is likely an accurate statement. Since 2015, the PA House and Senate have enacted laws relating to the opioid crisis each year. Most recently, during the 2018-2019 session of the PA General Assembly, the Senate passed a package of seven bills, all pertaining to the epidemic. This includes Senator Yaw’s own SB 112, which seeks to combat the opioid crisis by limiting opioid prescriptions to seven days unless there is a medical emergency involving the patient, as well as other medical exceptions. Senator Yaw says that common-sense legislation such as this is imperative to combatting the substance use crisis and it has the added bonus of not costing state taxpayers a single dime.

Demonstrating his knowledge of the issue to me, Senator Yaw also rattled off a number of other initiatives that have been passed or are currently being considered since he began spearheading this issue: Making naloxone more widely available to emergency providers and family members of those battling substance use disorder; enacting Prescription Drug Monitoring Programs in order to prevent doctor shopping both intra- and inter-state; mandating increased pain management training and drug dispensing education for anybody attending a PA medical school; and mandating counseling to minors (especially student athletes) who are being prescribed opioids. Currently, Senator Yaw is working on passing a bill that would bring greater uniformity to coroner’s reports when somebody overdoses.

The most paramount idea that Senator Yaw hopes to get across, and one that he brought up numerous times throughout the interview, is that addiction is a disease. He recognizes that there is a stigma around any form of illicit drug use and he even humbly admitted to sharing in that view before he began holding hearings on the crisis. But now more than ever it is imperative that people educate themselves on the topic and stop blaming the victims of addiction. To explain this, Senator Yaw compared it to a person with diabetes: “Some people can process sugar properly, and some people cannot. It all depends on your genetic make-up. Some people may be able to use a recreational drug once and be done with it, others become dependent and their body necessitates it.”

Because of this, Senator Yaw is also a big advocate for Medicated Assisted Treatment (MAT). MAT is the use of medication in combination with counseling treatments to help people overcome their dependence on opioids (it is also used to treat alcohol dependence and others). In these treatments, a patient will substitute whatever opioid they have been using for another safer drug, typically Suboxone or Vivitrol. They will take this on a regularly scheduled basis and slowly decrease the dosage until the urge to use becomes negligible. This has been somewhat of a controversial treatment for substance use disorder, but it has proven to be an effective method of overcoming addiction and allows the user to function in a more controlled way. He once again pointed to diabetes as an example for why this should be a more common practice: “If you’re a diabetic and you have to take insulin everyday that’s fine, but if you’re dependent on drugs and you’re taking more opioids to combat that dependency people look as if there is something wrong with you.”

Towards the end of the interview, I asked Senator Yaw if he had any advice for people who want to become more involved with the substance use crisis. His emphatic answer was to continue educating yourself. There is still misunderstanding surrounding the opioid epidemic and the people who are being affected by it and the best we can do is to keep learning as much about it as we can. He said that the skills he developed as a lawyer have been tremendously helpful to him throughout this entire journey – looking at the facts, talking to experts and getting first-hand accounts from those suffering, and then synthesizing all of that to draw informed conclusions about the nature of substance use disorder and the best steps forward. The more we continue to educate ourselves on the nuances of the substance use crisis, the better our chances will be to mitigate its devastating effects.

Recovery Housing: Funding and Government Action

By Cole Gordner

Over the last decade, recovery housing has proven to be an important tool in combatting the substance abuse crisis currently plaguing the United States. Recovery housing’s rise in popularity has brought new sources of funding, increased regulation, and greater efforts by the government to support its growth. This blog post briefly explores each of these areas with the goal of adding clarity regarding the funding, operation, and regulation of recovery houses. First, this post explains the role of recovery housing and explores the various avenues of funding available to the operators of such units through the federal and state governments, and via private foundations. It then explains the regulatory requirements that recovery houses must comply with if they accept federal funding or operate in Pennsylvania. Finally, this post will discuss some laws and initiatives currently being taken by the federal government and Pennsylvania to further promote the expansion and regulation of recovery housing.

Recovery houses are non-medical residences designed to support recovery from substance use disorders. They provide individuals struggling with addiction a safe space to form new and healthier social structures that reduce the possibility of relapsing into drug use. Recovery houses have proven themselves to be one of the most effective means of fighting addiction at the micro-level. Furthermore, they are cost-effective, as the reduction in illegal activity resulting from the success of these houses outweighs the costs of their funding. All of this has led to a proliferation of such houses throughout the nation in recent years. Along with this expansion has come a wider availability of funding for these homes, along with the federal and state governments taking a more active interest in their operation and regulation.

Limited funding for recovery houses is made available through a variety of both public and private sources. On the public side, the federal government and most states offer grants issued through an agency operating under departments of health. The federal government’s primary body for this is the Substance Abuse and Mental Health Services Administration (SAMHSA). Last year, SAMHSA issued millions of dollars’ worth of grants towards programs relating to recovery treatment and housing through their Access to Recovery (ATP) and Recovery Community Service Programs (RCSP). They have requested $89 million for FY2020 in order to continue funding these programs, along with grants for drug courts and other related services. The Secretary of Health and Human Services may also utilize Section 1115 of the Social Security Act to approve grants for “experimental, pilot, or demonstration projects that are found by the Secretary to be likely to assist in promoting the objectives of the Medicaid program,” which may include recovery housing services. Additionally, states may direct Medicaid funding to recovery services by exercising the Rehabilitation Services Option or applying for a waiver through Medicaid Section 1915(b).

Most states provide grants to operators of recovery housing similar to that of SAMHSA. For instance, Pennsylvania offers the Substance Abuse Prevention and Treatment Block Grant (SAPTB) through the Department of Drug and Alcohol Programs (DDAP). There are also a number of private foundations that offer to fund entities who are running recovery housing. The National Alliance for Recovery Residences (NARR) and the Robert Wood Johnson Foundation are two of the predominant organizations supporting recovery housing in the United States. In addition to grants, the NARR (who has affiliate organizations in nearly 30 states) offers insurance coverage to the operators of recovery houses.

As is always the case with the receipt of federal and state funding, recovery houses must comply with numerous regulatory requirements. Any recovery house that accepts federal funding must adhere to such laws as the Americans with Disabilities Act and the Fair Housing Act. Furthermore, operators of recovery housing must ensure that all in-house professionals and services rendered by these professionals comply with state regulations and that all local safety standards and ordinances are met.

Aside from funding, the federal government and Pennsylvania have been pursuing policies and enacting legislation that seek to promote access to recovery housing or regulate the operation of such housing. In 2018, President Trump signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act into law. This act mandates the Secretary of Health and Human Services, along with other qualified individuals, to facilitate the development of best practices for operating recovery homes. Just this year, the U.S. Dept. of Agriculture (USDA) and the U.S. Dept. of Housing and Urban Development (HUD) partnered up to expand recovery housing in rural areas, which have been heavily impacted by the opioid crisis but sometimes aren’t able to provide recovery services similar to more densely populated, urban areas. The USDA and HUD are now selling single-family residences that are no longer being used by the government at a reduced price to non-profit organizations who will convert them into recovery houses. 

Recently in Pennsylvania, Governor Wolf signed SB 446 into law. This gave the DDAP the authority to license, certify, and regulate recovery houses within the state. From now on, any recovery home operating in Pennsylvania that either receives public funding or referrals from public institutions will have to acquire certification from the state and comply with their guidelines.

While the government has been taking some positive steps towards supporting and regulating recovery housing, there is still progress to be made. In 2018, the National Council for Behavioral Health released a policy paper focused on the development of recovery houses. In this document, they outlined a few initiatives that the government could pursue in order to increase the effectiveness of recovery houses and make them more uniform on a national scale. The federal government has begun work on creating a model of best practices through the SUPPORT legislation, which was one of the proposed initiatives. Moving forward, the National Council recommends that greater technical assistance should be offered by the government to recovery houses, and that the federal government should incentivize recovery housing operators to adhere to nationally recognized quality standards.

Bibliography:

https://www.thenationalcouncil.org/wp-content/uploads/2017/05/Recovery-Housing-Issue-Brief_May-2017.pdf

https://www.thenationalcouncil.org/wp-content/uploads/2017/05/Recovery-Housing-Issue-Brief_May-2017.pdf

https://www.samhsa.gov/sites/default/files/partnersforrecovery/docs/RSS_financing_report.pdf

https://narronline.org/supporters/partners-in-excellence-2/

https://narronline.org/wp-content/uploads/2014/06/Primer-on-Recovery-Residences-09-20-2012a.pdf

http://www.williamwhitepapers.com/pr/dlm_uploads/Recovery-Residence-Draft-Practice-Guidelines-SAMHSA-2019.pdf

https://www.samhsa.gov/newsroom/press-announcements/201902151000

https://www.governor.pa.gov/newsroom/governor-wolf-signs-legislation-regulate-recovery-homes/

https://www.healthvermont.gov/sites/default/files/documents/pdf/State%20policy%20guide%20for%20Recovery%20Housing_0.pdf

https://www.recoveryanswers.org/research-post/oxford-houses-offer-both-recovery-benefits-cost-savings/

http://soberhouse.com/guide/how-is-recovery-housing-regulated/

https://www.medicaid.gov/medicaid/section-1115-demo/about-1115/index.html

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