Legal Prescription

ALRT's Exploration of Addiction, Law, and Medicine

Month: January 2020

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.


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