SUMMER 2022
A
To Action l l a C
Ge t
Understanding The Opioid Overdose Crisis
Involved
sosb erks.org In Berks Read It Online
2
THE RESPONSE // SUMMER 2022
Mon-Fri: 8am - 7pm Sat: 9am - 2pm Sun: 9am - 1pm
The Response is published through funding from county and state dollars in concert with the Berks County Opioid Coalition under the guidance of the Council on Chemical Abuse. cocaberks.org • 610-376-8669
EDITORIAL BOARD
T.J. Huckleberry Executive Officer, Berks County Medical Society John Adams District Attorney, County of Berks Kevin S. Barnhardt Commissioner, County of Berks Marcia Goodman-Hinnershitz Director of Planning & Resource Development, Council on Chemical Abuse Tracy Hoffmann Hoffmann Publishing Group Lee Olsen Olsen Design Group Architects, Inc. Stanley J. Papademetriou Executive Director, Council on Chemical Abuse
BERKS COUNTY’S OPIOID COALITION, SOS BERKS www.sosberks.com
BERKS OPIOID COALITION LEADERSHIP WITH SOS BERKS Kevin S. Barnhardt and Stanley J. Papademetriou Coalition Co-chairs
COMMUNITY SAFETY COMMITTEE
John Adams and Yvonne Stroman Co-chairs
COMMUNITY AWARENESS COMMITTEE Jennifer Kirlin Chair
DATA COMMITTEE
Justin Loose and Kathy Noll Co-chairs
PREVENTION EDUCATION COMMITTEE Cory Trevena and Jaclyn Steed Co-chairs
TREATMENT COMMITTEE Amanda Miller and Bernice Hines-Corbit Co-chairs
CONTENTS
SUMMER 2022
FEATURES 4 6
Getting Involved-A Call to Action The SOS Berks Opioid Coalition
10 Spiderman has Got to be Frustrated
12 Understanding the Opioid Overdose Crisis
14 The Opioid Epidemic: Meeting the Challenge 16 Blue Cares Blooms in Berks County
BERKS COUNTY OPIOID COALITION
20 The Warm Hand-off Program: A Life-saving Connection to Recovery 24 Berks County Treatment Courts: A Bridge to Recovery
26 The Changing Landscape of Prescribing in Pennsylvania: A Pharmacist’s Perspective
28 The Unspoken Pain
30 Berks County to receive $16.3 million from nationwide opioid settlement OPIOID COALITION VISION Identify opportunities to remediate the opioid crisis through the provision of evidence based/best practice strategies and resources. OPIOID COALITION MISSION The mission of the coalition is to determine the extent to which Berks County is being affected by the non-prescriptive use of opioids and the use of heroin through the examination of its devastating effects, both personal and societal, and to set recommendations that address the prevention, intervention, treatment and recovery supports of local residents that suffer from opioid addiction. 2669 Shillington Road, Box #438 Sinking Spring, PA 19608 | HoffPubs.com | (610) 685.0914 Designer | Kim Lewis
The opinions expressed in this publication are for general information only and are not intended to provide specific legal, medical or other advice or recommendations for any individuals. All rights reserved. No portion of this publication may be reproduced electronically or in print without the expressed written consent of the publisher or editor.
FOR ADVERTISING INFO CONTACT: Alicia@hoffpubs.com, 610.685.0914, ext. 210
READ THE RESPONSE ONLINE AT Response.HoffmannPublishing.com RECEIVE THE LATEST UPDATES BY FOLLOWING US ON SOCIAL MEDIA 3
FROM THE COALITION
Getting InvolvedA Call to Action From the SOS Berks Chairpersons by Coalition Co-Chairs: Kevin S. Barnhardt, Commissioner, County of Berks, and Stanley J. Papademetriou, Executive Director, Council on Chemical Abuse
B
etween 2015 and 2016 there was a 70% increase in the number of overdose deaths in Berks County. This increase was both sudden and shocking. The impact and devastation were experienced throughout Berks County - by the criminal justice system, by healthcare providers, by employers, by neighborhoods and most especially by families and loved ones. The enormity of the impact of this sharp increase in overdose deaths in our community demanded a local response. In 2016, the Berks County Board of Commissioner and the Berks County Criminal Justice Advisory Board established the Berks County Opioid Task Force comprised of public officials and other community leaders and stakeholders. This group began meeting in December of 2016 and continues to meet monthly. The task force created a strategic plan, established committees, and eventually re-branded itself as the SOS Berks Opioid Coalition. SOS Berks has a simple and concise vision – saving and improving the lives of Berks County residents. Since its inception five and one-half years ago, there has been a core of about 35 to 40 individuals who have consistently participated in SOS Berks to address the overdose issue in our community. Neither the heat of summer, the cold of winter, nor the quarantining of COVID-19 have deterred these individuals, and the coalition, from continuing to meet and develop ideas, strategies and activities to address the local overdose dilemma. This energy and effort are extremely important. Although the overdose problem has not been eradicated in Berks County (quite the contrary), the efforts of these individuals helped to increase awareness and remove obstacles for those seeking help.
4
THE RESPONSE // SUMMER 2022
Much has changed with the overdose crisis. It has evolved from the misuse of prescription drugs to the abuse of heroin. Today fentanyl has emerged as the drug responsible for most all overdose deaths. How we now address the problem has also evolved. We know more now and have adopted and added new and different approaches. Our expectation is that how we address the problem will continue to change the more we learn and understand. As the contributing factors to the overdose crisis continue to change, the SOS Berks Opioid Coalition recognizes, to effectively respond, it needs to change and grow. The task force initially formed was primarily comprised of policy makers and representatives from organizations needing to identify and coordinate services. While this collaboration is still important, our efforts now need more community input and involvement. Berks County’s population is diverse, comprised of individuals with various backgrounds. While this varied demographic adds to the richness of Berks County, it also requires a variety of ideas, voices and approaches when confronting a medical, legal and social issue such as the overdose crisis. Truly, one size does not fit all. We recognize this and realize our need for more community involvement. It is extremely important to have all segments of Berks County express and share their needs, their concerns and their ideas. There is no single answer, no quick fix, not magic cure. We need input from the community to help discover, develop and implement solutions.
There are many reasons why individuals choose to become involved in their community. One facet is the desire to help and be part of the solution. The desire to help is not a rare nor unique attribute. In truth, there are countless individuals in our community who want to help. Berks County is abundant with individuals who are kind and empathetic and desire to help. They understand that if we help our neighbor, we help our neighborhood, our community, and our world. An important factor when one seeks to become involved is connecting with the opportunities to help. While many have the desire to help, they may not be aware of how to help or where to start. Some people hear of opportunities to help through work, associates, family or friends. Others may become aware through the media. The SOS Berks Opioid Coalition is committed to connecting to members of the community so they can learn more about the issue and to lend a hand.
How can you help? Get involved. Maybe, you can choose many pathways to help pave the way to solutions. You can choose to participate in the SOS Berks Opioid Coalition or one of the committees. Or help organize an SOS Berks community awareness event for your neighborhood, place of worship or social club. Or volunteer by helping to distribute informational materials at community events and fairs. Or pick-up a Narcan® kit (the opioid overdose reversal medication) free of charge for a loved one – or yourself. All of us continue to stare down the reality of an overdose crisis as it devastates our community. Should you get involved in helping? That’s up to each individual to answer for themselves. How can you get involved? Contact us. Either through the SOS Berks email address sosberks@gmail.com or the SOS Berks website at Community Coalition | SOS Berks | United States.
Join us…..we look forward to you finding more about SOS Berks and joining the team...SOSBerks.org 5
FEATURE
“Stop Overdoses, Save Lives” The SOS Berks Opioid Coalition
In January 2016, as a local response to the emerging opioid epidemic, the Berks Opioid Task Force was organized by key community leaders from local government, criminal justice, drug and alcohol, healthcare, social services, and the business community. With the recognition that the scope of this epidemic required a strong collaborative approach, the Task Force evolved into the SOS Berks Opioid Coalition. SOS Berks works to facilitate connections with our community and its stakeholders to create initiatives that address the crisis. The coalition meets monthly and has subcommittees that focus on Community Awareness and Outreach, Healthcare and Treatment, Data Collection and Assessment, Prevention and Education, and Community Safety. Moving forward, the focus of SOS Berks is to expand efforts that contribute to the reduction of drug-related deaths and to overcome barriers to prevention, treatment, and recovery in Berks County. The Coalition is represented by a wide range of stakeholders from all sectors of the community and continues to grow its membership. The strength of SOS Berks is the dedication of its members. As the Coalition enhances and expands these relationships to increase its connection and visibility in our community, a unique opportunity exists to create meaningful, systemic, and sustainable changes capable of addressing all current and future drug threats.
6
THE RESPONSE // SUMMER 2022
Community Stakeholders
Albright College Alvernia University Berks Coalition to End Homelessness Berks Community Health Center Berks Connections/Pretrial Services Berks Counseling Center Berks Country Department of Emergency Services Berks County Children and Youth Services Berks County Commissioners Berks County Community Foundation Berks County Detectives
Berks County HealthChoices Program Berks County Intermediate Unit Berks County Jail System Berks County Medical Society Berks County Office of Aging Berks County Office of Mental Health/ Developmental Disabilities Berks County Office of Probation and Parole Berks County Office of the Coroner Berks County Office of the District Attorney Berks County Office of Veteran Affairs Caron Treatment Services Centro Hispano City of Reading Police Community Care Behavioral Health Organization Council on Chemical Abuse DoubleTree of Reading
Drug-free Workplace PA Easy Does It Esterbrook Pharmacies GEO Group Haven Behavioral Health/ Transformations Hoffmann Publishing Group Kutztown University LGBT Center NAACP Neighborhood Housing Services of Greater Berks, Inc. New Directions Treatment Services Penn State Berks Campus Pennsylvania Adult and Teen Challenge Pennsylvania Counseling Services Pennsylvania National Guard Reading Area Community College Reading Hospital Tower Health Reading-Berks Association of Realtors Safe Berks Service Access Management Southern Berks Regional EMS Treatment Access and Services Center United Way of Berks County University of Pittsburgh Program Evaluation & Research Unit Western Berks EMS YMCA of Reading and Berks County
7
FEATURE
In Their Own Words, Why SOS Berks? Cory Trevena, Caron Treatment Centers “SOS Berks responded to the devastation of the opioid epidemic by creating a coalition of diverse community members gathered around one goal: to save lives. Most of us have been personally impacted by this epidemic. We work diligently to make sure everyone has access to the compassionate support they need.”
Joi Honer , Retreat Behavioral Health and The Recovery Advocacy Project “The stigma around substance use disorder is a barrier to people getting help. SOS works together to educate the community about the disorder and recovey through media, education and awareness campaigns. Subcommittees create a multifaceted approach has increased awareness, understanding and encouraged compassion, central to helping people get well.”
Lydia Singley, County of Berks “I joined SOS Berks to help mitigate the impact of the opioid epidemic.”
William Santoro, MD Tower Health System “Berks SOS has increased the awareness of the problem in Berks County, helped reduce the stigma of substance use and disseminated information about treatment available. In doing so, Berks SOS has saved many lives in Berks County.”
John Adams, District Attorney “The Opioid Epidemic is a wat that needs to be fought on multiple fronts: Prevention, Treatment and Enforcement. SOS Berks has brought the leaders of all the fronts of this war together to combat this epidemic.”
Amanda Miller, Berks Counseling Center “SOS Berks is so impactful because the committee really looks at all perspectives, in order to address the Opioid Crisis. They do this by reducing the stigma of addiction and getting the resources, that are available, to those in need.”
Beth Derr, Friedens Lutheran Church, Oley “SOS Berks collaborates well with community organizers, and it continues to serve a very relevant need in our county. The coalition is committed to saving lives by offering education and training and promoting treatment for opioid/substance use disorder. Providing access to naloxone throughout our communities is a continued priority.”
8
THE RESPONSE // SUMMER 2022
Ramona Roberts, PsyD, Caron Outpatient Treatment Center “SOS Berks has helped with raising the awareness, reducing the stigma, and providing support and resources not just to those who are in the midst of addiction themselves, but to our community which to me just grows our empathy and helps us to be better humans to one another.”
Kathy Strain, Drug Free Workplace PA “The SOS Coalition has helped to raise awareness to the opioid overdose and substance use crisis in Berks county. In doing so, the members have helped to create positive change for people with a substance use disorder and their families which in turn leads to more of our community members finding long term sustained recovery.”
Jessica Jones, Berks County Area Agency on Aging “SOS Berks has worked to educate older adults in Berks County on safe and secure medication disposal. The coalition also has worked hard to provide on going community education on the opioid epidemic in Berks County, address the stigma related to drug use and has made Narcan accessible to the community to prevent overdose death.”
Ken Lebron, Berks County Veterans Affairs “Bringing awareness to a community and fostering a community collaborative is the first step for any community intend on ending substance use overdoses. Together, we agree to take a stand in this continued fight against drugs.”
Jaclyn Steed, Council on Chemical Abuse “The work of SOS Berks helps decrease the stigma of substance use disorder for those suffering and their families in Berks County. Education efforts of the collation have created awareness that this disease can happen to anyone. EVERYONE needs to understand what prevention strategies can be put in place and there is help and support available.” Bonnie Triebig, Berks Counseling Center “The work of SOS Berks is invaluable to our community – they have worked tirelessly to address the opioid epidemic from all directions. SOS Berks recognizes that prevention and stigma reduction are just as important as enhancing treatment and access to Narcan.” 9
LETTER FROM THE EDITOR
Spiderman has to be Frustrated
S
o, as this article will prove, I am a Marvel movie fan. With two young boys one could argue that I spent as much money on merchandise, rentals and tickets as I have on my taxes. I can safely say that I have watched each movie in its entirety at least twice, and re-enacted action scenes with my kids for more times than I can count. So, after the immense amount of dollars and hours spent on Marvel, I have come to one clear opinion: Spiderman has got to be frustrated. And not just him, I feel for Iron Man, Thor, Captain America, Black Widow, Captain Marvel, and Hawkeye. I have only sympathy for The Hulk, Scarlet Witch, Doctor Strange, Antman, and Black Panther (Wakanda Forever*). If I ever see the gang from The Guardians of the Galaxy, dinner’s on me.* Why do you ask?
T.J. “The Incredible Huck” Huckleberry Executive Officer Berks County Medical Society
Because try as they do, their job is never done. They lock up one villain, two more sneak into town. They blow up some monster, and somehow it survives and escapes. They save the city and half of it is leveled in the sequel. It seems that Marvel’s formula is that the villains only get smarter, the monsters only get bigger, and the battles only get uglier, and the city never…ever stays saved. Call me crazy…but are all those superpowers worth it? But then again, where would their multiverse* be without them? What would the good citizens do without their talents, selflessness, and bravery? Who would save the day? After all, these aren’t normal individuals, these are heroes. So, despite how much my sons’ wish it to be true, we do not live in a Marvel movie. But our worlds are eerily similar. We too have our fair share of monsters, villains, and battles, especially in our substance use and recovery community. Opioids, Fentanyl, cocaine… when one evil appears to be beaten a more formidable foe arrives. But we too have heroes. We too have those who use their talents, their selflessness and bravery to hold our monsters at bay. This edition, like a good comic book, is filled with these people, these heroes. And while none of them can wield ancient Norse war hammer*, carry a vibranium shield*, or utilize Stark technology to fly*, what they do for our community truly makes a difference.
10
THE RESPONSE // SUMMER 2022
From the moment we assembled* six years ago, Berks SOS has had its moments of triumph and adversity. But what has never waivered was our passion, our sense of mission, and our devotion to our community and those we want to protect. We all know that our victories are fleeting, and our adversaries never tire but we all should sleep well knowing that these dedicated people are on the job. On behalf of SOS Berks, I hope you see the progress and the hard work this team of community leaders has provided. They say that not all heroes wear capes, and SOS Berks is proof to that statement. Please enjoy this edition. *If you don’t understand these references, the asterisks represent major plot points to Marvel movies and characters. The author apologizes if you don’t get them. and encourages you to find a local teenager or grade school kid to explain them to you. Thanks!
11
FEATURE
Understanding the Opioid Overdose Crisis % of Methamphetamine and Cocaine Overdose Deaths without Opioid Involvement 9%
Count and percent of overdose deaths with opioids involved: 2018: 83% 2019: 87% 2021: 79% 2020: 84%
6%
6%
5%
6%
3%
3%
1% by David Kostival
2018
2019 Cocaine, no opioid
W
2020
2021
Methamphetamine, no opioid
Source: Berks County Coroner's Office
hen tracking national overdose deaths involving opioids, there has been a steady and sometimes rapid increase over the past 20 years. The National Institute on Drug Abuse reports that overdose deaths from any opioid overdoses were well under 10,000 in 2000. But by 2010, the number had risen to 21,088 and continued to rise to around 47,000 deaths in both 2018 and 2019. In 2017, The New York Times called the opioid crisis the deadliest drug crisis in American history, with it taking the lives of 90 Americans every day during that year. And then a significant rise occurred in 2020 when the number of deaths rose to 68,630 overdose deaths.
When speaking in the broadest terms, the opioid crisis includes prescription opioids; natural and semi-synthetic opioids and methadone; heroin and synthetic opioids (mostly fentanyl). The National Institute of Health explains the problem with prescription opioids is that they are powerful drugs which are often over-prescribed for the reduction of pain from a surgery or injury. The opioids can produce harmful side effects, including drowsiness, mental fog, nausea, constipation and respiratory depression (slowed breathing) that can lead to an overdose death. Continued use will lead to addiction, when average citizens – who never intended to use illegal drugs – are forced to turn to street drugs,
The Pennsylvania Department of Health has released information that there were 5,162 fatal overdoses in Pennsylvania in 2020, with 128 of those occurring in Berks County.
But the problem with street drugs is that there is no quality control, and they are often laced with additional substances such as Fentanyl. The Centers for Disease Control states Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine and is a major contributor to both fatal and nonfatal overdoses in the United States. The danger is that people are not usually aware that their drugs are laced with fentanyl.
That statistic isn’t really all that surprising since the COVID-19 pandemic has been attributed to the highest annual number of fatal drug overdoses on record in the United States. The COVID-19 pandemic did not help matters any because emergency rooms at hospitals were not as accessible for those who overdosed. And the numbers did not fall when many restrictions associated with COVID-19 began to ease. Preliminary data shows there were 5,224 lives lost to overdoses in the state in 2021. 12
THE RESPONSE // SUMMER 2022
The drug crisis in Berks County received considerable attention last September when there was an extreme surge of 101 overdoses and three deaths from a bad batch of street drugs. At the time, Berks County District Attorney John Adams said the incident
did shine a light on the topic of drug abuse. “It hits home that we need to make the efforts from a global perspective, not only from law enforcement, but also treatment facilities and resources to attack this problem,” Adams said a few weeks after the incident occurred. Another incident occurred this spring on April 9 when four people died and seven were hospitalized because of fentanyl-tainted opioids.
Berks County Commissioner Kevin Barnhardt has addressed the crisis many times in his official capacity as commissioner. Barnhardt is the co-chair of the SOS Berks Opioid Coalition, which was formed in 2018, branding itself as SOS Berks. The coalition consists of community members who are committed to reducing the number of opioid-related deaths in the county by fighting the stigma attached to addiction.
In early May, the Pennsylvania Department of Drug and Alcohol Programs Secretary Jennifer Smith came together with State Senator Judy Schwank and local substance abuse treatment providers in a roundtable discussion to discuss the continuing crisis.
Dr. William Santoro, chief of the division of addiction medicine at Tower Health and a member of the coalition, has said that because of the stigma attached to addiction, those suffering from addition often do not get treatment. He stresses that people should not be defined as addicts, but rather as having a medical condition.
Smith said there must be a continued urgency in addressing the crisis at the community level. “That is where change begins, and we must do all that we can to support substance abuse disorder treatment providers because treatment is such a crucial step on the road to recovery,” Smith explained. Schwank agreed, saying that Berks County should be an example for others to follow in terms of addressing the opioid crisis. She also said she wanted to continue working through the state to make sure local recovery teams have everything they need to help as many people as they can.
Santoro also says that the public needs to be educated in understanding addiction. Often, he said, people view addiction – especially the opioid crisis – as someone else’s problem until it affects them first-hand. Help with the education process could be on the way, as Berks County officials recently learned the county will receive more than $16.3 million over the next 20 years as the result of a settlement of a national lawsuit against four of the country’s largest pharmaceutical providers.
Substance Abuse Impacts The Entire Family You Are Not Alone
Visit Caron’s Education Alliance Resource Kit for: • • • •
Prevention Videos for Parents Resources in Spanish – Recursos en Espańol Free Digital Learning Courses Podcasts
NO INSURANCE? WE CAN HELP! WALK-IN ASSESSMENTS & TREATMENT REFERRALS, 8 AM-4 PM DAILY. COMMERCIAL INSURANCES NOT ACCEPTED
610-375-4426 19 N 6TH ST, STE 300, READING, PA HOURS: 8 AM-4 PM • M-F CARON.ORG/EA-RESOURCE-KIT
800-678-2332
Drug & Alcohol Assessments • Treatment Referrals • Peer-to-Peer Recovery Support for all Publicly Funded Berks County Residents
VISIT WWW.BERKSTASC.ORG FOR DETAILS 13
FEATURE
The Opioid Epidemic: Meeting the Challenge By John Adams, Berks County District Attorney
T
he battle continues right here in Berks County to somehow stop people from dying. As I have stated time and time again, there are no quality controls when you chose to buy and ingest drugs that are purchased on the street. The user, and even many times the seller, have no idea that the cocaine, heroin, or methamphetamine they are peddling or buying has been cut with fentanyl or many other substances. Buyers beware because you may die when you ingest these street drugs.
Detectives from the District Attorney’s Drug Task Force and the Reading Police Department identified at least three outlets who were distributing “street level” quantities of the tainted heroin. The heroin that was being sold that caused these overdoses were all packaged similarly in blue packets. Detectives quickly developed evidence and raided three locations and arrested several suspects. Although the outlets were closed and shut down by law enforcement, detectives continued to investigate the source of the tainted heroin.
This was proven once again when we faced another mass overdose episode on April 9th and April 10th, 2022. 18 people overdosed; 11 of those died because of ingesting what we believe to be cocaine laced with fentanyl. Detectives from the Reading Police Department and the District Attorney’s Office reacted immediately and while we haven’t made any arrests to date, they are working diligently on identifying the suppliers of the drugs, and I am hopeful arrests will be made in the near future. This was the second time our community has been rocked by massive overdoses. In September 2021, we had 101 people who overdosed in a three-day period. The death toll from that episode was three people who lost their lives. The September overdose episode was called a poisoning by our fellow SOS Berks member, Dr. William Santoro. This overdose episode resulted in over one hundred hospitalizations and required the issuance of a public health alert. This episode overwhelmed the healthcare capacity for Berks County.
Subsequently, the Berks County District Attorney’s Office Drug Task Force, the City of Reading Police Department, Pennsylvania State Police and Drug Enforcement Administration teamed up and launched an investigation. During the investigation, detectives identified an organization distributing large quantities of heroin, including the sources of the tainted heroin. They identified Aurelio Xarrazana Sanchez, who resides at 119 N. 3rd Street, Reading, PA, as the main outlet for the organization in Berks County.
14
THE RESPONSE // SUMMER 2022
As the investigation progressed, other suspects were developed which revealed a drug smuggling network that reached surrounding out of state sources. Detectives utilized a court authorized wiretap as the primary tool in the investigation. The wiretap began in December of 2021 and detectives monitored the criminal activity being conducted for approximately a twomonth period. Detectives identified twenty-three suspects that were active members of the organization and seven locations in Berks County that were utilized as points of distribution. As a result, search warrants were served, and numerous suspects were taken into custody. The following items were seized; a substantial amount of controlled substances with a street value of approximately $500,000, three firearms and a large amount of U.S. Currency believed to be the proceeds from drug sales. This drug ring stretched to the Bronx, New York. Twenty-three people were arrested in Berks County and three of the main suppliers were arrested in the Bronx because of this wiretap investigation. The fight continues. This successful investigation was the direct result of the first mass overdose that occurred in this County. The lesson to be learned is that law enforcement will not rest. We will continue to look to identify the source of these drugs no matter where that will lead us. And we will hold accountable those that are the cause of the opioid epidemic that too often has tragic consequences in our community. What we have learned from these tragic cases is that we cannot let our pedal off the gas. We need to chase down, identify, and arrest those responsible for spreading this poison in our community. We need to continue to treat those with addictions and continue to emphasize treatment because treatment works. While we need to combat the supply chain by arresting the sources or the seller of the poison, we also need to address the buyer so that they will not succumb to the tragic consequences that drugs can bring not only to the user themself but to the family and loved ones who are affected when a life is lost at a young age because of the tragic consequences of the opioid epidemic.
NEW DIRECTIONS TREATMENT SERVICES Empowering People to Make Lasting Changes NDTS offers outpatient services to help people recover from mental health or substance use disorders.
Outpatient MedicationAssisted Treatment Methadone & Buprenorphine Psychiatric Outpatient Clinic Medication Management Individual, Family & Group Therapy Referral Services
FULL-TIME PROFESSIONAL AND SUPPORT STAFF FLUENT IN SPANISH AND ENGLISH.
For more information and to schedule an appointment
610-750-6130
832 North Park Road, 1 Park Plaza Wyomissing, PA 19610 Monday – Friday 8 a.m. to 5 p.m. Contact us at
www.NDTS.org
NDTS is a private 501(c)(3) non-profit company that has been providing service since 1980. 15
FEATURE
Blooms in Berks County By Brian Kammerer, CRS
I
t was a bitterly cold, dreary, and overcast morning. Christmas trees, which were once the proud and majestic symbol of the holiday season, were now abandoned in the gutter, clinging to scraps of tinsel and garland. A few days earlier, a Birdsboro police officer had saved a young man’s life by administering Narcan and reversing the effects of an opioid overdose. I left my home and drove to meet Chief Todd Trupp of the Birdsboro Police Department to conduct the very first Blue CARES visit. Blue CARES (Cops Assisting Recovery Engagement and Support) is a collaborative “Community Policing Program” between Berks County law enforcement officers and the Council on Chemical Abuse. When a Berks County police officer uses Narcan (naloxone) to reverse an opioid overdose, the officer can then follow through with a referral to Blue CARES.
16
THE RESPONSE // SUMMER 2022
The uniformed officer and a Certified Recovery Specialist (CRS) conduct a joint visit to the overdose survivor’s home in the hope of connecting with the individual and offering access to treatment services. There is also an opportunity to engage with family members and provide them with information, support, and access to resources. During the first three years of this program, I have participated in over 400 Blue CARES visits. People often ask if the program is successful and my answer is always a resounding YES. There are many ways to measure success. Each visit has been unique in its own way; some have been heartbreaking while some have been truly inspirational. I will share some of my experiences and invite you to determine where the successes can be found. The overdose survivor was an eighteen-year-old white male student who overdosed at a local college. Chief Stinsky and
not know how to help her daughter. We provided her with information about family support groups and addiction education groups. She seemed relieved to hear us validate her suspicion that she needed recovery too. I believe that police officers empathetically supporting the family members of people with substance use disorder is a key component of the Blue CARES movement. And I believe that a mother learning that she did not cause her daughter’s disease, nor can she control it or cure it, but that she too deserves to recover, is another success.
I went on a Blue CARES visit to the overdose survivor’s home. When we knocked on the door, no one answered although we thought someone might be home. Therefore, we left behind a package of information and a letter describing who we were and why we came to visit. An hour later Chief Stinsky received a phone call from the young man, who thanked him for caring enough to come out and check on him. This was a kid who, involved in a subculture of drug use, probably never would have chosen to call and speak with a cop before, but he wanted to let the Chief know that he was getting help from a local therapist. I believe that breaking down barriers between people with a substance use disorder and the local police who protect and serve them is a huge success. A middle-aged woman, fearing the worst, met us at the side door of her home. She told Corporal Coe that her daughter had already gone into treatment following the incident a few days earlier. Through teary eyes, she described the hopelessness and powerlessness that only a mother of a person struggling with substance use disorder can understand. Mom said that she could see it coming, but could not do anything to stop it, and she did
Officer Homm of Exeter Police Department saved a 22-year-old man’s life from an opioid overdose on a Saturday night. On Tuesday morning, Officer Homm and I knocked on the young man’s door. A frail and proud woman invited us in without hesitation, and called for her grandson to come downstairs. When I explained to the family that this officer had responded to the call on Saturday, a wave of emotion came over the room. Gratitude and hugs flowed as freely as the coffee. The young man was enthusiastic to share his renewed commitment to recovery following his overdose. As we were leaving, in the parking lot, Officer Homm thanked me for the Blue CARES program. He told me that he normally only sees people with substance use disorders at their worst, in moments of crisis, and that law enforcement does not get to see or hear about the successes of recovery often enough. It is easy to become calloused, and it is too easy to think of people with substance used disorders only as criminals, and to forget that they are sons, daughters, mothers, fathers, and grandchildren fighting for their lives. I believe that keeping hope alive for our blue guardians that recovery happens is another far reaching success. Chief Kevin Rudy of the Penn State Police Department agreed to visit an overdose survivor with me. As we drove through the rolling hills of Berks County, the trees were waking up from their long slumber, and birds were singing a joyful song of warmer days to come. We met a nurse and her two teenage daughters at their home, where the other member of their family had overdosed two days earlier. Luckily, a police officer on the scene was equipped with naloxone that enabled him to save the man’s life. Her husband was already getting help at a local treatment center, but we heard the story of how he had been found by their daughters in the basement in the early stages of an overdose. He had begged them not to call for help, fearing judgement from neighbors or criminal charges from law enforcement that might Continued on the next page 17
FEATURE
Sgt. William Pletcher - American Red Cross Berks County Law Enforcement Hero 2022 Sgt. Pletcher participated in 147 Blue CARES visits between May 16 2021 and May 16 2022. Photo courtesy of WFMZ TV 69 News
Enjoy Live Music! Saturday, September 24, 2022 1:00-4:00 PM Soberstock is an annual free festival held at the beautiful Easy Does It Inc. campus at 1300 Hilltop Road in Leesport, PA Join us for the day to celebrate recovery in our community and to spread awareness of available services for both individuals and families seeking treatment and/or recovery.
MORE BANDS TO BE ANNOUNCED!
Check our Soberstock page for more information and updates!
easydoesitinc.org/events/soberstock 18
THE RESPONSE // SUMMER 2022
result in more problems for his family. Shame and humiliation is a life-threatening barrier to people who need help, and an unfortunate side effect caused by the stigma of substance use disorder. I could almost see the weight lifting off her shoulders as she told her story, perhaps for the first time. I shared a little of my own story, assuring her that recovery is possible and how we understand that addiction can affect any family. We were also able to alleviate some of the legal concerns and reassure her that the police were a friend in the community with her family’s best interest in mind. I believe that a police officer taking some time to listen to a story that someone has been too embarrassed to share may make all the difference. Historically, people with substance use disorders have been viewed as criminals with a lack of self-control. These views contribute to stigma that can push people to the outskirts of society and cause their family to lose touch with the community. As a result, these individuals and families can experience profound isolation and depression. Berks County law enforcement understands that treating people with a substance use disorder and their families with dignity and respect reduces that stigma. It has been incredible to witness the kindness and compassion displayed by law enforcement during Blue CARES visits. Each visit offers the potential to save someone’s life or to at least change someone’s perspective, and if that is not success, then I don’t know what is.
FEATURE
The Warm Hand-off Program: A Life-saving Connection to Recovery By Marcia Goodman-Hinnershitz, MSW
T
he genesis for the Warm Hand-off (WHO) Program emerged due a need to immediately connect overdose survivors to drug and alcohol treatment services. The goal of the WHO program is to provide treatment intervention to individuals entering the hospital with substance use disorders. The Berks County WHO program began as a collaboration between the two county hospitals (Reading Hospital-Tower Health and Penn State Health St. Joseph’s Medical Center), the Council on Chemical Abuse (COCA)and Treatment Access and Services Center (TASC). The leadership of Dr. Barbera at Reading Hospital-Tower Health and George J. Vogel, retired COCA Executive Director, led the way to move forward with an innovative approach to intervention. Due to the volume of overdose patients served by Reading Hospital, Dr. Barbera championed the importance of having on-site access to drug
20
THE RESPONSE // SUMMER 2022
and alcohol services. Penn State Health St. Joseph’s Medical Center choose to refer to the WHO program on an as-needed basis but has not seen the need for hospital-based services. All parties recognized the immediacy of the overdose crisis. The WHO program held the best hope to pro-actively address this health emergency. The guiding principle of the WHO program is that individuals receiving medical treatment for an opioid overdose at the hospital emergency department should receive the needed drug and alcohol interventions and treatment referrals. The goal of the WHO Program was to ensure that the overdose survivor is seen by a Certified Recovery Specialist (CRS) before discharge. According to Dr. Charles Barbera, CEO of the Reading Hospital, “We weren’t giving our opioid overdose patients
treated in the Emergency Care Unit (ECU) the same level of care as other patients.” For instance, if a patient had a stroke or trauma, the ECU physician calls a “code” signaling patient needs to be seen by the appropriate medical specialist. However, until the initiation of WHO services, an overdose patient would be treated for the physical condition and then released. Although the patient was given information regarding drug and alcohol services, it was rare that the patient followed through upon discharge from the emergency department.
Berks County Warm Hand-Off Program 1500
1228
1067
1200
Referrals
Referrals
1086
Referrals
876
Referrals
900 562
Referrals
600 300
143
Referrals
0
2016 2017 2018 2019 2020 2021 When the WHO program was first initiated at the Reading HospitalAn average of 57% of the patients referred to the WHO Program accepted treatment. The number of patients referred to the WHO Program Tower Health, the CRS was on decreased in 2020 and 2021 during the COVID19 pandemic. call and not onsite, resulting in a time lag in connecting with the The integration of the WHO program into an oftentimes patient. If the patient decided to leave before a CRS visit, a overburdened ECU setting required careful planning and valuable opportunity for intervention was missed. To address teambuilding. The on-going success of the WHO program, this barrier to service, COCA, together with Reading Hospital however, can be largely attributed to the commitment and ECU administration, made the decision to have the CRS staff perseverance of the TASC CRS assigned to the hospital and the onsite at the ECU. By embedding the CRS staff 24/7 in the Reading Hospital ECU medical staff. The shared responsibility ECU, the patient would receive vital drug and alcohol services of guiding struggling individuals to vital drug and alcohol before discharge. If deemed appropriate, the CRS may refer resources reflects the core belief substance use disorders are a the patient directly to an in-patient drug and alcohol treatment medical condition that must be addressed with the focus on facility with the CRS coordinating the referral and admission. treatment and recovery. Dr. Barbera attributed the success to the WHO program to the integration of CRS services in the emergency department. The perspectives of the CRS staff provide insight into how “Once we initiated 24/7 onsite CRS services, we saw 66% to a foundation for success was established during the early 75% of the patients being connected to treatment compared to stages of the WHO program. John Janiszewski, WHO 10%-20% before onsite services were put in place.” Program Supervisor and the first TASC CRS assigned to the WHO program, has always been persistent in building Originally designed to provide intervention to opioid overdose trusting relationships with the medical staff through informal survivors, in 2017 the WHO program at Reading Hospital education and dialog. These interactions helped to overcome was expanded to include any individual showing signs of a stigmatizing beliefs regarding the patient’s substance use. Once substance use. According to Dr. Barbera, alcohol is still the the nursing staff learned that the CRS could be an invaluable number one drug seen in the Reading Hospital ECU. The asset when treating patients with a substance use issue, the inclusion of a broader reach of WHO services to these patients CRS was consulted more frequently, evidentially becoming a has evidenced that 50% of the clients served report heroin/ vital part of the ECU team. Mr. Janisczewski reflected on the opioids as their primary drug while 31% report alcohol. As flexibility required of the CRS to learn ECU protocol while at drug trends shift, the WHO program will continue to evolve the same time adhering to the confidentiality required in the to ensure that all clients are referred to the appropriate drug provision of drug and alcohol services. With the care of the and alcohol treatment resources. patient remaining a priority, these barriers were overcome, and practical operational protocols were developed. Continued on the next page 21
FEATURE Connecting an individual with a substance use disorder to treatment carries with it a myriad of challenges. Providing these services in an ECU where the patient is experiencing a medical emergency adds greater complexity to the intervention. Christopher Brandt, a TASC CRS, emphasized how he builds rapport with the patient. “Typically, I introduce myself by explaining I am in long-term recovery myself, and I was someone who used and abused drugs and alcohol daily for years.” While Mr. Brandt pointed to his responsibility to gather client information during his initial interaction with the patient, “sometimes I must put the clipboard down first to build trust with them first.” When the CRS establishes trust with the patient and the patient accepts the treatment recommendation, the CRS must navigate other obstacles to ensure the patient makes the transition to the appropriate level of care. If the patient is recommended for residential care, funding must be authorized and transportation must be coordinated. If out-patient care is recommended, a next day appointment to TASC is made and the CRS follows up with the patient.
The best measurement of the success of the WHO program is the fact that ECU patients in Berks County now can be readily connected to drug and alcohol treatment at the time of a substance use related medical crisis. Not all patients are ready to accept the treatment recommendation. However, the WHO intervention is a critical first step in guiding the patient to recovery resources. The patient, rather than continuing the downward spiral of s substance use disorder, now has the opportunity to make a supported transition to drug and alcohol treatment, the beginning of the journey to recovery.
Recovery. Resiliency. Wellness. Community Care, a nonprofit recovery-focused behavioral health managed care organization, manages mental health and substance use disorder services for individuals in Berks County’s HealthChoices program. Our goal is to improve the health and well-being of the communities we serve. We offer substance use disorder services for adults, including: • Withdrawal management • Rehabilitation • Medication-assisted treatment • Certified recovery specialists If you would like more information about services or help with your recovery, call Community Care at 1.866.292.7886.
22
THE RESPONSE // SUMMER 2022
Pledge and receive a FREE non-alcoholic beverage at participating Berks County HERO establishments if you’re the designated driver for your friends and family.
Visit COCABerks.org/HERO to see a list of establishments
23
FEATURE
Berks County Treatment Courts A Bridge to Recovery By Judge M. Theresa Johnson, Berks County Court of Common Pleas
What does the word opportunity mean to you? Merriam-Webster defines opportunity as follows: 1: a favorable juncture of circumstances 2: a good chance for advancement or progress https://www.merriam-webster.com/dictionary/opportunity
T
he Berks County Treatment Court Programs, which include Drug, DUI, Mental Health and Veterans Courts, provide the true definition of opportunity for their participants. The treatment court programs are administered through a collaborative effort between the Berks County Courts, Adult Probation, District Attorney’s Office, Public Defenders Office, Council on Chemical Abuse, Berks Counseling Center, Pennsylvania Counseling Services, Reading YMCA, Berks Connections/Pre-Trial Services and New Directions Treatment Services. Individuals who have found themselves involved in the criminal justice system, because of a substance use disorder, may apply to participate in the Treatment Court programs. However, not all individuals are accepted, as the opportunity to participate is based on the current charge and the applicant’s criminal record. Prior to admission to Treatment Court, individuals complete an application and participate in a risk and needs assessment. The Risk and Needs Triage (RANT) helps to determine their appropriateness for Treatment Court and to begin to assess what services are necessary to help the individual succeed. In addition, the Probation Department administers the Ohio Risk Assessment System: Community Supervision Tool (ORASCST). This tool helps to assess the individual’s risk to reoffend, aids in determining their needs, and will help to identify
24
THE RESPONSE // SUMMER 2022
any barriers that could impact their ability to be successful. Additional programming may be assigned based upon the individual’s needs. Those who are selected for the program are provided with an opportunity to receive services that may have been previously unavailable to them. The program consists of four phases and can take between 18-24 months depending on the individual. During this time individuals participate in group and individual counseling. They attend NA/AA or other supportive meetings. If necessary, they are assigned a Recovery Support Counselor. In addition, they may have the opportunity to participate in the R3 program through Berks Connections/Pre-Trial Services. This program provides cognitive therapy as well as job training skills and coordinates job opportunities for the graduates in the construction trade. For more information, please see www.berksconnections.org. Recently the Treatment Court programs paired with the Penn State Master Gardeners Program and the Opportunity House for the development of community garden beds. The program first began with five garden beds and has extended to twentythree beds that grow vegetables for the participants and the homeless. In 2019 the garden produced over 500 pounds of vegetables. In October 2020, The Penn State Master Gardeners Program received a David Gibby Search for Excellence Award in community service for their involvement. The award recognized the work of the Master Gardeners on a State level. For more information on the program and award please visit https://extension.psu.edu/programs/master-gardener/counties/ berks/news/2020/master-gardeners-of-berks-county-bestoweda-david-gibby-search-for-excellence-award.
So, this opportunity to participate in Treatment Court sounds great, doesn’t it? Easy…all problems addressed and solved…. which leads to the next question…. what does the word trust mean to you? According to Merriam-Webster the word trust is defined as follows: as a noun 1a: assured reliance on the character, ability, strength, or truth of someone or something b: one in which confidence is placed 2a: dependence on something future or contingent : HOPE transitive verb 1a: to rely on the truthfulness or accuracy of: BELIEVE b: to place confidence in; rely on a friend you can trust c: to hope or expect; confidently trusts that the problem will be resolved soon 2a: to commit or place in one’s care or keeping: ENTRUST b: to permit to stay or go or to do something without fear or misgiving 3: to extend credit to intransitive verb 1a: to place confidence : DEPEND b: to be confident: HOPE https://www.merriam-webster.com/dictionary/trust
So, you find yourself in a stressful situation and a group of strangers, who are clearly working together, say to you “hey, I have this great opportunity for you to change your life, change your thinking…just TRUST me.” But why? Why do they want to help you? You are an adult and able to care for yourself and those in your past have not been so great or let you down. Why would now be any different? I have learned over the past eight years of running the Drug Treatment Court Program that trust is an enormous factor for the participants. It takes a while for the participants to trust the process. Some longer than others. But that’s ok… everyone is different and what works for one may not work for another. Our goal is to learn who the individual is, what are their interests, how can we help them to overcome what happened to them in the past and how can we help steer them towards being the best version of themselves. May was National Drug Treatment Court Month. The Berks County Treatment Court celebrated those individuals who have had the courage and strength to participate in this unique opportunity that Berks County offers by putting their trust in the counselors and case managers that have helped them along the way. We congratulate those that have maintained sobriety, are successfully employed, involved with their kids and are now giving back to our community.
Integrated Counseling and Physical Health and Wellness Services serving Adults, Youth and Families. Here are a few of the services we offer: • Outpatient Substance Use Disorder Counseling • Outpatient Mental Health Counseling • Individual and/or group therapy • Medication Assisted Treatment (MAT) • Certified recovery/peer specialists • Physical health and wellness services • Genoa Pharmacy on site (for both you and your family)
Dr. Netaji -
MAT Specialist Dr. Netaji, is board certified in Addiction Medicine and specializes in Medication Assisted Treatment (MAT). Dr. Netaji is a caring and compassionate physician who can help you on your road to recovery – always in a judgement-free zone.
A Certified Community Behavioral Health Clinic/Integrated Community Wellness Center
Learn how we can help you or someone you love by calling
610.373.4281
645 Penn Street, 2nd Floor, Reading, PA 19601 • berkscounselingcenter.org 25
FEATURE
The Changing Landscape of Prescribing in Pennsylvania A Pharmacist’s Perspective By Erik Esterbrook, RPh
A
mandatory. By calling and verifying a prescription, you could figure out pretty quickly if the script was indeed a legitimate one.
s a pharmacist in Berks County since 1998, I have seen the fluctuating nature of opioid prescriptions first-hand. The Prescription Drug Monitoring Program, defined by the CDC as “an electronic database that tracks controlled substance prescriptions in a state (source: www.cdc.gov/drugoverdose/pdmp/index.html),” has been a game-changing tool for pharmacists and opioid prescribers. Before electronic prescriptions and before the PDMP was available, the procedure that pharmacists employed when filling opioid prescriptions was to use the only resource we had available: the telephone.
One loophole with that process was prescriptions from the accurately if somewhat comically named “pill mills.” Pill mills can be defined as a doctor’s office or clinic that routinely prescribes or dispenses controlled substances without a medical necessity. The office staff of the pill mills would be trained to confirm all prescriptions. Due to the astronomical profits, the pill mill industry has flourished across the United States with significant law enforcement efforts targeted to this illegal practice. In Berks County, arrests continue to be made – in January 2019, an investigation revealed pill mill operators in Exeter Township, Berks County, illegally obtained at least 6,218 doses of opioid pills for street sales, with an estimated value of approximately $125,000.
When we received a new opioid prescription, we would call the prescriber to verify all of the information we were given. Most importantly, we would make sure that the prescriber actually wrote the prescription; that it was not a forgery. Unfortunately, forged prescriptions were much easier to pull off before electronic prescriptions for controlled drugs became
Number of Prescrip�ons Dispensed in Berks County Opioids Benzodiazepines S�mulants
222,084 200,974 180,415 160,099
163,558 141,750
81,021
2017
159,811
151,929
83,840
2018
85,875
2019
134,524
83,027
2020
127,741
85,363
2021
Source: Pennsylvania Office of Drug Surveillance and Misuse Preven�on 26
THE RESPONSE // SUMMER 2022
Berks County Prescrip�on Drop Boxes 12,000
POUNDS (LB.)
10,000 8,000 6,000 4,000 2,000 0
2016
2017
2018
2019
2020
2021 Approx. 638 Pills = 1 LB.
The pill mill type of prescription often made it much harder for me as a pharmacist when I had a “gut feeling” that something was amiss. If I refused to fill a script for a patient because I had the conviction that it was being misused, that patient could simply get a new script…and walk into one of the other 58 pharmacies in Berks County to try their luck there. With the backing of the prescriber’s office, it was difficult to prove misuse…and, unfortunately, misuse was a common occurrence. Another way that opioid prescriptions have been commonly misused is a process that we call “Doctor shopping.” Prospective patients could obtain an opioid prescription from their primary care physician for one medical issue, then go to the Emergency Room claiming a new ailment…and get another opioid prescription. If they would take the Emergency Room script to a different pharmacy from the one that had filled the original script from their primary care physician, there would be no way for the pharmacist to tell that the patient had an opioid script filled two days ago. Before the use of a PDMP, this was an all-too-common issue. The first few months that the Pennsylvania PDMP was up and running was extremely eye-opening for both prescribers and pharmacists. It was shocking to see those customers you would never expect–that you trusted–were receiving multiple opioid prescriptions from two or more prescribers, that were being filled at different pharmacies. There were many difficult conversations those first few months, and I recall personally handing out the phone number for Caron and the Reading Hospital treatment facilities. The Pennsylvania PDMP is an invaluable tool and has made an enormous difference in the prescribing of opioids. As a pharmacist I recognize that I play an important role in protecting the health of my customers and can make a difference when responding to an opioid prescription.
Inperium, Inc., a 501(c)(3) & 509(a)
Apis Services, Inc. (a wholly-owned
(3), offers approaches that facilitate
subsidiary of Inperium, Inc.) provides
access to business & professional shared
a progressive platform for delivering
services allowing organizations to focus
Shared Services to Inperium and its
on the advancement and sustainability
Constellation of affiliate companies.
of their missions through affiliation as
Delivering cost effective, general and
an alternative to traditional mergers.
administrative services in Human
Inperium’s multi-state network includes
Resources, Finance and Information
non-profits/for-profits providing person-
Technology to the Constellation allows
centric health related supports & other
the affiliated group of companies to
business services to the organizations it
focus their daily time and energy on
aids. We support the affiliated companies
improving their operational missions.
to foster an array of quality services, financial diversity & continuity of care by maximizing all of our collective resources. We are Affiliation Architects using a network of entrepreneurial organizations, talent, systems & orchestration to benefit missions & communities.
Inperium is a Pennsylvania non-profit corporation headquartered in Reading, PA. Inperium is the sole member of non-profit agencies that provide substance abuse, mental health, intellectual disability, and other health-related supports and services.
To learn more about business combinations and employment opportunities with Inperium & Apis visit our websites www.inperium.org or www.apismgt.org
135 North Prospect Street, Reading, PA 19606 Phone: (888) 270-5753 | Website: www.inperium.org
27
FEATURE
n i a P n e k o The Unsp
By Yvonne Stroman, MA, CRS
“Pain is inevitable; suffering is optional.” —Buddhist proverb
E
veryone would agree, pain is part of life. As people we experience it on multiple levels – physically, emotional, and spiritually. We lose jobs, homes, and loved ones. We get sick. We break bones. This is life and it hurts. But it does not have to rule our lives. Suffering is not part of life. We do it to ourselves. Unfortunately, our attempts to manage pain often turn it into suffering instead of relief. We are not necessarily given tools to manage pain. If you have physical pain, the remedy is to take medication – a substance that is taken into or placed on the body to cure a disease or condition. For example, antibiotics are given to cure an infection. Others view medication as a substance used for medical treatment. Whether prescribed by a doctor or purchased over the counter, medications can be used as a single dose or used for a period of time. In many instances, when used as prescribed, the medication works; pain is relieved, and suffering is no more.
28
THE RESPONSE // SUMMER 2022
Published in 2018, Dopesick is a definitive account of the opioid epidemic that charts this devastating crisis in America. Last year, HULU released an eight episode series based on this nonfiction book Dopesick: Dealers, Doctors and the Drug Company that Addicted America by Beth Macy. The series focuses on America’s struggle with the opioid addiction and its impact on individuals, families, and communities. And while the series focuses on a small town in the State of Virginia, it is a small representation of what has happened and continues to happen in every corner of America. Physical pain as a motivator for use of prescriptions, which when taken properly can resolve ailments. But beyond its “use as directed,” pain medications can be mis-used, leading to abuse, addiction, and in some instances death. The stories depicted on the miniseries
included: a worker in the coal mines who injured her back; the family physician who was involved in a car accident; the high school student who enjoyed being the life of the party; and the secretary who was faced with exposing her boss for lying to the public about the potential abuse for oxycontin when she was involved in a car accident and used Oxycontin for pain relief. The narratives depicted in the mini-series are similar to countless of thousands of individuals in real life who seek to be free of physical pain. What’s more, innocently, the enablers who supplied and/or endorsed the cure for physical pain were front and center. The leaders of Purdue Pharma had a desire to help individuals reduce or eradicate their pain. The research teams, physicians and sale people were delivered a strong message, “Oxycontin will take the pain away.” Backed by a stamp of approval from the Federal Drug Administration (FDA), Oxycontin quickly became available in milligrams of 10, 20, 40 and up. The number of milligrams was directly proportioned to the pain scale – the greater the pain, a greater the number of milligrams of the drug would be prescribed. Little is mentioned in the mini-series about the warning label. You know, like the warning label on a cigarette pack that says, “may be dangerous to your health”? Where appropriate prescription labels may warn, “not to be taken with alcohol,” but no mention that the product can become habit forming and lead to addiction. For the first time, last year, the Center for Disease Control stated there were over 100,000 overdose deaths due to opioids!! When you put that into perspective, 100,000 people would equal everyone who lives in the City of Reading! Everyone!! Somehow, we have got to do better. In 1988, when I entered addiction treatment for the first time, I remember my counselor saying to me, “what hurts you?” Very puzzled by the question, I looked at my hands and feel; rubbed my legs and replied, “Nothing.” My counselor looked at me and simply said, “Talk about what hurts you.” He planted a question in my mind that would take me some time to figure out. I was too scared to ask what he meant for fear of looking and sounding naïve, but today, I understand. The fact is, there are two levels of pain – physical and emotional. Physical pain we are oftentimes willing to confront. We want to feel better. So much so that the medication we take is charged with ensuring we feel better. And if one pill will make us feel good, three or four will makes us feel great! Emotional pain can be a little bit more difficult. The acknowledgment of emotional pain takes a little longer; if at all. But our emotional pain can be at the base of our physical pain. The desire to be heard, to be seen, to be supported, to belong, to be affirmed, to be celebrated, to be loved, and to be appreciated. At the core of who we are is emotions and feelings. When our
emotional selves are not validated, there is the tendency to turn to something that will. It is the unspoken pain that gets a false nourishment, through use of substances, like Oxycontin or other behaviors, so that we can feel better. The switch in our brain says. “Yes, this is the cure for your pain and do more of the drugs.” The more we push down the emotional pain, the greater the activity of using. Ultimately, we use to live and live to use. According to George F. Koob, Director of the National institute on Alcohol Abuse and Alcoholism, emotions are “feeling” states and classic physiological emotive responses that are interpreted based on the history of the organism and the context. How we feel about ourselves dictates our attitudes and perceptions of how we feel others see us. In many cases our emotional pain affects our mental stability and can lead to physical ailments. As a result, the physical pain is acknowledged and treated while the emotional pain is left untreated. Holding onto and facing emotional pain can be challenging for anyone. Without the support and tools to learn how to process emotional pain, feelings and perceptions can become difficult to acknowledge and/or manage. Spiritual well-being is the opposite of emotional pain and practicing it can address emotional blockages. Negative emotional states drive negative reinforcement. Positive emotional states drive positive reinforcement. “Act better than you feel” can be a good example of emotional wellness and what may be needed to begin healing emotional pain. Emotional pain and spiritual well-being influence one another and can overlap which makes having a connection to something greater than yourself the best way to begin the emotional healing process. We owe it to ourselves to give our emotional pain the attention it deserves. Dopesick portrays the dangerous journey we can face if pain is not resolved in a safe and medically sound manner.
Pain is inevitable. How we handle our pain determines the gravity of our suffering. We can and do recover.
29
FEATURE
Berks County to receive $16.3 million from nationwide opioid settlement by David Kostival
W
ith a national opioid overdose crisis raging out of control for more than 20 years, it was almost inevitable that pharmaceutical companies and drug distributors would eventually be forced to take responsibility. A landmark $26 billion settlement agreement was recently reached between the National Prescription Opiate Litigation Plaintiff’s Executive Committee and the three big drug distributors – McKesson Corporation, Cardinal Health, Inc. and AmeriSource Bergen Corporation – as well as opioid manufacturer Johnson & Johnson. The settlement is the first of its kind which will distribute funds directly to the state and local municipalities specifically for opioid relief programs. The agreement reached calls for Johnson and Johnson to pay $5 billion over 9 years and prohibits the company from manufacturing or selling opioids for 10 years. The three drug distributors will pay $21 billion over 18 years. Thousands of local governments will benefit from the settlement, which requires distributed funds to be used primarily for opioid remediation, and not restitution. The settlement came because of years of advocacy from the Plaintiff’s Executive Community (PEC), working on behalf of more than 3,300 community clients.
30
THE RESPONSE // SUMMER 2022
The PEC negotiation team issued the following statement: “We arrived at this moment after years of work by community leaders across the country who committed themselves to seeking funds they need to combat the opioid epidemic. The bottom line from this news is that help is on the way for first responders and healthcare workers on the front lines of this public health crisis. While nothing can truly make whole what was lost in this country, what we can do is ensure that thousands of communities nationwide have the tools they need to prevent the opioid epidemic from taking more lives.” The Pennsylvania settlement amount is $1,070,609,642, which is being distributed among the Pennsylvania counties which opted to join in the agreement negotiated by state Attorney General Josh Shapiro. On March 29, Berks County held a press conference to announce the county will receive more than $16.3 million over the next 20 years. County officials have stressed that the settlement funds are meant for opioid abatement efforts and are not a windfall for the county coffers. The funds cannot be put into the general fund to pay expenses or wages. The funds coming to Berks County will be managed by the Council on Chemical Abuse (COCA). COCA Executive Director Stanley Papademetriou told the county commissioners that a strategy for using the funds is being developed. “While the settlement offers some guidance, we think we have come up with a good strategy,” he said. Papademetriou added that the plan will be reviewed and updated every year to be certain COCA is making the best use of the funds. He also told the commissioners that the opioid crisis is not just a city problem and called it a community problem. “The funds should be used to provide services to every part of the community in a dignified and equitable manner,” Papademetriou said.
The settlement identifies approved abatement uses, which include: • Providing treatment of opioid use and co-occurring disorders • Supporting people in treatment and recovery • Providing connections to care • Supporting criminal justice involved persons • Addressing needs of pregnant or parenting women, including babies with neonatal abstinence syndrome • Preventing misuse of opioids • Ensuring the appropriate prescribing of opioids • Preventing deaths/providing harm reduction • Supporting first responders • Supporting leadership and planning coordination • Training • Research County Commissioner Kevin Barnhardt said the settlement has been a long time coming and that the money will be a tremendous value to the community. The next issue will feature an article written by Berks County’s First Assistant Solicitor, Cody Kauffman, regarding the proposed nationwide opioid settlement agreements with pharmaceutical distributors McKesson, Cardinal Health, & AmerisourceBergen and manufacturer Janssen Pharmaceuticals, Inc. The article will provide background on the opioid settlements and will discuss the potential impact of the settlements on Berks County. The article will further highlight how the settlement funds will be administered, what the funds can be used for, and when the funds are expected to be received by the County.
Berks County Commissioner Christian Y. Leinbach praised COCA for developing relationships with a variety of partners. “I don’t think there is any other entity, including the county commissioners, who could better administer these dollars,” Leinbach said.
31
TODAY THERE’S
HOPE for affordable and accessible life-saving treatment.
Hoy hay esperanza para un tratamiento a bajo costo y accesible que salve vidas When it comes to addiction, every second counts.
Cuando se trata de adicción, cada segundo cuenta.
Today, there’s hope for saving a life with
Hoy, existe la esperanza de salvar una vida con
NARCAN®. Berks County residents have
NARCAN®. Los residentes del condado de Berks
access to free NARCAN® opioid overdose reversal kits.
There’s hope for recovery, too. Residents have access to safe, affordable, and accessible drug and alcohol treatment options right here in Berks. Virtual telehealth options are also available.
tienen acceso a kits gratuitos de reversión de sobredosis de opioides NARCAN®.
También hay esperanza de recuperación. Los residentes tienen acceso a opciones de tratamiento de drogas y alcohol seguras, asequibles y accesibles aquí mismo en Berks. También se encuentran disponibles opciones de telesalud virtual.
Paid for with PA taxpayer dollars.
To order a Narcan® kit, find treatment, and learn more, visit cocaberks.org/HOPE. Para pedir un kit Narcan®, buscar tratamiento y obtener más información, visite cocaberks.org/HOPE.
