Mayors Office Opioid Task Force Report Reactions

Suggestion 1: Conduct a consumer directed media campaign about Opioid risks.

The City should implement a comprehensive, consumer-directed media campaign about
the dangers of opioids, which addresses specific populations along the developmental
life course (adolescents, young adults, adults, parents) and reflects the diversity of
Philadelphia. The campaign should educate consumers about other ways to treat pain. It
should also be available in multiple languages.
I was originally skeptical regarding the consumer-directed media campaign portion of
this recommendation, however, after reading that many Doctors prescribe opioids to people with
acute or chronic, but not life threatening, pain, I now agree that it is an important step to take.
That Doctors may be prescribing dangerously addictive substances to the public despite the fact
that the masses may not be aware of the dangers of opioids is both reckless and irresponsible. I
believe that creating a campaign to inform citizens that the opioids their doctors may prescribe
to them are very addictive, and, in some circumstances, deadly, will help to slowly inform the
general public of the risks they take when using opioids for non-cancer, pain related issues. I
also agree that informing the public of other, non-opioid, methods of pain treatment is a
worthwhile goal to pursue.

Suggestion 2: Conduct a public education campaign about naloxone. The City

should launch a citywide public education campaign to increase knowledge, use, and
access to naloxone, including awareness of legal protections (Good Samaritan law),
awareness of statewide medical standing order, and availability of naloxone through
various venues. The campaign should also be available in multiple languages.
If naloxone is an effective tool for treating opioid overdoses, its uses, and the fact that
any Pennsylvanian can gain access to it from a pharmacy prescription-free, should certainly be
heralded throughout the city. If the best way to inform others about this is through a
public-education campaign, then I believe that a city-wide public education campaign should
be held.

Suggestion 3: Destigmatize opioid use disorder and its treatment. The City should
conduct public education to raise awareness about opioid use disorder as a chronic
medical condition and to reduce the stigma of treatment for opioid use disorder. This
effort should recognize it as affecting everyone in Philadelphia, and use existing
programs and people with lived experiences to conduct individual and family education
in multiple languages and targeted at specific populations. Because stigma is a major
barrier to siting new services, the City should also partner with City Council, civic
groups, and neighborhoods to plan for new treatment programs and recovery support
services in key areas.
I agree that we as a society need to stop viewing those who abuse drugs as junkies or
addicts, and view them as those who are afflicted with a terrible disease. I believe that if the
public is reconditioned to view those afflicted by the opioid crisis as victims, not as bad people,
and that the crisis affects everyone in the city, they will be much more receptive to positive
treatment options rather than criminalization/ callous indifference towards the situation.
 Suggestion 4: Improve health care professional education. Health care professional
schools and provider organizations should require and have standards for broad,
interdisciplinary competency-based training for all levels of health care professionals on
pain, pain management and substance use disorder, and support evidence-based
approaches that change behavior of doctors and other prescribers when combined with
education, including prescriber detailing, outreach programs, and tailored small group
learning. The City should continue to convene professional schools and provider
organizations to discuss these efforts and encourage them to share their curricula on
pain, pain management, and addiction.
That doctors/physicians are not fully aware of the total effects that opioids may have on
individuals, which is to say, effects that are separate from overdose and substance use
disorder, is frightening, and compounding that with the fact that doctors may overprescribe
creates a truly dangerous situation for many Philadelphians. It is imperative that doctors/ any
professional who may prescribe opioids is fully aware of the risks associated with them, and that
established clinicians move further to evidenced-based prescribing techniques. I do believe,
though, that more resources should be spent elsewhere before educating professionals who do
not have the ability to prescribe opioids.

Suggestion 5: Establish insurance policies that support safer opioid prescribing

and appropriate treatment. Public and private insurers should 1) require prior
authorizations for opioid prescriptions; 2) increase access to alternative pain treatments;
3) make all FDA-approved medications in addiction treatment readily accessible; and 4)
improve coordination of care by reducing the separation between physical and mental
health services.
This is the section I have understood the least so far, so bear with me. I believe that if
insurance companies, by requiring prior authorizations of opioid prescriptions, can lower the
amount of opioids prescribed by doctors, then it may be a very good idea to do so. I also agree
that the lowering of insurance barriers for medication-assisted treatment can help more people
get treatment, and can also introduce alternative pain treatments to patients. It would also be a
good idea for insurance companies to develop disease management programs in order to
increase the rate of identification for opioid use disorder. I am wary that insurance companies
will be willing to implement these changes, however, it would cause positive change in the
community should they decide to do so.

Suggestion 6: Increase the provision of medication assisted treatment. The City

and substance use disorder treatment provider organizations should vigorously continue
its efforts to increase the provision of medication-assisted treatment (MAT) in all forms
as standard practice, and facilitate referral and/or provision of MAT at multiple sites
including emergency departments, halfway houses, outpatient practices, residential
treatment facilities, psychiatric facilities, medical facilities, primary care sites and
prisons. All consumers should be offered all options of treatment available to them,
including all FDA-approved versions of MAT. Treatment programs should introduce
these agents and offer both agonist and antagonist medications, within the treatment
program. Integrating MAT into all treatment settings will ease patients burden of
navigating the complex treatment system. All regulatory barriers to the use of MAT
should be identified and reduced.
Medication assisted treatment is clearly an effective tool at combating opioid addictions,
so any attempts to increase the provision of it should be heavily considered, especially in places
where those who are battling addiction are heavily concentrated (halfway-houses, primary care
sites, etc.). I agree that anyone struggling with opioid addiction should be given access to MAT,
so this sounds like
Suggestion 7: E xpand treatment acca solid suggestion to me.
CALL LAW DEPARTMENTess and capacity. The City should 1) increase the number of sites in
the city offering addiction treatment services; 2) expand weekend and evening operations for facilities at
multiple levels of care; 3) identify gaps in substance use disorder treatment capacity for special populations
and increase capacity of treatment slots and providers to engage these populations at all levels of care; 4)
partner with the state to resolve identification issues that are barriers to accessing treatment; 5) create a
web-based database for the general public and provider access to identify available treatment slots in real
time; 6) integrate information on how to access treatment into public education campaigns; 7) expand the
capacity of crisis centers and emergency departments in Philadelphia to assess and treat individuals with
opioid use disorder; 8) improve the quality of assessments for individuals entering treatment by adopting
ASAM Criteria; and 9) increase the use of peer recovery specialists to support individuals in their recovery
throughout behavioral health and medical settings.
In principle, I agree with all of the listed suggestions that are written under suggestion 7.
I believe that there should be more sites where those who need treatment can get it, and that
there should be more opportunities for those who need treatment to visit facilities that can offer
them care. It is also incredibly disheartening to learn that the treatment gap is massive, and that
many people who need treatment do not have any access to it, and all necessary steps should
be taken to remedy that situation. However, Im not sure if some of the goals listed in this step
are logistically reasonable/possible, such as the establishment of a web-based database for the
general public to view available treatment slots. I just think that thats a rather grandiose/ large
scale project that would take a bit to complete, and I also dont know how readily or easily the
state would work to fix identification issues that prevent some from access to treatment. The
adoption of ASAM criteria for the state is a great idea, as it may lead to better treatment options
for many patients. Some good, but possibly difficult to attain, goals in this section.

Suggestion 8: Embed withdrawal management into all levels of care, with an emphasis on recovery
initiation. The City should require all substance use disorder treatment providers at every level of care to
begin offering withdrawal management and place greater emphasis on developing comprehensive treatment
approaches to increase the likelihood of continued engagement in treatment. Individuals who enter
programs for withdrawal management should receive a comprehensive evaluation of potential psychiatric,
medical and psychosocial complications, and informed consent around the evidence base for
medication-assisted treatments (MAT). All individuals should be evaluated for the appropriateness of MAT,
and programs should offer all forms of MAT or be able to link individuals to them. Integrated services within
programs should include treatment of psychiatric disorders since the majority of individuals seeking
treatment for substance use disorders have a co-occurring psychiatric diagnosis. Treatment facilities will
also need to be able to address other substance use disorders that may be comorbid with opioid use
disorder. Psychosocial treatment and engagement of peer supports should be provided as early as possible
to combine other evidenced based practices with MAT.
Detox programs have been shown to be somewhat dangerous recovery options when
compared to MAT, relatively speaking, as detox programs are often independent, lack follow-up,
and dont involve any other recovery options. This contributes to the fact that those who engage
in detox programs are more likely to relapse or succumb to death as a result of an overdose
than those involved in MAT. Therefore, I agree that withdrawal management should begin to
phase out detox programs, because they put an emphasis on recovery and continued treatment
plans. It also makes sense that if withdrawal management options are increased, there will be a
higher number of slots available to those who need said options to help with their addiction.

Suggestion 9: Implement warm handoffs to treatment after overdose. The City should
ensure that people experiencing nonfatal overdoses revived in the field or in emergency
departments have unfettered access to services including dedicated centralized
coordinators, peers, removal of financial/ insurance barriers until services can be
identified, and use of MAT as bridge. Hospitals and behavioral health providers should
create systems and protocols for warm handoffs from emergency departments to
treatment providers. This warm handoff starts with appropriate MAT induction in
emergency departments and a take-home supply of medication.
Warm hand-offs seem like an incredibly smart way to treat non-lethal overdoses. Of
course those who overdose and are then released from the hospital without withdrawal
treatment are likely to overdose again. That is the nature of drug abuse. I agree that hospitals
should strive to provide those who have overdosed with access to treatment/support systems,
though there must be the caveat that those who are given service must request it, and not be
placed in it regardless of want. Also, it seems incredibly sensible that hospitals devise protocol
regarding warm handoffs, especially regarding when to administer medication to those who
have overdosed. It does seem somewhat idealistic to hope that hospitals will be able to supply
overdose victims with a take-home supply of medication, however that would surely aid the
recovery process. This is a step that largely relies on the willingness of hospitals to induce it,
though.

Suggestion 10: Provide safe housing, recovery, and vocational supports. The City should
work with other systems and elected officials to increase safe permanent supportive
housing, recovery houses, vocational support, and recovery support services for
individuals with substance use disorders, eliminate barriers to longer retention at
treatment facilities, and eliminate housing discrimination against individuals enrolled in
medication-assisted treatment and special populations. This expansion should include
support for youth and young adults through recovery high schools and collegiate
recovery infrastructure.
This is another suggestion that, while perfect in theory, is going to be incredibly difficult
to pull off logistically. Safe houses, recovery, and vocational supports to keep addicts off the
street are great ideas to keep those at-risk of relapsing from doing so, but, as the report states,
NIMBY is an incredibly prevalent and powerful belief system, as seen with prior attempts to
house the homeless, that will make members in the community unreceptive, to say the least, to
housing recovering drug addicts. Not mention the fact that the city must first have the funds to
either purchase or restore abandoned housing, and it feels to me that the city would rather
spend for other things before buying up housing.

Suggestion 11: Incentivize providers to enhance the quality of substance use disorder
screening, treatment, and workforce. The City should develop strategies to 1) increase
capacity and competency of non-substance use disorder (SUD) professionals in health
care and other social services to identify SUDs and work with them and 2) incentivize
qualified staff to work in the SUD workforce using the most current and supported
evidence-based practices and requiring continuing education: a) incentivize a
specialization in SUD Treatment, b) develop a standardized, uniformed, and mandatory
training that will increase effectiveness across all SUD treatment providers, c)
incorporate holistic offerings and alternative therapies into the scope of SUD treatment,
d) develop city-wide standard rigorous training for certified recovery specialists and
certified peer specialists and incorporate peers across private and public systems.
I believe that it would be a smart idea to incentivize and train non-substance use
disorder professionals to be able to identify SUDs, as it would increase the number of
competent officials who can identify and treat substance use disorder. I also think that work
should be done in order to increase the number of able SUD professionals, and that training
should in fact become more stringent to help those who are already in the workforce become
more efficient at their jobs, and to help those who are entering the workforce deal with SUDs
more easily. It is also a good idea to incorporate alternate treatment options for those who are
struggling with SUDs, as having many options to treat them may make recovery time for some
patients shorter than it may be with MATs.

Suggestion 12: Expand naloxone availablity. The City should develop a strategic plan to
make naloxone readily available to reverse opioid overdoses. The plan should engage
governmental agencies, community-based organizations, health care providers,
pharmacies, and private citizens who may know individuals using opioids. The plan
should prioritize supporting naloxone programs and activities that have the greatest
likelihood of achieving overdose reversals.
As has been stated before, naloxone is the best option to reverse lethal overdoses, and
as such, its uses should be disseminated throughout the public and it should certainly be made
easily accessible to said public. I also think that having four separate arms to distribute
naloxone is a solid idea, because it gives people more opportunities to use it, especially if its
given out for free at pharmacies. It als goes without saying that those who oversee the
distribution of naloxone should also receive training in order to gain familiarity with the drug and
its uses. This I, of course, agree with. I do think that it may be difficult for the city to purchase
naloxone using their own personal funds (they may be unwilling), so the thought that naloxone
should be distributed strategically to those who have a greater chance of dealing with an
overdose victim is intelligent and well-thought out.
Suggestion 13: Further explore comprehensive user engagement site(s). The City and/or
partner organizations should further explore the possibility of implementing one or more
comprehensive user engagement sites (CUES), on a pilot basis, in which essential
services are provided to reduce substance use and fatal overdose (including referral to
treatment and social services, wound care, medically supervised drug consumption, and
access to sterile injection equipment and naloxone) in a walk-in setting.
I believe that the recorded success of SFCs and the theory of safe consumption, as
mentioned in the report, serves the point that the city should attempt to implement one or two
comprehensive user engagement sites, where safe consumption is a possible option, perhaps
only as a test run, to see if they could be as effective as SFCs have been. Of course, these
programs must first be thoroughly vetted to ensure that they are safe for patients and that they
are capable of giving effective care before they can be even set up as pilot programs. Also, a
worrying barrier to this plan is a lack of community engagement, or even active community
opposition, toward these sites (read:NIMBY), like weve seen with methadone clinics at certain
spots in the city.

Suggestion 14: Establish a coordinated rapid response to outbreaks. The City should
develop a strategy for identifying (in real time) and responding to significant surges in
the number of opiate overdoses (outbreaks) in a non-coercive manner. The strategy
should aim to prevent additional overdoses by increasing situational awareness,
improving deployment of resources, and enhanced treatment services.
Prepping the public safety and medical communities to rapidly deal with outbreaks is a
smart strategy. This becomes especially helpful should a new mix of deadly opioids hit the
streets, as these communities will be able to work together in order to figure out the mixture and
source of the drugs, and they will then be able to figure out a solution to the problem. Again,
developing a system such as this falls under the responsibility of the city, so it may be not as
feasible as other suggestions in the list, though it is a very interesting and thoughtful idea.

Suggestion 15: Address homelessness among opioid users. The City should expand
outreach and specialized programs to meet the unique needs of individuals with opioid
use disorder who are homeless, such as the Citys Safe Haven, Journey of Hope, and
Housing First programs.
As the report states, housing programs have been very beneficial at treating both
substance abuse disorder and mental health issues, not to mention at reducing homelessness,
shelter costs, and health care costs. Expanding those who are homeless, and/or those who
struggle with SUDs, access to affordable, or free, housing programs should be a no brainer
when it comes to treating opioid abuse. The issue I see with this, again, is pushback among
community members who do not want to have a development near them that houses recovering
drug users. What could possibly solve this issue is mentioned in suggestion three-
destigmatizing drug addiction and drug users. By opening the minds of people in
rejectivecommunities to the possibilities that free housing may offer to patients, the chance
that this suggestion comes to fruition raises significantly, Id wager.
Suggestion 16: Expand the courts capacity for diversion to treatment. The City should
collaborate with the court system, the District Attorneys office, the Defenders
Association, and treatment providers to expand existing court-sanctioned treatment
programs to increase capacity, including but not limited to Drug Treatment Court and the
Accelerated Misdemeanor Programs.
This is a great idea in terms of treating those who have been arrested for nonviolent
felonies and also have SUDs. Using the drug treatment court, which gives felonies a chance to
avoid jail time and instead receive treatment, is a wonderful option that keeps our prisons from
filling up while at the same time helping those who need it. Accelerated Misdemeanor Programs
(AMPs) also serve a somewhat similar role as treatment courts. They work to expedite the
misdemeanor process by allowing users to get treatment for their addictions rather than having
them get incarcerated for nonviolent offenses. I think this is a good program, and Id be curious
to see the results of such a program in the city (the report has said that these programs were
effective at helping both the health of users and the safety of the public in other cities).

Suggestion 17: Expand enforcement capacity in key areas. Federal, state and local law
enforcement agencies should 1) expand capacity for investigating those who divert
prescription opioids, focusing on pharmaceutical companies and opioid prescription
abuse by registrants, recognizing that there are DEA regulatory sanctions as well as
state and federal criminal penalties that can be levied against registrants involved in the
illicit distribution of prescription opioids; and 2) take action against drug dealers who
prey on people trying to recover at clinics and treatment facilities.
There isnt too much to write on this section. I agree that it would be a good idea for law
enforcement to expand their ability to crack down on those that enable opioid addiction, and
specifically those who take advantage of recovering users at clinics. Of course, this would
require additional funding, and theres always a battle in government when additional spending
is involved.

Suggestion 18: Provide substance use disorder assessment and treatment in Philadelphia
Department of Prisons. The Philadelphia Department of Prisons should provide
substance use disorder assessment to all inmates upon entry and comprehensive
treatment during incarceration, with a continuum of care plan upon release, which
includes a plan to obtain an identification card to facilitate treatment.
This may be one of my favorite suggestions in the entire list. There is so much good that
can come out of having treatment options available to a prison population in which about 60% of
prisoners are drug users. As the report states, treatment during incarceration increases the
likelihood of engagement in treatment post-incarceration and correlates with positive outcomes
such as reduced recidivism, increased abstinence, and decreased overdose morbidity in the
weeks immediately after release. The benefits of having a support system for those convicted
far outweigh any possible con, and help lower the brutal cycle of prison that so afflicts those
who suffer from SUD. It is also in line with my belief that prison, for a decent majority of those
convicted (especially for nonviolent crimes), should be about rehabilitation rather than about
punishment. I really really like this idea.