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Two New Prescribing Guidelines Substance Use Crisis

July 22, 2020

Harrisburg, PA – Wolf Administration officials announced today that two new prescribing guidelines, Guidelines for the Safe Administration of Subanesthetic Ketamine and Treatment of Acute and Chronic Pain in Patients With Sickle Cell Disease (SCD) have been published to assist physicians working to treat patients.

“These two prescribing guidelines developed by the Safe and Effective Prescribing Task Force are the latest available to assist healthcare providers as they treat their patients,” Secretary of Health Dr. Rachel Levine said. “These guidelines bring the total number to 14 available to physicians as they work to treat people who are already dealing with the disease of addiction. It is important that physicians look at a wide range of therapies as they work to treat these subsets of the population.”

The ketamine guideline differs from previous prescribing guidelines by addressing administration of a non-opioid. The ketamine guideline provides best practices for the subanesthetic administration of Ketamine for a variety of conditions. This includes recommendations for the treatment team, treatment location, patient selection, and patient monitoring.

The SCD guideline provides best practices to treat acute painful crises that occur with SCD patients as well as best practices for chronic pain care. The SCD guideline addresses the specific needs of that patient population. This can help prevent the misapplication of recommendations to populations that are outside the scope of other prescribing guidelines, including patients experiencing acute sickle cell crises. It is especially important to have resources specifically for the treatment of SCD patients as this patient population often experiences racial disparities and stigma.

“Health care professionals play a vital role in combatting the opioid crisis,” said Department of Drug and Alcohol Programs Secretary Jen Smith. “The reality is that even individuals with opioid use disorder experience chronic pain and need treatment plans that meet their unique needs. We must give physicians the tools to adequately treat individuals living with substance use disorder to ensure they can lead happy, healthy lives.”

The Opioid Command Center, established in January 2018 when Governor Tom Wolf signed the first opioid disaster declaration, continues to meet each week to discuss the opioid crisis. The command center is staffed by personnel from 17 state agencies, spearheaded by the departments of Health and Drug and Alcohol Programs.

On July 6, the Opioid Command Center released its strategic plan, highlighting accomplishments to date and providing a roadmap for the continued work to help those with substance use disorder. The plan, available here, includes five goal areas: prevention, rescue, treatment, recovery and sustainability.

Work to address the opioid crisis focuses on three areas: prevention, rescue and treatment. Efforts over the past several years, working with state agencies, local, regional and federal officials, have resulted in significant action to address the opioid crisis:

  • The Prescription Drug Monitoring Program has reduced opioid prescriptions by 34 percent and has virtually eliminated doctor shopping.
  • The number of people receiving high dosages of opioids (defined as greater than 90 morphine milligram equivalents per day) has dropped 53 percent since the PDMP launched in August 2016
  • The Opioid Data Dashboard and Data Dashboard 2.0 has provided public-facing data regarding prevention, rescue and treatment.
  • 14 Pennsylvania Coordinated Medication Assisted Treatment (PacMAT) programs are serving as part of a hub-and-spoke model to provide evidence-based treatment to people where they live, with just under $26 million dedicated into the centers.
  • More than 45 Centers of Excellence (COEs), administered by the Department of Human Services (DHS), provide coordinated, evidence-based treatment to people with an opioid use disorder covered by Medicaid. The COEs have treated more than 32,500 people since first launching in 2016. A recent announcement regarding COEs was made by DHS.
  • The waiver of birth certificate fees for those with opioid use disorder has helped more than 4,600 people, enabling easier entry into recovery programs.
  • A standing order signed by Dr. Rachel Levine in 2018 allowed EMS to leave behind more than 2,400 doses of naloxone.
  • Education has been provided to more than 6,600 prescribers through either online or face-to-face education.
  • 882 drug take-back boxes help Pennsylvanians properly dispose of unwanted drugs, including 178,540 pounds of unwanted drugs in 2019.
  • The Get Help Now Hotline received close to 36,800 calls, with nearly half of all callers connected directly to a treatment provider.
  • The state prison system has expanded their Medication Assisted Treatment (MAT) program which is viewed as a model program for other states.
  • A body scanner pilot project was successful in reducing overdoses and violent crime in a number of facilities. Body scanners are in place in more than 30 locations and are currently being expanded to additional facilities.
  • Several agencies have worked together to collaborate on the seizure and destruction of illicit opioids across Pennsylvania.
  • Education and training on opioids has been provided to schools. Future plans are in place to make opioid education a standard component of their school-based training.
  • The coordination with seven major commercial providers has expand access to naloxone and mental health care, while also working to make it more affordable.
  • Naloxone has been made available to first responders through the Commission on Crime and Delinquency, with more than 63,400 kits made available and close to 12,700 saves through that program. More than half of those saves, 6,633, occurred in 2019.
  • EMS have administered close to 39,500 doses of naloxone and more than 10,000 doses were made available to members of the public during the state’s naloxone distribution last year.

More information on the opioid crisis can be found on the Department of Health’s website at health.pa.gov or follow us on Facebook and Twitter.

Nate Wardle, 717-787-1783 or RA-DHPressOffice@pa.gov
Rachel Kostelac, 717-547-3314

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