PA Senate Health and Human Services — 2026-03-17

Thank you so much, Chairwoman Brooks. And I agree that there's nothing we do that cannot be improved. That's the nature of the human experience. And we're very glad to see that the level of substance abuse deaths are going down. That's certainly the trajectory that we are seeing and want to see. Particularly saw it go down really significantly in Philadelphia County. And Philadelphia County is one of the counties that I represent. We're always looking for ways to improve. and I'm glad we're having this conversation so we can hopefully find additional ways to save lives.

Absolutely. Good morning. Thank you, Chairman, Chairwoman Brooks, Chairman Haywood, and members of the Senate Health and Human Services Committee for the opportunity to testify today. I am Dr. Latika Davis-Jones, and I have the pleasure of serving as Secretary of Pennsylvania's Department of Drug and Alcohol Program. I applaud the committee for raising this important issue and appreciate the opportunity to discuss my department's role in medications for substance use disorder treatment. First I like to begin by outlining what substance use disorder is and is not Substance use disorder is a chronic medical condition It is a disease a family disease that we need to normalize and integrate care for Substance use disorder is not a crime, it's not a moral felling, and substance use disorder cannot be addressed with a one-size-fits-all approach. And as the state's leading authority on our response to overdose and the opioid epidemics, I assure you that my department is here to help anyone who is seeking support for opioid use disorder, alcohol use disorder, and all other substance use disorders. Substance use disorder is a treatable disease. And with the right treatment and support, recovery is not only possible, it's probable. Individuals can and do recover every single day. However, due to the nature of this disease and its impact on the brain, individuals may return to substance use following recovery. Research shows that most effective treatment and recovery outcomes are achieved through medications when taken alone or combined with counseling and behavioral therapy. There are two distinct substance use disorders which may be treated with medications. One is opioid use disorder. Two, alcohol use disorder. Facilities providing, hold on one second. My pages are just mixed up. Give me one second. Sorry, excuse me.

According to two leading organizations on this issue, the Centers for Disease Control and Prevention and the Substance Abuse Mental Health Services Administration, the most effective approach for treating opioid use disorder involves the use of one of three FDA-approved medications. They are buprenorphine, methadone, and altruxone. Similarly, there are three FDA-approved medications for the treatment of alcohol use disorder, one of them also being naltrexo. Decades of research, including guidance from SAMHSA, demonstrates that all of these medications are safe and effective. Each medication meets different clinical needs, and the decision about whether or not to use one of these medications during treatment should rest solely between a patient, their prescribing doctor, and the treatment team. I would like to take the opportunity to explain my department's role in these medications. D-DAP licenses treatment facilities that provide buprenorphine, methadone, and L-trexone. Pennsylvania currently has 105 treatment facilities that provide FDA-approved medications. Facilities providing buprenorphine and methadone for the detoxification or treatment of individuals with opioid use disorder are licensed as narcotic treatment programs. Facilities that provide methadone for the treatment of individuals with opioid use disorder must also obtain an opioid treatment program certificate from SAMHSA. From day one I made it a priority to travel to many of your districts to meet with those who are closest to both the pain and the progress of the opioid and overdose crises in the communities you represent Over the past three years, I traveled across Pennsylvania, meeting with community leaders, treatment providers, and people with lived experience. I've heard repeatedly that the exclusion of these gold standard medications creates unnecessary barriers to care, barriers that prevent people from accessing the most appropriate medications for their treatment and recovery. And I've also heard stories of success, like a mother in Pittsburgh who has been in recovery for 14 years and uses methadone as a part of her recovery. However, she spent eight of those 14 years in silence that she was in recovery because of the stigma associated with using a medication to treat her opioid use disorder. It wasn't until the experience of delivering her child that she found her voice and wasn't afraid to speak up anymore. Today, she works in the field as a peer navigator in a Pennsylvania hospital, and she has started an advocacy group to promote understanding, education, and safe spaces for anyone who is using a medication for their substance use disorder to feel comfortable sharing their story out loud. And she also lives by her own words. I am a mother. I am on methadone. And I am a good mom. I'm often asked how success on medications for substance use disorder is determined. And I'll say that success is individualized. It can be the ability to work. A parent being reunited with your children. Stopping the use of substances. or just being a mom. That's success. The bottom line is every recovery journey is different, and we need to ensure support is accessible for all. Buprenorphine, methadone, naltrexone serve as critical life-saving tools in the continued fight against the opioid epidemic. Efforts to limit access to these medications are often rooted in misinformation or stigma about medications, despite their proven effectiveness. The consequences of limiting access to medications for opioid use disorder and or alcohol use disorder are real and far-reaching. The list is long, and it includes negative consequences like reduced survival rates, lower treatment retention, increased maternal mortality, increased criminal activity, and having a harder time finding and keeping a job. Every Pennsylvania deserves the opportunity to decide if medications for an opioid use disorder is right for them. And all three FDA-approved medications align with scientific evidence, best medical practices, and the most effective treatment and recovery outcomes for individuals with opioid use disorder. By improving access to these medications through low-barrier care and reducing the stigma surrounding the use of them, we can save lives and strengthen families, communities, and our collective public health. I commend the committee for bringing this issue to the forefront and having this conversation in a public space. I look forward to continuing the dialogue with each of you. Thank you, and I'm happy to answer any questions you may have.

Dr Lynch Yes thank you very much Chairperson Brooks Chairperson Haywood distinguished members of the committee Thank you very much for the opportunity to speak with you today Again, my name is Dr. Michael Lynch. I'm board certified in emergency medicine, medical toxicology, and addiction medicine and practice all three disciplines. And so here today I was asked to speak about medications for opioid use disorder, which of course is a large topic. And as my students will tell you, I could talk for hours, so I will spare you that. But I think, you know, and Dr. Davis-Jones really, I think, established a great foundation. You know, I think one of the really useful pieces of evidence that we have is the National Academy of Medicine did a very large, very comprehensive review of the literature related to medications for opioid use disorder. And their piece was eventually titled Medications for Opioid Use Disorder Save Lives. And I think that that title sort of tells the overarching story. There are seven main takeaways that I'll summarize. One, opioid use disorder is a treatable chronic brain disease. Two, the FDA-approved medications already listed are effective and save lives. Three, long-term retention on the medications for opioid use disorder is associated with improved outcomes. Four, lack of availability of behavioral health interventions is not a sufficient justification to withhold medications. And I'll point out that that doesn't suggest that it's not important and effective and a critical piece of treatment. It simply says that if a patient is not engaged in that, it's not a reason to withhold medication. I just want to make that clear, and I'll touch a bit more on that. And most people who would benefit from medication-based treatment do not receive it. It's effective across all treatment settings, and they specifically say withholding or failing to make available FDA-approved medication in any health care or criminal justice setting constitutes a denial of appropriate medical treatment. And then finally, confronting the major barriers to the use of medications is critical to addressing the opioid crisis. So these are the takeaways from the National Academy of Medicine, so not exactly sort of a fringe organization. And that is my assessment. Certainly, I don't put myself in the same category of the overall body of evidence. And so I think that from there we have to understand, and I'll borrow from Ted Lasso if there are any fans here, all people are different people, right? So, you know, what is true on a population base? And I spend a lot of time thinking at the population level, as of course you do as well. What is true there may not be true for every single individual. The pathways to recovery are highly variable. What works really well for one person may or may not work really well for another. And that is absolutely critical to keep in mind. It's something I try to take into every room when I go to talk to a patient. I want to hear from them what their goals are, and I want to have a conversation about how we help them get there. And of course, informed by the evidence, and together, we discuss the options, I provide education, and we come up with the best treatment plan. And that, I think, is fundamental to the individual level, the micro level. At the macro level, what I need to be able to do is all the tools available to me with as few barriers as possible so that when I match that patient with the most appropriate treatment, I don't run into barriers connecting them to it. Of course, evidence-based, of course, legal. You know, that is foundational. So that is where I see at a population level the primary work related to medication for opioid use disorder is. We want to make sure that it's accessible, that there aren't unnecessary barriers, and that people anywhere and everywhere, regardless of socioeconomic status, which county they're in, rural, urban, have access and easy access. And unfortunately. We know that despite excellent work at the state level and at the county level to improve those things, which have improved from a decade ago, it's a completely different world in a positive way. And I think those are lots of the reasons that we're seeing that decline in overdose death. I'll say it's very multifactorial. There's treatment side, there's also supply side pressures that have all contributed. But, you know, Dr. Volkov, Nora Volkov, the director of NIDA, said in a piece that she wrote in 2024, essentially, we don't really need to research or study medication treatment for opioid use disorder. We know that it works. We know that it's effective. What we need to focus on is making sure people can access it. And I think that that is a really good direction from somebody who's been at NIDA for 23 years at this point as director, installed under President Bush. So that is, for my purpose, the focus. When I'm trying to educate people, I try to overcome a lot of the stigma that they've heard, certainly in the treatment community, among my colleagues, in the recovery community even. There are areas where being treated with a medication is seen as not real recovery. Even some of the language where we've seen an evolution from the term medication-assisted treatment to medication for addiction treatment or medication for opioid use disorder. And in my opinion, and the reason that we've seen that evolution is that it is a treatment. It is not the only treatment. It is a treatment. Behavioral health and behavioral therapies are, as I said, absolutely critical. The majority of patients who have an opioid use disorder have a co-occurring behavioral health disorder that absolutely needs to be addressed, in addition to the behaviors and the behavioral modifications that are essential for long-term recovery. But we also know that everybody going into treatment is either not ready or not willing at that moment to engage in that. And so ideally, if we are treating with medication, what I'd like to see or what I hope to see is that patients get to a point where they're stable and then be able to engage more meaningfully in those behavioral supports that we know are so important. And so ideally, in my opinion, that is where we want to get to is making those resources, medication, behavioral health, physical health as integrated and as accessible as possible for the most people possible. And so with that, I know that we have incredible panelists that are going to speak as well today, and I look forward to hearing from them. And I will be happy to answer questions. Thank you.

Thank you very much for this opportunity, and I'm very honored to be here and a very happy moment for me. I would say that I began in the opioid treatment, because I think about it heroin treatment at the time with a direct relationship with Vincent Doe and Maureen Dicewinder who started methadone treatment and that was a complete change of direction as has been noted here already from the way people had approached the problem before and I noticed the term of heart at the time was medication-assisted treatment, and that is, as we just heard, a questionable distinction there. But anyway, I wanted to add to the discussion that comes from a larger perspective. One is we don't have anybody who just uses opiates. semi-copioid use disorder. They're using lots of drugs and not just opiates. And I think it's very important to keep in mind that this larger context that there is to it. And I think the other thing I would like to make sure we understand is how important it is to deal with the extent of the problem and also the issue of people who are leaving the program so much. Most of the people come for very brief periods of time, and what we're trying to get to is absolute recovery, which includes no use of any of these drugs. And I think it's important to have that larger context of where we're going. The unfortunate characteristic in our field is one group fighting with another over who's got the better treatment program. And the answer is we really need all of them. And it's very important to keep that diversity in what we're doing. I, having been in this field now for 50 years and more, one of the things that has been very important to me is the more ambitious goal of thinking about recovery from substance use disorder and what that is and how it is established. And one of the questions that I had was how good could this be and outcomes be for this disorder? And there was one way of approach that I saw that did that, that really produced long-term recovery regularly. And that was what happens to us with physicians who have substance use disorder, and they are involved in the state physicians' health programs, as you'll have in Pennsylvania also. And the way they are treated is quite striking, beginning with residential treatment, usually for a month. and then they're followed up for five years and required to have drug testing during that time to keep on their licenses. In any event, 90% of those people, physicians, come out with lasting recovery We followed up a sample of them the first national study of how they were doing five years after they completed their program and they were doing very well indeed And one of the things that was striking to me about that was we asked them what part of the program had been most helpful to you in your recovery. and sustaining the recovery for over five years. And the treatment they received was rated very highly by them. But interestingly enough, twice as many picked AA and NA as picked treatment as the thing that they had found most helpful. And I was very impressed by that. And I think that one of the aspects of recovery support that we underestimate is the importance of AA and NA. And I mean those specifically, not just recovery support. And I want to emphasize that here, but also to recognize that most of the people who stay in methadone, And there are fairly short periods of time. And we need to find ways to do a better job, I think, of keeping people in treatment until they are in recovery. But I'll end here and be happy to participate in any way in whatever you do. And I'm greatly honored to be included in this distinguished discussion.

Thank you. Thank you, Senator Brooks, Senator Haywood, and the rest of this esteemed committee for the honor of testifying before you today. As the senator said, I am the policy director for Substance Use Disorder Treatment Services for the Rehabilitation and Community Providers Association. RCPA has more than 400 members, the majority of whom provide human services to more than 1 million Pennsylvanians annually. Our addiction treatment provider members account for about 400 of the state's approximately 800 Department of Drug and Alcohol Program licensed facilities. They represent the entire treatment continuum, outpatient, including methadone and buprenorphine programs, intensive outpatient, partial hospitalization programs, and every residential level of care. It's not lost on me that of the six testifiers today, I am the only one who is not a doctor. That said, I consider it a privilege and a responsibility to represent not only the provider community, but perhaps even more importantly, to be here as a member of the recovery community. I am a person in long-term recovery from the disease of addiction, which for me means I have not had a drink or drug in more than 14 years. I also am a certified recovery specialist. Before I found recovery I lost both of my brothers my only siblings to drug overdose deaths I taught at age 28 and Josh a little more than two and a half years later at age 25 which makes me the last living child of my parents In my years of recovery, I've had an opportunity to work with and meet a lot of recovering people, as well as a lot of grieving families. I've visited a lot of treatment facilities and learned and frankly unlearned a lot of things over those years. In preparation for today's hearing, I visited two more facilities, two RCPA members, Berks Counseling Center in Berks County and Hanover Treatment Services in York County. We spent hours at each location meeting with physicians, nurses, counselors, and patients to discuss the critical importance of medication in treating opioid use disorder. I want to briefly share with you a sampling of what I heard from two of those patients. Robard is 48 years old. Between 1996 and 2020, he spent 20 years incarcerated. 20 of 24 years in prison because of a heroin addiction that led to crimes, including robberies and thefts, to support his addiction. During that 24-year span, he spent no more than four months at any one time out of prison. On July 7, 2026, this year, he will celebrate six years of recovery, which for him means that he does not drink or use drugs, thanks in large part to buprenorphine, which he continues to take as prescribed, along with his program of recovery that includes outpatient treatment, 12-step fellowship, and his religion. I also want to tell you a little about Tracy. She experienced the horrors of trauma of addiction for years as she ran between York County and Baltimore, which has often been referred to as the U.S. heroin capital. She regularly put her life at risk. She was raped. She tried various detoxes in residential treatment facilities, and she kept using. Today, she has 15 years of recovery, thanks in large part to methadone and her treatment program. She's repaired relationships, she operates a successful cleaning business, and she will proudly joke with you that there are people who actually trust her with the keys to their homes and businesses, whereas this certainly was not the case in the past. These experiences are irrefutable evidence of the life-saving and life-transforming power of medication to treat opioid use disorder. These patient stories include acknowledgement of the role that counseling and recovery supports play in their recovery. Each of them also said that the only way they have been able to stay on this path is with the help of medication. RCPA's treatment provider members are strong advocates for the use of medication and behavioral therapies as the most effective pathway for patients to stop their use of illicit opioids and begin to make the many difficult changes that will enable them to sustain their recovery and achieve their goals. To be clear, however, although we believe that medication is most effective when paired with counseling, we also support several other positions, each of which is supported by research. Number one, medication alone is treatment and prevents overdose deaths, in fact, more so than behavioral therapies alone. Medication must be accessible regardless of whether an individual agrees to counseling or other recovery supports. We must not place artificial limits on the amount of time someone uses a medication to treat their addiction. And lastly, individuals must have the freedom to choose the treatment path that works best for them to find the recovery that they seek. The danger in treatment is that the treatment is not a good place for them. Trying to force a particular brand of treatment or recovery that limits the most effective tool we have for preventing opioid overdose death, either through policy or simply the perpetuation of stigma, is that through our judgment, we put others' lives in grave danger. I have seen time and again this very scenario end in death When friends who could not stop using illicit opioids Refused to use medication because of the stigma put upon them by others In closing, I want to share one final perspective with you My brothers died in 2005 and 2007 I can assure you that my parents would much rather have their two dead sons alive and using a medication to treat their opioid use disorder than lying side by side in a graveyard in Portage, Pennsylvania, Cambria County, which is where they are today. I implore this committee to try to put themselves in the shoes of parents who, despite having given those children their best efforts, have lost a child to an overdose death. Reflect on the guilt, the shame, the questions, the lost opportunities, and the anguish and the longing in the soul at the fact that they will never speak to or touch their child again for the rest of their lives on this earth. This committee has great power and influence to help Pennsylvanians give themselves the best chance for recovery and to help those who love them avoid the trauma and grief a preventable drug overdose creates. Thank you very much for the opportunity. I look forward to further discussion.

Thank you so much, Senator Brooks. Thank you so much, Senator Brooks. It really is a privilege and an honor. I want to thank you. I also want to thank your associate, David, because he's been very helpful. This morning, I was at the Hilton. They said, all right, it was right around the block. I made a wrong turn. I was lost, and were it not for David, I would be wandering around with the homeless, addicted population in Harrisburg without my naloxone safety. And so thank you, David. I also, I believe I was referred to you by my good friend and colleague, Mike Harrell, who was the chief executive officer of Gedenzia for many, many years. And you know he a colleague and Gdenzia is like the treatment program Samaritan Day Top Village in New York a long integrated interdisciplinary treatment program that has a continuum of care which is so vital and necessary for the addicted population And so and I no stranger to Pennsylvania My sister and brother and nieces and my mother live in Duncannon And I come every year on Christmas and my mother's birthday. She's going to be 101 in April 2nd. So I'm going to be seeing her. So I'm no stranger to Pennsylvania also. So it is indeed a privilege. Also, I just want to qualify. You sat me next to Senator Haywood, the secretary, and Jason. They're paragons of physical fitness. Now, I know it's a setup. I might be an aging, older, an aging out of shape guy from New York, but I'm not stupid. This is a setup. and correct me if I'm wrong, Senator Haywood, correct me if I'm wrong. You look at these two when they stand up. They're really remarkably physically fit. You look good. Okay. So I'm going to be speaking today specifically about the need for integrated treatment. I want to qualify and put this in context. I'm a strong believer in medication-assisted treatment. I prescribe a lot of methadone and buprenorphine. What we usually mean by medication-assisted treatment is the opiate substitution therapy. Methadone and buprenorphine we're talking about. Methadone now is more frequently prescribed with fentanyl, which is such a powerful opiate. And methadone is a more powerful opiate substitute than buprenorphine. But I prescribe a lot of methadone. Believe it's vital and necessary. But I do not agree that standing alone opiate substitution therapy and naloxone for harm reduction, which we also use, you know, we do a lot of training in that. That is not sufficient to treat the addiction crisis. and I have to say that I speak nationally and internationally about addictions and what is needed. Kensington, Pennsylvania is known nationally and I speak about this internationally as a model for how not to do it. It turned out to be a disaster and people know this throughout the nation and the world, that Kensington is like Needle Park in Zurich. I actually visited Needle Park when I was at the ISAM conference. Needle Park in Zurich, you can't even know where it is. It was a total failure. They dismantled it. But in Kensington, the philosophy was no criminal justice intervention, just let people stay on the streets, use addictive drugs, shoot up, and just let them do it and offer them what they want, totally voluntary. Well, that didn't work out, and it won't work out. What you need, and I would have to say that both Gidencia and Karen are models for how to do it nationally and internationally. Cadenzia and CAREN are integrated treatment programs that provide a continuum of care with a combination of medication treatment that we use in addition, the behavioral therapy, the 12-step facilitation, the contingency management, the community support sort of community therapy. And that's what's needed. Get these individuals, badly addicted, and as was pointed out, they often have co-occurring mental health disorders, serious ones. Get them the help they need. Meet them where they're at. We believe that. You don't want to really get aggressive with too many of them, but you don't keep them where they're at. You get them the treatment they need. Their judgment is impaired. and they need this comprehensive continuum of care. And that's what's needed now to resolve our addiction crisis, the number one public health problem and crisis throughout Pennsylvania, the nation, and the world. Thank you, Senator Brooks and Senator Hayward.

Chairman Heyman and members of the committee, I hope you can hear me well.

Oh, good. Okay. So, yes, my name is Sally Sattel. And I think I should preview my comments here. I agree with all of my colleagues. They do take a slightly different direction, as you'll see. But let me address a key question up front. Does medication-assisted treatment work or medications for opioid addiction? Yes, they do. As opioid compounds themselves, methadone and buprenorphine suppress drug withdrawal and craving. They can reduce overdoses by 50%. This is well-replicated finding, and they enhance retention and treatment. But those two states I mentioned, drug withdrawal and craving, are very destabilizing to the drug user, both physically and emotionally. And they play a large role in perpetuating drug use and exposing people to lethal risks. And that's where the benefit of methadone and buprenorphine come in. They really are a way to help patients kind of stand still so they can stop chasing drugs and allow themselves to focus on their recovery. But these benefits should not seduce anyone into thinking that methadone or buprenorphine is all we need to combat opioid addiction. The question I was specifically asked to address today is whether these medications can become ends in and of themselves, crowding out behavioral treatment, maybe even accountability. And that's a very legitimate question. I guess I can give you firm statistics on it but I can tell you and I think this is where I depart from some of my colleagues here that the more we think of addiction in medical and neurobiologic terms the more likely we are to put too much faith in medications alone Now, I should say, all my colleagues did talk about rehab, but it's clear from funding patterns that rehab is not as much of a priority for many policymakers as the medication, as funding medications. All for funding medications. They are necessary, but they are not sufficient. Because I think it's very important, actually, that we recognize addiction is not a classic disease. I understand the motivations for calling it a brain disease and for medicalizing addiction. We want to keep it out of the criminal justice system, and we certainly don't want to criminalize addiction. We want to cover treatment costs. We want to cover research. funding. But it can be confusing when we consider methadone as a classic disease, and it's not. Now, you might say, well, don't drugs change the brain? And of course they do. But that doesn't necessarily make it a brain disease. The crucial fact, however, is that these changes do not prevent people from making choices. Numerous lab studies show that people addicted to alcohol and stimulants and opioids can control their use when they're offered incentives. To be fair, those choices are harder to make when people are under the sway of addiction. Harder, but not impossible. An avalanche of data shows, again, that sanctions and incentives make an enormous difference. But I also should add that these choices are more difficult to make when people are living in drug-infested neighborhoods, and especially in a place like Kensington. So the problem, though, is this. These medications, as everyone has attested, are very effective when they are taken. The problem is that patients, and I've worked in methadone clinics for 30 years, people are very ambivalent. ambivalent, very conflicted about going into treatment. Why is that? Well, I'll just very briefly say it's because of the reasons why people use drugs. And this is why, again, I resist thinking about it as a brain disease because it doesn't get us to think about motivations for using drugs. And at baseline, the reason is that drugs, frankly, help people cope. They can numb their mental pain, even though they are highly self-destructive, they are also very effective in that way. We know that fewer than one in 10 people report they even need care. That's data from the Substance Abuse and Mental Health Services Administration. They tend to drop out at high rates after entering treatment, and this means policymakers have to consider two basic options. I'll speed up here. The first is harm reduction. That comes sort of in two flavors. The The first is what I would consider aspirational harm reduction, needles, of course, Narcan, other kinds of assistance that try to move people towards treatment as opposed to just making it possible subsistence harm reduction is what I call it, to live in these debauched neighborhoods like Kensington where no one gets better. The other option, though, is for people who are too resistant to get treatment when we know they're otherwise endangering their lives. One is compelled care. This is a very fraught issue, but it involves civil commitment. It's worth considering. We know that people, we have significant data showing that compelled care actually works as well, if not better, than voluntary care. And finally, the second option, again, is intensive use of drug courts and really enlightened ways of harnessing the criminal justice system to help people get into care. So I'll end by saying that the medications that we've discussed can be very, very essential in stabilizing people, but it's towards a goal, which is to pursue long-term rehab, whether that's in the context of voluntary or compelled intervention. Thank you.

Senator Laughlin. I really appreciate the time consideration, Chairwoman. Dr. Sattel, I've been reading through your written testimony here, and I want to read out loud the one paragraph where you talk about thinking of Kensington, which I have toured Kensington twice myself. I attended a roundtable there with the former U.S. drug czar, Dr. Gupta. And when we talk about harm reduction, I would like to expand the scope of that a little bit. Because in a traditional context, when folks in this space talk about harm reduction, they talk about the addicted person and how to keep them alive, which is admirable. I don't want to minimize that. But as a legislator, I look at harm reduction. part of what I look at is the entire community, because the people that live in and around Kensington deserve a component of harm reduction for their neighborhoods as well. And I think I just wanted to say that out loud, that the community at large deserves harm reduction as well, and I'm talking about the crime rates, having children walk through needle caps strewn all over the sidewalks things such as that. So I just wanted to get that out in the testimony here. But in your written testimony talking about the addicts that are living in Kensington, and I'll paraphrase here a little bit, it seems like they have no choice left because they are in such a downward spiral. And I realize I'm paraphrasing and I'm not trying to put words in your mouth. But I agree with you. And Senator Williams and I have a mandatory involuntary commitment bill, Senate Bill 716, for those of you that like to look up the bill numbers. What I would like to see happen, and I say this as a compassionate person, and that if I had a if I had a family member that was hopelessly addicted to these opioids living in Kensington, this is what I would like to see, right? I want to know how long in your opinion would it take someone to be off these drugs whether it by their own volition or whether they are committed involuntarily to break the physical part of this and then we could work on the mental part of their addiction as well So if you have a number of days in your head that you've seen in your practice. yeah oh um yeah it takes um it usually takes us about two weeks to a month to stabilize get the

So we need to do some work in that space as well. Look, I have to run. I wish I had more time today. But please know that this is an issue that I feel passionately about. And I think that there's room to make improvements, obviously. And I will continue to work with Senator Brooks on this issue. And I will talk to Senator Anthony Williams about this as well. He's a co-prime sponsor on my bill. And I look forward to working with you as well. So thank you, Senator. Thank you.

Absolutely.

And there are cost-efficient models like Gdenzia for that rehabilitation phase. A lot of the funding comes from the federal government through Medicaid and Block Grant. And so for those severely addicted now I'm talking about, not the moderate addictions, you have an integration rehabilitation phase, which can last anywhere from, let's say, three months to even six months. Or if somebody is severely impaired in all these areas needing mental health housing addiction treatment medical treatment mental health that can take more time But you can have these cost models like Gedenzia and we have them in New York that are supported, Samaritan Daytop Village, by our commissioner.

I appreciate your comments, Dr. Bond, and I look forward to working with you as well, with all of you folks, actually, because we have an issue here, obviously, and it's going to take a multi-pronged approach to trying to tackle some of these issues. But thank you all for being here. Thank you.

Okay, that's a very good question. and meaning leading into recovery, well, the definition of recovery is actually involved. Some people think if somebody is on medication-assisted treatment, that is in recovery if they are a model for all of the other behavioral parameters. However, there are some people who will be on medication-assisted treatment long-term, but there are many who actually are interested in going off of the medication-assisted treatment. Interestingly, some of the doctors discourage that. They think that they should be on forever medication-assisted treatment. We don't agree with that. If the individual wants to taper down, we help them, and we have helped a number of them, get off of the opiate substitution therapy, which has its advantages.

I agree. It's all true. people who come off. And the important word that Dr. Bunt mentioned is taper. You really have to go slow. For example, in our methadone clinic, it often takes a year or more to come down off methadone. Some of that is mind over matter. I understand that, but it doesn't matter. You want to be successful. You just do it slowly. I have to say we've had people on methadone for decades, but they get monthly take home. Methadone itself is actually very inexpensive. It's pennies. and they live productive lives. So it's all possible.

Senator Haywood. Consistently, we hear that Medicaid assisted medical system treatment is not just the only answer. I overwhelmingly hear that from those in the trenches, whether they're providers, whether they're families, whether they're folks that are addicted. And that was part of your testimony, Dr. Lynch. I think, Jason, you had mentioned behavioral health, Secretary Jones But I do want to ask you what is the measuring tool to determine whether someone should be put on MAT Because I do have a slide here from one of the MCOs and I want to read to everyone what this slide says. Unless there is a specific rationale, MAT should be continued indefinitely. Tapering an individual off of a MAT simply because use of medications is contrary to their philosophy would be unethical. Opioid withdrawal management, detoxification on its own is not a treatment method for opioid use disorder and is not recommended. So this came from an MCO to the providers. So as we talk about full recovery, and if this is what the providers are being told, how are we following up with the mental health aspect, the behavioral health, and a full spectrum of recovery?

A part of the process when someone enters into treatment, they have to get a full psychosocial assessment. That psychosocial assessment allows the treatment facility, specifically the clinician, to work directly with the individual addressing the needs of the individual. So we're talking about everything from addressing their medical conditions, the behavioral health co-occurring conditions, looking at trauma, looking at their environment, looking at those social supports that would be available. And as a result of having that assessment, then a treatment plan is developed with the patient collaboratively to determine the goals and the next steps for that individual. And what I would say is that when you think about treatment, you know, in a treatment plan and when people engage in such services, it is individualized, right? And methadone, buprenorphine, naltrexone is just one of the tools, some of the tools in the toolbox that are available. And people do need to be educated about their options. And people engaged in treatment have an opportunity to determine their path forward. And so while I can't speak to what's on the slide and what was said from the MCO, what I can tell you is what we license for and what we look for as a part of our annual licensing visits and monitoring visits is that treatment plan, those case consults. Does the treatment plan and the progress notes align with what is documented in the chart and the path forward for the individuals engaged in treatment? So, again, it's individualized. It is really a collaborative process between the patient, a prescribing doctor, should a person want to be on medications, and then thinking about that whole treatment team that could be a peer support services along with case management and other supports that may be in place.

And what I will do, as some of you are aware, that I do meet weekly with the Health and Human Services Secretaries. And so, as you know, the MCOs sit under the Department of Human Services. And so this is a statement that I can, you know, this is a topic that I can take back to the Health Hub to talk about what I've learned today. Be willing to do that for sure.

Yes, I do. And I would respectfully disagree with the MCO on that position. But I do want to clarify that I believe, as many of us do, that recovery can be with medication-assisted treatment. If the individual's behavior and interaction with their peers and the community is responsible and pro-social, That, I believe, is in recovery. And so they can be on their buprenorphine and methadone and be in recovery. However, I respectfully disagree, and this goes to the nature of opiate addiction, that individuals should be encouraged, and I see this in our profession, that individuals should be encouraged to stay on their medication-assisted treatment, often methadone indefinitely. And the doctors often discourage the individual from trying to taper down. We work with a lot of individuals who have tapered down successfully and they have a better quality of life. There are certain things with the opiate substitution that diminishes certain aspects of behavior and emotions and interaction interpersonally. So every individual should have that right to taper off if they wish to do so. And we commend that. We think that's good. And we work with them gradually getting off of it. However, not too fast. Some people think you can stop it very quickly. That's not the nature of opiate addiction. It's a long-term process. I want to mention one more thing that relevant to public policy And that is what we seeing now is the emergence of and it was predictable stimulants even among those addicted to opiates So we're seeing people in our treatment programs who are on medication-assisted treatment, and now they have a problem with cocaine or methamphetamine. Now, there's no medication-assisted treatment for those stimulants. And people with that stimulant, and we went through this with a crack methamphetamine. The African-American population was affected much more severely. And what you saw is the consequences of homelessness and even psychotic behavior with the stimulants. stimulants. And if you think that just medication-assisted treatment, methadone or epiphanorphine and naloxone is okay, and that the individual can refuse urine toxicology, which there are some in our field who promote that, they can refuse if they want to. That's their right. They're voluntary. Addiction is a disease like diabetes. Well, I don't agree with that addiction is a disease that affects the individual's personality. And if they're in withdrawal, you know, they often resort to crime and unethical behavior. So what we're seeing now is an escalation of the stimulant abuse. So, therefore, we believe it should be required to have the urine toxicology when they go in to get their medication-assisted treatment to prevent the deterioration related to these other drugs and get integrated treatment. Medication-assisted treatment, all for it. Harm reduction, I'm all for it. But integrated continuum of care.

I did want to make sure Mr. Snyder had an opportunity. He was bringing the microphone close to him before I asked my question.

There's so many things that I would have liked to have addressed over the last 15 minutes, but I'll delay us.

Okay. So I've got to make a couple quick statements. the cocaine crisis that you referred to that had a dramatic effect on African Americans had a public policy response of incarceration. That was the public policy response.

So part of the challenge in terms of dealing with people who have these conditions is avoiding the public policy responses that we had in the past. And I know you mentioned that the Kensington approach was not incarceration. And the Kensington, the incarceration system, the jail system, is not a place for resolution of hundreds and thousands of people who are subject to these addictions. So I just want to be clear about that. The incarceration solution was tried. The incarceration solution was applied to the African community That not something we want to do again So I just want to be clear about that Now I want to go to the cost associated with the behavioral solutions For about 10 years or 15 years, I was a primary housing lawyer, or Gaudenzia. And as the primary housing lawyer for Gadenzia, we were struggling to find locations where the treatment could occur. The cost of the housing part of the solution was enormous. And I also heard reference to the five-year physician program, which I'm very happy for the physicians. But, of course, a significant part of our population are not physicians. They don't have access to that kind of special treatment that physicians get, special programs that physicians get. So I remember under Governor Wolf, he had these centers trying to increase the treatment locations. It was extremely expensive, more expensive than we in the General Assembly were willing to pay for. So as we think about the treatment side of the solution, do any of the panelists have something to share with us about the cost of these treatment solutions when we look at the thousands of people who would need them and our prior efforts under the Wolf administration to provide these centers of excellence?

I don't have numbers related to the cost of treatment, but we'd be more than happy to share information that we would have from the perspective of the Department of Drug and Alcohol Programs,

Thank you, Mr. Snyder. You know, you had mentioned the number $6 billion. Unfortunately, not enough of that $6 billion actually gets to the providers that are providing the treatment. I will say that Medicare pays almost $280 per person per week for methadone and almost $300 per week for buprenorphine, with injectables costing even more, and that's per week. Dr. Bunt, you had a comment?

Dr. Lynch, did you have a comment?

Dr Bynum Yes I agree with my colleague for the most part but I just want to clarify with respect to stopping discontinuing medication treatment that leads to overdose That is discontinuing it without the proper supervision. In other words, you know, they leave treatment, they stop abruptly or they stop more quickly than they should be. under supervision and guidance like we provide, I do not believe that the risk of overdose is high. In fact, I think that it's not even increased. If they work with skilled, knowledgeable clinicians to taper, and it's monitored and supported, the gradual tapering with psychosocial support, that they can achieve that without a risk of overdose. Well, and I think it also is a result or consequence of not requiring these folks to follow through on a continuum of care with a support network, talking to someone, the mental health aspect. And we're getting away from those continuum of cares that actually set up people for failure to come off of MAT.

I would like to make a comment. Thank you very much for this opportunity. We're talking about people leaving MAT. Most people leave MAT without tapering. They walk away from a substantial dose and leave the treatment. The way we're talking now, it looks like people come into MAT and they want to stay forever. Some do, but that's a pretty small part of the population. It's a big part of the people who are there. But if you look at admission cohort, what happens to the people, I think you have to recognize that the people who are leaving are relatively rarely leaving after they cut down gradually to zero. They're walking away from major doses. And you can see what that is. The presumption that people, if you'll let them stay there, will stay there, is wrong. There are some who do that, of course, but it's a relatively small percentage of them. But it's a big percentage of the people who are there at the time. So you're used to that. So I encourage people to look at what that retention rate is and what are the circumstances under which people are leaving. And it's striking to me what the methadone or buprenorphine dose is of people who are leaving. Thank you.

I was just going to say that's where the criminal justice system can come in. Certainly, I mean, so many folks in our clinic, they do commit crimes. And as the senators was saying, of course, we're not talking about incarceration, but there are very creative deflection and diversion programs that we can put in place and that are in place. And and that is one reason why people, you know, stay in treatment. The idea is to get them to the point where they have something to lose. And that's why they don't want to resume use. But until then, you often have to have as much containment as possible.

And again, I want to stress that I'm continuing to hear that that support network is not being established for the folks that are on MAT. And that's part of what we're seeing if they do go off, if there is a consequence. You need the counseling. And I've heard that repeatedly from doctors.

Yes, it's been fascinating listening to all of this. So we use the term MAT, medically assisted treatment. treatment, that seems to imply that there is some additional treatment that goes on beyond the medication. Is that a fair statement?

It can be. Well, it can be.

Well, it can be implies that it cannot be. So Medicaid-assisted treatment is sometimes just giving people pills? It can be as a harm reduction approach, simply giving someone access to medication for their opioid use disorder. Okay.

engage in counseling at a particular point? Do you pull their medication from them?

I do want to be very, very clear. I think that everyone involved in this hearing today feels that MAT is an important tool. I think what we're trying to discuss is, are we over-utilizing MAT? Are we abandoning counseling and support networks? I, you know, should the reimbursements be more than just MAT? That's the conversation I think we're trying to determine here. And I think all the testifiers have said, well, MAT is a tool. I think there's differing opinions on how overutilized.

Yes. I mean, look, the discussion was interesting, but absolutely. So, Dr. Blunt, what you were suggesting makes sense to me that there would be some people, particularly when they initially show up, who, you know, you give them the medication because there's an initial need, but that you're trying to encourage them to get into some form of additional services. And I think the point I was going to ask some specific questions about that, but the disagreement that seems to exist amongst the panel already has proven my point that there's some, even amongst experts who sit before us, there's some level of disagreement about that. Another question on this. Could a person be treated for opioid substance abuse without the drugs? Is that also possible?

So you're saying they always have to be offered. Do they have to be encouraged?

Let me just say from a point From a policy perspective, there are some programs and some providers who believe that recovery equates to abstinence. And there are some programs around the nation, I don't know how many in Pennsylvania, that have residential treatment for opiate addiction. They don't provide medication-assisted treatment. I don't agree with that. That's not good medicine because it should be accessible to any person addicted to opiates because it can make the difference between them living and dying. And so we've made a lot of progress in New York. When going back years back in day top, they believed abstinence was no buprenorphine, no medication-assisted treatment. I was the one who really got buprenorphine in the residential treatment programs. Got resistance from a lot of people. Oh, you're just substituting. substituting buprenorphine and methadone is not violating abstinence it's not violating recovery and it's key to them achieving recovery if the experienced clinician is

supervision. Well, so, so Dr. Blunt, I just want to say, I do say one, I will say I'm, I'm, I personally am comfortable with the way you have described it. Something about the way Dr. Lynch describes it is unsettling to me. And it feels almost like what drug pushers do to people. And, And maybe you all just have a different way of characterizing it. But Dr. Blunt, which you described sounds more like medicine. And Dr. Lynch, with all due respect, it sounds like you're pushing the drugs onto people in a way that is unsettling. But that perhaps is just a perspective from the way you've expressed yourselves. Dr. Jones, you were right.

Well, thank you. I don't want to dominate too much, but I just wanted to say that, look, my former executive director who was in recovery for, geez, Kasib has spent 25, 30 years in recovery, something like that, passed on. But he was an abstinence person, but also understood that he would always talk to me about the fact that the medications were good for some people. One of the concerns that he expressed was, one, that there was a financial incentive for some providers to keep people addicted to the treatment drugs. and two, that some providers were moving away from the full gamut of services because for most people, addiction begins because you're dealing with some other underlying issues, and not for everyone but for many people, and that those issues also needed to be addressed. But in many cases, the people who were administering the medications only saw their role as to give you a pill. and not to provide all the other services. That is unacceptable to me. And finally, I am concerned that the Commonwealth not set up a methodology for payment that creates fiscal incentives for just giving the pills, and if people no longer want the pills, that that then dramatically impacts the ability of the provider to continue to provide long-term services, which might be needed long after medication has stopped. And so, Dr. Jones, look, I do agree that there needs to be a spectrum of services available to people, and I certainly believe that those services need to include medicated-assisted treatment. But I think we also need to be very careful that we not have, we not create a situation where people are fiscally incentivized to just push pills. We need to acknowledge, as it was acknowledged, that there is a significant portion of the population that could benefit from medication, that a significant portion of that population also needs support services, not just medication. And while there may be a very small group of people who could benefit from just medication, that that should not be the sole goal of it. And while we say that, the most powerful thing that this government tends to do is spend money. And the way we set up our fiscal incentives need to parallel that goal Thank you Madam Chair Thank you Senator Street That concern has been shared with me many many many times

with that Senator Haywood would you like to make a closing statement yes thanks so much this has been a fantastic conversation I want to turn the mic on I want to thank you all for your presentations um thank you Jason Snyder your family story was compelling you being a survivor was compelling and your voice here in the General Assembly needs to be heard that's my closing statement