Opioid crisis sparks comparisons to Vietnam

The prescription-drug addiction crisis has been more than two decades in the making. Now, all levels of government are scrambling to stop a public health disaster that Pennsylvania's top drug official described Tuesday as the worst since the 1918-19 flu.

Meetings in Philadelphia highlighted the urgency, with physicians gathering in the morning and a top federal drug official appearing at another panel in the afternoon. Meanwhile, Gov. Wolf announced Tuesday that all public high schools will get free supplies of the drug Narcan to reverse overdoses of opioid painkillers and heroin.

Gary Tennis, secretary of the state's Department of Drug and Alcohol Programs, called the U.S. epidemic the worst public health threat since the Spanish flu nearly a century ago. He predicted that within a few years, annual drug fatalities will exceed the 58,000 American military deaths during the entire Vietnam War.

Michael Botticelli, the White House official in charge of drug policy, struck a different tone before the afternoon panel at the National Constitution Center. "I'm moved by the tragedy of this epidemic but also moved by the hope of this epidemic," he said, noting that President Obama has made it a top priority and has put $1.1 billion to expand treatment in his proposed budget.

Botticelli's appointment last year as director of the White House Office of National Drug Control Policy was symbolic. He openly discusses his 27 years of recovery from alcohol addiction.

The emergency overdose-reversal drug naloxone was discussed throughout the day. Wolf announced that his administration had partnered with Adapt Pharma, which sells the rescue drug as Narcan, to supply all public high schools in the state free. The Irish company has its U.S. headquarters in Radnor.

But not all schools are likely to accept it, Tennis said, adding that some prefer to keep a drug-free public image.

And Philadelphia City Councilman David Oh announced a series of community meetings around the city about the opioid crisis focusing both on illicit pain pills and heroin. (See the schedule online at http://bit.ly/1YsqkiJ.)

Nearly two dozen doctors and other health officials from around the region spent the morning at the Philadelphia County Medical Society sharing observations and ideas. Physicians were long criticized for failing to adequately treat pain, and the response, more prescriptions of pain pills, ended up leading many patients to addiction.

But how do you hold the line on prescribing pills without harming people who genuinely need the pain relief these medications provide?

The answer is often complicated - but not always.

Andrew Gurman, an orthopedic surgeon from Altoona, Pa., who is president-elect of the American Medical Association, recalled a study by a small hand-surgery practice in Iowa. The doctors routinely prescribed 30 pills after surgical procedures for conditions such as trigger finger and carpal tunnel.

When they surveyed their patients, they discovered that most took fewer than half the pills prescribed.

"The total amount of unused opioid analgesics from these 250 patients was 4,639 tablets," the doctors wrote in the Journal of Hand Surgery. They could be swiped and sold on the street. The practice halved its routine initial prescription to 15 pills.

The overdose-reversal drug naloxone has sparked a lot of interest as well as confusion.

The U.S. Centers for Disease Control and Prevention issued opioid guidelines for primary-care physicians last month. They included a recommendation that doctors prescribe naloxone to patients who are getting pain pills legitimately but could be at risk for overdose.

At the roundtable, one doctor worried about legal liability for prescribing naloxone. Tennis, the Pennsylvania drug official, said that not prescribing it was a far bigger legal risk.

The reversal medication is often prescribed to family members, since someone who is overdosing would be unable to revive themselves. That third-party practice is unusual, and required a change in state law. The Wolf administration went further - as have several other states - in issuing a "standing order" that does not require a prescription.

But many pharmacists don't understand how it works, said Rachel Levine, the state's physician general, who has been speaking with pharmacy groups. She also said that insurance coverage varies.

The state's Medicaid program will cover naloxone prescribed to either the patient or a family member, she said. Aetna will as well, a spokesman said Tuesday. Independence Blue Cross will cover only the patient, a spokeswoman said.

A legal change also allows police - often the first to respond to an overdose - to carry naloxone. But only seven counties - including Chester, Delaware, and Philadelphia - are doing so countywide, Tennis said. About half the counties - among them Bucks and Montgomery - have partial coverage, he said.

dsapatkin@phillynews.com

215-854-2617

@DonSapatkin