PA’s top health official: “Addiction is a medical illness — not a moral failing.”

Pennsylvania Secretary of Health Dr. Rachel Levine tells Retreat why battling the state’s substance abuse crisis is her no. 1 priority

By Reed Alexander

Pennsylvania’s top public health official has her work cut out for her.

Dr. Rachel Levine has had a long and celebrated career in medicine. A graduate of Harvard University and Tulane Medical School, the former Pennsylvania Physician-General and med school professor was elevated to her current cabinet-level post by Democratic Gov. Tom Wolf in October 2017. Since then, she’s set her sights squarely on the state’s drug crisis.

“As we have seen nationally, in Pennsylvania, the rate of overdose deaths due to opioids has been going up so drastically over the last five to 10 years, that it was readily apparent as soon as we took office that this would have to be one of the priorities of the administration,” Levine told Retreat in an interview. It’s “symptomatic of a national crisis,” she added.

Indeed, on the national spectrum, Pennsylvania has been one of the states most dramatically impacted by the ongoing epidemic of substance abuse. Recent data from the Drug Enforcement Agency found that Pennsylvania’s average rate of overdose-related fatalities in 2017 was nearly twice the national average. The state lost some 5,456 residents to drugs that year.

Levine and her team have deployed a number of solutions in order to combat the urgent problem. She says Pennsylvania’s government has identified three distinct “pillars” in their approach: Prevention, Rescue, and Treatment.

The first — “Prevention” — means partnering with other statewide agencies including the Department of Drug and Alcohol Programs and Department of Education to raise awareness for the danger of drugs. Levine added that she’s also been working directly with doctors and drug prescribers over the past several years, to encourage them to be more judicious in prescribing habit-forming medications.

The second pillar — “Rescue” — is about springing into action when substance abuser’s lives are on the line, such as in the case of life-threatening overdoses. One of Levine’s landmark achievements in that regard were the statewide executive orders she signed as Physician-General in 2015, which significantly increased the accessibility that Pennsylvanians now have to naloxone.

Naloxone is a non-habit forming medicine, taken as a nasal spray, which can quickly reverse drug overdoses and save lives. Levine’s orders made it available for police officers, EMT’s, firefights, and other emergency responders to have on them or in their vehicles at all times.

She also made abundant supplies of naloxone available to the ordinary public at minimal costs. Now, Pennsylvanians can walk into any pharmacy and request the medication; Medicaid, Medicare, and commercial insurance companies cover its cost. To augment this, the government gave away an additional 6,000 free naloxone kits to anyone who asked for one at 80 sites statewide in December. 

Some 20,000 lives have been saved by naloxone, Levine said, since her orders took effect.

“Everyone is a first responder,” she said. “We want the public to have access to naloxone… [and] the people suffering from the disease of addiction are very keen to have access to naloxone so that others can save their lives, or they can save their friends’ lives.”

The third pillar — “Treatment” — is about getting substance abusers into treatment programs, and, eventually, into sobriety, Levine said. She believes that the expansion of Medicare is vital in helping more patients afford treatment, but she also believes that a combination of “medication-assisted therapy” (MAT) and counseling are crucial.

Innocuous as that belief may sound, MAT has stoked fierce opposition from critics who claim that the use of additional drugs (like ones that help people overcome their reliance on opioids) in treating a drug abuse problem makes no sense.

“Not only is there a stigma about addiction in general, but there’s a stigma about MAT, that it’s a crutch,” Levine conceded. “I view that completely differently. I think it’s a tool. I think that these medications are extremely useful tools.”

The controversy around MAT is reflective of the deep, entrenched prejudices that exist in the discourse around substance abuse treatment. Another one says that substance abuse is a choice, and that abusers don’t have enough willpower to beat their addiction once and for all.

It’s a myth that Levine pulled no punches in confronting.

“Addiction is a medical illness, it’s a disease,” she said. “It’s not a moral failing… We need to continue to get that message out… Eighty percent of people who use heroin actually started with prescription opioids that they obtained either legally or illegally.”

Although she’s proud of the efforts Pennsylvania has made to battle the drug crisis since she took office, Levine is wearing no blinders about the challenges that lie ahead. One of them is the emergence of highly lethal fentanyl in an increasing number of drug-related deaths.

Fentanyl is a narcotic that’s 30 to 50 times as powerful as heroin and, according to recent CDC data, was involved in as many as 70% of fatal overdoses in 2016.

The crisis has grown so threatening that Gov. Wolf recently renewed a declaration calling the opioid epidemic a “disaster,” which he called “the best current means we have to maintain a concerted effort focused on fighting this scourge on our state and our nation,” in a statement.

There may be no immediate end in sight, but Levine vowed that the fight will continue when Gov. Wolf, recently reelected in the 2018 midterms, is sworn in for his next four years in office on January 15th.

“Gov. Wolf remains committed to the opioid crisis,” Levine concluded. “We’re very excited and enthusiastic about our second term.”