To Help Opioid Users, Pennsylvania Tries Deregulating

The government's responses to the opioid crisis have usually involved writing more laws, not repealing them. In a welcome break with that pattern, Pennsylvania Gov. Tom Wolf announced this week that he's temporarily waiving a slew of cumbersome regulations that have prevented substance abusers from accessing life-saving treatments.

"I am taking this step to protect Pennsylvanians from this looming public health crisis, and I am using every tool at my disposal to get those suffering from substance use disorders into treatment, save more lives, and improve response coordination," Wolf announced Wednesday.

Wolf's order:

  • enables EMS providers—including EMTs—to "leave behind" the overdose reversal drug naloxone. (They are already allowed to administer it.)
  • waives regulations that prohibit pharmacists from partnering with other organizations to distribute naloxone, thereby allowing them to provide the drug to prisons and treatment programs. Those institutions can then distribute the drug to at-risk individuals upon their release.
  • waives the face-to-face physician requirement for Narcotic Treatment Program admissions to allow initial intake review by a certified registered nurse practitioner or a physician assistant, both of which are more than qualified to do this kind of work. (A registered nurse could also handle this function, but that's a topic for another post.)
  • waives the fee required to obtain a copy of a Pennsylvania birth certificate for indigent residents who say they are experiencing opioid addiction. This makes it easier for them to access treatment and receive welfare benefits, since those services often require a copy of the certificate.
  • waives a rule that prohibits satellite facilities of a centralized treatment clinic from administering medication-assisted therapy, which will expand the number of places patients can receive care.

I asked Jeanette Bowles, a public health researcher who served on Philadelphia's Opioid Task Force Harm Reduction and Overdose Prevention Subcommittee, what she makes of Wolf's move. "It looks like there are areas where [the governor] is providing more autonomy," she replied. "That seems to suggest, especially with Wolf's use of the word 'innovation,' that if we were to attempt to set up a harm reduction program like a supervised injection facility, the state might not get in the way of it."

Most of these reforms are long overdue. In 2016, Pennsylvania's drug overdose rate per 100,000 people was more than twice the national average, according to a report from the Drug Enforcement Administration.

But the plan isn't perfect. Some components of it—temporarily rescheduling fentanyl to mirror the DEA's recent emergency scheduling, expanding access to the state's Prescription Drug Monitoring Program, making Neonatal Abstinence Syndrome a reportable condition—are likely to produce some undesired consequences. Prescription drug monitoring programs do, in fact, curb excessive prescribing, but they also give physicians an incentive to taper the medications of chronic pain patients for legal, rather than medical, reasons. Informing pregnant women that their drug use will be reported to a government agency may discourage them from seeking the care they and their infants need. And rescheduling fentanyl will simply allow prosecutors to exert more leverage over street-level dealers, who are often unaware of exactly what they're selling and who often are substance abusers themselves.

But on balance, Wolf's initiative is a step in the right direction. More can be done—state-level legislation allowing clean needle exchanges and supervised injection sites, for instance—but the precedent the governor has established here is a good one: He's shown you can help opioid users by backing off instead of clamping down.