Policy Platform / Questionnaire
Opioid Crisis Action Network Policy Platform
Over 100,000 Americans died of drug overdoses in 2020, up 30% from 2017 and double the total from a decade ago. The Opioid Crisis Action Network (OCAN) was founded in January, 2018, by Heather and Larry Arata after the overdose death of their 23-year-old son, Brendan, to help those in recovery, research and lobby for solutions to this public health emergency. The following is our 2022 Policy Platform:
1. Insurance Companies, Medicare and Medicaid must cover a continuum of care of at least 90 days of treatment per incidence of relapse. The CDC has determined that addiction is a chronic disease. Therefore, “minimum days of coverage per year” language in state laws (PA Act 106 of 1989) must be eliminated because they are often used as maximum days of coverage, despite the prohibition of this practice. The “seven-day review,” the practice in which doctors must justify to insurance companies or the government, additional treatment for patients every seven days, must be eliminated. Doctors, in consultation with their patients in recovery, should determine the duration of treatment, not insurance companies or the government.
2. Limits to coverage duration for prescriptions for medical best practices medication assisted treatment (MAT) regimes addressing addiction must be eliminated. Insurance company, Medicare or Medicaid mandates to reduce or curtail prescriptions of medications over time must be eliminated. Judges in drug courts must not mandate that those practicing medical best practices MAT regimes stop taking their medications over time. Doctors, in consultation with their patients in recovery, should make these decisions, not insurance companies or the government.
3. Vote Yes on PA Senate Bill 975, the “Deny no one treatment or coverage for treatment because they are sober act,” prime-sponsored by Senator Judy Schwank (D-Berks), would prohibit the common practice of denying coverage for treatment because the patient reporting for treatment is sober at the time of reporting for treatment. By definition, those in recovery suffer from urges to relapse which are very often fatal. Fortunately, urges to relapse are treatable. This life-saving treatment should not be denied, nor should its coverage. This bill was written by OCAN Co-founder, Larry Arata, in response to his son, Brendan, being denied insurance coverage for admittance to a treatment center because he was sober. Insurance companies believe treatment to the sober is “not medically necessary.” PA SB 975 is now in the Senate Health and Human Services Committee chaired by Senator Michele Brooks (R-Erie). Please email her (mbrooks@pasen.gov) and urge her to post the bill to a committee vote.
A similar bill, HB220, passed the PA House last year but it lacked the critical language requiring insurance companies to cover the admittance of the sober to treatment centers. Treatment centers do not turn people away because they are sober. Insurance companies refuse to cover the admittance of the sober to treatment centers and this practice must be prohibited.
4. Vote Yes on PA Senate Bill 976, the treatment center and recovery home transparency act,” prime co-sponsored by Senator Judy Schwank (D-Berks) would mandate that the PA Department of Drug and Alcohol Programs (DDAP) distribute a questionnaire to all treatment centers and recovery homes in PA. The questionnaire responders would provide basic information about the services provided, qualifications of staff and outcomes at these facilities. DDAP would publish the responses on their website. Those facilities that choose not to respond will be listed as “did not respond.” It is important that those evaluating treatment centers and recovery homes have access to vital information like facility locations, number of beds available, number of staff, qualifications of staff, willingness of facility to accept those who are pursuing MAT regimes, ability of facilities to address the dual diagnosis (addiction and mental illness) of patients and outcomes data like average days sober of patients / residents, relapses and deaths. OCAN drafted this bill in response to the difficulty Heather Arata had evaluating recovery homes for her son, Brendan. Vital information enabling this life-saving decision regarding the best facility for Brendan was not available. This must be corrected. Treatment centers and recovery homes should be transparent and share vital information and the state must make this information available to PA families. PA SB 976 is now in the PA Senate Health and Human Services Committee chaired by Senator Michele Brooks (R-Erie). Please email her (mbrooks@pasen.gov) and urge her to post the bill to a committee vote.
5. Vote NO on PA SB165 which would prohibit supervised injection sites from opening anywhere in PA. Supervised injection sites save lives, increase the likelihood of users seeking treatment, prevent disease, reduce litter, save taxpayers money by reducing ambulance trips to respond to overdoses and bring use indoors out of the sight of children.
6. Vote YES on PA SB926! Support syringe service programs (SSPs) in Pennsylvania! SSPs distribute clean syringes to drug users in order to prevent the spread of diseases like hepatitis and AIDS.
We ask you to contact Senator Lisa Baker's office and demand SB926 to be moved out of the Senate Judiciary Committee and onto the floor.
OCAN supports the Pennsylvania Harm Reduction Network’s call for the community and Pennsylvania’s legislators to support PA HB2264 and SB926 for Syringe Service Programs (SSPs)!
7. Every county in the nation must implement a medical best practices medication-assisted (MAT) drug treatment program for substance use disorder for inmates in their county jails. Federal and state prisons must also implement MAT programs for their inmates. Only three counties have done so as of 7/11/22 (Philadelphia Inquirer article). This program will save lives, decrease recidivism and taxpayer expenditures.
8. Every high school, college and medical school should teach an overdose prevention curriculum, Narcan training should be provided and Narcan should be distributed to every high school, college and graduate school nurse, teacher, administrator and security staff member. Narcan should be available in the first aid kits aboard every train, plane and bus in America. Every crew member should be trained in its use. It is time to get serious about saving lives.
9. Recovery homes should welcome those pursuing medical best practices and not discriminate against them. Recovery homes must not forbid residence to those following medication assistance treatment (MAT) regimens. Recovery homes should secure the medications to prevent their theft and track (maintain records) about their use to prevent abuse.
10. Vote YES on PA HB1021, “Lloyd’s Law,” prohibiting life insurance companies from denying policies or increasing the premiums of life insurance policies because applicants have Narcan on their prescription profiles. Applicants with Narcan prescriptions do not present an increased risk to life insurance companies and life insurance companies should not be allowed to discriminate against them. Lloyd’s Law is named for the late Lloyd White whose mother, Sharon White, OCAN Board Member, was denied life insurance because Narcan was on her prescription profile. HB1021 is prime sponsored by Rep. Benjamin Sanchez (D-Montgomery). Please contact your State Rep. and ask him / her to vote yes on this bill!
11. The cornerstone of the delivery of local mental health, drug and alcohol treatment services in PA for the past 21 years to 2.9 million Pennsylvanians enrolled in Medicaid is a highly successful program called Behavioral Health Choices (BHC). Each county can choose to manage its own program or work with other counties to form collaborative partnerships between county leaders, treatment and recovery professionals and individuals and families in need of help. BHC must be retained and any legislative or regulatory attempt by regional and national insurance companies to replace it must be opposed.
Background Information:
There is a consensus among medical professionals who treat those suffering from substance use disorder that a continuum of long-term care and medication- assisted treatment regimens lead to a significant reduction in costly and often deadly relapses. Tragically, a long-term continuum of care is often not covered by private insurance, Medicaid and Medicare. This is in violation of a 2008 federal law, the Mental Health Parity and Addiction Equity Act, which mandated that insurers treat mental health conditions to the same extent they treat physical issues. No one in the medical community believes that a patient suffering from opioid or other substance use disorder reaches recovery / remission after seven, fourteen, or even twenty-one days of treatment, but specialists at facilities must spend substantial time justifying the need for additional treatment through formalized, regular “seven-day review” sessions with insurers. Indeed, desperately needed treatment is often interrupted by insurance companies, Medicaid or Medicare after seven, fourteen or twenty-one days. Most who receive this brief level of care suffer costly or deadly relapses. This costly, stressful, unproductive, unnecessary and industry-wide practice, dictated by private health insurance companies and the government, must be eliminated. Instead, a continuum of care of no less than ninety days including in-patient treatment, followed immediately by a partial hospitalization program (PHP) with residence in a state-registered sober-living facility, followed immediately by intensive outpatient treatment (IOP) with residence in a state-registered sober-living facility, must be covered by private health insurance companies, Medicaid and Medicare. This minimum 90- day duration of a continuum of care has been found to reduce significantly the incidence of costly and deadly relapses. Treating those suffering from substance use disorder with best medical practices including a minimum continuum of 90 days of care will save lives and money and must be covered by health insurance companies and our government.
2. Along with a minimum continuum of 90 days of care, medication-assisted treatments also have been found to significantly reduce incidence of costly and deadly relapses. Again, these medical best practices are most-often not supported by most recovery homes in America and not co-incidentally, most of those in recovery are not prescribed these life-saving treatments. Vivitrol (naltrexone), a monthly injection that blocks neuro-receptors that allow the desired “high,” is an effective treatment against urges to relapse. Suboxone and Subutex (buprenorphine), achieve even greater results. Methadone treatments have proven to be the most successful prevention of relapse. Insurance companies must not limit the duration of prescriptions of these medications, nor should judges. Again, treating those suffering from substance use disorder with medical best practices including medication-assisted treatments (MAT) will save lives and money. Recovery homes should welcome those pursuing medical best practices and not discriminate against them. If an owner of a recovery home who forbids residence to those following MAT regimes applies for a license for a second or any subsequent recovery home, that home must allow those who are pursuing MAT regimes to be residents.
3. After undergoing treatment and remaining clean and sober for over 60 days, Brendan Arata suffered severe cravings to use heroin that drove him to report to the facility where he was first treated. The facility wanted to admit him but coverage was denied by his private health insurance company because he had no traces of drugs in his blood. The insurance company was willing to risk that Brendan suffer a deadly relapse before they granted him needed treatment. The insurance company insisted it was merely following ASAM (American Association of Addiction Medicine) protocol. This is a baffling common occurrence reported by many in recovery. When Larry Arata and two treatment specialists who volunteered to join him met with several high-level officials of Independence Blue Cross and Magellan in March, 2018, the specialists presented this oft-repeated scenario and explained that the insurance companies were turning the ASAM criteria on its head, misinterpreting and over-emphasizing the first layer, dictating that if a patient reports intoxicated to a treatment center, he or she must not be refused treatment. Instead, the specialists advised the insurance company officials that they should have agreed to admit Brendan (and others like him) for at least a few days of counseling and an injection of Vivitrol (naltrexone) or a prescription of Suboxone (buprenorphine) to reduce his cravings. After a long silence, the officials from Magellan responded that they adhere to all ASAM protocols and PA Act 106 (1989) requirements. Federal and state laws must mandate that no patient suffering from effects of substance use disorder reporting to a treatment facility be refused coverage for treatment by private health insurance companies, Medicaid or Medicare, whether or not he or she is intoxicated or has trace amounts of illicit drugs in his or her blood.
4. Each state’s regulatory agency (Department of Drug and Alcohol Programs, DDAP, in PA) should provide a web-based application that informs those evaluating recovery homes basic information about the services provided by and qualifications of the staff managing the home. It is important that those evaluating treatment centers and recovery homes have access to vital information like facility locations, number of beds available, number of staff, qualifications of staff, willingness of facility to accept those who are pursuing MAT regimes, ability of facilities to address the dual diagnosis (addiction and mental illness) of patients and outcomes data like average days sober of patients / residents, relapses and deaths. OCAN drafted this bill in response to the difficulty Heather Arata had evaluating recovery homes for her son, Brendan. Vital information enabling this life-saving decision regarding the best facility for Brendan was not available. This must be corrected. Treatment centers and recovery homes should be transparent and share vital information and the state must make this information available to PA families. PA SB 976 is now in the PA Senate Health and Human Services Committee chaired by Senator Michele Brooks (R-Erie). Please email her (mbrooks@pasen.gov) and urge her to post the bill to a committee vote.
Sober living homes are an important component of a best practices continuum of care for those recovering from substance use disorder. In fact, these facilities represent one of the fastest growing sectors of the economy. However, they are largely unregulated; state and federal standards for the training of staff, and inspections monitoring their safety and management are lacking. As a result, while many sober living homes provide excellent care, some are predatory, stealing money from and even selling drugs to residents. US HR 4684, the Ensuring Access to Quality Sober Living Act, is a bill that passed the US House in May, 2018 and awaits Senate approval. At the state level, we are happy to report that PA Senate Bill 446 was signed into law by Governor Wolf. These bills, if properly implemented and enforced, would effectively provide the foundation for the regulation of sober living facilities. An important element of regulation not encompassed in these bills is the requirement for all facilities that treat the addicted, not just sober living homes, to maintain a database of outcomes including days sober per patient and the number of total relapses and relapses per patient and overdose deaths of patients. We must require these facilities to link with primary care doctors of their patients so that a continuum of care is encouraged and outcome data can be tracked. Families comparing heart surgeons can obtain relevant data about doctors and facilities and the link from surgeon to primary care doctor is a prescribed best practice. We must require that families evaluating treatment for a loved one suffering from substance use disorder have the ability to make informed decisions about their care and are provided with the same continuum of care. Federal, state and local governments must enact and enforce legislation that insures treatment facilities and sober living homes provide quality care to those recovering from substance use disorder. The mandated collection of patient outcome data and provision of links to primary care doctors of patients will enable government regulators at all levels to hold treatment providers accountable.
5. PA HB 1393: Many users of cocaine, methamphetamine, and even marijuauna have died from fentanyl overdoses, not suspecting they were in danger of ingesting the deadly drug. This life-saving bill, with two crucial amendments, expanding drug checking equipment and removing the personal use barrier for third-party checking, passed through the House voted 0-200, on June 20, 2022. It now is before the PA Senate Judiciary Committee, chaired by Senator Lisa Baker (R-Luzerne). Please email her (lbaker@pasen.gov) and urge her to post this bill for a committee vote.
6. SB926! Pennsylvania families and communities are devastated by the needless loss of loved ones. Drug overdose is the leading cause of accidental death in PA and has the 3rd highest rate of overdose deaths in the country. PA also ranks with the 9th highest rate of new HIV infections nationwide. Hepatitis C rates are also rising across the state. Currently, most local health departments, medical professionals, and social service providers are not legally permitted to provide syringe services in PA.
PA SB 926 will increase life-saving access to sterile syringes and other medical supplies, disposal of syringes, HIV/HEP-C testing, naloxone distribution and training, treatment referrals for mental health, substance use disorder, and other social services to prevent disease and death among Pennsylvanians. Tell Senator Baker to vote YES on SB926 by taking action now!
7. Prison and jail-based MAT treatment programs: Only three PA counties implemented MAT treatment programs for their inmates as of 7/11/22 (Philadelphia Inquirer article). As a nation, we should insure that inmates do not leave prison or jail with the same addictions with which they entered them. Implementing MAT programs in prisons and jails nationwide will save lives, decrease recidivism and taxpayer expenditures.
8. According to the Philadelphia Inquirer op ed by Mickey Kennedy (8/12/22), students are not aware of the dangers of drugs laced with fentanyl and this results in increasing numbers of fatal overdoses every year. Schools are not equipped with life-saving Narcan and staff are not trained in its use. Support programs which implement overdose curricula in every high school, college and graduate school in the nation. Arm their staffs with Narcan and train them to save lives.
9. According to a Time magazine article (2018), only twenty per cent of the nation’s recovery homes admit residents pursuing medical best practices medication-assisted treatment programs. This discrimination must stop. If an owner of a recovery home discriminates in a home they own, their next home must allow those who pursue MAT. This is a means to permit the controversial practice of segregating homes between those pursuing MAT regimes from those employing abstinence-only practices, while insuring that there are an increasing number of homes supporting those pursuing MAT. This supports medical best practices and will save lives.
10. In PA, the cornerstone of the delivery of local mental health services for the past 21 years to 2.9 million Pennsylvanians enrolled in Medicaid is a highly successful program called Behavioral Health Choices (BHC). Each county can choose to manage its own program or work with other counties to form collaborative partnerships between county leaders, treatment and recovery professionals and individuals and families in need of help. Given this record of success, it is hard to imagine why anyone would want to dismantle BHC but that is exactly what some representatives in Harrisburg are attempting to do through ill-advised bills that would replace it with a sweeping one size fits all system run by large, national insurance companies or for profit corporations. This effort to replace BHC with managed care organizations ignores the needs of key local policy stakeholders, mental healthcare professionals and the patients and their families. PA Lawmakers must reject these reckless proposals to dismantle BHC and re-commit themselves to strengthening this successful, medical best practices model.
Delaware County Platform:
In 2017, Delco lost an average of four residents per week to overdoses and Brendan Arata, 23, was one of them. Delco families with a loved one suffering from substance use disorder often do not know where to turn for help and when they turn to the county, the services provided are limited. Best medical practices are not universally endorsed or promoted adequately by our county government. There is no easy way for a family in need to discern a good sober living facility from one that is predatory. The county must provide families guidance through the maze of treatment methods and facilities.
A new county health department must work with local hospitals, treatment facilities and doctors to insure that adequate levels of care are available to meet the needs of those suffering from mental health and substance use disorder. Our loved ones should never be told that a bed is not available to them or a doctor certified in an area of treatment is not locally available.
Brendan Arata, like most those suffering from substance use disorder, also was plagued by other mental illnesses. Sadly, there is a shortage of medical facilities and practitioners in Delaware County and our region at large that are equipped to address patients with dual diagnosis. A new county health department must insure that facilities are expanded and doctors are recruited to meet these local needs.
In order to address the terrible shortage of sober living homes that provide supervised medication assisted recovery regimes, owners of sober living facilities who apply for a license to open a second (or already own more than two facilities and are applying for an addition license), must be required to provide this level of care in the new facility.
The county must adopt a response to the overdose crisis that emphasizes the saving of lives and harm reduction instead of law enforcement and the criminal justice system.
The county must expand its drug, mental health and veterans’ courts and allow and support those in medication assisted recovery regimes to participate in these alternative courts.
There are over two million Americans in prison and most of the incarcerated are serving sentences related to their drug use. Yet, almost no prison facilities offer best medical practices for drug treatment. In fact, until recently, the privately run Delaware County, PA prison, offered no treatment programs whatsoever. OCAN applauds the prison board and county council for implementing a new program (reported by the Daily Times 4/3/19) providing prisoners with 90 days remaining in their sentences who suffer cravings with three monthly injections of Vivitrol that can continue after they are released. This program will decrease the common occurrence of overdoses shortly after release. This program is an excellent start that should be expanded to include all prisoners who suffer from cravings. Federal, state and local governments must implement drug treatment programs employing best medical practices in all prisons so that when these citizens are released, they are not craving drugs. This will reduce recidivism, save money and lives.
Those in prison due only to the violation of probation through failure of a drug test, belong in treatment, not prison.
Delaware County must work with local school districts to implement a evidence-based prevention programs.
Candidates, please respond to the following questions / request for information: