January 2024 Report

New Laws Target Overdose Epidemic
By John Finnerty from Capitolwire.com

HARRISBURG (Jan. 8) – State data shows that drug overdoses claimed at least 3,700 lives in Pennsylvania last year. What the final tally for the year will be remains unclear because overdose death data can lag by months.

“The Shapiro Administration is using every tool at its disposal to improve and expand access to lifesaving services and resources including substance use disorder treatment, naloxone, syringe services programs, fentanyl test strips, and xylazine test strips,” said Neil Ruhland, a Department of Health spokesman. “DOH has continued to add different, cost-effective naloxone options to the naloxone standing order and implements numerous overdose prevention programs across the Commonwealth. The DOH also remains committed to advocating for the expansion of syringe services programs. These evidence-based, life-saving programs are backed by 30 years of research and practice, have bipartisan support in the legislature, and are endorsed by more than 180 public health organizations across Pennsylvania,” he said.

In 2022, drug overdoses claimed 5,153 lives in Pennsylvania. That was down slightly compared to 2021 when 5,356 lives were lost to drug overdoses in the state. The overdose death toll in the state peaked in 2017 when 5,425 lives were lost to overdoses. That prompted former Gov. Tom Wolf to declare and opioid epidemic emergency to empower state agencies to more effectively collaborate to combat the drug scourge. The death toll dropped in 2018 and 2019 only to begin increasing again as fentanyl began to play a greater role in overdose deaths.

In 2022, fentanyl was involved in more than 78% of overdose deaths.

Based on the data available thus far, fentanyl was blamed in about 69% of overdose deaths in 2023. In 2017, fentanyl was blamed in 66% of overdose deaths.

Xylazine was blamed in almost 18% of overdose deaths last year, compared to less than 15% in 2022. Xylazine didn’t show up on the state’s tracking of most common drugs involved in overdose deaths in 2017, and in 2018, the drug was cited in just over 1% of overdose deaths.

New Laws Target Overdose Epidemic

Two of the 33 bills signed into law by Gov. Josh Shapiro in December deal directly with trying to help combat this ongoing drug overdose crisis.

Act 66 aims to help address workforce shortages by offering regulatory flexibilities for treatment providers and in turn improve access to those who need their services. The bill allows certified registered nurse practitioners and physician assistants to fulfill the on-call physician requirements of a treatment program. The change would address massive physician shortages particularly seen in rural parts of the commonwealth, according to a release from Sen. Michele Brooks, R-Mercer, the prime sponsor of the legislation.

In addition, the law also increases counselor, counselor supervisor and counselor assistant caseloads in inpatient residential treatment settings to give providers more flexibility in how they can use their employees and expertise. It also waives clinical experience requirements so individuals with related advanced degrees can get to work immediately and help meet staffing needs.

“While the General Assembly has addressed many challenges in combating the opioid epidemic and decades-old addiction crisis, increasing flexibility and opportunity for staff at these treatment facilities will add another tool in the fight against substance abuse all while increasing access to treatment services,” Brooks said.

Act 43 would expand fentanyl and xylazine drug testing in hospital emergency departments.

Last April, the Shapiro administration moved to reschedule xylazine as a Schedule III drug, meaning it can’t be obtained over-the-counter. Xylazine had most commonly been used as an animal sedative, but its illicit use has grown in popularity among drug abusers.

The House, in October passed legislation, House Bill 1661, that would criminalize possession of xylazine, That bill is now in the Senate where it’s gone through second consideration and is now awaiting a final vote.

Summary of PVMA Statement on the Illicit Use of Xylazine from April 28, 2023

The Pennsylvania Veterinary Medical Association (PVMA) expresses gratitude to Governor Shapiro’s office for addressing concerns about scheduling xylazine as a Schedule III controlled substance. Emphasizing xylazine’s crucial role in veterinary medicine, particularly for large animals, PVMA highlights its importance in safe handling and medical procedures. Concerns are raised about potential restrictions affecting legal access, with only two U.S. manufacturers and the risk of scarcity due to increased regulatory burden. PVMA advocates for a focus on preventing illicit importation and supports the Combating Illicit Xylazine Act in Congress. They request a sunset provision in the Department of Health’s final-form rule for consistency with potential federal legislation. Appreciating the Governor’s attention, PVMA recognizes the office’s commitment to community safety and anticipates continued collaboration on this critical issue. Link to full statement.

PVMA will continue to advocate for the licit use of Xylazine by veterinarians while still keeping regulations in place to prevent the illicit use of the drug.

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Telehealth and the Veterinarian-Client-Patient Relationship

by Corinne Tolan 

An Update from the AVMA House of Delegates

Representing Pennsylvania: Dr. Christina Dougherty and Dr. Kate Boatright

The latest update from the AVMA’s House of Delegates (HOD) delves into the critical intersection of Telehealth and the Veterinarian-Client-Patient Relationship (VCPR). Highlighting the potential benefits of telehealth in veterinary practices, the document introduces concepts such as teleadvice for basic queries and teletriage for urgent cases without requiring a VCPR. However, it strongly emphasizes the indispensable role of an in-person visit in establishing a comprehensive VCPR, crucial for informed diagnoses and tailored treatment plans.

The document outlines the inherent differences between human and veterinary medicine, debunking comparisons and underscoring the unique challenges in animal healthcare. It stresses the risks associated with eliminating the in-person visit requirement, including delayed diagnoses, inappropriate drug use, and public health concerns. Furthermore, the AVMA argues against a virtual VCPR as a solution to access issues, advocating for mobile veterinary services for both access and quality of care.

A significant focus is placed on the potential pitfalls of telemedicine, warning against overprescribing, emergence of “pill mills,” and the ensuing increase in complaints and liability. The AVMA asserts that a virtual VCPR poses enforcement challenges, leading to health and welfare risks for animals and limited recourse for clients.

In conclusion, the document advocates for a balanced approach, prioritizing relationships over technology. The Coalition for Connected Veterinary Care, led by the AVMA, stands as a collaborative effort to responsibly integrate telehealth tools into veterinary practices while maintaining the importance of establishing a VCPR in-person. For a comprehensive understanding of the issues and recommendations, please read the full text, linked below.

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