PCEDA Board of Directors


Martha Roberts, Chairperson, 

Morgan Tressler, Vice Chairperson

John Gerner, Secretary

Patti McLaughlin, Treasurer

Russ Hoover, Asst Secretary/Treasurer

Rich Pluta, At Large

Frank Campbell, At Large

Kevin Fitzpatrick

James Fuller

Greg Gordon

Duane Hertlzer

Mike Lawler

Dawn Lowe

Steve Peters, Sr.

June Reisinger

Paul Rudy

Brenda Watson

Shawna Weller

Derek Whitesel

Emery Yoder


PCEDA Staff

Michelle Jones, Program Director


Board meetings are on the second Thursday of each month at 8 a.m.  at the Perry Business and Tourism Center in New Bloomfield. Meetings are open to the public and guests are welcome. 


 

At an opioid round table event in early 2019, the Perry County Economic Development Authority hosted a number of experts on the state of the opioid crisis in Perry County. The Perry County Economic Development Authority contends that a Healthy Community provides a Healthy Workforce which creates a Healthy Economy.  The opioid epidemic touches every aspect of a rural community and clearly has a major impact on the county’s small business and workforce health.

This event was a follow up to a roundtable discussion the Perry County Economic Development Authority hosted with Senator Bob Casey in August 2017. The following are a list of questions submitted to the panelists from the audience and their responses. 


If you need assistance in dealing with a substance abuse or dependency issue please contact Perry Human Services at 717-582-8703  or visit:  https://perryhumanservices.org

 


KD: Kristin Daneker: Executive Director Perry Human Services

BB: Brenda Benner: Chair Perry County Health Coalition

BR: Becca Raley: Executive Director Partnership for Better Health

JL: Jill London: Recovery Services Director Centers of Excellence and Baby Love Programs Hamilton

Health Center

JC: Jack Carroll: Executive Director Cumberland-Perry Drug & Alcohol Commission

AB: Andrew Bender: Perry County District Attorney

SH: Steven P. Hile: Perry County Sheriff

KBentley: Kathleen Bentley: Executive Director Perry County Literacy Council

KS: Kent Smith: Susquenita School District

KB: Karen Barclay: Perry County Prison

RM: Roger Miller: Director of Probation PC

KG: Kristie Gantt, LSW: Adminstrator of Perry County Children and Youth Services Agency


 

Do we have models from other cultures or nations, regarding characteristics of economies in which minimal addiction problems occur?

BR: This question is fairly expansive and beyond my scope but here’s one resource: https://www.unodc.org/wdr2017/field/WDR_2017_presentation_lauch_version.pdf

JL: I do not currently have any evidenced based research on that topic

JC: The incidence of alcoholism and drug addiction varies widely between countries. There are many different cultural, sociological, legal and economic factors that may explain the differences. Some countries have adopted more of a harm reduction approach to substance abuse. The effectiveness of such approaches is a matter of ongoing debate.

One result of our country’s current opioid epidemic is that the United States leads the world in overdose fatalities by a large margin. See chart below. It appears that the overconsumption of prescription opioid painkillers is one factor that sets us apart. An oft-mentioned statistic illustrating this is that while the United States accounts for slightly less than 5% of the worldwide population, we consume 80% of the world supply of prescription opioids. 

KBentley: One model worth study is “The Portuguese Experiment”.

“Portugal’s problem arose from the end of the dictatorship of the Second Republic, an authoritarian regime that ruled the country with an iron fist from 1933 to 1974. The group was inspired by, based on, and enforced conservative and authoritarian principles; when it fell, an entire generation of Portuguese people indulged themselves on freedoms that had long been denied to them. Atop that list, says Medical Daily, were drugs. Soldiers returning from newly liberated, former African colonies (Angola, Portuguese Guinea, and Mozambique) brought home cannabis, and black marketeers imported heroin and cocaine.”

“Dr. João Castel-Branco Goulão, one of the architects of Portugal’s drug policy, explained that his country was ‘completely naïve’ about drugs. Under the rule of the Second Republic, Portugal had been closed off from the outside world, with no social liberties for its people. When that government ended, drug and alcohol abuse was not only commonplace, it was practically encouraged.”

“Unsurprisingly, when the party ended, the heroin was still there, and in a few short years, the country was suffering. Other European nations had the time to discover what not to do with drugs, said Dr. Goulão, but Portugal was thrust into the deep end of the learning curve. By the time authorities realized what had gone wrong, ‘we had a huge amount of people who were addicted mainly to heroin’.”

“By the 1990s, almost 1 percent of Portugal’s citizens had a heroin addiction. The epidemic became the number one public health issue in the country. In response, the government created a task force consisting of doctors, judges, and mental and social healthcare workers. Dr. Goulão was one of the people tasked with saving his country. In 1998, he and his team came up with a plan that no one saw coming: decriminalizing all drug use, and creating new policies and programs that would treat addicts and prepare them for reintegration into Portuguese society.” If addiction is a disease, argues Dr. Goulão, then why arrest sick people? The task force operated under the assumption that the addiction epidemic was medical in nature, not an issue of law and order.”

“To that effect, Portuguese citizens who were apprehended with drugs were offered therapy instead of jail sentences. Fear of prison is what makes addicts go underground, and incarceration costs taxpayers more than treatment. Dr. Goulão’s team could logically make the argument that there was less to lose by providing drug addicts with health services that would actually address their problems.”

“The Portuguese government agreed. Under the 2001 laws, citizens found guilty of possessing small amounts of drugs (no more than a 10-day supply of the given substance) were sent to a panel made up of a psychologist, a social worker, and a legal advisor, who would then devise an appropriate treatment plan. The citizen in question would be given the right to refuse to accept the decision of the panel without criminal punishment. Jail would not be part of the arrangement.”

“Unsurprisingly, the new plans were not universally accepted at first. Portugal was a poor, socially conservative, and majority Catholic country; the word on the street was that decriminalizing drug possession would do nothing but make Portugal a haven for drug tourists and make the preexisting drug problem worse. Portugal was already home to the highest levels of illegal and dangerous drug use across Europe; removing jail from the response paradigm seemed like national suicide.”

“…But in 2009, a report issued by Washington, DC’s Cato Institute revealed that five years after personal possession of drugs was decriminalized in Portugal, the effects across the country far exceeded expectations:

  • Illegal drug use by teenagers dropped.
  • Rates of HIV infections by sharing contaminated needles dropped.
  • The number of people seeking treatment for substance abuse more than doubled.

https://deserthopetreatment.com/drug-abuse/other-countries-treatment

 “In March 2018, the US-based advocacy organization Drug Policy Alliance led a large delegation to Portugal to learn more about the impacts of decriminalization of drug use on health outcomes and society. DPA has just released the above video to tell part of the story.”

“Portugal decriminalized possession of small amounts of any drug—even though the substances themselves remain illegal. In practice, this means police records, jail time and other major sanctions no longer apply to people who use drugs. In the place of a punitive regime, dissuasion commissions were established through the Ministry of Health, without any association with law enforcement or the Ministry of Justice.”

“When police encounter someone with a small quantity of illegal drugs, the attending officer confiscates the substances and refers the person to a dissuasion commission. These are comprised of a legal professional and a health or social services official.”

‘If you are a person who uses drugs and appears before the dissuasion commission, you are given access to treatment on demand. If you don’t want to or can’t stop using drugs, harm reduction services are available to anyone who needs them,’ says Hannah Getzer, DPA’s senior international policy manager, in the video.”

‘As a result of the commission’s assessment of potential drug dependency, the person may also face sanctions, like fines or required therapy, according to DPA’s briefing paper. ‘Drug criminalization fuels the United States’ dual crises of mass criminalization and overdose deaths,” said Widney Brown, managing director of Policy at DPA. ‘The Portuguese experience demonstrates that decriminalizing drugs—alongside a serious investment in treatment and harm reduction services—can significantly improve public safety and health.’ https://filtermag.org/2019/02/28/portugal-decriminalization-drug-use-explained/

 

What are the primary incentives for students to begin using opioids/etc? 

JC:  Young people begin to use alcohol, tobacco and other drugs for many reasons. Here are some of those reasons:

• curiosity

• to gain acceptance from a certain peer group

• the excitement or risk of doing something wrong or illegal

• to rebel against parents and other authority figures

• to be like older youth or adults in their lives

• to experience the fun and pleasurable effects they’ve heard about

• to self-medicate as a way of coping with stress, anxiety, depression and/or some traumatic experience they may have had

 

BB: Peer pressure, the need to fit in

KB: Peer Pressure, experiment, self medicate, self esteem, fit in

JL: From what we hear from program participants, the main reason is to fit in with peer groups. Since we don’t serve many adolescents, we don’t have much input on that topic.

KS: Who knows for sure?  Suspect peer pressure may play into this.

AB: In the criminal justice system we have seen students becoming addicted primarily through two avenues: (1) cases where students were prescribed an opioid for legitimate medical reasons and develop a dependency; and (2) cases where the student was simply experimenting with the substance for recreational purposes and became addicted.  

BR:  I believe that our biggest problem with youth and opioid addiction was generated by the heavy use of prescription pain killers to address pain needs for people of all ages. Sadly, student athletes who experienced injuries during their high school and college years became victims of big pharma. Our federal regulators and health care providers have been doing a good job of reducing those ricks. As a society, we need to rethink how we understand and address pain.

KBently: A percentage of PCLC’s youth population (17 – 24) are recovering from opioid addiction. Some students relapse, but most maintain their recovery throughout their program participation. These individuals are driven to meet a goal. Addiction will prevent them from doing so and they know it. So, they are thinking forward. The goal is a factor in their recovery. Most of these students disclose their addiction during the intake process. Based on collective information and experience, the risk factors underlined below are the primary incentives that created a path to their opioid use:

Known risk factors of opioid misuse and addiction include:

Poverty

Unemployment

Family history of substance abuse

Personal history of substance abuse

Young age

History of criminal activity or legal problems including DUIs

Regular contact with high-risk people or high-risk environments

Problems with past employers, family members and friends (mental disorder)

Risk-taking or thrill-seeking behavior

Heavy tobacco use

History of severe depression or anxiety

Stressful circumstances

Prior drug or alcohol rehabilitation

https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372

What % of addicts have total recovery?

JC: Achieving and sustaining recovery from a substance use disorder isn’t easy. There are many barriers and considerable stigma that must be overcome. And the strength of the heroin and illicit fentanyl available today makes it even more challenging.

But treatment does work, and recovery is happening for many each and every day. According to Voices and Faces of Recovery there are an estimated 23.5 million Americans living in long-term recovery from a drug or alcohol disorder. Each of these individuals offers hope to those who are still struggling. This is critical because recovery emerges from hope.

Relapse for someone with an addiction is a return to drug use or drinking after a period of abstinence. Due to the chronic nature of the disease it is common and frustrating part of addiction treatment and recovery. But it is not a failure, and it does not mean a person is doomed to spending the rest of their life in active addiction.

The key is how a person responds to a relapse. As with other health disorders, symptom reoccurrence should serve as a trigger for renewed intervention, treatment and recovery support. It is estimated that 40 to 60 percent of those addicted to drugs will relapse at some point from their plan of treatment. The National Institute on Drug Abuse has pointed out these relapse rates for drug addiction are about the same as relapse rates for diabetes, hypertension, and asthma, which also have both physiological and behavioral components.

BB: 20%

KD: There is not an easy answer to this question.  There are many factors that contribute to ones sustained recovery such as support network, living environment, Mental and physical health, etc.  Not everyone in recovery is the same and everyone’s pathway to recovery is also different.  From what I have researched there are approx.. 23.5 million Americans living in recovery.  This was taken from drugfree.org (2012) survey. 

KBentley: “Lost among the headlines of opioid addiction and overdose deaths are the many quiet stories of recovery. An estimated 22 million Americans — that includes the three of us — are in recovery from opioid and other addictions. We say “estimated” because states and the federal government don’t track recovery like they track addiction rates or overdoses.”

“Tens of millions of Americans have successfully resolved an AOD problem using a variety of traditional and non-traditional means. Findings suggest a need for a broadening of the menu of self-change and community-based options that can facilitate and support long-term AOD problem resolution.” https://www.statnews.com/2018/08/30/measure-addiction-recovery-rates/

 

What is cost of methadone/suboxone vs. vivitrol? (include cost of travel)

BR: (include cost of travel) It varies and local providers will have the best sense of this. Here’s a broad overview comparing these medication costs: https://www.cleveland.com/metro/2017/04/vivitrol_suboxone_and_methadon.html

JC: Methadone is the least expensive of the three forms of medication-assisted treatment for opioid use disorders. Typically the outpatient methadone treatment providers use a “bundled rate” which covers the cost of the methadone medication, related medical services and any group or individual counseling that is provided. An average rate is about $15-$17 per day, for a cost of about $480 a month. Methadone patients make daily trips to the clinic to receive their daily dose of methadone, so this does involve additional travel costs.

Suboxone is a brand name for one form of buprenorphine. An average monthly cost for the medication alone is about $435, but it can range from $200 to $700+ per month. The cost will vary based upon dosage and where it is purchased. In addition, there are initial and monthly medical costs that will vary based on the medical provider. And finally, there is the additional cost of the individual and/or group substance abuse counseling.

Vivitrol is the brand name for the injectable form of naltrexone. The cost of a monthly injection can range from around $1,000 to $1,375 depending upon the supplier and the provider. As with Suboxone there are also initial and monthly medical costs. And there is the additional cost of substance abuse counseling services.

All three forms of medication are only intended to be used as an adjunct to substance abuse counseling, hence the term medication-assisted treatment. Please note that all of the costs cited above are broad estimates. Actual costs will vary from provider to provider, and may be subject to change.

KD: I am unsure of the exact cost of Vivitrol without insurance but I do know it’s very costly (upward of a thousand dollars an injection).  I use to work at a methadone clinic (Discovery House) and the cost without insurance is $105 per week.  Medical assistance will cover the cost of the clinic if eligible.  Depending on the facility, will depend on if they take private insurance.  As far as cost of travel, that will depend on the client and where they live.  There is not a methadone facility in Perry County so any travel would be outside of the county.  There are some facilities near Perry County which would include Mechanicsburg, Harrisburg, State College & Camp Hill areas.   Suboxone prescription is covered by most insurance companies and again will depend on the provider if they accept your insurance.  Out of pocket can be pricey again, unsure of exact cost.  What can be costly is the drug and alcohol counseling that usually has to go along with getting a script for these medications.  If you do not have insurance usually the county drug and alcohol offices can assist with funding for outpatient treatment.  If you have private insurance, the client may have to search around for a facility who accepts it, as not all providers take private insurance.  Medical assistance recipients usually are accepted at most places.  Rabbit transit if eligible, through medical assistance, can offer transportation to and from these facilities. 

KB: $1,000/mo/shot

JL: Methadone/suboxone are much cheaper than vivitrol.  Our patients have medical assistance and their insurances pay for the medications, with minimal co pays.  The cash cost is based upon where they receive the medication from, however, we do not refer our patients to cash only clinics.  Travel prices vary due to location. 

KBentley: Non-hospital based residential Methadone treatment programs costs average around $76.13 per day per person. Visiting a Methadone clinic on an out-patient basis costs an average of $17.78 per day per person (http://www.methadonecenters.com/typical-methadone-clinic-cost/)

The cost for Suboxone sublingual film (2 mg-0.5 mg) is around $158 for a supply of 30 film, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans. A generic version of Suboxone is available, see buprenorphine/naloxone prices. https://www.drugs.com/price-guide/suboxone

The average price of a Vivitrol is approximately $1,906 per shot and is generally injected once a month. https://www.singlecare.com/prescription/vivitrol

 PCLC has served recovering addicts who have received or are receiving methodone, suboxone and/or vivitrol. The majority of these individuals are eligible for Medicaid that supports the costs of the medication and the transportation to receive it. The individual must use a provider that accepts their Medicaid insurance. Some Medicaid insurance vendors are not accepted in Perry County. If a person is receiving methodone or suboxone treatments through a center out of the county, they may only be able to travel three days per week on the subsidized ride provided by Rabbittransit. They must have childcare or pay for the child to ride with them. PCLC has served students who were receiving methodone for years. Hamilton Health Center of Perry County will open an extension of Hamilton Harrisburg’s Center of Excellence in Newport. Vivitrol will be available to residents in the county and to inmates at the Perry County Prison.

 

What prevents mandatory or voluntary random drug and alcohol testing in schools or government work places?

JC: Some school districts do operate random drug testing programs for students as a condition of participating in extracurricular activities. For guidance on establishing and implementing such a program we recommend that school district administrators and solicitors consult with the PA Department of Education.

Many workplaces – government and private business – require pre-employment drug screening. Many employers also utilize drug testing as a tool when there is suspicion that an employee is under the influence while at work. In these cases it is recommended that drug testing be just one part of a comprehensive Employee Assistance Program. Information about setting up an Employee Assistance Program can be obtained from Drug Free Workplace PA. Here’s a link to their website: https://www.drugfreeworkplacepa.org/.

BB: This is usually a policy. I believe people do not want others to know that they have users in their departments, so they do not test.

KB: Gov, unions

KS: PENNSYLVANIA - The Supreme Court of Pennsylvania ruled that without a showing of a specific need, random drug testing is unconstitutional under state search and seizure law. Students and parents brought the case challenging a school's policy of random, suspicionless drug and alcohol testing of students seeking parking permits or participating in extracurricular activities. (Theodore v. Delaware Valley School District. 11/20/03)

KBentley: https://www.drugfreeworkplacepa.org/.../PA-Drug-Testing-Laws-and-Regs-April-201...

There is no specific Pennsylvania drug testing law. In general, Federal law has no requirements or prohibitions when it comes to drug testing in Pennsylvania. However, there is a common law on wrongful discharge and two official provisions that controls an employer’s drug testing program in the workplace.

Wrongful Discharge Common Law: In Pennsylvania, an employer has the right to terminate an employee for any reason as stipulated under the at-will employment doctrines. But an employer could be liable to wrongful discharge if there is a violation of any public policy upon terminating a particular employee. In this connection, drug testing in the workplace, if done not in accordance with Pennsylvania’s drug testing procedures and policies, violates public policy.

Pennsylvania Drug Testing Policies: Pennsylvania transportation employees are required to undergo alcohol and drug testing as mandated by the US Department of Transportation Federal Motor Carrier Safety Administration. An employee terminated from work due to a failed drug testing submission or procedure as required by his employer is not eligible to file and receive unemployment compensation.             https://www.drugabuse.gov/related-topics/drug-testing/faq-drug-testing-in-schools

In June 2002, the U.S. Supreme Court broadened the authority of public schools to test students for illegal drugs. The court ruled to allow random drug tests for all middle and high school students participating in competitive extracurricular activities.

I understand that most rehab programs last 30 days in-patient, followed by some outpatient services. However, medical specialists have indicated that 90 days in-patient is much more likely to prevent relapse. Are there 90 day in-patient options for our Perry County systems? 

KD: There are no drug and alcohol services in Perry County other than Perry Human Services and the new Hamilton Health Center, Center for Excellence program.  Perry Human Services is an outpatient counseling facility and yes you can attend for as long as you need (90 days or more).   There are long term treatment facilities and would need insurance/ funding approval for more than a 30 day stay.  Yes long term treatment is best but not always available and mostly its due to insurance funding L.

KB: Have to go to Cumberland or Dauphin and depends on what insurance will pay.

BB: Not for everyone

JC: The length of stay in an inpatient substance abuse treatment program is supposed to be determined by medical necessity. Inpatient residential treatment programs are designed to provide 24/7 support for individuals who lack sufficient control over their alcohol or drug use to be able to stay clean or sober on a daily basis. The length of stay in inpatient should reflect individual clinical needs. It should not be based on a provider’s predetermined schedule or on arbitrary limits imposed by an insurance or managed care company.

The Cumberland-Perry Drug and Alcohol Commission and PerformCare both have providers in their networks that can offer a 90-day inpatient option for individuals who meet the medical necessity criteria for that length of stay.

Research does suggest that the best indicator of success in substance abuse treatment is the length of time that an individual participates in treatment. Some evidence indicates that a person’s brain needs significant time to heal from the biochemical and neurological damage caused by the addiction. I’m not aware of research that specifies how much of the treatment duration should take place in an inpatient setting. Simply put, though, the longer someone stays engaged in substance abuse-related counseling, regardless of the level of care, the better their chances of attaining sustained recovery.

RM: Yes, they are available.  However, they are not funded by private insurance and are rarely recommended due to funding.

BR: Good question—I believe it often depends on the quality of a person’s insurance. There has been a statewide effort to press insurers to cover full treatment cycles, which I understand some plans offer.

What infrastructure is in place in the county for outpatient services for post-rehab stays?

KD: Speaking from Perry Human Services perspective, after care is a much needed service that is not always follow through with after a client is discharged from inpatient.  We at PHS accept referrals from many inpatient rehabs and set up after care appointments with clients for when they are discharged.  Keeping clients engaged in treatment continues to be a struggle as there are many barriers our clients face, especially when leaving rehab or prison.  We at PHS have a Certified Recovery Specialist on board as of Oct 2018.  One of his goals it to help clients to stay engaged, addressing those barriers and lack of support and assisting with getting the clients engaged in outside recovery support, which continues to be an areas that clients lack.   

JC: There are two licensed drug and alcohol outpatient treatment agencies with sites in Perry County. Perry Human Services is based in New Bloomfield. Although Diakon Family Life Services is based in Mechanicsburg, in Cumberland County, it does offer a satellite site in New Bloomfield.

There are also a number of licensed substance abuse outpatient agencies located in Cumberland County that are available to Perry County residents. Some of these facilities are Gaudenzia West Shore in Mechanicsburg, Mazzitti & Sullivan in Mechanicsburg, Roxbury in Carlisle, and NHS Stevens Center in Carlisle.

KBentley: Perry Human Services facilitates counseling throughout the county and at the Perry County Prison. Hamilton Health Center of Perry County in Newport will operate the Perry County Center for Excellence open to all insured and uninsured Perry County residents.

https://perryhumanservices.org/

https://www.hamiltonhealthcenter.com/center-of-excellence/

BR: Perry Human Services can share more about these options. There are also several outpatient treatment providers in Carlisle, Mechanicsburg, Lemoyne and Harrisburg. Here’s a link to our detailed guide for Perry and Cumberland Counties: http://www.forbetterhealthpa.org/wp-content/uploads/2018/06/Opioid-Resource-Guide-v14-HiRez.pdf

BB: Nothing within the county. However Hamilton does plan to offer more opioid services.

 

 Does Perry County get enough beds when needed for rehab or are there wait times?

KD: There are no inpatient rehab facilities in Perry County.  Where you live does not affect rehab bed availability.  Many rehabs have expanded their facilities adding more detox and inpatient beds but sometimes it takes daily calls to find availability at these facilities.  There are people to help navigate clients through this process because the window of opportunity is very slim when someone in active addiction says they are ready for treatment.  Perry Human Services, Hamilton Health Center or Cumberland/ Perry drug and alcohol commission in Carlisle can also help through this process.  The drug and alcohol commission in Carlisle can also fund clients for treatment if insurance is a barrier.

KB: Usually wait time

JC: Perry County residents without insurance have access to the contracted provider network of the Cumberland-Perry Drug and Alcohol Commission. Perry County residents with Medical

Assistance have access to the contracted provider network of the Capital Area Behavioral Health Collaborative (CABHC) and PerformCare. Both of these networks include several licensed detoxification units, inpatient rehabilitation programs and halfway house programs.

Inpatient treatment options in both the Commission and the CABHC/PerformCare public-funded networks have been increased in recent years. As a result, in most cases admission to drug and alcohol inpatient care can occur within one or two days. However, placement time will vary based on an individual’s unique treatment needs and the availability of matching treatment slots at any given point in time.

JL: If a patient in our COE is interested in rehab, we conduct a bed search along with the behavioral health mco for the first available bed. The options are across the state as long as the client is open to go. 

BB: I don’t believe there is always sufficient quantities.

KBentley: Perry Human Services (PHS) would be best positioned to answer this question. When PCLC has a student or resident who decides that rehab is their path, PCLC contacts PHS. The request is addressed immediately (even on a weekend) and the process moves forward quickly. Rehabs are located throughout the state. PCLC referrals have entered rehabs as far away as the Philadelphia and Pittsburgh areas. A successful rehab outcome is dependent on the individual. Rehabs require a degree of compliance and a serious investment in the treatment.

BR: Kristin Daneker or Jack Carroll will have the best “real time” sense of this. My latest understanding has been that things are working well in terms of bed access for rehab.

 

What, if anything, is being done in schools to prevent children from becoming users?

JC: Pennsylvania public schools are required to provide K through 12 drug education. The schools have considerable latitude in how to meet this requirement. One option is to utilize evidence-based curricula. This can be a challenge for schools, though, because evidence-based programs are time intensive i.e. they require a considerable amount of instruction time. The schools face many competing demands for classroom instructional time in order to maximize student academic performance.

The Commission believes that schools have a unique opportunity, as well as a responsibility, to provide quality substance abuse prevention and intervention programming. However, we also believe that it is unfair and counterproductive for a community to expect its schools to shoulder all of the responsibility for substance abuse prevention among youth. The Commission believes that substance abuse prevention is primarily the responsibility of parents and guardians, but in a larger sense we believe it is also the shared responsibility of anyone who has regular contact with youth.

KD: Drug and alcohol programs are being provided in all 4 Perry County Schools by Perry Human Services and other outside agencies.  There are evidenced based programs such as “Too Good For Drugs” which Perry Human Services uses.  Strengthening Families program (another evidenced based curriculum for families) is also ran through Prosper/ PHS at West Perry Middle School. 

KS: Curriculum is in place to address this.  Schools also work with outside agencies and governmental agencies to present pragrams on the subject.  Student Assistance Teams are in place within our schools.  Staff are trained before they can be a part of the SAP programs. 

AB: The Perry County District Attorney’s Office and Perry County Drug Task Force have supported and will continue to support drug prevention educational programs in our schools.  In our elementary schools, we have been a long time supporter of the Officer Phil program that includes as a component drug and alcohol abuse prevention.  Additionally, at the high school level our Drug Task Force has been involved in educational outreach programs where the DA and Task Force detectives have presented programs to students on opioid issues seen in Perry County and our court system.  These presentations included bringing a sentenced drug dealer from the Perry County to discuss with students candidly why he became a drug dealer in hopes that the students would not repeat his mistakes. 

KBentley: Perry Human Services (PHS) offers drug and alcohol education through classroom presentations to the grades 1 – 8 in the county’s school districts. All middle and high schools in Pennsylvania have a Student Assistance Program (SAP). These teams’ functions are to identify and refer students who may be using substances or dealing with mental health concerns. PHS prevention staff serve on teams in all Perry County school districts. PHS operates family and teen groups that focus on causation and prevention. https://perryhumanservices.org/

BR: The Partnership for Better Health recently funded to grants to Perry Human Services for them to offer a Teen prevention curriculum, as well as a Strengthening Families program that engages parents.

BB: Education

The question of ‘what it looks like’ hasn’t been answered. We know what ‘a drunk’ looks like, as well as someone high on marijuana. I don’t know what the signs (physical or otherwise) are of someone using opioids. 

BB: Many of those are hard to identify.

AB: There is not necessarily one way to define how an opioid addict looks.  In the criminal justice system we see addicts from all walks of life, all economic levels and all professions, some of whom exhibit few if any physical indicators that they are addicts.  That being said, significant changes in health and behavior can be indicators that there may be a problem.  A friend or loved one may have trouble keeping jobs, showing up to work on time, financial issues, relationship problems, sudden weight loss, flu like withdrawal symptoms if they are not getting their drugs at the time, etc. that could be an indicator of a problem. 

 JC: Symptoms of acute opioid intoxication typically include:

 

• loss of alertness

• decreased awareness or responsiveness

• confusion or delirium

• extreme fatigue, sleepiness

• slowed breathing

• changes in heart rate

• small or constricted pupils

• constipation

• track marks on skin

• weight loss

• mood swings

 The symptoms of opioid withdrawal (also known as “dope sickness”) are similar to flu symptoms:

 • strong cravings for opioids• anxiety• nausea/vomiting• muscle aches• severe sweating• agitation• restlessness• diarrhea• shivering• abdominal pain• excessive tearing and runny nose• insomnia• yawning• dilated pupils

  Signs of an opioid overdose include:

 • slowed or stopped breathing• unconscious or non-responsive• limp body• pinpoint pupils• pale face and clammy skin• purple or blue color in lips and fingernails• choking sounds or snore-like gurgling

 When the signs of a possible opioid overdose are present it is crucial to seek emergency help immediately!

KD: There are a lot of information about opiate addiction, signs and symptoms on line or education materials that I can provide from our agency.  Some good info I just pulled from the internet:

Behavioral symptoms:  Lying about pain to receive prescriptions for opioids,  Making appointments for multiple different doctors to receive multiple prescriptions for opioids,  Poor performance in work, Unexplained periods of absence, Isolating oneself from friends or family members, Stealing medications from others

Physical symptoms:  Noticeable changes in personal appearance, such as weight loss or changes in hygiene, Scabs, sores, or puncture wounds suggestive of IV drug use, Poor motor skills and coordination, Digestive problems, such as vomiting or diarrhea, Nausea, Pupil constriction

Cognitive symptoms: Slowed thinking, impaired judgment and problem-solving, Feeling detached from one’s surroundings, Difficulty concentrating

Psychosocial symptoms: Emotional swings, Sudden, unprovoked outbursts, Irritability, Depression, Paranoia

Effects of Opioid Withdrawal & Overdose Effects of opioid withdrawal: When a person ceases using opioids after developing a dependence, his or her body needs to readjust to functioning without the drug. This process is called withdrawal. While opioid withdrawal is generally not life-threating, the symptoms can be extremely unpleasant. They include:  Agitation, Anxiety, Nausea and vomiting, Diarrhea, Yawning, Watery eyes, Runny nose, Loss of appetite, Muscle spasms, Cravings for opioids

KB: Skinny, withdrawn, track marks on arms. If withdrawing

KBentley: PCLC has encountered and served students and participants who we learned were using opioids. The most common characteristics include those underlined below. Individuals who are actively engaged in opioid use typically miss classes with no notice and do not respond to calls or texts. They stop attending but may later return when they are in recovery.

Signs of Addiction:

Sleep habits change. The person may sleep more or less than normal.

Drowsiness. The person may nod off unexpectedly in the middle of a conversation, during a meal or while watching TV.

Flu-like symptoms appear frequently. The person may have nausea, fever and headache. This is caused by the opioid, not a virus.

Unplanned weight loss. Opioids can cause a change in a person’s metabolism.

A reduction in energy level or physical activities such as exercise. It’s common that regular exercisers reduce or stop their workout routines.

Changes in personal hygiene. Things like shaving or hair care may fall to the wayside.

Old habits may reappear. For example, individuals who quit smoking in the past may start smoking again.

Work routines change. The person may show up late or skip work all together.

Libido (sex drive) diminishes. Testosterone and estrogen levels may change, which can alter a person’s interest in sex.

Relationship changes. The person may spend less time with friends who were important in the past.

Spending becomes erratic. Household cash may unexpectedly disappear. Unusual credit card charges may start appearing on the monthly statement.

The addicted person starts to steal things. Items around the home or workplace may disappear. These are often pawned to raise cash to support the drug addiction.

https://www.aurorahealthcare.org/patients-visitors/blog/what-are-the-12-key-signs-of-opioid-addiction

BR: There’s a lot of reliable information about signs of addiction online. Some of the things to look for include changes in regular behavior, changes in moods, patterns of being less motivated to participate in things that they once enjoyed, problems at school or work, poor hygiene/sloppy appearance, memory lapses, unexplained financial troubles, poor judgement, attitude that nothing matters, irritability…