The Heroin and Opioid Epidemic COMMONWEALTH, Volume 20, Issue 1 (2018). © 2018 The Pennsylvania Political Science Association. ISSN 2469-7672 (online). http://dx.doi.org/10.15367/com.v20i2-3.184. All rights reserved. The Heroin and Opioid Epidemic Pennsylvania’s Statewide Disaster Emergency MARK A. NORDENBERG Chancellor Emeritus and Chair of the Institute of Politics, University of Pittsburgh JANICE L. PRINGLE School of Pharmacy and Director of the Program Evaluation Research Unit, University of Pittsburgh The following was written on behalf of the Special Issue Editors by Mark Nordenberg. Earlier this year, I had the privilege of helping to host the officers and directors of the National Safety Council (NSC) when they brought a compelling new exhibit, “Prescribed to Death: A Memorial to the Victims of the Opioid Crisis” to the University of Pittsburgh, its first stop on a national tour. The very fact that an organization as respected as the NSC— which built its reputation through impactful work in more traditional areas, such as highway safety—has chosen to make the opioid crisis a priority is noteworthy. The exhibit itself visually underscores two key messages. Consisting of 22,000 white pills—one for each of this country’s prescription opioid overdose deaths in the prior year—dramatically mounted on a pure black background, the exhibit instantaneously conveys a clear sense of the enormity of the prob- lem. The fact that the face of a victim has been carved onto each of those 22,000 pills serves as a stark reminder that the epidemic is taking a heavy human toll. As the exhibit itself proclaims, “behind every statistic is a face, a person and a story.” 2 Mark a. NordeNberg aNd JaNice L. PriNgLe Those same messages were highlighted in a pair of eye- catching headlines in the December 31, 2017, edition of the Pittsburgh Tribune- Review. The first captured the shocking magnitude of the region’s still- growing opioid overdose epidemic: “Decade of Death: Overdoses Claim 825 Lives in Westmoreland County over 10 Years.” To add context, this was the toll in a county consisting of suburban communities, small towns, and rural areas, outside the Com- monwealth’s major urban centers. The second headline focused on the anguish that accompanies each over- dose death: “Families of Overdose Victims Left to Grieve and Wonder.” Some sense of that pain was conveyed through the accompanying stories of human loss. Particularly gripping was the account of the mother who lost two sons in the space of a single evening, when they overdosed on the same batch of fentanyl-l aced heroin in the basement of her home. The article was accom- panied by a photograph of her sons’ graves—positioned appropriately, but tragically, right next to each other. My own knowledge of the opioid overdose epidemic was very limited until David Hickton, then the United States Attorney for the Western District of Pennsylvania, reached out to ask for help. Dave had been a pioneer in mobiliz- ing regional resources to meet the challenges of this crisis. That work attracted national attention, which led to his further service as coauthor of the National Heroin Task Force report, jointly released in 2015 by the U.S. Department of Justice and the White House Office of National Drug Control Policy. Dave already was working with a broad- based civic advisory group of West- ern Pennsylvanians and asked if Pitt’s Institute of Politics (IOP), which I now chair, could organize a group of Pitt researchers and University of Pittsburgh Medical Center (UPMC) clinicians to complement the efforts of his group. That was the beginning of my immersion in work directed to the ongoing damage being done by the opioid overdose epidemic—to individuals, to fami- lies, to communities, and even more broadly, to the fabric of American society. Since then, the IOP has been actively engaged on multiple fronts. It took the lead in drafting and distributing A Continuum of Care Approach: Western Pennsylvania’s Response to the Opioid Epidemic, a report offering a frame- work for meeting this challenge on a regional basis. It also took a lead in preparing—through a process that, though not ultimately successful, was educational—a submission to the MacArthur Foundation’s $100 million, winner- take- all, grant competition. Our hope had been to use those high lev- els of support to implement a regional plan that could be replicated elsewhere. The IOP—in partnership with the U.S. Attorney’s Office, the Program Evalu- ation and Research Unit (PERU) of Pitt’s School of Pharmacy, and the federal Drug Enforcement Administration (DEA)—also has cosponsored a series The Heroin and Opioid Epidemic 3 of day- long, opioid outreach programs designed to promote best practices throughout Western Pennsylvania. The more familiar a person becomes with their selfless efforts, the more impressed he or she must be with the tireless commitment of the large num- bers of people who are devoting their lives to battling this crisis. However, that also makes the unrelenting march of the epidemic, even in the face of such efforts, all the more frightening. The aim of this volume of COMMONWEALTH is to enhance the effec- tiveness of those determined efforts by sharing information and ideas about the opioid epidemic from a range of experiences and perspectives. It begins with a thoughtful commentary from Pennsylvania Attorney General Josh Shapiro, who has made the epidemic a priority and championed partnerships between public health and public safety. The remainder of the volume con- sists of highly complementary articles written by some of the country’s most respected and well- published researchers and clinicians in this field. Given the nature of our working group, almost all of the authors have Pitt or UPMC connections, and aside from the Attorney General, all are from Western Pennsylvania. However, the work and reputations of this distin- guished group are national and international in scope, and their perspectives will be of value to anyone engaged in the battle against the heroin and opioid epidemic. From the first launch of our efforts in this area, the leadership provided by Terry Miller, the director of the IOP, has been indispensable. Earlier in her career, Terry had been the founder and first executive director of POWER (the Pennsylvania Organization for Women in Early Recovery). Her work at POWER and her ongoing involvement as a volunteer left Terry with knowl- edge, experience, contacts, and a deep reservoir of respect within the com- munity of addiction professionals, all of which proved to be invaluable in the work undertaken by the IOP in this area. Professor Janice Pringle, a faculty member in Pitt’s School of Pharmacy, directs that school’s Program Evaluation and Research Unit, which includes both the Overdose Free PA website and the Pennsylvania Opioid Overdose Reduction Technical Assistance Center. In a broad range of ways, but par- ticularly in helping to oversee the development of this issue of COMMON- WEALTH, Jan has contributed insights grounded in her own rich experience, as well as a lot of hard work. It has been a privilege to work with her as coedi- tor on this project. Lynn Mirigian, who directs the Pennsylvania Opioid Overdose Reduction Technical Assistance Center, played a critical role as a coauthor of two of this volume’s articles. Her well- developed sense of the efforts being undertaken in 4 Mark a. NordeNberg aNd JaNice L. PriNgLe counties around the Commonwealth was a key asset in all of our work, and she became the initial bridge to our peer reviewers. I also want to acknowledge Monica Gaydos, who did an excellent job of copy editing from her position within the Program Evaluation and Research Unit of the School of Pharmacy at Pitt. We were helped enormously by our colleagues at Temple University, the fine public research university located in the “other corner” of the Common- wealth. We needed to develop an effective approach to peer review for a col- lection of articles addressing different aspects of the same general topic, which meant that each article needed to be reviewed both individually and as part of the whole. For that help, we turned to the Center for Public Health Law Research at Temple and its sister group, Legal Science, LLC, which tracks 50- state drug laws relating to the prevention of opioid overdose and death. We received extraordinary help from two key professionals there. Scott Burris is an international drug policy expert who is a professor of law and public health at Temple, where he directs its Center for Public Health Law Research. Elizabeth Platt, who had been a senior research associate at that Center, now serves as research manager at Legal Science and in that role, man- ages the Prescription Drug Abuse Policy System, a resource funded by the National Institute on Drug Abuse. They both offered thorough and thoughtful critiques as peer reviewers, enhancing this volume in the process. We also are grateful to Heidi Grunwald, the director of the Institute for Survey Research and codirector of the Center for Public Health Law Research at Temple, for her help in making these arrangements. We are indebted to the leadership of COMMONWEALTH, both for pro- viding us with this opportunity and for being consistently supportive as our work unfolded. Four people are deserving of special thanks: J. Wesley Leck- rone of Widener University, the Editor; Michelle Atherton of Temple, the Managing Editor; Joseph McLaughlin, Associate Editor and Director of the Temple University Institute for Public Affairs; and Richard Stafford of Carn- egie Mellon University, a member of the Editorial Advisory Board and the first person to reach out and propose this special one- topic issue. Governor Wolf ’s recent declaration that Pennsylvania’s heroin and opioid epidemic is a “statewide disaster emergency,” is something that never had been done before with respect to a public health crisis. That action was grounded in a number of findings. Two, in particular, are worth repeating here: • The opioid crisis is of such magnitude or severity that emergency action is necessary to protect the health, safety, and welfare of affected citizens in Pennsylvania; and The Heroin and Opioid Epidemic 5 • Pennsylvania’s opioid crisis impacts all areas of the state—including urban, suburban and rural communities—and all ages—including both young people and older Pennsylvanians—and is unprejudiced in its reach and devastation. Those frightening characteristics should help ensure that, even in these frequently divisive times, we remain united in our commitment to meet and defeat this crisis. Without any doubt, much hard work still lies ahead, and sound policy choices will be essential to maximizing the effectiveness of those efforts. It is the shared hope of everyone involved in the creation of this spe- cial issue of COMMONWEALTH that it will be a distinctive source of well- informed guidance for those fighting to advance this noble cause. Mark a. Nordenberg joined the University of Pittsburgh’s law faculty in 1977 and cur- rently holds the special academic rank of distinguished service professor. He served as dean of Pitt’s Law School from 1985 to 1993, and as chancellor of the University from 1995 to 2014. Currently, he serves as chair of the University’s Institute of Politics. The Institute’s mission is to provide a neutral, nonpartisan forum for elected officials and other civic leaders to consider policy issues of importance to Western Pennsylvania. In recent years, addressing the opioid overdose epidemic has been one of the Institute’s highest priorities. Janice L. Pringle is an epidemiologist by training, with extensive experience in health services research. She is a professor at the University of Pittsburgh School of Pharmacy, and the founder and director of the Program Evaluation Research Unit (PERU) within the University of Pittsburgh School of Pharmacy. Her area of expertise is health services research and organizational health. She has developed a framework for assessing organi- zational health and guiding systems transformation. Dr. Pringle has secured over $140 million in grants and has developed health care policy research that has been used to inform policy development at the state and federal levels.