NPR reports two high schools in Berks County losing six former students to heroin overdose within two years. One high school student did heroin in the school bathroom before class. She collapsed in class but survived the “close call,” and now the middle and high schools stock naloxone, the fast-acting antidote, in the event of an overdose.

Stories depicting Pennsylvania’s heroin epidemic are not difficult to find. WNEP in Scranton describes how Georgiann McKay cried when talking about her 25-year-old son, Kevin, who died of a heroin overdose. In August 2015, Washington County in southwestern Pennsylvania recorded eight heroin overdoses in 70 minutes, according to The Washington Post. The county reported 16 overdoses in 24 hours and a total of 25 overdoses in two days. Three people died and many were saved by a recent decision to provide each first responder with naloxone.

“We don’t ever have to worry about that medication expiring because it’s always used,” paramedic Phil Salamone told NPR. Naloxone is one of many approaches needed to combat the heroin epidemic in Pennsylvania.

The Heroin Problem in Pennsylvania

Severity

Drug overdose is now the leading cause of injury death in the United States, surpassing gun deaths and car crashes. The total is concentrated in the Rust Belt, the Great Lakes region and the Northeast, according to The Washington Post.

Pennsylvania was ninth in the country for drug overdose deaths in 2015, says the Centre Daily Times, and heroin is the most common drug identified in fatal overdose victims. No standards exist in Pennsylvania to accurately track heroin overdose deaths, but sources point to a large and growing figure. The state’s physician general estimates that in 2014, roughly 2,500 Pennsylvanians died from heroin. Nearly 5,500 died from overdoses in 2017, PennLive reports, with heroin or opioid painkillers detected in 80 percent of the deaths.

“This is the worst healthcare epidemic, healthcare crisis, in not just our lifetimes, in the last 100 years,” said Gary Tennis, secretary of Pennsylvania’s drug and alcohol programs, according to WNEP. “The last time we had an epidemic of this severity was the great flu epidemic of 1918.”

Contributing Factors

Prescription painkillers may be partly to blame for the heroin crisis. People who abuse or are dependent on opioid painkillers are 40 times more likely to abuse or be dependent on heroin, according to the Centers for Disease Control and Prevention. Rachel Levine, physician general for Pennsylvania, believes that people once addicted to prescription painkillers are switching to heroin, which is less expensive. Guidance counselors add that kids who start with marijuana may pivot to prescription painkillers and then heroin.

The price of and access to heroin, specifically in rural Pennsylvania, is a strong factor. “Young people in rural Pennsylvania can buy heroin more easily than a bottle of wine and getting high with the opiate can be cheaper than buying a six pack of beer,” according to a Reuters report from September 2014. Proximity to heroin distribution centers like Baltimore adds to accessibility, and many rural residents who have few economic prospects view dealing heroin as an attractive career option.

The epidemic crosses all geographic, economic and racial boundaries. Heroin has affected both genders equally and doesn’t discriminate by age, according to Centre County coroner Scott Sayers in the Centre Daily Times. “This is not just a teenage problem,” he said. “It’s not just a 24- to 38-year-old problem. You have seniors that are struggling with addiction. It’s not a particular race, even though we’re seeing a higher number of addicts that are Caucasian.”

More middle-class people are addicted to heroin via prescription opioids, leading to the regular buying and selling of heroin in bars, nightclubs, homes and more unlikely places, according to addiction psychiatrist Neil Capretto in The Washington Post. And while people addicted to heroin need help more than they need incarceration, lack of space in treatment centers is a major problem. People who cannot afford treatment face greater odds of overcoming the problem. Today’s heroin is also much more potent than the heroin of previous eras.

Due to these factors and signals, many believe overdoses and deaths will continue. A detective in rural Pennsylvania described the area to The Washington Post as “kind of like ground zero.” “If we had a serial killer killing one-tenth as many [people], we’d have the National Guard here,” Capretto said. “We’d have CNN here every night.”

How Pennsylvania Is Combating Heroin Abuse

There is stigma against people who are struggling with addiction. “Some people, for example, view addiction as a choice, or a conscious decision,” according to the Center for Rural Pennsylvania. “Others question why government is spending precious limited financial resources on those who opt to abuse drugs.”

The Center for Rural Pennsylvania published findings from statewide hearings on the heroin epidemic. The hearings concentrated on specific components of treating heroin and opioid addiction.

Addiction Is a Chronic Disease: Healthcare and treatment professionals agree that addiction is a chronic disease, and it should be treated comprehensively and individually. “We need to treat this illness from a disease model rather than one that is currently viewed as a moral deficiency or as criminal behavior or even a matter of self-choice,” said Cheryl Andrews, executive director of the Washington County Drug and Alcohol Commission.

Treatment Must Be Individualized and Clinically Driven: Treatment plans from previous years don’t work with people addicted to heroin and opioids, because there is no “one-size-fits-all” approach. Instead, treatment providers can apply current theory and research to cognitive behavioral therapies and medication-assisted treatment options. Regardless of the treatment plan, it will only work if services are accessible, available and affordable. In Pennsylvania, only one in eight individuals who need addiction treatment are able to access it.

Full Continuum of Care: Individuals with addiction require a full continuum of care that can span three to six months of residential treatment, followed by outpatient treatment and recovery supports that include non-hospital rehabilitation, halfway houses, outpatient peer counseling and medication-assisted treatment.

Integrating Pain Management Education in Medical School Curriculum: Participants in the hearings reported that 80 percent of heroin users began with the abuse of prescription drugs. The over-prescription of pain management drugs is partly the result of the absence of pain management education in medical schools.

Workforce Issues: The workforce of physicians and counselors who treat those with addiction needs to increase.

The hearings also addressed a number of other issues. Topics included the expansion of the availability of naloxone, specialized treatment courts for drug offenders, the need to educate children about the dangers of drug addiction, the desire to reinstate mandatory sentencing minimums for drug dealers (most are not users; this is a lucrative and sometimes violent business), the need for inmates to receive services when they are released and uniformity in how heroin deaths are reported.

The Role of Behavioral Health Professionals

Behavioral health professionals can help provide support for people with drug addiction and can make a difference for those obtaining individualized and clinically driven treatment.

Alvernia University’s online B.A. in Behavioral Health prepares students for graduate studies or work in rehabilitation centers, hospitals and other environments. The program takes place in a convenient online format to accommodate students’ work and personal schedules.