UPMC is urging treatment for drug overdose survivors

Every day ambulances carry people just revived from overdoses to UPMC Mercy, only to have some of them walk out and promptly use heroin or fentanyl again.

Starting last month, however, many of them leave with a vial of Narcan, an appointment for treatment and the expectation that their health insurer will be offering help the next day.

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start the next day. That’s not easy. “There’s no central organizing entity that has a realtime list of every facility or outpatient program” along with the number of open slots, said James Schuster, chief medical officer for Medicaid and behavioral services atUPMC Health Plan.

Dr. Schuster said that last month the health insurer created an overdose followup pilot program for its clients, including some 550,000 who have the insurer’s Medicaid or Medicare products. When an overdose puts a client in UPMC Mercy, an insurance case manager reaches out the next day.

The case manager often encounters a person whose life is in “general chaos,” said Ann Giazzoni, a licensed clinical social worker who supervises the case managers. “Many of these folks are in crisismode.”

Some are urgently concerned about finding a warm place to stay, having their electricity restored or finding something to eat, she said. The insurance plan connects them with agencies that can help.

The case manager eventually tries to bring the conversation around to treatment and enroll the client in a parttime outpatient program or a full-time, inpatient rehab, depending on their needs, Ms. Giazzonisaid.

Some people refuse all help, she said. Others seem touched that someone is reaching out to them at a tough time.

Dr. Lynch said the most effective way to get people into treatment is to recruit them into an “alliance” of family, community members and professionals who want them to get better.

The General Assembly, though, is weighing a sterner approach: allowing family members to petition to have addicted loved ones ordered into treatment.

A 10-month-old bill by Sen. Jay Costa, D-Forest Hills, the minority leader, is being rewritten in advance of possible consideration in the spring. If it becomes law, a drug user’s spouse, relative or guardian will be able to petition the county after an overdose, suicide attempt, drug-fueled violent outburst or period of lifethreatening behavior. The county then would issue a warrant ordering the drug user to go to a facility for an evaluation.

A review officer then would check the evidence, and, if appropriate, order treatment, potentially including inpatient rehab. The emerging amendment does not include any punishment, though, if the user refuses the involuntary treatment or walks out early.

At a hearing Friday of the Senate Democratic Policy Committee at Duquesne University, Tina Flowers, an attorney from Hampton whose son, Spenser, died from an opioid overdose on Jan. 1, called the measure “one very important tool for families to help their loved ones. Perhaps if he had been mandated to treatment, his story, and in turn our family’s story, would have been very different.”

Dr. Lynch, though, told lawmakers that fear of involuntary commitment might deter some people from asking for help.

“What we don’t want to do is drive people away from their families, because of the risk or threat of involuntary treatment,” he said.

Another complication: The region already has a shortage of slots in treatment programs, said Marc Cherna, director of Allegheny County’s Department of Human Services.

“We have weeklong waiting lists for treatment for people who want to voluntarily go, right now,” he said.

Mr. Costa said the state should take several measures to increase the availability of treatment, but he didn’t think involuntary commitments would likely flood the system.

“We don’t know how many folks will avail themselvesof this option,” he said.

“We’re trying to fashion something on that spectrum that tries to find the best medium between individual rights and getting people to the right treatment options,” he said, noting that the Legislature likely will debate the issue in the spring.

Those who track overdose data now expect that by the end of 2017, the number of drug deaths in Pennsylvania will reach 5,000, breaking last year’s record.

“At the end of the day,” Mr. Costa said, “what we’re doing now is not working.”