What’s the best way to get heroin off Pennsylvania’s streets and to help people with addiction?
If you’re President Donald Trump’s administration, the answer is the creation of a commission to combat the opioid epidemic combined with a tough-on-crime approach that emphasizes longer sentences and deep cuts to existing federal programs.
Two state senators from Western Pa. now have their own idea: They want to institute harsher penalties for people convicted of selling heroin who are found with more than three doses of naloxone. The punishment would add up to a year to the person’s prison sentence and bring a $5,000 fine.
The legislation’s Republican authors — Sen. Randy Vulakovich, who represents part of Pittsburgh, and Sen. Kim Ward of Greensburg — say the harsher penalties are meant to deter dealers who would use naloxone to draw in customers. Their proposal has not yet been introduced.
But experts in overdose prevention say the legislation is misguided in its approach.
“This bill really doesn’t make sense on a bunch of different levels,” said Alice Bell of Prevention Point Pittsburgh. “It speaks to a real misunderstanding of how drug markets work.”
Monique Tula, executive director of the national Harm Reduction Coalition, made a similar point via email: “This is troubling legislation that completely misses the mark and an example of draconian policies that end up causing more harm than good.”
Bell is Prevention Point Pittsburgh’s overdose prevention project coordinator. It’s her job to make sure people who use opioids in Allegheny County have access to naloxone, also known by the brand name Narcan.
“We want to make sure that there is a large supply of naloxone in the drug-using community,” Bell said. “We know that people who use drugs are most likely to be on the scene when someone overdoses.”
More than 3,500 people in Pennsylvania died of drug overdoses in 2015, and Wolf expects that number to be to more than 4,500 for 2016. In Allegheny County alone, 610 people died of drug overdoses last year — up from 424 in 2015. Opioids were involved in 75 percent of those cases, with heroin and potent fentanyl fueling those deaths.
Pittsburgh Emergency Medical Services administered 2,320 doses of naloxone in 2016, according to the county. Prevention Point Pittsburgh alone distributed nearly 3,000 doses last year and documented 450 overdose reversals. Bell estimated that 98 percent of those life-saving doses were administered by a person who uses drugs.
That statistic is similarly high nationwide. A report published by the Centers for Disease Control and Prevention in 2015, and co-authored by the Harm Reduction Coalition, found that 82.8 percent of laypeople who administered naloxone were themselves drug users.
“It’s critical that we try to blanket that population,” Bell said.
The truth about “Narcan parties”
Ward and Vulakovich’s co-sponsorship memo cites “reports nationwide of drug dealers distributing Narcan along with heroin to users” to justify the increased penalties.
“It is obviously important to make Narcan widely available,” the lawmakers write, “but it should not be used as a marketing tool for dealers who want to increase their chances of a repeat customer.”
The senators appear to be talking about so-called “Narcan parties,” reported gatherings with both drugs and naloxone. (Vulakovich and Ward could not be reached for comment.)
They’re not the only lawmakers who claim these parties exist. At a public hearing on opioids last year, state Sen. Lisa Boscola said “kids are having opioid parties with no fear of overdose,” while state Rep. Daniel McNeill claimed “drug dealers are throwing Narcan parties.”
TV news reports in Pennsylvania on the subject cited law enforcement officials in Lancaster and Landsford who claimed the parties are taking place. Pittsburgh station WPXI’s story on the “dangerous trend” cited the Carbon County borough’s police chief, not any local officials.
Pittsburgh Public Safety spokesperson Sonya Toler said the department isn’t aware of any “Narcan parties” occurring in the city. Naloxone is usually found with people who use drugs, as opposed to dealers, she added.
Outside the state, Manchester, N.H. Mayor Ted Gatsas claimed in March 2016 naloxone was being used by dealers as a “selling tool.” The previous month, 14 people died of an overdose in that town.
Bell said she’s never heard of naloxone being used as a marketing tool, although there are dealers who keep kits.
But she added that viewing people who sell heroin and use heroin differently can create a false dichotomy. “The reality is, a lot of people who use heroin at some point may sell heroin,” she said. That could be a group of people who buy a larger amount at a cheaper price, divide it among friends, then sell some to make extra money, she said.
Bell also questioned why the lawmakers would target dealers who use naloxone to allegedly draw in customers but not those who would use another lure. Why not cheeseburgers? she asked. Or even socks?
“People are repeat customers to dealers who have strong dope and who have a consistent supply,” she said, “not because they are handing out additional naloxone.”
A holistic approach
Wolf’s administration issued a standing order for naloxone in October 2015, meaning a person can obtain the drug at most Pennsylvania pharmacies without a prescription. Allegheny County Health Department Director Karen Hacker issued one six months before that, in May.
“We need to prevent people from dying,” she said. “We’ve been proactive in trying to get this naloxone out there.”
Hacker said the county has worked with law enforcement to ensure officers and other members of that community are utilizing naloxone. The county’s Medical Reserve Corps was recently trained how to administer the drug, she said. The next push, Hacker said, is getting naloxone in the hands of more people who work directly with drug-using communities. The county recently obtained a grant to do just that.
Naloxone distribution is just one piece of the county’s strategy, which also includes “reducing the amount of opioids that are available, identifying people that are addicted [and] getting more treatment options,” Hacker said.
Criminalizing addiction isn’t a part of that strategy, but other municipalities are turning to that tactic. In February, Washington Court House in Ohio began charging people who needed to be revived with naloxone with “inducing panic,” a misdemeanor.
“If we’re going to make a difference in the opioid epidemic, we need to ensure broad access to treatment for substance use and mental health issues, and stable, affordable housing, and jobs,” the Harm Reduction Coalition’s Tula said by email. “Until then, we can’t arrest our way out of the opioid crisis by trying to cut off demand or by criminalizing possession of a life-saving drug.”
Getting naloxone into communities most impacted by the drug crisis is more important than ever, as fentanyl continues to ravage Western Pa. Hacker said she recently spoke to individuals in recovery who had come into contact with the synthetic opioid, which can be deadly in tiny amounts. She said the way they spoke about fentanyl was “so different.”
“We don’t have time,” Hacker said. “We have to do as much as we can.”