Treating Heroin and Opioid Use Disorder
Treating Heroin and Opioid Use Disorder
Every day, we lose 10 Pennsylvanians to substance use disorder. This disease affects each and every Pennsylvanian and threatens entire communities in our commonwealth.
Help is available for Pennsylvanians battling substance use disorder and their loved ones. This guide will connect you to the resources you need to live a long and productive life.
Need treatment? Call the Get Help Now Hotline at 1-800-662-4357 to speak with a professional.
If somebody has taken drugs and becomes unresponsive, call 911 immediately. These resources are intended for preventive measures only.
Call the hotline
Are you or is someone you know suffering from substance use disorder? We can help. Call 1-800-662-HELP (4357) for information about treatment resources. Your call is confidential. The hotline is staffed by trained professionals 24 hours a day, seven days a week, and is available in both English and Spanish.
Find a County Single County Authority
Local treatment programs are administered through county drug and alcohol offices called Single County Authorities. These programs can help with treatment funding, assess the need for treatment or other services, and make referrals to match treatment and/or service needs.
Find a Center of Excellence
Centers of Excellence, created by the Wolf Administration in 2016, are designed to get more people into treatment and keep them engaged in their care. The centers coordinate care for people with Medicaid. Treatment is team-based and “whole person” focused, with the explicit goal of integrating behavioral health and primary care. More information about Centers of Excellence.
To find a Center of Excellence near you, view the map below:
Find a treatment provider
You also can reach out directly to treatment providers near you. A treatment provider or facility provides treatment options for those suffering from substance use disorder.
What is Naloxone?
Naloxone is a medication that can reverse an overdose caused by an opioid drug (prescription pain medication or heroin). When given during an overdose, naloxone blocks the effects of opioids on the brain and restores breathing within two to eight minutes.
Naloxone has safely been used by medical professionals for more than 40 years, and has only one function: to reverse the effects of opioids on the brain and respiratory system in order to prevent death. Naloxone is safe to use and has no potential for abuse (a person can’t get high or become addicted to it). Naloxone does not work to reverse overdoses from other types of substances.
How do I get naloxone?
Family members and friends can access naloxone by:
- Obtaining a prescription from their family doctor
- Using the standing order issued by Rachel Levine, M.D., Secretary of Health and PA Physician General. A standing order is a prescription written for the general public, rather than specifically for an individual.
To use the standing order, print it and take it with you to the pharmacy or have the digital version on your phone. Download the standing order from the Department of Health (PDF).
If you are unable to print it or use the digital version, the standing order is kept on file at many pharmacies. If a pharmacy does not have it on file, they may have the ability to look it up.
Naloxone prescriptions can be filled at most pharmacies. Although the medication might not be available for same-day pickup, it often can be ordered and available within a day or two.
What types of naloxone are available?
Two of the most common ways naloxone is administered are intranasal (nasal spray) and auto-injector.
- Intranasal has two pieces that are easily assembled: a prefilled medication tube and an atomization device, which is sold separately. The nasal piece may not be stocked at your local pharmacy; however, they may assist in ordering it. Additionally, the nasal atomization device can be ordered from a number of medical supply companies without a prescription.
- The auto-injector comes in a manufactured dosage form (similar to an EpiPen) and has a recorded message to talk you through giving the medication.
Please note, not all pharmacies have both forms, and insurance coverage can vary depending on the type of medication being purchased and each individual insurance plan. Check your insurance prescription formulary or call your benefits manager to determine if the medication is covered by your plan or if your purchase will be an out-of-pocket cost.
Does insurance cover naloxone?
Insurance companies vary in how they cover naloxone and other drugs used to treat an opioid overdose. Prior to having a naloxone prescription filled with a pharmacy, consumers are encouraged to check with their insurance carriers to find out whether naloxone is a covered benefit under their policy. If so, check to see what form of naloxone is covered, and any cost-sharing amounts that may apply under the policy.
Will fee-for-service and managed care organizations pay for naloxone dispensed under the standing order for Medical Assistance recipients?
Will Medical Assistance require a prescription in order for the pharmacist to fill the naloxone for a Medical Assistance recipient?
Per 55 Pa Code, Chapter 1121 — Pharmaceutical Services — §1121.52, pharmacists can treat the standing order as a verbal order for Medical Assistance recipients.
Can a person other than the eligible Medical Assistance recipient (friend or family member) obtain the naloxone at the pharmacy on the recipient's behalf? Will the Medical Assistance Program make payment?
PA Medical Assistance will make payments for naloxone for the eligible Medical Assistance recipient.
Is prior authorization required by Medical Assistance for any of the naloxone products or supplies?
The Evzio auto-injector is covered by Medical Assistance but requires prior authorization. Generic naloxone is covered without the need for prior authorization.
Where can a pharmacy access Medical Assistance billing procedures for naloxone and the nasal actuator?
The fee-for-service program will post information related to billing for naloxone on the DHS Pharmacy Services website. Pharmacies will need to contact each managed care organization individually to obtain information about their billing procedures.
Will copays apply for the naloxone products and nasal actuator?
No, the Medical Assistance copay will not apply.
Is there a limit to the number of times that a Medical Assistance recipient can get naloxone?
No, there is no limit to the number of fills that can be obtained.
The Magnitude of the Epidemic
The opioid epidemic affects every walk of life. Rich, poor, black, white, young, or old — the opioid crisis is unprejudiced in its reach and devastation. At least 10 Pennsylvanians die every day from a drug overdose, with more than 5,300 overdose deaths in Pennsylvania in 2017 alone.
How to Use Naloxone
How do I administer naloxone?
When given during an overdose, naloxone blocks the effects of opioids on the brain and restores breathing within two to eight minutes. Here’s how to administer naloxone nasal spray:
STEP 1: Peel back the package to remove the device.
STEP 2: Hold the device with your thumb on the bottom of the plunger and two fingers on the nozzle.
STEP 3: Place and hold the tip of the nozzle in either nostril, until your fingers touch the bottom of the patient’s nose.
STEP 4: Lastly, press the plunger firmly to release the dose into the patient’s nose.
Want to know more about how to administer naloxone?
- Talk to your health care provider and/or pharmacist
- Take a brief online training through the Department of Health:
While it is not necessary to obtain a training certificate in order to purchase naloxone, learning these important details will help you respond properly in the event of an overdose and also meet the immunity requirements of PA Act 139.
Can I get in trouble for giving someone naloxone?
Through the ‘Good Samaritan’ provision of Act 139, friends, loved ones, and bystanders are encouraged to call 911 for emergency medical services in the event an overdose is witnessed and to stay with the individual until help arrives. The provision offers certain criminal and civil protections to the caller so that they cannot get in trouble for being present, witnessing, and reporting an overdose.
Administering Naloxone: Physicians are permitted to write third-party prescriptions for naloxone, and you are immune from liability for giving naloxone if: 1) you believed the person was suffering from an opioid overdose (heroin or prescription pain medication) and 2) you called for medical help/911 after giving the medication.
What are the do's and don'ts in responding to an opioid overdose?
✓ DO support the person’s breathing by administering oxygen or performing rescue breathing.
✓ DO administer naloxone.
✓ DO put the person in the “recovery position” — on their side — if they are breathing independently.
✓ DO stay with the person and keep them warm.
✘ DON’T slap or try to forcefully stimulate the person — it will only cause further injury. If you are unable to wake the person by shouting, rubbing your knuckles on the sternum (center of the chest or rib cage), or lightly pinching them, they may be unconscious.
✘ DON’T put the person into a cold bath or shower. This increases the risk of falling, drowning, or going into shock.
✘ DON’T inject the person with any substance (salt water, milk, “speed,” heroin, etc.). The only safe and appropriate treatment is naloxone.
✘ DON’T try to make the person vomit the drugs they may have swallowed. Choking or inhaling vomit into the lungs can cause a fatal injury.
Where can I get trained to administer naloxone?
- EMS: For EMS agencies licensed through the Department of Health, and for certified EMS providers, training will be provided through the Department of Health’s Learning Management System.
- Law enforcement: For training of law enforcement officers by law enforcement officers, the Department of Health Training on naloxone can aid every law enforcement agency and professional in the Commonwealth of Pennsylvania. In order to access, you must be registered as a member of the site.
- For Chester County Law Enforcement only: Visit Good Fellowship Ambulance and EMS Training Institute.
- Friends, family, and all other non-licensed, non-certified fire or EMS agencies and providers: Visit getnaloxonenow.org or the training website.
The fee-for-service program posts information related to billing for naloxone. Pharmacies will need to contact each managed care organization to obtain information about their billing procedures.
If you are a pharmacist in Montgomery or Allegheny counties, please note that there also are standing orders in your county. In addition, CVS has developed a standing order for their pharmacies nationwide.
Review the Opioid Dispensing Guidelines maintained by the Pennsylvania Department of Health.
I'm a first responder. What do I need to know?
The enactment of Act 139 allows first responder organizations to obtain, carry, and administer naloxone in the event of an opioid overdose. According to Act 139, a non-licensed first responder agency must first enter into a written agreement with an EMS agency. This written agreement is valid only under the consent of the EMS Medical Director or another physician. View the Standing Order Naloxone Prescription for PA Firefighters and Law Enforcement Officers.
The Naloxone for First Responders program is designed to provide naloxone to first responders at no cost.
I’m a school administrator/official. What resources are available to me?
The National Association of School Nurses believes that the safe and effective management of opioid-related overdose in schools should be incorporated into the school emergency preparedness and response plan.
Governor Wolf and the Pennsylvania Departments of Health, Education, State, and Drug and Alcohol Programs announced a statewide partnership with Adapt Pharma to provide a free, two-dose carton of Narcan (naloxone hydrochloride) nasal spray to public high schools in Pennsylvania.
Though the program is no longer accepting new applications, enrolled schools can reorder naloxone from Adapt Pharma.
Drug Take-back Boxes
The Department of Drug and Alcohol Programs, in partnership with the Pennsylvania Commission on Crime and Delinquency, the Office of the Attorney General, the National Guard, and the Pennsylvania District Attorneys Association, spearheaded an expanded prescription drug take-back box program to reduce the amount of prescription drugs available for potential misuse and abuse.
Through grants, this program has placed hundreds of take-back boxes across all 67 counties. Since its start in January 2014, hundreds of tons of prescription drugs have been collected and safely discarded.
Find a drug-take back location near you.
Opioid Use Disorder and the Wolf Administration
The Wolf administration has made the fight against opioid use disorder a top priority. Since Governor Wolf took office, he and his administration have worked with the General Assembly to take aggressive steps to combat opioids, making Pennsylvania a national leader in the fight.
In 2015, Governor Wolf expanded Medicaid, which has allowed more than 125,000 Pennsylvanians with an opioid use disorder to access treatment. Without this expansion, thousands of Pennsylvanians would be suffering without help.
Governor Wolf signed a first-of-its-kind statewide disaster declaration to enhance state response, increase access to treatment, and save lives. This disaster declaration is bolstering the administration’s existing response by speeding up and expanding access to treatment, improving tools for families, first responders, and others, and further enhancing coordination and data collection to improve state and local response.
Governor Wolf also has provided funding to implement 45 Centers of Excellence throughout the commonwealth that have connected tens of thousands of people with substance use disorder to life-saving treatment.
Governor Wolf signed legislation that limits the number of opioids a patient can receive in emergency rooms to a seven-day supply with no refills, and put the same restriction in place for minors, no matter where they get a prescription.
Additional steps the Wolf Administration has taken to combat the crisis include:
- Launching a prescription drug monitoring program that allows prescribers and dispensers to monitor who is obtaining opioids, who prescriptions are being obtained from, and how often they are prescribed.
- Making naloxone available to all Pennsylvanians through a standing order.
- Distributing naloxone to police departments, first responders , and schools.
- Expanding the use of prescription drug take-back boxes.
- Developing a warm handoff policy to get those who have overdosed directly into treatment.
- Improving prescribing guidelines for the safe and effective use of opioids, including in sports medicine, for minors and Pennsylvanians on Medicaid, as well as improving education for medical professionals on opioid prescribing.
- Launching a 24/7 helpline, 1-800-662-HELP, for those who need immediate assistance with drug and alcohol problems.
- Developing effective opioid tapering practices for medical professionals.
- Launching a workgroup on infants with substance exposure to work on Plans of Safe Care.
- Starting collaboratives to work on improving care for mothers and babies.
- Requiring medical students to take opioid prescribing curriculum.
- Requiring Pennsylvania physicians to take two hours of education in pain management.
The commonwealth is making progress when it comes to battling this public health crisis, but this is not the end of the administration’s efforts.