Staffing, 'tranq,' opioid funding mark Pa. House hearing on budget request

Mar. 28—HARRISBURG — The Pennsylvania Department of Drug and Alcohol Programs is considering exemptions sought by treatment providers to exceed a regulatory staffing ratio in order to care for patients with substance use disorder.

Acting Secretary Dr. Latika Davis-Jones explained during a budget hearing Tuesday before the state House Appropriations Committee that not all providers can meet the 1:8 provider-to-patient ratio given the current struggle to hire staff. Such requests are being expedited, she said.

Department administrators are reviewing the ratio and a separate regulation on counselor credentials for potential changes but that, for now, individual requests rather than blanket exemptions are being considered to exceed the ratio.

"We want to do our due diligence," Davis-Jones told state Rep. James Struzzi, R-Indiana.

Gov. Josh Shapiro's proposed budget has the Department of Drug and Alcohol Programs in line for $369.5 million in spending, with $48.1 million from the commonwealth's general fund, just a 0.4% increase.

Davis-Jones and Deputy Secretary Ellen DiDomenico considered questions from lawmakers about workforce struggles, the intended use and oversight of settlement funds from opioid manufacturers and the emergence of the street drug "tranq" — a mix of fentanyl and the animal sedative xylazine.

The mixture is potent and deadly. The opioid overdose reversal drug, naloxone, hailed as a miracle medicine during the overdose epidemic, has no effect on a xylazine overdose.

Struzzi helped usher into state law the legalization of fentanyl test strips, allowing users to test for a substance now suspected to be present in most street drugs including counterfeit pills and stimulants where an opioid might not have normally been expected.

Davis-Jones said there is movement behind a testing mechanism for xylazine, too. Educating the public on its prevalence and dangers will be important in potentially preventing fatal overdoses, she said.

"We do know that it's infiltrating the market here in Pennsylvania with a lot of deaths occurring in Philadelphia and surrounding areas," she said.

State Rep. Ben Waxman, D-Philadelphia, asked whether the Department of Drug and Alcohol Programs (DDAP) might consider establishing supervised injection sites. A former communications director for the office of Philadelphia District Attorney Larry Krasner, Waxman spoke of a site in New York City that has medical supervision and wraparound services to help those with substance use disorder.

Davis-Jones said she is supportive of needle exchanges and harm reduction in general, and that DDAP will continue its work to expand access to naloxone.

"As it relates to supervised injections, that's not part of the work we've sought to do in our department," she said.

Davis-Jones told state Rep. Torren Ecker, R-Adams/Cumberland, that the department passed on $1 million in the state's share of opioid settlement funding to Philadelphia, which added to funds all 67 counties received individually so far.

The data, she says, show extra support is necessary for the Kensington neighborhood which has become synonymous with America's street drug culture. The funding will support mobile response units.

"Oftentimes, individuals were lost at follow-up. These are individuals who would go back into the Kensington community and not come back for the next appointment. This is a mobile team that would go in based on those referrals and connect with those folks who have some touch with the system but may not follow up," DiDomenico said.

Settlement funding and money from the commonwealth's medical marijuana program allowed DDAP to provide more than $18 million to treatment and case management professionals through a student loan repayment program.

The program is intended to help with recruitment and retention.

Grants are made in two installments and recipients must verify that they remain active in the industry.

DiDomenico called the program one with "short-term impact."

"We keep people in the field when they might have left otherwise," she said.

Medication-assisted treatment, or MAT, is becoming increasingly prevalent among treatment providers. Davis-Jones said a regulatory change eliminating waivers for doctors to prescribe MAT medications like naltrexone or methadone led to a 15% increase in providers writing scripts: from 5,959 in 2022 to 6,877 in 2023.