One of our core values here at Community Human Services (CHS) is relevance, and as an organization who provides social services and support, it is our responsibility to keep up with current housing and community issues. In order to move forward and help the people of Allegheny County, our programs have to adapt to change—changes to the neighborhoods, to funding, to Pittsburgh’s affordable housing dilemma, and changes to the health epidemics weighing the County down. This includes developing solutions to help combat the opioid crisis crippling many Allegheny County communities. Recently, CHS was awarded $1,218,373* for our Opioid Use Disorder Housing Pilot Program.
But more on that in a minute. Before we explain how our pilot program will impact Allegheny County’s opioid epidemic, it’s important to provide context on how opioids are impacting the County and Pennsylvania overall and how current initiatives are and aren’t solving the problem. Buckle in—statistics are coming.
While Allegheny County has been combating the repercussions of opioids for nearly a decade already, the recent lack of media coverage on opioid-related deaths (focusing instead on the lawsuits against the pharmaceutical companies themselves) may infer that opioid use has decreased. But the numbers suggest otherwise. Each year since 2013, Allegheny County has surpassed prior records for fatal drug overdoses. In 2016, 613 deaths were caused by heroin and fentanyl. In 2017, overdose fatalities hit 737. The top two drugs implicated in the most recent overdose death data are the opioids fentanyl (74%) and heroin (39%). With a population of 1.2 million, Allegheny County now experiences 1 fatal overdose for every 2,693 residents—far exceeding state and national rates.
To put those numbers in perspective, think about this: Heinz Stadium holds 64,000 seats. Every game is sold out. That’s means by the time the clock runs out in the fourth quarter, 23 people aren’t making it back home. If you consider the families and friends tied to those 23 people, the numbers quickly escalate to a crisis level.
While Allegheny County finally saw a decline in opioid-related deaths last year in 2018, we should refrain from celebrating or wiping our hands clean of the problem. The decline is partially from the result of a short-term fix called Naloxone hydrochloride, which is not a long-term solution.
Naloxone hydrochloride, known as naloxone and Narcan, is a life-saving medication that can temporary stop or reverse the effects of an opioid or heroin overdose. While it reduced the amount of overdose deaths in 2018, Naloxone hydrochloride is not stopping people from continuing to use opioids.
Part of making sure our housing and residential programs stay relevant is by training our staff and supplying our service locations with supplies of Narcan nasal spray, a prefilled, needle-free device of naloxone hydrochloride. Other organizations within the County have realized the link between naloxone hydrochloride and saving lives, including the Allegheny County Jail, who from 2016 – 2018 distributed over 1,400 naloxone kits to the people they released. PA Governor Tom Wolf kicked off Stop Overdoses in PA: Get Help Now Week, a statewide initiative to distribute free naloxone at 80 locations around the state to help reduce the amount of opioid-related overdose deaths.
But we’re only treading water on the opioid epidemic. By the time states come up with a solution, the problem has morphed into something different, forcing them to start over and reassess. While our staff have saved many lives, even naloxone hydrochloride cannot combat the growing popularity of fentanyl. Fentanyl is much more powerful than heroin. Because it can create a stronger high, it’s being cut into heroin to increase its potency. Dealers can supply less for more money, and therefore make more money quicker. Dealing drugs is a business after all. But the major issue with this is that drug users buying heroin do not know if their supply is laced with fentanyl, or with how much. And because of this, the results are often deadly. While we used to be able to revive clients with one dose of Narcan after a heroin overdose, it’s now taking two, up to four doses of Narcan to revive overdoses involving fentanyl. And that’s if revival is even possible. 75% of first responders say they have seconds to minutes to revive someone who is showing overdose symptoms involving fentanyl. So while naloxone hydrochloride may save lives by preventing overdose deaths, the growing presence of fentanyl is making it harder and harder to continue decreasing overdose death numbers, let alone stabilize them. The more fentanyl increases, as the statistics are already showing they are, then we very well may begin seeing another increase in overdose deaths in the County. Fentanyl already causes 74% of overdose deaths in Allegheny County, and as this drug’s prevalence increases, the supplies handed out in free days and by organizations are going to be spread thinner and thinner, and a limited supply will only increase the cost. Then what?
If the opioids and life-saving medications are too contentious to stabilze the epidemic, then we need to change the approach and focus on what’s going on with the drug user. Substance Use Disorder (SUD) is a chronic disease that must be managed over time through stable treatment services at graduated levels of care. Living on the street or in an unsafe, unstable environment is a fraught existence focused on survival rather than positive change, and it signifies a lack of essential resources, supports, and basic life needs and skills. Addiction is a complex, lifelong battle that users contend with each day, whether they are in the throes of their addiction or in recovery. It impacts directly and indirectly, affecting not only the addict but the families, friends, and neighborhoods of that individual. And in a state that has the fourth highest rate of opioid overdoses, decreasing opioid addiction requires more than stopping opioids from getting into the hands of users or providing life-saving medication for overdose revival. It’s much more complex than that. Withdrawal symptoms during detoxification are painful and can last for days, which is the timeframe when long-term users are more likely to relapse if they are not properly supported. It can take several weeks before a person is fully restored to their pre-opioid neurological state. That is a critical time to make sure housing and supportive care are available. If a relapse does occur, the user is more than likely to fatally overdose, as they may use the same amount they had before entering treatment when their tolerance to the drug was higher or they will purchase a supply laced with too much fentanyl. If that relapse does involve fentanyl, that life-saving medication may not be enough to save their life. Again, we have to focus on long-term solutions.
So how do we break this cycle? Accessing safe and affordable housing is one of the most common obstacles for people trying to recover from opioid addiction, especially those with a criminal record. Of the 903 people who used the Allegheny County’s winter shelter in 2017-2018, 41% had a substance use issue. So providing housing is a critical key piece to keep recovering addicts from relapsing or becoming/returning to homelessness. If a person with SUD does not have supports to help them find stable housing away from the environment that fueled their addiction, it’s only the more difficult for them to stay on the path to recovery. Housing stability is critical in a person’s ability to remain in treatment at any level of care.
On Wednesday, April 3, Pennsylvania was awarded $15 million for a new program to help people trying to recover from opioid addiction find supportive housing that connects them to what they need to break the cycle of addiction. The $15 million to fund this pilot program will be spread out among 16 organizations in counties that have some of the highest rates of opioid use and fatal overdoses. CHS is one of those organizations.
Under the Commonwealth of PA Dept. of Human Services, CHS was awarded $1,218,373* for our Opioid Use Disorder Housing Pilot Program. It is designed to help Adults 18+ who have Opioid Use Disorder (OUD), are at risk of homelessness or housing instability, and who live in Allegheny County. Theses awarded funds will cover the costs of housing search assistance, rental assistance, basic needs services, benefits enrollment, employment and income supports, peer support and education, and drug and alcohol case management to support participant recovery. We’re aiming to serve 200 people throughout the pilot program’s first full year. Of those 200 participants, 50 will receive a Housing Choice Voucher to sustain permanent and stable housing. The goal is for participants to show greater longevity in housing, self-sufficiency, and overall reduced hospitalizations.
CHS will collaborate across systems in Allegheny County, including the Dept. of Human Services (DHS) and Human Services Administration Organization (HSAO). DHS will serve as the coordinating body for the program and HSAO, who currently serves individuals with substance use disorder and other behavioral health issues, will provide case management. Initially, referrals will come from a select group of recovery houses and centers of excellence, which are part of the OUD system of care and are equipped with linkages to treatment and recovery support. Limiting referral partners during this initial project period is so Allegheny County can effectively pilot this initiative, but it ultimately aims to open services to individuals referred from other sources.
Jeremy Carter, Chief Housing Officer for CHS, explains: “We see the opioid crisis in our existing homeless services programming. However, there is a distinct need to coordinate resources and services between housing providers, drug and alcohol treatment providers, and Allegheny County DHS. It is the only effective way we can tackle both the substance use disorder and the housing instability. Currently, people with an Opioid Use Disorder (OUD) cannot access rental assistance programs unless they fall into homelessness. With this program, we want to prevent people from entering the homeless system, and give them the supports they need to stabilize. We know for a fact that stable housing—with supports—decreases chronic drug use and increases overall health conditions. Without stable housing, people are at very high risk of relapsing or lethal overdose.”
Rural organizations will require and use different supports than urban ones, and this state-wide initiative is designed for that flexibility. Again, the focus is for these programs to stay relevant to the shifting issues of the opioid epidemic within their area. Organizations will be able to create localized solutions that best address the barriers people are facing when they try to find housing while recovering from opioid addiction. Our goal at CHS, as with all of housing assistance programs, is for participants to reach self-sufficiency. We’re looking at the long-term. Instead of keeping people alive, we want people to live their lives. That means providing care management so people keep appointments for treatment, have connections to resources for their mental and physical health, and most importantly, are surrounded with support from several types of necessary resources.
As more information comes out about this pilot program in Allegheny County, we’ll keep you informed.
If you or someone you know wants to carry Narcan or Naloxone as a bystander or a cautious opioid user, visit OverdoseFreePA to find a location near you where kits are available.
*The official contracted amount awarded to the CHS pilot program is $939,505, not the 1.2 million as stated in this article at time of publication.