Interview with Rep. DiGirolamo

Gene DiGirolamo has served since 1995 as State Representative for Pennsylvania’s 18th District, encompassing Bucks County. He is Republican chair of the House Human Services Committee. Rep. DiGirolamo talked with PPR as part of our series on the Philadelphia Opioid Crisis. Interview has been edited for length and clarity.

Penn Political Review: Can you tell me a little bit about your background?

Rep. DiGirolamo: I am the chairman of the Human Services Committee in Harrisburg. And the majority chairman and the drugs issue and treatment and addiction and prevention and the department of drug and alcohol programs [at the] state department does come under the jurisdiction of my committee.

I took an issue in this addiction and treatment because of my oldest son Gene’s heroin addiction about 20 years ago. I believe I was in my second term in the legislature, back about ‘95 or ‘96. So, as a parent, I really know what a family goes through when they have a loved one or son or daughter (in my instance, a son) who’s addicted to drugs (and in this case, heroin) because that’s what we’re experiencing with this epidemic. So it’s just a terrible thing for a family to go through. My son is one of the lucky ones, he was able to get into treatment. So I know treatment is effective and does work, and he is now in long term recovery and doing very, very well. So going through that as a father really heightened my awareness of how to fight this disease. When my son was going through his addiction, which was 18-20 years ago, the heroin and the opiates weren’t as prevalent as some of the other addictions, which was cocaine and methamphetamine and alcohol. Alcohol is still by far the number one abused drug, by far. But the focus has been on the opiates and heroin. And boy, instead of getting better, it’s getting worse. The coroner’s report and the DEA’s report for 2016 showed that 4,642 people in Pennsylvania died from drug overdoses. Almost 90 % of them, opiates or heroin were the primary cause of death. The city of Philadelphia certainly has been experiencing a large number of those deaths, but no less in the counties. Bucks, Delaware, Montgomery are really experiencing a surge. I believe it was almost a 30% increase from the year before. So this is a big problem.

PPR: What is going on at the state level to address this problem?

GD: We’re saving lives with the Narcan. The problem is, if people don’t get help and get into treatment, after you save their lives, they’re going to be right back on the street using drugs again. And that same person, they’re going to save their lives a week or two later again.

One thing we should be doing, and I know the Attorney General is looking at this because he’s partnered with a bunch of states to do a criminal investigation against these drug companies that manufacture these opiates, to see if they (which I believe they have) misrepresented the dangers of these opiates, not only to the public but also to the medical profession. I believe, like a lot of other people, that the drug companies had a campaign for years to increase the sales of these opiates, and again, misrepresented the dangers of addiction to these opiates. I would like to see the attorney general in Pennsylvania, who is Josh Shapiro, who I like a lot, file a civil suit against these drug companies. And I think there’s only five of them that make these opiates. It’s Endo, Teva, Purdue, Johnson & Johnson, and Allergan. They are the main producers of the opiates. He should be filing a civil suit against them for damages, and make them come in here and help clean up the mess that they’ve created with these opiates. I foresee it as happening much like happened with the tobacco settlement, where many of the states,( or almost all of them) got together and filed a lawsuit, a civil suit against the tobacco companies, which I think since then has generated about 250 billion dollars, payments from the tobacco companies that they’ve paid out to the states.

We’ve also got to stop the flow with these opiates out on the streets. And I think the medical profession and the doctors and the people who are prescribing this are really starting, over the last two or three years, to try to stop the flow of these prescriptions. Which means they’re realizing that you don’t need to prescribe 30 at a time and a refill when maybe a 3-5 day supply would be sufficient. I think we see that happening around the state of Pennsylvania with doctors, they’re not prescribing this stuff like they used to. But then you have these stories in the paper with these doctors, and it’s usually a bunch of doctors in an office profession, that are just prescribing this stuff like water. And then you hear stories of tens of thousands of these things that were prescribed for no legitimate reason and they end up out on the street. I think that goes on quite a bit. So we’ve got to make sure from the law enforcement side that we give them the tools to stop that stuff.

We have a prescription drug database which has been up and running for a year now, this August it’s a year… doctors and pharmacists will have access to it, and law enforcement and the attorney general. So I think we’re doing some good things.

PPR: Yes. And in terms of treatments, what do you think is the biggest solution? Specifically, what do you think of safe injection sites?

GD: Well, I’ve never been a big fan of these safe places for people to shoot up. I really need some convincing to believe that’s a good thing. I don’t think law enforcement, for a variety of reasons, is OK with that either. So I need some convincing about that. But the biggest area that I see where the need is…you try to find a treatment or a detox bed, in the state of Pennsylvania, especially on the weekend–Friday, Saturday or Sunday night–there are none available, they’re all full. And everybody will tell you the same thing. So, capacity, while we are right now at the peak of this epidemic, is a big problem. I would like to see…we have a lot of empty state buildings around the state of Pennsylvania…I would like to see the state get involved and partner with treatment facilities to maybe open up some of these buildings that are closed and abandoned, and use them for treatment.

One of the other things I want to point out, it’s what’s going on down in Washington with this health care debate. These bills that passed out of the House, and then what the Senate was talking about doing also, which thankfully they didn’t get enough votes to move another bill. The changes they want to make in Medicaid–not Medicare but Medicaid. Medicaid is what some people call public assistance. Medicaid is the insurance people get, and a lot of people are really getting drug and alcohol treatment from Medicaid. And there was part of the Affordable Care Act which was the expanded Medicaid, which Pennsylvania decided to opt into. I think there are 725,000 people in Pennsylvania have health insurance with this expanded Medicaid, and have access to drug and alcohol treatment. If they make changes down there to the states and their Medicaid, traditional and expanded, it is going to be disastrous for our state, because people who have an addiction to heroin, especially…you’re not going to get better with 10, or 15, or even 20 days of treatment. You need 30 days, 60 days, 90 days of treatment. And it’s expensive. And Medicaid has been paying for those long-term stays of treatment for people that need the help. So we’ve got to make sure they don’t make any of these changes or cuts to Medicaid like they’re talking about.

PPR: At the state level… what do you see as the biggest barrier to the state doing everything they should be doing, from your perspective, to address this crisis?

GD: Well, as with a lot of things, it’s funding. Money. I think we do a good job…the state provides every one of the counties money for addiction treatment. It’s in the state budget, it’s in line items embedded in the state budget. Now the counties, Philadelphia included, use this money to help people who do not: A) have insurance at the workplace or commercial insurance or B) qualify for Medicaid. You have this large population in between who do not have insurance, commercial insurance at the place of work, or do not qualify for Medicaid for one reason or the other. So there is a large population in between who have no insurance at all. And if they need help with addiction treatment, the only place they can go is their counties, who do have money to help these people out. But it’s never enough. They always run out of money. I think it’s on a monthly basis they get their allocation. But they’re always running out of money. So more money for treatment would always be a blessing.

PPR: Where do you think that money should come from, at the state level?

GD: Well, we’re still battling right now on the state budget. Nobody want to raise taxes. I would go back to [the idea of] filing a lawsuit against drug companies. If we would do that and be successful, there’s where the money should come from. I’ve approached them a number of times about trying to help out, coming willingly. They don’t want to come willingly, so we’re going to have to force them to come to the table, and that’s by filing a lawsuit. And other than doing that…there are a lot of other places in the budget that need more money…in my opinion this is life and death, trying to get people help. We’re talking about taxing the Marcellus Shale; to me that’s a no-brainer that we should be doing. That’s a way we can generate a significant amount of revenue for the budget that might be able to help out with drug and alcohol treatment also. So if you’re going to generate more money, you’ve got to get the revenue from somewhere, and most of the time the only place you can really do it is by raising taxes or fees or somehow. But I think the Marcellus Shale is the first place we ought to be looking to raise additional revenue for the budget, which could certainly help out with funding for drug and alcohol treatment.

PPR: Are there any other ideas or bills that you want to highlight or discuss?

GD: There are a couple of other issues that I think would be helpful. You mentioned my one bill that would impose a 10% impact fee. It’s going to be difficult to get passed, because again that is a tax increase. Now we do have in the bill that the fee can not be passed on to the consumer. The drug company would have to absorb the 10% tax. I’d really like to get that bill passed, but at this point I don’t know if I’ll be able to get the votes to get it out of committee, much less get it up on the floor for a vote, because of the part that it is a tax increase. So there are some other ideas, about the database, making sure that the doctors look in the database every time they write a prescription for an opioid. Right now they do not have to, they’re not forced to look in, only on new patients. I think that would really be helpful, especially when it comes to the drug addict knowing that if they go before the doctor, and the doctor is going to look in the database, that they’re not just doctor shopping where they try to go to multiple doctors, they’re not going to be able to get away with that. That’s one issue I think is important, if we can get that done. Making these doctors that prescribe Buprenorphine, making them do counseling, I think would really, really be helpful. And not allowing them to have…I think right now they can have a hundred or more patients a month prescribing…I think that’s way too much. I think that’s more a federal issue than a state issue. Making these drug companies be responsible…I know some states are looking at putting in legislation…how many of these opiates you’re allowed to prescribe at a time. Some states are doing that; I’m not quite sold on that yet. I know the doctors would not like to have people telling them what they’re allowed, and how many they’re allowed to prescribe to their patients; they wouldn’t be happy with that. Again, this capacity for beds for treatment is a big issue. We really need to up capacity, to try to get a handle on this epidemic maybe for the next 2 or 3 years, to get our hands around this.

PPR: So, given the political, financial, social realities of this…where do you see this heading in the next 3,5,10 years even?

GD: I think people across the spectrum in government and society really are taking this thing seriously. We’ve let it get way out of control. We should have had this type of focus 5,6 years ago. I still continue to direct a lot of my anger against these drug companies. They have made literally tens of billions of dollars in profits from the sale of these opiates and I can’t help but believe they knew what was going on, they knew how dangerous this stuff was. They misrepresented the dangers of this stuff to the doctors and the public.And they should share an awful lot of the responsibility for what happened. The FDA, the [Food and] Drug Administration, just recently pulled for the first time…one of these opiates( and the drug company agreed with it) one of these opiates out of the pipeline. It’s called Opana. It was really being abused…it has a time release formula and the addicts couldn’t wait to get their hands on it. So the FDA just decided that the dangers from this were far outweighing the benefits.They pulled it off the market. I think they probably need to do that with some of these other brand name opiates; get a handle on this Buprenorphine.It’s just all over the place. Make sure that Medicaid stays the way it is and pays for treatment. I think that’s the way we’re going to get a handle on it, a little at a time. It’s not going to be easy. It’s not going to be an overnight thing that goes away.We need to put a laser focus on the problem, and all hands on board.

PPR: Thank you very much Representative!