Opioid Addiction in Farm Country a Sad Legacy

From Lancaster Farming

September was National Recovery Month, launched in 1989 to promote new evidence-based treatment, celebrate the vibrant recovery community and the service providers who furnish support, and to offer hope for those still struggling.

Three years ago in September, Pennsylvania joined Farm Town Strong, an effort spearheaded by the American Farm Bureau Federation and the National Farmers Union to bring attention to the opioid epidemic in farming communities and offer resources to those battling addiction.

The scope of the crisis in rural America was staggering, with 74% of farmers and farmworkers reporting they had been directly impacted by opioids, three in four farmers saying it was easy to access large amounts of opioids without a prescription, and one in three adults saying addiction treatment was readily available.

“Addiction is a is a complex disease that can’t be reduced down to simple neurobiology,” said Dr. Adam Scioli, medical director and head of psychiatry at Caron Treatment Center in Wernersville, Pennsylvania. The nonprofit rehab facility was founded as Chit-Chat Farms by recovering alcoholic Richard Caron and his wife, Catherine (Tildon) Caron, and opened the doors to its first patients in 1959.

Multiple factors play a role in both the development of a substance-use disorder and its progression, Scioli said, including co-occurring mental health conditions, such as depression or anxiety, that may also need addressing.

Sickness, Not Sin

“I had a mentor here many years ago who had a very, very simple way of summarizing it,” said Rev. Jack Abel, senior director of spiritual care at Caron. “He was a Catholic priest, but he used to say, ‘Jack, my understanding of this is that it’s sickness, not sin.’ And I think that can be helpful, sometimes, for people who have strong faith backgrounds.”

Faith communities especially may tend to view addiction as a moral failure, when it’s not, he said. Such a viewpoint can contribute to a reluctance to seek help, he said, and offer the false solution that a person in active addiction can simply make better choices, or simply repent

“One of the things that kind of defines addiction, in my experience, is that it’s frustratingly irrational,” Abel said, and so appealing to an addicted person’s power of reason can be useless. Thus, he said, it is difficult to intercept addictive behavior without intervention.

Faith communities excel at caring for the sick, he said, and so ministering to those afflicted boils down to changing that community’s mindset.

“It’s a different approach, where we encourage healing instead of repentance,” Abel said. “And that’s the direction that I’ve always tried to take with people, whether religious or not.”

Not Going Away

“Over the past, I’d say, 20 years, the increase in total number of deaths involving opioids, particularly fentanyl and other synthetic opioids, has increased dramatically,” Scioli said, adding that the opioid crisis was finally declared a nationwide public health emergency in the fall of 2017.

Fentanyl, which is about 100 times more potent than morphine and 50 times more potent than heroin, is sold by prescription, typically as a slow-release patch for severe pain treatment. It is also manufactured in illegal drug labs.

“We’re acutely aware here at Caron of the need to address substance use and, in particular, opioid use, because there’s a high likelihood of fatality,” Scioli said. “It certainly can happen very quickly. It certainly can happen on the very first use. And the unfortunate fact is that opioids that people are ingesting have gotten more dangerous because fentanyl has been either adulterating them, or people are actually seeking fentanyl.”

A large number of fentanyl overdoses occur in people who don’t even realize they are taking the drug, he said.

Opioids are in a class all by themselves when it comes to treating addiction, Scioli said.

“We at Caron actually have an opioid track where we focus on the disease opioid use disorder exclusively as a separate and distinct phenomenon, which requires a biopsychosocial spiritual approach,” he said.

That approach includes making sure the patient has a safe and comfortable withdrawal, helping them decide whether to use a medication — such as buprenorphine (Suboxone) — to assist recovery, and assuring they have the support network to sustain them once they leave the treatment facility.

“Addiction is certainly a family disease, and we have recognized that since our origins,” Scioli said. “There’s an expression here at Caron that resonates with me, that ‘the patient is the family and the family is the patient.’ We talked about the importance of a supportive environment, and that involves, when someone comes into treatment, making sure that their family members or loved ones understand that addiction is a disease and not a choice and that there are going to be certain supports that their loved one requires in order to succeed, not just changes at home, but attitudinal changes toward their loved one, who is now a patient.

Sadly, Scioli said, not everybody is able to overcome addiction.

“And when there’s a loss, the loss is felt by far more people than that person who was trapped in addiction probably ever realized. The disease of addiction does not discriminate based on socioeconomic status or gender or occupation—whether or not you have children or you are a child.”

National Dental Group Works to Improve Access for Patients with Disabilities

The American Dental Association (ADA) shared several ideas about how Congress can ensure greater health outcomes for people with disabilities by providing accommodations in health care settings and further developing a health care workforce that understands the needs of people with disabilities. The ADA also urged Congress to provide grants for the training and continuing education of dentists on treating patients with disabilities to dental schools, dental residency and fellowship programs, and dental associations.

Click here for more information.

Pennsylvania Transportation Department Accepting Unsolicited Public-Private Partnership Proposals Until October 31

Submission period applies to PennDOT-owned projects and infrastructure

The Pennsylvania Department of Transportation (PennDOT) Office of Public-Private Partnerships (P3) announced today that it is accepting unsolicited proposals for transportation projects from the private sector through October 31.

The submission period applies to PennDOT-owned projects and infrastructure. During this period, the private sector can submit proposals offering innovative ways to deliver transportation projects across a variety of modes including roads, bridges, rail, aviation, and ports. Proposals can also include more efficient models to manage existing transportation-related services and programs.

The private sector may also submit applications for non-PennDOT-owned assets directly to the P3 board during this time. Transportation entities outside of the governor’s jurisdiction, such as transit authorities, may establish their own timelines or accept proposals year-round. Unsolicited proposals are being accepted through 11:59 p.m. on October 31. Instructions on how to submit a project and information on the unsolicited proposal review process can be found on the state’s P3 website, www.P3.pa.gov.

The state’s P3 law allows PennDOT and other transportation authorities and commissions to partner with private companies to participate in delivering, maintaining, and financing transportation-related projects.

As part of the P3 law, the seven-member Public Private Transportation Partnership Board was appointed to examine and approve potential public-private transportation projects. If the board determines a state operation would be more cost-effectively administered by a private company, the company will be authorized to submit a proposal and enter into a contract to either completely or partially take over that operation for a defined period of time.

The next unsolicited proposal acceptance period will occur in April 2023. To learn more about P3 in Pennsylvania, including active projects, visit www.P3.pa.gov.

Welcome the Appalachian Leadership Institute Fellows!

Congratulations to the 40 fellows selected for the 2022-2023 Class of the Appalachian Leadership Institute!

This class of ARC’s leadership development program includes a diverse network of professionals representing all 13 Appalachian states and a wide spectrum of perspectives and sectors, including tourism, healthcare, education, civil service, and more.

“These leaders are already growing their Appalachian communities and will be even better equipped to drive positive change after their work with this program,” said ARC Federal Co-Chair Gayle Manchin. “I am eager to see this class of fellows collaborate across state lines to set big goals that will help the entire Appalachian region thrive.”

Over the next nine months, the fellows will participate in sessions focused on skill-building with regional experts, peer-to-peer learning, and case study analysis. They will then join a robust network of program alumni across the region.  Click here to read about the 2022-2023 Class!

CMS Releases Inflation Reduction Act Information and FLU Toolkits

See below for recently released information about the Inflation Reduction Act.  You can view a timeline showing when these changes happen in the Medicare, Medicaid and the Children’s Health Insurance Program, and Health Insurance Marketplace®.   Also the See Frequently Asked Questions has information about reduced drug prices and enhanced Medicare benefits under the Inflation Reduction Act.

It is FLU season and CMS has prepared Partner materials to be shared with the public!  These can be accessed on CMS.gov using the links below.

This CDC page of helpful FAQs is a great resource, too.  Remember that it’s safe to receive the updated COVID booster at the same time as the Medicare flu shot.

Pennsylvania Health Department Recognizes Expansion of Innovative Food Program Supporting 50 Hospitals

Acting Secretary of Health and Pennsylvania Physician General Dr. Denise Johnson recognized fifty hospitals in 26 counties for creating a culture of health by offering nutritious foods and beverages to patients, employees and visitors, and promoting locally-sourced and sustainably-produced products.

Dr. Johnson joined leaders from Philadelphia and the Hospital and Healthsystem Association of Pennsylvania (HAP) to recognize the 50 hospitals participating in the Good Food, Healthy Hospitals programOpens In A New Window.  Click here to access the list of hospitals, by scrolling to the SEE what’s happening at our pledge sites” section of the page.

“The Department of Health is proud to partner with the Philadelphia Department of Public Health and the Hospital and Healthsystem Association of Pennsylvania to implement food service guidelines to help ensure better nutrition is available daily for thousands of patients, employees and visitors at hospitals throughout the state,” said Dr. Johnson. “We commend those who have committed to adopting and further innovating this program that gives access to healthy, local food to so many people. Healthy food is an important tool in both healing and preventing illness.”

Healthcare facilities participating in Good Food, Healthy Hospitals pledge to voluntarily adopt food, beverage and procurement standards in all areas where food is purchased, served or sold. These standards include, among others:

  • indicating vegetarian, heart healthy, and whole grain options on patient menus
  • placing healthier beverages and snacks at eye level for consumers
  • prominently displaying nutrition information of foods and beverages
  • replacing regular fried chips with baked varieties
  • promoting water as a healthy and necessary beverage choice throughout the hospital
  • purchasing locally-sourced and sustainably-raised foods where possible
  • purchasing rBGH-free dairy products

The hospitals work closely with the Good Food, Healthy Hospitals team, including the Philadelphia Department of Public Health (PDPH), the Pennsylvania Department of Health and HAP, for technical assistance and collaboration with participating hospitals.

“We strive to promote healthy, livable communities,” said PDPH Health Commissioner Dr. Cheryl Bettigole. “The hospitals participating in the Good Food, Healthy Hospitals Initiative have demonstrated that you can make it easier for patients, staff and visitors to eat a nutritious diet. It’s this type of leadership and investment that is making our hospitals safer, healthier places.”

Started in 2014, the Good Food, Healthy Hospitals initiative continues to expand. WellSpan Health, Endless Mountain Health Systems, Magee Rehabilitation Hospital (Jefferson Health), Geisinger Medical Center Muncy, and St. Luke’s Carbon and Easton Campuses have signed the pledge for a total of 50 participating hospitals located in 26 counties across the commonwealth. In Philadelphia, 15 hospitals continue implementing the program’s food service guidelines.

“Hospitals do more than treat illnesses and injuries — they partner with patients and their communities for better health,” said Andy Carter, president and CEO of the Hospital and Healthsystem Association of Pennsylvania. “HAP is proud to support Pennsylvania hospitals’ efforts toward better access to nutritious food, more educated food choices, and healthier patients and communities through the Good Food, Healthy Hospitals program.”

The expansion across Pennsylvania is made possible by the State Physical Activity and Nutrition (SPAN) Program grant and Preventive Health and Health Services Block Grant. Pennsylvania was one of 16 states awarded the SPAN grant from the Centers for Disease Control and Prevention in 2018.

More information on healthy eating can be found on the Department of Health’s website at www.health.pa.gov

For more information about Good Food, Healthy Hospitals, visit www.foodfitphilly.org/gfhh/Opens In A New Window

White House Selects a Christmas Tree from a Pennsylvania Farm as its Official Christmas Tree to Stand in the Blue Room

The White House will select its official 2022 Christmas tree to stand in the iconic Blue Room from Evergreen Acres Tree Farm.

On October 10, 2022 at 10:00am EST, Robert Downing, the White House Executive Usher, will lead a delegation to officially select the 2022 White House Christmas Tree.  The tree will be chosen from the many beautiful firs and pines growing on Paul and Sharon Shealer’s Christmas tree farm, Evergreen Acres.

The Shealers earned the honor of providing the official White House Christmas tree when their Douglas Fir entry was selected as Grand Champion at the National Christmas Tree Association’s National Tree and Wreath Contest. To qualify for the national contest, Shearles first had to win the 2021 Pennsylvania Farm Show’s competition earning the opportunity to represent Pennsylvania in the national contest.  Paul Shealer shared, “We were thrilled to win Grand Champion and are even more excited and privliged that our farm will provide the White House’s official Christmas tree. Evergreen Acres takes great pride in its trees every year, and it seems this year we can stand even taller!”

The tree selection event will include statements from Tim O’Connor, Executive Director of the National Christmas Tree Association, a representative from the Pennsylavania Department of Agriculture, and Randy Cypher, President of the Pennsylvania Christmas Tree Growers Association.

“Pennsylvania growers produce one million of the nation’s most impressive Christmas trees every year,” Pennsylvania Agriculture Secretary Russell Redding said. “We’re proud to showcase our finest growers at the PA Farm Show each January. We’re even prouder that the Shealer family qualified to win the National Christmas Tree competition by winning at Farm Show and will grace the White House, representing our commonwealth proudly and focusing the eyes of the nation on world-class PA-grown product.”

The event will take place at 10:00am at Evergreen Acres Tree Farm located at 135 Fort Lebanon Road, Auburn, PA 17922.

For more information about the official White House Christmas tree selection at the Shealer’s Evergreen Acres, please contact Aaron Grau at 717-229-9227 or aaron@christmastrees.org.

Children Living Near Pennsylvania Fracking Sites At Increased Risk of Leukemia, Study Finds

From State Impact PA

Correction: Nicole Deziel of the Yale School of Public Health says Pennsylvania’s wellhead setback from schools and homes should be 1,000 meters. That distance was incorrect in the original version of this story.  

Children who live close to fracking sites in Pennsylvania have a higher risk for the most common form of childhood cancer, a new study found.

Researchers at the Yale School of Public Health used the Pennsylvania Cancer Registry, along with state data on unconventional oil and gas drill sites, to determine that children born within two kilometers, or 1.24 miles, of an active well site were two to three times more likely to be diagnosed with acute lymphoblastic leukemia between the ages of 2 and 7.

The study was published in the journal Environmental Health Perspectives. It looked at 405 children diagnosed with that type of leukemia between 2009 and 2017, and included 2,080 controls matched by birth year.

“The magnitude of the elevated risk that we observed was fairly striking,” said Dr. Cassandra Clark, a post-doctoral fellow at the Yale School of Public Health and co-author of the report. “After accounting for a variety of socioeconomic, demographic and biological factors that could potentially be underlying this association, it was consistent.”

Acute lymphoblastic leukemia is one of the most common childhood cancers, which is why the researchers chose to look at it. Additionally, a known cause is benzene, a chemical released by oil and gas drilling activities into both air and water. The five-year survival rate in children with acute lymphoblastic leukemia is high, at 90 percent.

Unconventional gas development is also referred to as fracking, which is a part of the overall process that injects water with chemicals at high pressure into shale rock formations deep underground to release oil and gas. Water that returns to the surface often includes those chemical additives, along with long-buried naturally occurring toxins and radiological material.

More than 10,000 unconventional natural gas wells were drilled and fracked in Pennsylvania between 2002 and 2017. The Department of Environmental Protection has reported more than 1,000 spills in that period, along with fielding about 4,000 residential well water complaints between 2005 and 2014. Many who live in rural areas rely on water from private wells, about one-third of which are within two kilometers of a wellhead.

The natural gas industry maintains it operates under regulations meant to protect public health. The Marcellus Shale Coalition has said the industry’s “top priority” is protecting health and safety of workers, the environment, and people who live near fracking operations.

One unique aspect of the Yale research includes tracing potential drinking water exposure.

“It really is a superb study,” said Dr. Bernard Goldstein, former dean of the University of Pittsburgh School of Public Health and an expert in environmental causes of childhood leukemia.

Goldstein is not associated with this study. He has conducted prior research into exposures due to oil and gas wastewater in Pennsylvania.

“It looks at a potential problem in ways that include new exposure metrics, which are really needed,” he said.

Goldstein says that though the factors that contribute to childhood leukemia are complex and still unclear, benzene is the one known link.

The interdisciplinary team of researchers included experts on leukemia and environmental science, as well as hydrogeologists. In addition to the location of well sites, researchers mapped individual watersheds and determined the flow of water from well heads to the children’s homes. They did not survey the families to determine individual sources of drinking water.

Still, they say the research shows that a child living within 1.2 miles of a well site, which is within their watershed, could be at a higher risk of exposure through drinking water.

Previous research has shown an association between fracking activities and health impacts, but determining the path to exposure is more difficult.

“I think we have about 50 epidemiological health studies demonstrating increased adverse health outcomes in communities that live near unconventional oil and gas sites,” said Dr. Nicole Deziel, a co-author of the study and associate professor at the Yale School of Public Health in the Department of Environmental Health Sciences. “I think it would be very important to understand which exposures or hazards might be driving these associations.”

Deziel says she wants the study to impact public policy, including regulations on residential setbacks from wellheads and density of drilling sites. Pennsylvania requires a 500-foot setback from schools and homes. Deziel says it should be 1,000 meters, especially since her findings show greater impacts for children exposed in utero.

Those results, she said, suggested “that that may be a sensitive time window, which is also consistent with some other studies of other environmental exposures.”

Biden Administration Releases National Strategy on Hunger, Nutrition and Health

From the National Rural Health Association

Alongside the White House Conference on Hunger, Nutrition, and Health this past Wednesday, the Biden Administration released its National Strategy on Hunger, Nutrition, and Health. Please see below for a summary highlighting the most rural-relevant proposals.

The National Strategy is made up of five pillars, each with corresponding goals and action items to achieve the listed goals:

Pillar 1: Improve Food Access and Affordability

Help more individuals experiencing food insecurity benefit from federal assistance programs.

  • The Administration will work with Congress increase funding for Older Americans Act nutrition programs. This will help address rural seniors’ unique health, social, and nutritional challenges associated with shopping and cooking.
  • The Administration will make it easier for eligible individuals to access federal food and health services. The Department of Agriculture (USDA) will partner with other agencies to increase outreach and awareness for SNAP to older adults and other populations.
  • USDA, through American Rescue Plan funds, will expand online shopping for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). NRHA is hopeful that this will expand access for rural residents that travel longer distances to grocery stores.
  • The Administration will support Congress in removing unnecessary barriers for SNAP recipients, like the inability to purchase hot and prepared foods with SNAP dollars.

Invest in community and economic development to increase access to food. Almost 40 million Americans live in areas where no grocery stores are nearby, including rural areas.

  • The Federal Trade Commission will publish a report summarizing how supply chain distributions have affected grocery stores, including independent grocery stores that often serve rural communities.
  • The Federal Emergency Management Agency and USDA will partner to integrate food security as a priority area when conducting outreach with state, local, and Tribal leaders for disaster planning and messaging. This is especially important for rural areas when there are natural disasters and other emergencies.

Pillar 2: Integrate Nutrition and Health

Provide greater access to nutrition services to better prevent, manage, and treat diet-related diseases.

  • Expand Medicare and Medicaid beneficiaries’ access to food as medicine by supporting legislation to create a pilot program for Medicare coverage of medically tailored meals for beneficiaries with diet-related health conditions.
  • The Centers for Medicare and Medicaid Services (CMS) will use its 1115 demonstration authority to pilot innovative coverage options for diet-related interventions. For example, CMS just announced that it approved Oregon and Massachusetts’ Medicaid state plans for nutritional assistance and medically tailored meals.
  • The Administration will support legislation to expand nutrition and obesity counseling to more Medicaid beneficiaries, specifically in states that have not expanded Medicaid and have large rural populations. The Administration also supports expanding nutrition and obesity counseling to Medicare beneficiaries who currently may only seek counseling in a primary care setting with a primary care practitioner. CMS will examine its authority to increase access to such counseling.
  • Indian Health Services (IHS) will implement a National Produce Prescription Pilot Program. Produce prescriptions provide fresh fruits and vegetables as a medical treatment or preventative service for patients who are eligible due to diet-related health risk or condition or food insecurity.
  • The Department of Veterans’ Affairs (VA) will implement produce prescription programs and mobile food pantries that will aid our rural veteran population.
  • CMS will develop a strategy to increase access to diabetes prevention and treatment for Medicare and Medicaid beneficiaries. NRHA looks forward to this work as rural residents are at a greater risk for diabetes.
  • CMS will support efforts to develop the data infrastructure needed for food insecurity and other social determinants of health (SDOH) elements to be captured in electronic health records. NRHA is hopeful that CMS will support rural providers in this endeavor.

Pillar 3: Empower All Consumers to Make and Have Access to Healthy Choices

Create healthier food environments and a healthier food supply.

  • The Administration will work with Congress to expand incentives for purchasing fruits and vegetables with SNAP.
  • USDA will make investments to support local and regional food and farm businesses.
  • USDA will establish Regional Food Business Centers to support local food business growth, particularly in rural and underserved areas like Appalachia, Colonias, the Mississippi Delta, and in Tribal communities.

Pillar 4: Support Physical Activity for All

 Build environments that promote physical activity.

  • Expand the Centers for Disease Control (CDC) State Physical Activity and Nutrition Programs to all states and territories. The Administration will work with Congress to expand the Program from 16 states to nationwide.

Pillar 5: Enhance Nutrition and Food Security Research

  • HHS and USDA will create a 2025 Dietary Guidelines Advisory Committee with a diverse membership, including geographic diversity. The committee will review dietary guidelines with a health equity lens.
  • USDA will conduct research to better understand nutritional needs of Native Americans and Native Alaskans.
  • USDA will leverage its partnership with the University of North Dakota to better understand Native diets and Indigenous foods.
  • CMS will measure SDOHs, including food insecurity, for at-risk Medicare Advantage beneficiaries.

Medicare Open Enrollment Resources Posted

Medicare Open Enrollment is approaching, October 15.  In preparation, materials are being released to be shared with consumers, colleagues and others who may assist Medicare consumers.

  • The attached Press Releases announce the Medicare Advantage landscape.
  • The Medicare Health & Drug Plan Finder  will be updated with the 2023 Medicare health and prescription drug plan information on October 1, 2022. 1-800-MEDICARE is also available 24 hours a day, seven days a week to provide help in English and Spanish as well as language support in over 200 languages. People who want to keep their current Medicare coverage do not need to re-enroll.
  • To help with their Medicare costs, low-income seniors and adults with disabilities may qualify to receive financial assistance from the Medicare Savings Programs (MSPs). The MSPs help pay Medicare premiums and may also pay Medicare deductibles, coinsurance and copayments if people meet the conditions of eligibility. Enrolling in an MSP offers relief from these Medicare costs, allowing people to spend that money on other necessities like food, housing or transportation. Individuals interested in learning more can visit here. 
  • To view the premiums and costs of 2023 Medicare Advantage and Part D plans, please visit: https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovgenin

Select the various 2023 landscape source files in the downloads section of the webpage.

Shareable Social Media, Videos, TV & Radio Ads will be placed in the CMS Medicare Open Enrollment website located  HERE.