North Central PA Times

Dr. Perry Meadows, Medical Director of Government Programs at Geisinger Health Plan, knows full well the importance of drug and alcohol treatment centers in Pennsylvania when he says, “The more opiate treatment providers can do in-house, the more services we can provide and the better we can improve the overall health and quality of life in those with substance use disorder.”

“When someone with substance use disorder agrees to treatment, you may have five minutes. That’s why the more opiate treatment providers can do in-house, the more services we can provide and the better we can improve the overall health and quality of life in those with substance use disorder. The bottom line is, we want to keep these folks alive. And we want to make sure that we give them the best quality of life that we can give them,” Meadows told North Central PA Times.

Meadows elaborated on the vital role that treatment centers play in addressing substance use disorder in the Commonwealth of Pennsylvania.

“You can have your inpatient centers or your intensive outpatient centers, but a majority of substance use disorder treatment, especially with opiate use disorder, is not done on an inpatient or intensive outpatient basis. It’s done outpatient, in a number of different clinical settings,” said Meadows.  

“With the changes in the Drug Enforcement Agency’s requirements regarding prescribing buprenorphine [a drug to treat opioid use disorder, more commonly known as “Subutex”], just about any physician can prescribe buprenorphine. Now, I’ll qualify that by saying that most physicians are not comfortable with that. I work with a wide range of outpatient treatment clinics across Pennsylvania and they do a fantastic job caring for those with substance use disorder, especially opiate use disorder and alcohol use disorder.”

Meadows added he had spoken with two organizations earlier that day with respect to plans to expand their services “beyond just treating the substance use disorder” and addressing root causes.

“The Commonwealth’s Department of Human Services, in Harrisburg, through Medicaid has established a ‘Center of Excellence’ program and there are more than 200 opiate use disorder treatment centers that are considered ‘Centers of Excellence’ under the Medicaid program. Granted, they see more than just Medicaid, they’ll see Medicaid [and] commercial Medicare. Under the ‘Center of Excellence’ program, they provide the medical care, but they also provide other services like case management or care management, where they have other people in the program that work with individuals to assist them with other needs, such as what we call ‘social determinants of health,” said Meadows.

“Because in my mind and in the ‘Center of Excellence’ program concept, you really have to address the whole person. And if you’re not addressing the whole person, you’re not going to really assist them getting into recovery. Now, what is a social determinant of health? It can be something such as transportation, it could be food, it could be housing, it could be clothing. Many of these people have needs far beyond what they need in terms of strictly treating their substance use disorder. And that’s how a lot of these outpatient programs can really assist in keeping people alive, basically.”

The “Center of Excellence” program began in 2016, to highlight facilities providing a holistic view of treating substance use disorder, through examining physical health, behavioral health and social needs.

Meadows emphasized that addressing the underlying causes of a patient’s substance use disorder through evaluating their social determinants of health is critical for their success in recovery.

North Central PA Times also asked Meadows about how Pennsylvania’s current healthcare worker shortage is affecting how treatment centers are able to provide care.

"Are there some staffing shortages out there? Yes, but the bigger issue is a shortage in the number of providers that are willing to treat people with substance use disorder. There may not necessarily be a staffing shortage, as much as it is a lack of providers that are willing and able to care for the whole person with someone who has a substance use disorder,” Meadows said.

“It’s not an easy population to work with. It’s not like your routine, run-of-the-mill person that comes in with arthritis in the knee or hypertension, or something like that. For hypertension, you check the blood pressure, you fill a prescription, you send them on their way and you see them back in six months. You can’t do that with someone with substance use disorder; they’re high-intensity, especially early on in treatment. They require a lot of care.”

Sixty-three of the state’s 67 counties are considered a partially or primary care health professional shortage area (HPSA), according to a 2021 report by Marsh McLennan.

Tort reform advocates have said that criminalization of medical errors has been a contributing factor in the shortage of healthcare workers in Pennsylvania.

Curt Schroder, Executive Director of the Pennsylvania Coalition for Civil Justice Reform (PCCJR) told the Pennsylvania Record, “Criminalization should be limited only to areas where intentional harm to a patient is committed. Errors, while very unfortunate, should not be treated as criminal acts.”

“PCCJR would oppose any attempt to further deal with medical errors through additional criminalization of unintentional behavior,” Schroder added.

His comments followed the passage in Kentucky of the nation’s first-ever law decriminalizing medical errors by healthcare providers, except in cases of gross negligence or misconduct

The Kentucky bill was passed, in part, to deal with a shortage of healthcare workers in that state.

The cause is not just professional for Meadows, but personal – his stepson faced substance use disorder, and has been in recovery for three years.

Meadows, in addition to his role with Geisinger Health, serves as a member of the Susquehanna Valley Regional Opioid Coalition. He has been a physician for nearly 40 years and graduated from the Marshall University School of Medicine.