DENVER–The Left views The American Legislative Exchange Council as a pawn of corporate influence. There were some protests at the organizations annual meeting in Denver, Colorado in July. They were mild. No fires were started, and no vandalism occurred. They came, they chanted, and then they dispersed. That was it. While progressives chanted the usual liberal talking points outside of the Hyatt Regency in downtown Denver, a significant number of state legislators were figuring out a way to knock out what seems to be an unstoppable killer: opioids. Around 1,700 people attended the event held in July, where the topic has taken a rather disturbing trend. It’s now the deadliest drug crisis in American history. It’s killing close to 90 people a day. No racial or ethnic group is safe. According to The New York Times, the Midwest, Appalachia, and New England are the hardest hit regions. The introduction of fentanyl into this crisis, coupled with the over-prescription of opioids, has led to an astronomical increase in overdoses. Fentanyl is often mixed in with heroin to reduce the price, but offers a dose that’s 50 times more potent, leading to lethal results. Simply touching fentanyl has sent members of law enforcement to the hospital. In Ohio, one officer merely brushed off the substance off his uniform after answering a drug-related call in May. He overdosed an hour later; fentanyl can seep into the bloodstream through skin contact. In Florida, a ten-year-old boy was suspected of accidentally touching the substance at his community pool. He later overdosed and died. Authorities said contact could have come when he touched a towel.
Is it a problem with Big Pharma or is it an offshoot of the larger issue with heroin addiction? Some had different opinions about the source of the matter. Over-prescribing seem to be the area that the media focuses on, but other experts noted how prescriptions have gone down 15 percent over the past 15 years, and how the overwhelming majority of people who are given opioids by their doctor are not addicted. At the same time, we’re the nation that consumes the most opioids, and at the rate we’re going—650,000 people will be killed as a result of this epidemic. Reuters reported that in 2015, one third of all U.S. adults were prescribed opioids. Right now, the number of DUI deaths from opioids has increased seven-fold, the biggest spike since 1995, based on studies done by Columbia University. USA Today wrote recently, “In a paper published last month in the American Journal of Public Health, researchers found that the prevalence of drivers with prescription opioids detected in their systems at the time of death surged from 1.0% in 1995 to 7.2% in 2015. The three most commonly detected opioids were oxycodone, morphine and codeine.”
We’ve seen bits and pieces of this story that often put on the backburner due to other news emanating from the Trump White House, like his former White House communications director going off on profanity-laced tirades against senior staff, health care, and special elections. In the meantime, state legislators have to fight a war using every available resource afforded to them in combating this epidemic. Townhall was given a pass into the various ALEC workshops at the conference to see how this crisis is impacting the states, and how they’re fighting back.
It’s Not Just An Inner City Problem
Maryland State Sen. Michael Hough and Wisconsin Rep. John Nygren spoke at the first workshop, where they discussed how their respective states are responding to the heroin/opioid epidemic. Hough said that deaths from heroin overdoses are equal to that of cancer and stroke. Concerning fentanyl overdoses in 2007, there were only 17 deaths in Maryland. The first nine months of 2016, there were 738 deaths. By the end of the year, over 2,000 people had died from fentanyl or heroin overdoses. It’s not just in the rural areas, where Hough’s senate district is located; he represents Maryland’s Frederick and Carroll counties, which are outside Baltimore. In Baltimore, an estimated 29,000 people are addicted to heroin.
Hough has worked with Gov. Larry Hogan to increase penalties for those who willingly sell fentanyl, people who mix it, cut it, and sell it. While scores of people are dying, the drug dealers are making insane profits from this method. Sadly, the state mandated that Naloxone (Narcan) be available at schools. It also mandated that addicts charged with drug offenses must be given treatment within a 30-day timeframe. Prior to these changes, an addict would be charged and then have to wait six-to-seven months waiting for a bed at a treatment center, plenty of time to do more drugs in the interim.
Criminal justice reform was also a topic where Hough said that Maryland had very strict mandatory minimum law after Len Bias overdosed on cocaine in his dorm room at the University of Maryland in 1986. At the time, he was selected to play basketball for the Boston Celtics. He also worked to reform those sentencing laws, where those who had small amounts of narcotics would be handed down 10-year sentences. There’s also a RICO statute carved out for drug dealers. It’s redirects enforcement and punishment to the big fish and gives judges more flexibility in handing down sentenced for low-level offenders.
Rep. Nygren knows the epidemic all too well. His daughter, Cassie, is struggling with heroin addiction, being arrested and incarcerated over the past three years for her drug use. In 2013, Nygren went public with this family matter. He noted that there are 28 bills that are aimed at combating this problem in Wisconsin alone, with 11 signed into law by Gov. Scott Walker last Monday. All but one was passed unanimously. Nygren said there is a fiscal and human side to this issue. On monetary matters, on average it costs the state $38,000 ($35,000 for men, $41,000 for women) to keep an inmate incarcerated. The recidivism rate with drug offenders is virtually 100 percent. One of the things Nygren saw we must do as a society is recognize we have a culture of addiction in our midst. The state also passed Good Samaritan laws, so that those who call for help when an overdose does occur are not charged with a felony. Narcan has also been adopted on an optional basis for first responders and some 4,000 lives have been saved in the process.
Rep. Nygren also stressed that this wasn’t a partisan effort. You don’t get that with drug reform bills passing unanimously, all hands were on deck for this. Three treatment centers, called Hope Centers, were established, targeting the underserved and rural regions. Now, three more are being established to exclusively serve the underserved. It’s been a success and those on the state’s Medicaid rolls are eligible.
Prevention is one of the biggest obstacles in this fight. The old D.A.R.E. campaigns and “just say no” do not resonate. Nygren found that working with the medical community is highly effective, especially when it comes to prescription drug monitoring. Early results of the program, which went into effect in April of this year, found that there was a reduction of 11 million prescriptions between October 1-December 31 of 2016 compared to the same time from the previous year. The over prescribing of opioids has certainly contributed to this problem. Law enforcement has been participating, but Nygren said they weren’t the major player. Educating students is another key aspect, as the schools are part of the front lines in fighting the opioid crisis. He noted that their attorney general is using whatever resources at his disposal for his Dose of Reality campaign.
It’s 30 Times Worse Than The Crack Cocaine Epidemic
Later in the afternoon, Seth Leibsohn noted that this epidemic is killing around 90 Americans a day at the workshop that centered on getting the response to this crisis right. It’s 30 times worse than the crack cocaine epidemic of the 1980s. Leibsohn is president of the Arizona-based Not My Kid and former chief of staff to Bush 41’s Education Secretary Bill Bennett, who moderated this panel and was our first so-called “drug czar.” Leibsohn added that this isn’t an issue with prescription drugs; it’s a fentanyl and heroin, which is 70 percent of the problem. He noted that a lot of states have started off fighting this problem on the wrong foot, including his home state of Arizona, which labels it an Rx problem. It’s heroin-related. He also pushed back on the notion that we cannot do much about this because the war on drugs is a failed policy. Drug usage peaked in 1979. By 1992, usage was reduced by 50 percent, 60+ percent for some narcotics, because the nation decided to do something about it. The entertainment industry did not glamorize drug use, it had anti-drug messages embedded in its programming and there were endless speeches from politicians about drugs were common. This was a kitchen/dinner table issue, so let’s get back to teaching people about prevention.
Sean Noble, president of American Encore, said that while he’s not well versed with the policy aspect of the drug issue, he finds it to be an existential threat to the foundations of our country. What he wants to do is find a message, or a prevention story, that was highly successful and amplify it. He cut several ads for Americans for Sensible Drug Policy during Arizona’s pot legalization initiative, which he admitted was a bit of trial and error. One was a rather emotional ad about a mother who lost her son to addiction; marijuana was the first drug he chose. A lot of attendees in the room thought it was effective. It actually tanked with swing voters, who didn’t believe it. The other one framing marijuana legalization as just another avenue for Big Tobacco to get rich also fell flat. The ads finally found a good groove when they focused on a mother’s worries pot candies and treats that are left out in reach of children. It played on the accidental ingestion fear since regular candy and snacks look identical to ones laced with marijuana. This was targeted to 400,000 mothers on Facebook and proved effective, as was the one that focused solely on pets being sent to the veterinarians because of pot-laced treats being left around.
People take prescription drugs that don’t belong to them, fentanyl and heroin use from the three parts to make up this epidemic. The panel did say that overprescribing opioids used to be more of an issue. It’s not, though they added that doesn’t mean it’s not a problem, just not the driving force that’s fueling this destructive event. Rep. Nygren, who also attended the morning session, pushed back a little on the claim, noting that the entry drug for opioid addicts was prescription drugs, and that he end point in this morbid journey was death, usually by heroin use. Leibsohn was adamant that this isn’t the core issue, however, noting that 90 percent of Americans who are prescribed opioids do not become addicted to them. Prescription drug usage has gone down 15 percent over the past three years.
What Colorado Is Doing To Fight Back
In Colorado, Dr. Rob Valuk, director of the Colorado Consortium for Prescription Drug Abuse Prevention, noted that the state really didn’t take notice until a 2011-12 survey showed that six percent of Coloradoans twelve and older were using opioids for a non-medical reasons (i.e. the leftover pills in our medicine cabinets). Dr. Valuk spoke at the panel concerning how a collective approach to the opioid crisis was essential to finding solutions at curbing drug abuse.
The number of those with leftover drugs is quite startling. Dr. Mark Bicket of Johns Hopkins University conducted research that showed out of 810 patients who were prescribed opioids for various surgeries—caesarian section, oral surgery, lung, and shoulder—two thirds had leftovers. Bicket’s findings found that more than half of the pills prescribed were unused, less than one third had disposed of the pills, and less than 10 percent had considered following proper protocols for disposal. This was one of the main objectives for Dr. Valuk: proper disposal.
As a result, Gov. John Hickenlooper created the Consortium in 2013, with over 400 members from various health professions, state agencies, and other task forces dealing with this issue working on reducing abuse. It was given a budget of $1 million from then-state Attorney General John Suthers. Their mission is straightforward: develop and execute policies and programs dealing with prescription opioid abuse, reduce overdose deaths, and increase treatment for addicts, reduce non-medical use of opioids. Dr. Valuk added that this is all done through public-private partnerships; no new government programs or agencies were created to deal with this problem.
Concerning public awareness, the campaign began in 2015; it increased awareness for safe usage, storage, and disposal. Concerning the latter, Dr. Valuk mentioned that the “behavioral intent” to use a safe disposal program showed much improvement. Concerning the safety disposal boxes, the official name is TakeMedsBack. It began with a $300,000 budget, with the goal of having a box in every one of Colorado’s 64 counties by 2017. Right now, there are 80 boxes in 41 counties. The purchasing for Narcan for first responders was launched in 2016. In all, this is bottom up approach centered on safe disposal sites and public awareness campaigns. Almost every dollar that they spend is on advocacy. Their goal for 2016 was to prevent 92,000 people in this age group is misusing opioids.
As we grapple with how to deal with this problem, and there are many opinions on what to do first. ABC News reported that Attorney General Jeff Sessions wants a war on prescription drugs, sending 12 federal prosecutors to areas heavily impacted by addiction. The legal mandate will focus on opioid scams and health care schemes. Ohio, where almost 10 people die a day, is the guinea pig for this effort, which is officially called Opioid Fraud Abuse Detection Unit. Yet, there are a few problems. For starters, Ohio has reportedly already done this (via The Columbus Dispatch):
Cameron McNamee, spokesman for the Ohio Board of Pharmacy, said that to his knowledge, nobody at the U.S. Justice Department has contacted his agency, which has long been fighting improper opioid prescribing in Ohio.
He said the board already is required by state statute to look for aberrant prescription practices. In fact, enforcement agents in his office who go after dirty docs and pharmacists are funded by federal grants.
“We try to coordinate and use data analytics to identify medical practitioners who might be over-prescribing,” McNamee said.
Despite the efforts already in place, the board of pharmacy would welcome additional help, McNamee said.
“It’s an all-hands-on-deck situation,” he said.
Antonio Ciaccia, director of government and public affairs for the Ohio Pharmacists Association, an industry group, said, “I’m not sure how much the feds will be able to do with it other than duplicating efforts.”
He said the state created the Ohio Automated Rx Reports System in 2006 to help identify “doctor-shopping” patients. He added that state licensing boards in recent years have tightened professional rules and monitoring.
“The state of Ohio has been a leader when it comes to data analytics for prescription-drug modeling,” Ciaccia said.
Will this be declared a national emergency? A White House panel, led by New Jersey Gov. Chris Christie, recommended calling our opioid crisis just that. At a press briefing yesterday, Health and Human Services Secretary Tom Price was asked repeatedly if President Trump would make it official.
“Well, the President certainly believes that we will treat it as an emergency -- and it is an emergency,” said Secretary Price. “When you have the capacity of Yankee Stadium or Dodger Stadium dying every single year in this nation, that's a crisis that has to be given incredible attention, and the President is giving it that attention.”
When asked again whether it’s a national emergency would be declared, Price said that as of now, it’s not in the cards, but “all things are on the table.”
Secretary Price added:
“Most national emergencies that have been declared in the area of public health emergency have been focused on a specific area, a time-limited problem -- either an infectious disease or a specific threat to public health. So we believe that, as this point, that the resources that we need, or the focus that we need to bring to bear to the opioid crisis at this point can be addressed without the declaration of an emergency, although all things are on the table for the President.”
Declaring the opioid epidemic a national emergency would give states access to the federal Disaster Relief Fund and temporary suspend the rules and regulations from other federal programs. Keith Humphreys of Stanford University said one of those waivers, no Medicaid reimbursements for large drug treatment centers with 16 beds or more, would be temporarily disregarded. Frankly, before deciding whether the states and or the federal government should play the key role in addressing this issue, it seems all parties involved need to form a consensus about whether this is a Rx-centered problem or one that's an offshoot from our war with heroin. There were two schools of thought that were represented at the ALEC conference, each with very compelling evidence. The libertarian movement will certainly take the position that government needs to continue reforming drug laws and get out of the way. In Ohio, you saw that states are already doing some of the things proposed by the attorney general. For now, it seems the state legislators at the conference recognize the problem, they’re proposing legislation to deal with it, and any help from the federal government would probably be well received, albeit they need to talk to state officials to avoid duplicating efforts. In the meantime, scores of Americans succumb to overdosing on opioids every day, and the Trump administration is not yet convinced that this is worthy of a national emergency designation.