Virginia Policy Changes Aim to Stem Opioid Deaths, Increase Treatment
Last year alone an estimated 800 Virginians died from opioid overdoses. In part three of our week long WCVE News series Facing Addiction, Craig Carper examines the Commonwealth’s response to the opioid crisis.
Virginia Secretary of Public Safety Brian Moran says the state won’t be able to arrest its way out of the opioid epidemic. He says solving the problem will require a holistic approach from law enforcement, medical professionals and the community at large.
Moran: We had users, recovering addicts over and over tell us that they had been arrested numerous times and the threat of arrest or even the threat of incarceration did not prohibit them from using. It was really an addiction. As soon as they got out they were merely a sober addict at that point and they would use again, only to get arrested again. But ultimately with this much demand it is very difficult to prevent distribution when so much demand exists.
In September of 2014 Governor Terry McAuliffe created a Task Force on Prescription Opiates and Heroin, which was co-chaired by Secretary Moran and Virginia Secretary of Health Dr. Bill Hazel.
Hazel: You see more people now dying from opiates than from motor-vehicle accidents and this is something we’re seeing statewide and it’s a little different in different areas of the state. What has driven this probably is several things. Number one there has been an increase in the number of prescription medications that have been diverted and are available and when you talk to the law enforcement folks, I remember a gentleman from the high intensity drug trafficking agency for Appalachia saying “there’s just too many pills out there.”
Hazel says Doctors have been prescribing more and more opiates since the late 80s but the numbers have dramatically increased in recent years.
Hazel: And then frankly the Press Ganey scores where hospitals are rated, one of the quickest ways to get yourself marked down publicly is to not prescribe narcotics for pain management. So that has led to pressure for physicians to prescribe.
Responding to this criticism the opiate task force expanded the state’s Prescription Monitoring Program, requiring physicians to check the system before they prescribe opiates and to log them after they do. New rules require doctors who prescribe large amounts of opiates to have mandatory continuing education on prescribing practices.
Moran: We over-incarcerate in the US but we also over-opiate, we use our pain killers. We’re five percent of the world’s population yet we use over 80 percent of the Hydrocodone, over 80 percent of the opiates in the world. So this really does need to be addressed from the medical community as well.
Some doctors are exploring alternative methods to manage pain. Hazel points to anti-inflammatory medications.
Hazel: Back 15 years ago I did some joint replacement surgery in South America, I went down for two years to Bolivia and these postoperative patients did not have narcotics. They used anti-inflammatory medicines. This is entirely anecdotal, but my experience was I’m sure they had the same amount of physical trauma from the surgeries but they didn’t experience the suffering. So I think there is a cultural piece to this as well.”
The group recommended and the General Assembly approved, a Good Samaritan law that would reduce the legal consequences for drug users who report another user’s overdose.
In addition the state has expanded the use of Naloxone, a life-saving drug that can reverse an opiate overdose. CVS is the first pharmacy chain in the state to make both the inhalable and injectable versions of the drug available without a prescription. Families who have a loved one with an opiate addiction can now keep a supply on hand and be ready to respond in case of an overdose. Hazel says law enforcement officers in the field are also effectively using Naloxone.
Hazel: We know in Virginia Beach they, I think have had nine rescues with Naloxone since their program started earlier this year. It’s been about one a week since it started.
Expanding the number of drug courts in Virginia has been another priority for the McAuliffe administration according to Moran. These courts or court dockets allow judges to recommend substance treatment and counseling while staying at a halfway house rather than sending an addict to jail. While some Republican lawmakers have pushed back against these efforts, the use of drug courts in Virginia is growing.
Moran: I’m a big fan of drug courts. If we can provide more services early on to these drug abusers, one it’s financially it makes more sense than incarceration at $28,000 per year and again it addresses not just the symptom but the underlying problem. Unfortunately it’s a lot harder than it should be to get a drug court in your area. It’s just a revolving door with many of these individuals. If you addressed the addiction early on it would certainly expedite their treatment and save the Commonwealth a lot of money.
The General Assembly has also authorized a new substance abuse disorder treatment waiver through Medicaid.
Hazel: The good news is that is something we’ll be able to bring online and that will help a number of people. The bad news is probably 90 percent of the individuals who are addicted will not be eligible for that coverage now. So that’s a plus minus thing.
According to data from the Virginia Department of Health, the number of fatal overdoses due to prescription opioids decreased about 25% from about 490 to 365 in 2015, however total opioid deaths continue to rise including those attributed to heroin and fentanyl.
Hazel: It’s going to take a long sustained effort. It’s not like the problem is static. The problem is moving. The drug is changing. Even as we watch it we’re seeing more potent compounds of heroin and fentanyl so it is a moving target and we will be at this for a while.
Craig Carper, WCVE News.
Photos: Craig Carper - 88.9 WCVE News
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