A bipartisan group of Colorado lawmakers has assembled six bills for the 2018 legislative session that are intended to address the ongoing opioid crisis. Art Way, senior director of national criminal-justice reform strategy for the Drug Policy Alliance and state director for the DPA's Colorado office, sees most of these efforts as steps in the right direction. However, he emphasizes, more still needs to be done to truly deal with the issue.
"I think we're finally starting to get there and starting to look at alternatives," Way says. "But we're a long way from realizing the fact that we're wasting a lot of time and money making felons out of people we supposedly want to help."
Final versions of the bills won't be available until next year's session gets under way. But here's how they're summarized by the Colorado House Democrats:
• Create training programs for health professionals, law enforcement, and at-risk communities for safe opioid prescribing, medication-assisted treatment and overdose prevention.
• Limit most opioid prescriptions to a seven-day supply for acute conditions and mandate that medical professionals check the Prescription Drug Monitoring Program database before writing prescription refills.
• Create a pilot project for a supervised injection facility in Denver. Like needle-exchange programs, data show that SIFs do not increase the use of illicit drugs, but do reduce the spread of diseases like HIV and hepatitis C while increasing referrals to medical and/or substance abuse treatment.
• Expand the Colorado Health Service Corps program, which includes loan repayment and scholarship programs for medical professionals who commit to working in underserved areas where substance abuse is more likely to go untreated.
• Significantly increasing access to residential treatment to qualifying individuals with substance use disorders.
• Improve "prior authorization" standards to ensure that insurance companies and Medicaid give timely approval for medication-assisted treatment so patients with substance use disorders don’t go back to opioids while waiting for approval to begin their treatment. The bill also makes sure pharmacists are able to administer certain kinds of medication-assisted treatments and reduces co-pays for physical therapy, acupuncture and chiropractic alternatives to narcotics.
Of these proposals, the one that most cheers Way involves supervised injection facilities of the sort touted in our February profile of the Harm Reduction Action Center's Lisa Raville. "That's a big victory," he enthuses. "I don't think many people saw that coming at the beginning of this committee. So props to Lisa Raville and the Harm Reduction Action Center for using this situation to help prevent overdoses."
Way also lavishes praise on the process from which the bills sprang. "This committee brought together a bunch of different non-governmental organizations, as well as governmental agencies, to present on the issues of opioids and overdoses, and they really did a good job of educating themselves." As a bonus, "bills that come out of interim sessions like this already have support. They hit the ground running, so to speak, when the actual session starts."
That's not to say each piece of legislation is a slam dunk. "There are going to be some issues around trying to limit people's prescriptions to a seven-day supply," Way believes. "I'm pretty sure that's not going to go over as easily during the actual session as it did during the interim session, because not everybody was there."
Still, he's relieved that some proposals were left on the cutting-room floor. In one piece of legislation, Way reveals, advocates "tried to raise penalties for distribution of synthetic opioids. But allies got together — the ACLU, us, the Colorado Criminal Justice Reform Coalition, the Harm Reduction Action Center — and did their part to make sure penalties weren't raised."
Why, in Way's view, would this approach have been a mistake? "The line between user and seller on the street is very limited," he maintains. "It's not a bright line. Most of the people actually cutting the product are much higher on the chain. By trying to criminalizing those who law enforcement would say are involved in distribution, we're really going after the same community we're looking to help. But they kicked that out, and now, the Colorado Commission on Crime and Juvenile Justice will study the issue of whether penalties actually have an impact on overdoses and the drug trade — which we obviously think they don't."
While the committee was assembling the bills, Way adds, "there was a lack of discussion regarding how decriminalizing drug use and possession and even defelonizing low-level sales would actually save us a lot of money — money we could reallocate into doing some of the things they mention we should do."
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If Way had his druthers, Colorado lawmakers would "mimic what Portugal did — fully decriminalize drug use and possession at a certain level. Then we could take all the savings from the judiciary and law enforcement and reallocate that money into providing proper treatment and harm-reduction services in the community independent of the criminal-justice system — meaning you don't have to have law enforcement contact or a charge levied against you in order to access these services."
In addition, he goes on, "we would defelonize low-level petty sales, because many low-level, petty sellers are users themselves — and to turn these people into felons is expensive and does nothing to address the problem at hand. And we should also get the University of Colorado or Colorado State University to do a study on heroin-assisted treatment where we would provide some of the more chaotic drug users pharmaceutical-grade heroin that would keep them off the streets. That would seriously impact the black market, since 20 percent of all drug users buy 80 percent of the drugs. If we target the population of chaotic drug users, who may be buying two or three times daily, we would have a large impact on some of the negative realities we see when it comes to drug prohibition instead of just continually arresting this population."
Such approaches may be a bridge too far for many current legislators, and Way understands why. In his words, "Our politicians are still trying to unwind from forty, fifty, sixty and, in some places, eighty years of drug-war propaganda. They still think we need a criminal-justice hook to deal with this issue."
Yet the new passel of proposals, and particularly the supervised-injection-facility bill, give Way hope that progress will continue. "Three or four years ago, people would look at you like you were crazy when you'd bring up something like supervised injection facilities," he acknowledges. "That's one thing about this epidemic. Because of it, we were able to cut through the BS a lot quicker than we would have if it wasn't for the fact that soccer moms, and their sons and daughters, are now dealing with the opioid issue instead of just the transient community and the 16th Street Mall rats."