Addressing the Opioid Crisis
As Colorado Attorney General, I made addressing the opioid crisis my top priority. During my first term, our department has taken major strides to address this crisis, but there is much more work to do. As we commemorate Overdose Awareness Day, it is important that we recognize the factors driving the national rise in overdose deaths and work to implement strategies that promise to save lives. Empty talk and misleading political attacks won’t address this crisis. And, worse, they only dishonor the memories of those we have lost.
Over the last four years, I have heard from many parents who have lost children to this opioid crisis, and their stories stay with me. I met Tami at a Substance Abuse Task Force meeting when she told me about her son Braden, who died of fentanyl poisoning from a pill he thought was a legitimate prescription drug. She joined me in working on and pushing for new legislation in this area (as captured in this story). As we pressed for this legislation, I met Trisha, who told me about her son Keith, who struggled with opioid use disorder and wanted to get help, but ended up overdosing while on a waitlist for treatment. These are just two of the many lives we lost and can honor by working hard to address this crisis.
Overdose deaths have risen nearly every year for the last quarter century. This is a devastating trend driven by a number of dynamics. One crucial contributor to this crisis is the irresponsible actions of pharmaceutical companies that put profits over patients—companies that we have held accountable for their illegal conduct. Another one is that our nation has a connection crisis—individuals are less connected to one another and less able to support those struggling with addiction.
With the reduced availability of prescription opioids, synthetic opioids have become more prevalent and used by those struggling with addiction. In recent years, deaths due to heroin and prescription drugs have begun to decline. But synthetic opioid deaths—primarily fentanyl—are up. In fact, more Americans died of overdoses last year—mostly from opioids—than gun violence and car crash deaths combined.
Let’s start with how easy these drugs are to obtain. The first wave of the crisis involved major companies—like Purdue Pharma—pushing out prescription pills like OxyContin, including by encouraging doctors to overprescribe them. Patients were lied to—told that these drugs were not addictive. But they were addictive. Those patients who became addicted were at risk of overdose, and many of them ultimately died from overdoses.
Drug cartels recognized the large number of Americans struggling with opioid addiction. They stepped in and illegally manufactured and pushed heroin as an alternative to prescription pills. Because it was cheaper and more available, many struggling with addiction switched to heroin. More recently, these same cartels have marketed counterfeit pills that contain fentanyl, which is 50 times more potent than heroin. The net result of this crisis—now in its third wave—is that, as a recent article explained, “[s]ince the introduction of OxyContin in 1996, more than a million Americans have died of a drug overdose, including a record of nearly 108,000 Americans last year alone. And it’s not slowing down: Overdose deaths are on track to double, to two million, by 2030.”
Stopping this deadly trend will take a strong commitment to enforcing our criminal laws, stopping fentanyl trafficking, raising awareness, providing access to Narcan, and investing in addiction treatment and education. In short, it is too easy for those struggling with addiction to get access to opioids (and, increasingly, fentanyl), too easy for them to end up incarcerated, and too hard to seek and receive treatment. We must not let up in this important work, and we must redouble our efforts. With the $500 million our department recovered for Colorado by holding Big Pharma companies accountable, we are positioned to more comprehensively tackle this challenge.
The magnitude of this problem requires a comprehensive strategy with efforts by the federal, state, and local governments throughout the U.S. The following are some of the strategies we are now deploying to meet this challenge.
Interrupting fentanyl traffickers and the illegal supply chain. Stopping the flow and availability of these dangerous drugs is a critical first step. By going after drug cartels and drug dealers, we can get fentanyl off our streets and save lives. Our department has taken on such cases (such as this one) and will continue to do so.
In the case of many “overdoses,” the drugs sold–made to resemble real Xanax or oxycodone pills–kill those unaware that they are taking fentanyl. These deaths, like Braden’s, should not be classed as overdose deaths at all. Rather, such deaths are akin to poisonings of unknowing users.
This past legislative session, I pushed for changes to strengthen the criminal laws for those who transport and deal fentanyl. While the legislation doesn’t go as far as I asked for, it still provides valuable tools to address this crisis. In addition to new criminal penalties and resources for going after drug traffickers, the law provides resources for treatment, promotes increased access to Narcan to prevent overdose deaths, and supports greater awareness and education for children about the dangers of these drugs.
Investing in addiction treatment, recovery, education, and awareness. Our department has begun the work of investing opioid settlement funds in education, awareness, treatment, and addiction recovery programs. 90 percent of those funds are being invested at the local level, by those on the ground dealing with this crisis daily. Estimates vary in Colorado, but around only 20 percent of those who need treatment can gain access to it, and individuals like Keith who are struggling with addiction are dying while on waitlists for treatment. With the $500 million from our litigation against Big Pharma, Colorado is positioned to provide more avenues for treatment and recovery than were previously available. As Alamosa County Commissioner Lori Laske, the chair of the San Luis Valley opioid response region, said at a recent conference, these funds and her region are poised to develop drug treatment options in the Valley for the first time due to these new resources. The opportunity presented by these funds is a ray of hope.
Stopping illegal counterfeit prescription drugs. Our department is also working with pharmaceutical companies on a strategy to push back on counterfeit pills meant to resemble legitimate prescription drugs. This strategy will reinforce a critical, life-saving, message: if you need a prescription medication, you must get a prescription from a licensed doctor and have it filled by a licensed pharmacist. Other methods could easily result in taking a dangerous substance and could result in an overdose, as 2 out of 5 counterfeit pills containing fentanyl have a deadly dose for a non-user.
Treatment for those struggling with addiction in the criminal justice system. The problem of those struggling with addiction ending up in county jails is one I hear from sheriffs throughout Colorado. And they all say we need a different approach. In the Alamosa County Jail, for example, Sheriff Robert Jackson told me that 90 percent of those in his county’s jail struggle with opioid addiction, but that community lacks the resources, facilities, and services to help them. In the entire San Luis Valley, there are no drug treatment centers. And in jails, medication assisted treatment is still in the process of being adopted in Colorado. Thankfully, we have made real progress in Colorado distributing Narcan to first responders so they can save the lives of those overdosing.
For persons dealing with addiction who leave the criminal justice system, the experience is that the forced detox experience—without an opportunity for treatment—leaves them at risk of overdosing. Indeed, that is what happened to Keith. We must and we will invest in developing more treatment opportunities for those in the criminal justice system, which can enable people to live and rebuild their lives.
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Addressing the opioid overdose crisis is among the most important work we do at the department. And this crisis—25 years in the making—will not end quickly. The issue is complex and won’t be solved by political slogans or cheap talking points. I am committed to providing Coloradans with honest and collaborative problem solving, not political games and falsehoods.
Our team played a national role in the litigation that brought back $500 million to our state, and we developed a regional framework to spend those funds at the local level. In a second term, we have much work ahead to ensure this framework successfully results in the drug treatment, recovery services, effective education and awareness, and harm reduction efforts like Narcan distribution that saves lives. We also must ensure the funds we successfully secured to combat fentanyl traffickers are used swiftly and effectively to fight those who knowingly push fentanyl and cause more deaths from this dangerous drug. Going forward, there is hard work ahead, and we are committed to that work, developing serious solutions and effective collaboration between public health leaders, law enforcement, government, and other sectors to save lives.