~ For more than three years, AG Herring and his team have pushed for enforcement, education, and treatment initiatives that can save lives and curb the opioid epidemic ~
Virginia Beach, Va. – During remarks in Virginia Beach before the Virginia Association of Chiefs of Police annual conference, Attorney General Mark R. Herring outlined his recommended next steps for the Commonwealth of Virginia as we continue to confront the national epidemic of opioid and heroin abuse. Attorney General Herring has made combating the heroin and prescription opioid epidemic a top priority, attacking the problem with a multifaceted approach that includes a commitment to enforcement, education, prevention, and legislation designed to save lives.
“The opioid crisis is the most pressing public safety and public health crisis confronting Virginia today. It is a wave that has been building for decades and we’re now seeing it wash over communities and families in every corner of the country, and from every walk of life,” said Attorney General Herring. “This epidemic doesn’t discriminate and it doesn’t lend itself to simple solutions like more arrests, or simple messages like ‘just stop using.’ We have to recognize that this is a complex problem that calls for a multifaceted solution. My team and I have been working on this problem every day for nearly four years, and we’re not going to stop because we are still losing too many treasured friends, spouses, siblings, children, and parents to this epidemic.”
During his term, Attorney General Herring and his team have:
- Worked more than 90 cases against dealers and traffickers involving more than 434 pounds of heroin worth more than $25 million on the street
- Joined a bipartisan coalition of Attorneys General from across the country in an ongoing investigation to evaluate whether manufacturers have engaged in unlawful practices in the marketing and sale of opioids
- Sought sanctions against more than 260 medical professionals for opioid-related infractions
- Launched www.HardestHitVA.com as a comprehensive resource for treatment, recovery, and educational resources
- Created an award-winning documentary to educate young people on the dangers of heroin and prescription opioids
- Been recognized by the recovery community for his work to address the crisis
- Won passage of laws to make naloxone more widely available, to create the state’s first Good Samaritan “safe reporting” law, and to expand access to the Prescription Monitoring Program
- Supported federal efforts to improve the availability of treatment and recovery resources
- Partnered with U.S. Attorney Dana Boente to create the Hampton Roads Heroin Working Group to develop holistic, community-driven solutions to the heroin and opioid crisis
- Made prescription drug disposal kits available across the Commonwealth
Going forward, Attorney General Herring will expand on the collaborative, multi-faceted approach that has proved successful in raising awareness of the problem, educating Virginians on the realities of substance use disorder, and helping to save lives. His priorities for continuing to combat this epidemic fall into three major categories:
- Law enforcement initiatives
- Support from the medical community
LAW ENFORCEMENT INITIATIVES
Attorney General Herring created the OAG’s first team of regional prosecutors to focus on high-priority cases involving heroin and fentanyl trafficking and distribution, and violent gang activity. He and his team have worked with the U.S. Attorneys for the Eastern and Western Districts of Virginia to prosecute major cases in federal court, and with Commonwealth’s Attorneys across the state to handle major cases in state court. Attorney General Herring and his team have worked more than 90 cases in state and federal court against dealers and traffickers involving more than 434 pounds of heroin worth more than $25 million on the street. He and his team are also part of an ongoing investigation to evaluate whether manufacturers have engaged in unlawful practices in the marketing and sale of opioids.
“I’m really proud of the work that my team and I have done to supplement incredible work going on at the local level to combat the supply side of the equation,” said Attorney General Herring. “We have increased prosecutions of dealers and traffickers to record levels, taking down some of the biggest trafficking operations in the state moving millions of dollars of deadly drugs through our communities. We know that we won’t arrest our way out of this problem, and we know that law enforcement has already been asked to bear a disproportionate share of the burden of this problem. There are still more tools that we can and should give our officers, deputies, and prosecutors to hold dealers accountable when they profit off addiction, and to get these dangerous individuals and their deadly drugs off the streets.”
New laws to crack down on deadly fentanyl. Fentanyl was responsible for 622 opioid overdoses last year, representing more than half of all opioid overdose fatalities and a 1,300% increase since 2005. Fentanyl can be deadly in microscopic doses and users often have no idea whether the drug they are ingesting is laced with fentanyl that could kill them within minutes of use. Because fentanyl can be deadly in such small doses, Virginia needs to include an amount that would constitute “possession with intent to distribute” no larger than one gram, and because new fentanyl analogs are constantly being created by illicit chemists, the law should make it clear that fentanyl analogs will be prosecuted in the same way as traditional fentanyl and may be subject to lower distribution thresholds because of their potency. This is similar to what Kentucky and other states have done to combat fentanyl. The General Assembly should also clarify that a dealer or trafficker can be charged with felony assault on a law enforcement officer if their fentanyl causes an overdose by a first responder or law enforcement officer who is responding to the scene and exposed to the drug.
Drug-induced homicide. For three years, Attorney General Herring has pushed to close a loophole in Virginia law that allows heroin/fentanyl/opioid dealers and traffickers to escape accountability when their drugs kill a Virginian. Unfortunately, the General Assembly has failed to close the loophole for three sessions. Currently, drug-induced homicide cases are taken to federal court, including by prosecutors from AG Herring’s team, but Commonwealth’s Attorneys in Virginia need a tool that is just as strong so we can hold these dealers and traffickers accountable in state court.
Naloxone pricing. In 2015, Attorney General Herring led a bipartisan coalition that authorized all first responders to carry and administer naloxone, an overdose antidote that has saved tens of thousands of lives around the country. The bill also empowered the Virginia Health Commissioner to issue a standing order to authorize the dispensing of naloxone, making it available to Virginia families without a prescription. As first responders in communities around the country are called on more frequently to administer naloxone, the escalating cost has become a common concern.
To address this concern, along with recent spikes in the price of naloxone, the General Assembly should authorize the Attorney General to investigate potential price gouging and to increase transparency in pharmaceutical pricing, which would give the attorney general and the public access to more information that could help detect price gouging.
Improved Good Samaritan law. Because those who witness an overdose are often drug users themselves, there has historically been hesitance to call 911 for help for fear of being prosecuted. In 2015, Attorney General Herring led a bipartisan coalition that created Virginia’s first “Good Samaritan” or “safe reporting law,” which encouraged those in the presence of an overdose to call 911 with the promise of limited immunity for possession of drugs. However, the Good Samaritan protections do not kick in until trial, meaning that someone who calls 911 could still face arrest and be charged. The law should be amended so that Good Samaritans are given the option of referral to treatment, but are not arrested and charged when they did the right thing.
Drug courts. In recent years, it has become clear that the criminal justice system is not the most appropriate venue for addressing substance use disorder. Doing so has put a tremendous strain on our criminal justice system, including our jails and sheriffs, who have become de facto providers of addiction and recovery services. Because drug courts and pre-trial services have proven to be effective and efficient venues for addressing the underlying substance abuse that accounts for many criminal offenses, these commonsense programs should be made available in every locality in Virginia.
SUPPORT FROM THE MEDICAL COMMUNITY
While the country awaits the resources and assistance that could come with a federal public health emergency declaration by President Trump, Virginia’s State Health Commissioner has already declared the opioid epidemic to be a public health emergency. Doctors, pharmacies, hospitals, and other stakeholders in the medical community have begun to take a central role in addressing this pressing public health crisis. In recent years, the Board of Medicine has expanded the amount of addiction and pain management training required of doctors, limited the amount and potency of prescription drugs that can be provided at one time, increased screening of patients for substance abuse, and provided naloxone to patients with high doses or high numbers of opioid pills. Attorney General Herring will continue to engage the medical community and encourage doctors, nurses, and other prescribers to implement reforms that protect and meet the needs of patients.
“The opioid epidemic is just as much a public health crisis as a public safety one, and we must treat it as such,” said Attorney General Herring. “The fact is, this problem often has its roots in the medicine cabinet as opposed to the streets. Something as simple as a sports injury, minor surgery, or dental work can expose a person to powerful drugs that can send them down a path of dependence and addiction. The medical community-from doctors, to nurses, to insurance companies-is increasingly recognizing that they have a key role to play in turning this problem around and they must have a seat at the table in developing and implementing community-based solutions. This is the approach we’ve taken in the Hampton Roads Heroin Working Group where medical professionals sit right alongside law enforcement and affected families. We all have a part to play and we all have knowledge and skills to contribute.”
Incentivize alternatives to opioid prescriptions. Health plans should reevaluate their payment structures to eliminate policies that incentivize the prescribing of opioids over other potentially effective treatments like physical therapy or simple over-the-counter pain relievers. A bipartisan group of state attorneys general is currently working together to engage insurance companies on this very issue.
Mandatory PMP check. Virginia’s prescription monitoring program (PMP) can be a powerful tool for preventing doctor shopping and eliminating abusive prescriptions, but it is only useful if it is actually checked by a prescriber. Right now PMP checks are only required under certain circumstances, which means some doctors may be unknowingly providing prescription opioids to patients who are also receiving drugs from other sources. Virginia must require a query of the PMP for every opioid prescription, regardless of length of treatment or dosage, without exception.
Expand Medicaid/Protect the essential health benefit. One of the most powerful things Virginia could to do address the opioid crisis is expand the eligibility of Medicaid to allow more Virginians to access treatment and recovery services. Additionally, Virginia should ensure its Congressional delegation opposes changes in federal law that would eliminate the requirement that insurance policies include mental health and substance abuse treatment.
Build relationships between registered peer recovery specialists and the medical and law enforcement communities. Virginia has recently established a “peer recovery specialist” registration for individuals who have successfully entered long-term recovery and have now been trained to assist others on their recovery journey. Each emergency room, law enforcement agency, and local/regional jail should establish relationships with the authentic recovery community, including one or more registered peer recovery specialists who can be made available to an overdose victim or drug user who enters the emergency room, interacts with law enforcement, or is incarcerated.
RECOVERY, TREATMENT, PREVENTION, AND EDUCATION
Throughout his work to combat the opioid epidemic, Attorney General Herring has kept recovery, treatment, prevention, and education as equal priorities alongside enforcement. He and his team created innovative educational materials for middle and high school students, including an award winning documentary, “Heroin: The Hardest Hit.” He has supported federal efforts to expand access to treatment, opposed the repeal of the Affordable Care Act, which would have been a major setback to treatment and recovery, and has been recognized by the recovery community for his efforts.
“Even as we educate Virginians on the dangers of these drugs, we must also make sure the stories of successful recovery are told because there is life after addiction and there is hope in recovery,” said Attorney General Herring. “There’s no one-size-fits-all prescription for recovery. Each person’s path will be unique and they need access to a range of treatment options. Too often Virginians are forced to suffer in silence because of shame or stigma associated with substance use disorder. We have to make it clear that individuals who reach out for help will find respect, support, and compassion.”
Eliminate federal restrictions on using Medicaid in residential treatment settings. Because of an antiquated, decades-old rule, Medicaid places a restriction on use of funds for residential in-patient substance abuse treatment. A bipartisan group of state attorneys general is currently evaluating proposed federal legislation that would remove this unnecessary restriction nationwide.
Ensuring integrity of suboxone clinics. Medication assisted treatment (MAT) can be part of a successful recovery plan for many individuals dealing with substance use disorder. Virginia, like many states, is seeing a rise in the number of disreputable suboxone clinics that ignore regulations and laws or employ weak controls. This has led to a rise of abuse and misuse of suboxone, undermining public confidence in MAT and endangering lives. To ensure integrity in the MAT field, the General Assembly should require that a doctor be at least a partial owner so that the clinic is shut down in the event of license suspension and require stronger record keeping to prevent the diversion and misuse that can too easily be hidden by cash-only transactions.
Engage insurance companies in solutions. Health insurance companies can play a key role in addressing the epidemic by ensuring they treat substance abuse as a health crisis and provide coverage for necessary treatment and recovery services. Attorney General Herring and his state attorney general colleagues are exploring ways to get insurance companies to commit to a number of voluntary measures that can help stem this crisis, like increasing the number of insurance plans that cover substance use disorder, extending the number of days of treatment that can be covered, removing pre-authorization requirements for addiction treatment, coverage of MAT, and tighter controls on reimbursement for opioid prescriptions.
Incorporate heroin/opioid education and prevention into middle and high school health curricula. Attorney General Herring has made youth education and prevention a priority, launching a new module in his “Virginia Rules” program aimed at educating middle and early high schoolers on the dangers of opioids. He also created an award-winning documentary called “Heroin: The Hardest Hit” that is now part of the 9th grade health curriculum in localities from Hampton Roads to Southwest Virginia.
Prescription drugs are the drugs young people are most likely to have access to through the medicine cabinet of a parent or grandparent, and research has shown a strong link between prescription drug misuse and opioid or heroin dependence. In fact, among people aged 12 or older who misused pain relievers in the past year, about half reported getting the drugs from a friend or relative. Therefore, education must start earlier, either by statute or regulation from the State Board of Education, so that Virginia students understand the dangers of these drugs before they reach high school.
“Handle with Care” pilot program. Virginia should pilot a “Handle with Care” program to help better meet the needs of a young person who has lost a parent to an overdose or who has a parent confronting an addiction. Too many young people have witnessed an overdose by a parent or even been called on to revive a parent with naloxone during an overdose. This traumatic experience can lead to poor school performance or disruptive behavior that can be better handled when the school system is made aware of the situation at home. The program has been successfully piloted and implemented in communities around the country, including statewide in West Virginia.
Pilot “The PreVenture Program” in one or more Virginia high schools. This program, which has proven successful in Western Europe, Canada, and Australia, seeks to identify and intervene in the lives of young people who are at higher risk of substance abuse because of other co-occurring behavioral disorders like social anxiety, impulsivity, and risk-taking. Attorney General Herring wrote a letter to the National Institute of Health supporting a grant proposal from Virginia Commonwealth University and more than two dozen high schools that were willing to implement this evidence-based program.