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Judy Ford Wason Center for Public Policy

Wason Center

April 18, 2018

The Opioid Crisis in the Commonwealth

Issue / State

Opioid pill bottles

The current opioid epidemic is positioning itself to be the deadliest drug crisis in American history. Experts estimate that more than two million Americans have abused or become dependent on prescription pain pills and street drugs. Latest numbers from the Center for Disease Control and Prevention show fatalities reaching above 42,000 in 2016 – that’s an average of 115 opioid overdoses each day. This number is almost double the number of causalities in 2010 and five times higher than figures from 1999.

Opioid drugs are made to imitate the pain-reducing properties of opium. They act on opioid receptors in both the spinal cord and brain to reduce incoming pain signals. In addition to relieving pain, opioids also activate the reward areas of the brain by releasing the hormone dopamine which a euphoria or high, underlying the potential for misuse and addiction. Included in the spectrum of opioid drugs are legal painkillers, such as morphine, oxycodone, and hydrocodone, as well as illegal drugs like heroin or fentanyl.

Notably, the number of opioid medications prescribed by doctors increased from 112 million in 1992 to a high of 282 million in 2012. While that number has since declined, falling to 236 million in 2016, the opioid crisis continues to rage across the country as President Trump declared the epidemic to be a nationwide “public health emergency” in October 2017. At the federal level, politicians are introducing regulations and funding to help fight against the opioid crisis. The 21st Century Cures Act, allocated $1 billion in grants over two years to provide funding to states for expanded treatment and prevention programs. In August 2017, Attorney General Jeff Sessions announced the launch of the Opioid Fraud and Abuse Detection Unit to prosecute people who commit opioid-related health care fraud. State legislatures have also begun taking initiatives to combat the opioid crisis.

The opioid epidemic is nothing new to Virginia. Prescription opiate deaths are occurring statewide, specifically concentrated in Southwest Virginia, Southside, Hampton Roads, Metro Richmond, and the Shenandoah Valley. Heroin overdose fatalities are most common in Hampton Roads, Metro Richmond the Shenandoah Valley, and Northern Virginia. In 2014, more people had died from opioid overdoses than fatal car accidents. By the end of 2016, the amount of fatal opioid overdose deaths had increased by over 70%, compared to the previous five years. It is estimated that Virginia state and local governments spend $613 million per year in substance abuse costs, specifically related to public safety and health care services.

In November 2016, Governor Terry McAuliffe declared the Virginia opioid addiction crisis a Public Health Emergency. His declaration came in response to the increasing number of opioid-related overdoses across the state. “Too many families across Virginia and the nation are dealing with heartbreak and loss as a result of prescription opioid and heroin abuse epidemic. We cannot stand by while these drugs harm our communities and our economy. That is why I support [the] decision to declare a public health emergency, to heighten awareness of this issue, provide a framework for further actions to fight it, and to save Virginian’s lives” said Governor McAuliffe. Throughout his tenure as governor, McAuliffe was successful in developing initiatives to fight against opioid abuse and fatal overdoses in Virginia, including enacting legislation aimed at treatment and health care accountability. Additionally, in October 2017, McAuliffe announced that the state had received $596,000 in grants from the Department of Justice for the purpose of developing a statewide plan focused on collaboration and increased data sharing between criminal justice and health agencies.

When he was running for governor, Ralph Northam campaign on a policy plan that would fight against opioid addiction by providing treatment and recovery resources for all Virginians who need them. In his agenda, Northam articulated that he would reinstate the emergency declaration in response to the opioid crisis, fund supportive housing for people with addiction, specifically focusing on pregnant and parenting women, and create a public dashboard with opioid overdose metrics to enable state and local officials to focus on the Virginia communities with the greatest need. In relation to opioid abuse and law enforcement, Governor also advocated for jail diversion programs and transitional treatment programming for individuals reentering the community post-incarceration.

Now that he has entered office and the 2018 session has begun, constituents will be looking to see how much treatment for opioid addiction is incorporated into the upcoming budget and legislation. As of this past Sunday, the budget passed by the Senate Finance Committee indicates that their priorities are set high on directing money to fight against opioid abuse. Additionally, the newly introduced interconnectivity between the Commonwealth’s Prescription Monitoring Program database and all of its border states, as well as 21 other states, should work to provide healthcare professionals with necessary prescription information with dispensing medication.

Opioid abuse is increasing in Virginia due to high prescription levels for opioid drugs, lack of education on the dangers of opioid abuse, and limited resources for treatment. Virginia’s Medicaid program spent $26 million on opioid use and misuse in 2013, with $10 million of this spending occurring in Southwest Virginia. Additionally, $28 million was spent on ER and inpatient hospital treatment for Medicaid members with substance abuse issues. In fact, some regions even reported spending close to $2 million per year on ER and hospital costs related to substance abuse among the Medicaid population.

In our recent survey examining public attitude towards the treatment of opioid abusers, we find that 78% of Virginians support providing treatment for individuals who abuse opioid drugs without a prescription. When looking at partisan support, 85% of Democrats and 65% of Republicans agreed that opioid abusers should receive treatment. Our data also found that support for treatment for individuals abusing opioid prescription drugs was consistently high across all demographic groups, sitting at least 70% and even going up to 84% among black voters. This is a high number compared to the 13% of Virginians who would prefer to see them face criminal charges. Given the robust support for treatment over criminal charges by the public, it looks like opioid drug-related reform and treatment will receive bipartisanship support in this session. This sense of bipartisanship has also been echoed by legislators, too, as reform towards the opioid crisis tends to be a common middle ground within which representatives agree.

Wason Center survey regarding whether opioid abusers should receive treatment or jail time.  All demographics measured except Republicans indicated at least 75 percent approval for treatment over jail time.

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