Keeping the heroin problem under control

by Lindsay Cates

With 75 percent of overdose deaths in Virginia and other states now involving heroin and opioids, policy makers at every level of government are rushing to amend current laws and pass new legislation to combat the increasing fatalities.

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In March, President Obama told an audience at the National Rx Drug Abuse and Heroin Summit that prescription opioid and heroin abuse has to be something at the top of his administration’s radar. The New York Times reported that the Obama Administration requested $1.1 billion in funding from Congress this year to fight opioid addiction.

In response, the U.S. House passed a measure this month that would authorize $103 million a year in grants from fiscal 2017 to 2021 to help states pay for prevention and treatment, although the bill wouldn’t actually provide the money. The Obama Administration encouraged Congress this week to secure the necessary funding.

Rockbridge County has taken a multi-faceted approach, and Commonwealth’s Attorney Christopher Billias says the county is known for being one that’s generally very tough on drugs. Although methamphetamine production is still Rockbridge County’s No 1. drug problem, Billias said he has seen heroin use increasing.

“For a while there you didn’t see much heroin,” Billias said. “Now it has come back and the problem when you’re talking about heroin is you are bringing drugs in from a different place.”

One goal for the Rockbridge Regional Drug Task Force has been making the business of drug dealing an unpleasant one in Rockbridge County. “If you make the conditions uncomfortable, they’ll do business elsewhere,” Billias said. “If you make the business unprofitable, they won’t sell in your county.”

Drug CourtBillias calls the drug-busting work that happens between the task force and his office a “well-oiled machine.” And when it comes to punishing users in particular, he hopes a drug docket will further increase collaboration.

Similar to a drug court, a drug docket would provide a more comprehensive approach to getting repeat offenders away from using drugs, but without using taxpayer money to fund the program. A drug docket would accomplish the same sort of monitoring by linking people on probation with a specific judge to monitor their progress. Billias is working with newly appointed Rockbridge County Circuit Court Judge Anita Filson to put the program in place by the end of 2016.

Billias also wants to get tougher on dealers with more jury trials so that the citizens of Rockbridge County and Lexington can be heard. “Oftentimes jury results are the voice of the community,” Billias said. “We’ll see what people on the jury think about people who come into Rockbridge County to sell drugs.”

While Rockbridge County has been able to keep tabs on the flow of heroin, at the state level it is harder to keep up.

Legal Consequences

Virginia’s heroin laws are relatively harsh and simple possession can result in one year in prison and/or a $2,500 fine. However, first time-offenders are unlikely to do any prison time—they are usually eligible for a drug-abatement or drug court program, which provides treatment services and supervised probation instead of incarceration. In Virginia, heroin does not need to be found directly on the person for him or her to be charged with possession. A person can still be charged, for example, if heroin is found in the back seat of his car.

For selling heroin in the Commonwealth, there are stricter penalties. Sale can result in five to 40 years in prison and a fine of up to $500,000. The penalties increase depending on how much of the substance is found, and if there have been previous charges.

Billias explains the process of prosecuting heroin cases in the Rockbridge County:

Federal law has even harsher penalties. First-time possession results in one year in prison and a $5,000 fine. A second possession charge is two years in prison and a $10,000 fine. First-time sale or manufacturing carries with it a maximum of 15 years in prison and $25,000 fine. Second-time sale or manufacture is 30 years in prison and a $50,000 fine.

Statewide Policy

According to Statewide Forensic Epidemiologist Rosie Hobron, the scariest part of the heroin problem is not being able to control it.

“We’re seeing a lot of drugs that we haven’t ever seen before,” Hobron said. “We can’t monitor heroin use, and how it’s coming into the country, and where it’s going.”

Prescription opioids, however, are easier to control with policy. An expanded, mandatory Prescription Monitoring Program (PMP) is one legislative initiative that successfully passed in Virginia in 2015. Jodi Manz, policy advisor in the Virginia Office of the Secretary of Health and Human Resources, said data and monitoring is one area where the Virginia legislature has been receptive to changes. The bill became law in 2015 and requires all pharmacists to be registered with the PMP. Another 2016 law requires that any opioid prescribed for more than 14 days must be checked with the PMP.

Manz said the 14-day restriction creates awareness for pain medication prescribers who don’t realize that there is a problem. “Doctors are prescribing 30-90 day prescriptions…a lot of times we need fewer days than that,” Manz said.

Expanding the PMP was a recommendation brought forward by Virginia Gov. Terry McAuliffe’s Task Force on Prescription Drug and Heroin Use.  The task force was created by executive order in September 2014 in response to the growing number of heroin and prescription opioid deaths in the state. The 32-member task force is divided into five work groups—education, treatment, data and monitoring, storage and disposal, and enforcement.

In 2015 the task force was also successful in getting the legislature to approve an expanded pilot program to make Nalaxone and Naloxone training accessible to more first-responders in Virginia. Nalaxone is a drug that can treat a narcotic overdose in an emergency situation. Some critics say Nalaxone is an enabler, and does nothing to stop addicts from using, but Manz says that getting the drug out to more first-responders is imperative.

Other policy successes so far include the creation of the Health and Criminal Justice Data Committee to share opioid-related data across agencies, and a law that requires hospices to notify pharmacies about the death of a patient—a creative initiative that Manz says might be unique to Virginia. End-of-life care centers are often in possession of opioids, and this law will ensure that unused pills are not sitting around after a patient dies.

Drug diversion is a major concern for Virginia policy makers.

Drug diversion is a common way for addicts to maintain their supply. An addict will steal from a family member or friend’s medicine cabinet, go through garbage, and find ways to get access to nursing homes or end-of-life care centers, says Manz.

The medical component to the issue also creates challenges. Manz said that many treatment options are out of the question since Virginia’s Medicaid coverage is lean. “There’s 400,000 people in Virginia who do not have access to affordable health care, which makes treatment difficult,” Manz said. “When people say they need treatment and there are no resources for them, it’s very frustrating.”

There has also been a lot of input from the federal level and local level. “It’s an all hands on deck thing; there’s never been this much attention,” Manz said.

In the Commonwealth, further policy goals for the drug task force include continuing education for opioid prescribers, and developing a state website as a resource for public and professional use.

Click here to see an overview of the legislation that has passed, or is currently pending, in Virginia.