Across our state, the opioid epidemic is destroying lives and ripping families apart.  On average, another Coloradan dies from an opioid overdose every 17 hours. In 2016, across the whole country, more people died of drug overdoses—the vast majority of which were from opioids—than American casualties in the Vietnam and Iraq Wars combined.  All across our state, Coloradans are becoming dependent on opioids and dying from overdoses.  And, in many cases, we are responding to this crisis by putting opioid users in jail.  We need to do better.

The essence of the opioid crisis was described by Jason Chippeaux, COO of Health Solutions, “the crisis is a wildfire with zero containment — growing, but lacking unified command. In the meantime, people are dying.”  He added that “it will not be a single silver bullet; it will be a multi-faceted solution” to address the crisis.  I agree.  Today’s crisis has many causes, and calls for innovative and compassionate responses.

As our next Attorney General, I will address the opioid epidemic by approaching it as a public health crisis.  While punishing drug dealers is appropriate, the jailing of opioid users—now widespread in Colorado—is harsh and ineffective.  We need our leaders across state and local government to use a range of innovative strategies to support drug treatment options.  And we also need to work to decrease the likelihood that people become dependent on opioids in the first place.

A critical first step in addressing the crisis is to hold accountable the pharmaceutical manufacturers and distributors who encouraged the use of opioids—even though they knew the risks they posed.  In too many cases, an oversupply of these drugs found their way into the market—sold illegally by drug dealers and pill mills.  An initial response — which is important, but inadequate to wholly address this crisis — is to hold these drug dealers accountable for their unlawful behavior.  Also, we must try to understand the impact of the availability of legal cannabis, which, according to a preliminary study, may be providing an alternative source of pain management and may be associated with a reduction in the number of opioid-related deaths by 6.5 percent since 2015.

Under the leadership of our Governor, Colorado has taken some key steps to reduce the likelihood of individuals becoming dependent on opioids.  Colorado has recently restricted access to opioids under its Medicaid program and has established locations where people can safely dispose of unused opioids.  We are also—and must continue to step up—training our first responders on how to use the overdose-reversing drug naloxone.

Holding Pharmaceutical Companies Responsible

Over the last 20 years, the increased access to opioids was highly profitable for many pharmaceutical companies (as explained in this article.)  In Colorado, we saw a 100 percent increase in the number of opioid prescriptions between 1999 and 2016.  And during that time, the number of overdoses also went up drastically: over 200 percent by 2014.

As the Washington Post reported, a number of distributors didn’t take the Drug Enforcement Agency’s efforts seriously. They went to Congress to override the DEA’s authority to regulate this dangerous behavior. Thankfully, a number of State Attorneys General’s offices have either opened investigations or brought actions against these companies for distributing opioids that they knew or should have known would end up creating dependencies and/or end up in the hands of drug dealers.  Similarly, a number of Colorado counties, including Denver, Huerfano, and Pueblo have already filed suit.  And for good reason—companies like Purdue Pharma knowingly lied to patients, leading them to take opioids and destroying lives in the process.  As Attorney General, I will take action to hold these companies accountable.  After we win this lawsuit, Colorado will receive financial support that it can use to support drug treatment, which is an important part of addressing this crisis.

Addressing Illegal Drug Trafficking

We must hold those engaging in illegal drug trafficking accountable.  From 2011-15, the amount of heroin seized annually in Colorado rose over 2,000% as the number of heroin-related deaths more than doubled. As Attorney General, I will investigate and prosecute bad actors in the prescription opioid supply chain, and collaborate with local, state, and federal law enforcement to punish those making money by selling such dangerous drugs.  The Attorney General’s Office can support the prosecution of drug dealers by assisting rural counties in investigating, prosecuting, and preventing the manufacturing, trafficking, and distribution of opioids.  Finally, we need to oversee the opioid supply chain, ensuring that excess amounts of opioids are not allowed to be diverted to illegal uses.  One way to do that, as piloted in other states, is providing collection points for people to drop off—and have destroyed—unused pills.

Moving to a Public Health Model

For those who are using and addicted to opioids, the essence of a public health mindset is to evaluate how to approach opioid users with an eye toward providing treatment opportunities, not a jail sentence.  Under the Governmental Entrepreneurial Leadership Accelerator program I founded, a team developed a model for reaching out to opioid users who congregate in the Denver Public Library.   This team, which had two law enforcement officials on it, developed a strategy for pairing a police officer with a mental health professional.

We need to encourage experimentation and innovation around the state in addressing opioid use.  Consider, for example, the Longmont Department of Public Safety now supports the Police-Assisted Addiction Recovery Initiative, which connects low-level offenders with law enforcement officers specially trained to help them obtain treatment.  In Pueblo and Alamosa, the communities have received Law Enforcement Assisted Diversion (LEAD) grants, enabling case workers to work with opioid users as an alternative to incarceration.   For Alamosa, this response is critical because of the acute overcrowding in its jail, over 90% of whom are opioid users.  As Attorney General, I will work hard to encourage best practice and support intiatives around the state who are responding to the crisis with innovative solutions (such as IT MATTRs).

A number of communities in Colorado have developed drug courts, enabling those abusing opioids to get the help they need rather than face a prison sentence.  As Attorney General, I will work with leaders around the State—including our District Attorneys, County Sheriffs, public health officials, and mental health professionals to encourage diversion efforts to drug treatment as opposed to criminal sentences wherever possible.  I will also seek to bring drug treatment and mental health services to jails and prisons for those who present a threat to society or have committed serious crimes and need treatment.

Providing Support for Drug Treatment

As our next Attorney General, I will support drug treatment through a multi-faceted approach. In addition to obtaining money from successful suits against pharmaceutical companies, I will work to protect the Affordable Care Act, which provides some Medicaid-funded treatment options for people who are dependent on opioids.  I will also work to strengthen Medicaid, providing more support for those in drug treatment.  I will take steps to make sure that insurance companies support drug treatment, and I will ensure that they do not defy federal laws that require them to provide parity in access to life-saving substance abuse treatment.  Finally, we need to develop ongoing peer support and other programs beyond intensive 2 month programs because, as Judy Solano, the Executive Director of the Southern Colorado Harm Reduction Association explained, it takes 6-12 months for the addicted brain to heal and truly rewire itself.

Cutting Through Bureaucratic Red Tape

When clinicians seek to create centers where patients can be treated for opioid addiction, they frequently encounter bureaucratic obstacles that leave healthcare professionals frustrated and patients without critical care. As Attorney General, I will work to simplify the permitting process, prioritize responsiveness, and ensure that care providers have access to efficient customer service and transparent information.  One clinician I spoke to in Crowley County told me of his experience with red tape while attempting to open a treatment clinic.  This is unacceptable and we need a sense of urgency on this issue.  I will bring that mindset and work to create a fast-track licensing system.

Few issues involve the trauma and raw emotion of the opioid epidemic.  In many groups I speak with, a large number of those in the room are directly affected by this crisis, with family members’ dependent on opioids or a casualty of an overdose.  We need our next Attorney General to make this issue a top priority, collaborating with leaders across our state to hold the pharmaceutical companies accountable for their part in this crisis, working effectively to punish drug dealers, and treating those dependent on opioids with a public health mindset.  That’s why creating and supporting drug treatment opportunities will be a central goal of my leadership on this issue.

This post, originally written in January of 2018, was revised in August of 2018 based on a roundtable discussion of community leaders hosted by Action 22 in Pueblo in July of 2018.