The Opioid Epidemic Has Devastated Virginia’s Families. Here’s How I Will Fight Back.
Addiction to opioids and prescription painkillers is an epidemic that is ravaging our Commonwealth. More Virginians now die from opioid overdoses than car accidents. In 2016, there were over 1,400 drug-related deaths in Virginia — a 38 percent increase from 2015.
No family is immune from addiction. We must recognize that a tragedy of this magnitude cuts across race, region, gender, class, and ideology, leaving no community untouched. This epidemic has torn apart families and overwhelmed medical professionals with the sheer volume of cases they see every day. There should be no stigma attached to seeking help in breaking an addiction and finding a path to recovery. In the words of Sister Beth Davies, who has spent decades fighting for social justice in Southwest Virginia, it’s past time for addiction science to supersede stigma.
It is important to remember how we arrived at this point — corporate greed has been a driving force behind the flood of opioids in our Commonwealth, and any comprehensive approach to ending the opioid epidemic must also end the profitability of addiction. Prescription painkillers are often the cheapest way to address pain issues, creating an incentive for insurance companies to refuse to cover non-prescription pain management programs. Big Pharma lines its pockets every time a new patient becomes addicted to painkillers, and even the successful legal findings against them have produced no dent in their business strategy.
In the words of Sister Beth Davies, it’s past time for addiction science to supersede stigma.
Governor McAuliffe’s administration has rightly declared the opioid epidemic a public health emergency, established a senior-level task force to focus on solutions, and signed into law several bipartisan proposals that address aspects of the response. These reforms range from broadening the criteria of who may lawfully dispense naloxone to authorizing the creation of syringe exchange programs in at-risk communities to reduce the transmission of disease. My administration will build on those efforts, working with stakeholders to ensure that these laws are implemented effectively, funded properly, and expanded where needed.
Though our Commonwealth has taken aggressive steps, there is more we can do. Not only is it essential to provide communities with the resources they need to treat addiction — we must also act to address one of the major causes of addiction: mental illness. In Congress, I voted for the Affordable Care Act (“ACA”), which designated mental health and addiction treatment services “essential benefits” that must be covered by marketplace plans and expanded Medicaid, dramatically increasing access to these programs. Though the ACA was an important first step, Republicans in the General Assembly have blocked Medicaid expansion and prevented hundreds of thousands of Virginians from accessing affordable health care.
True solutions to this epidemic cannot be found without an aggressive plan for expanding economic opportunity. Without reliable pathways into good jobs, too many communities will continue to suffer from the hopelessness that often leads to drug dependency. That is why I have released a working families plan offering two years of free community college and paid apprenticeships, so we grow our economy from the ground up and the middle out . In a time when the forces of automation and monopolization increasingly threaten workers’ job security, the next governor must advance a bold agenda for working families that will push wages higher.
On the campaign trail, I have met with survivors of the opioid crisis in every corner of the Commonwealth. One of the most memorable statements made during a roundtable discussion was by a man I met in Tazewell who became addicted to prescription pain medications as a way to cope with childhood trauma. He said “no one cares how much you know until they know how much you care,” when discussing the need for personalized counseling in treating addiction. There are so many Virginians committed to ending the epidemic in our Commonwealth. My community-based plan of attack will focus on providing needed resources to the front lines of this struggle.
As we tackle this crisis, it is important to acknowledge that addiction has ravaged communities of color for decades, and the response has too often been a lack of empathy and a compulsion to over-incarcerate. The recent, science-based shift in attitudes — toward treating addiction as a chronic disease — is heartening. However, we cannot limit our views to this one crisis. We must increase access to mental health and addiction treatment services for those struggling with drug dependency of any type and mental illness in any form.
There are no easy solutions, but working together we can heal our communities and stop the spread of this disease.
1. Provide Virginians with Alternative Pain Treatment Options
Expand Availability and Use of Effective, Non-Opioid Pain Management Options
Research increasingly shows that medical marijuana can reduce the use of opioids and other pain medications, while alleviating symptoms of serious medical conditions. It is time for Virginia to join twenty-eight other states and the District of Columbia in establishing medical marijuana programs. I will work to legalize and regulate medical marijuana in Virginia and direct tax revenue towards opioid addiction treatment programs.
Expand Insurance Coverage of Counseling and Comprehensive Non-Prescription Pain Management Therapies
Chronic pain is a serious issue in the U.S. and Virginia. Many doctors and pain specialists acknowledge that continuing to prescribe opioid pain medication to patients with chronic pain can often lead to addiction.
There are evidence-based alternatives to pain medication. Unfortunately, these options are increasingly cut from insurance coverage. Prescribing medication is a much cheaper treatment in the eyes of insurers, despite its risks. Requiring insurers to start reimbursing alternatives to opioids is the first step to giving practitioners and patients more flexibility to find the treatment that works best for them without simply relying on pain medication.
2. Stop Unnecessary Opioid Prescriptions by Holding Providers Accountable
Strengthen State Regulatory Control of Prescription Pill-Trafficking
Just this year, the FBI prosecuted a Richmond-area doctor who illegally made $2.4 million prescribing 120,000 Oxycodone pills to drug dealers. “Pill mills” — facilities like doctors’ offices or pain management clinics that inappropriately dispense large quantities of pain medication prescriptions, often for non-medical reasons — are a major player in the opioid epidemic and must be stamped out.
We need to strengthen our ability as a Commonwealth to identify pill mills and prevent them from over-prescribing these highly addictive medications. Utilizing our prescription drug monitoring program as a guide, I will work with our Attorney General to identify chronic over-prescribers, crackdown on illegal prescribing practices, and reduce the number of facilities allowed to dispense prescription medications.
Improve Full Use of our Prescription Monitoring System
Monitoring the prescription of opioids is an essential tool in reducing addiction and overdose rates. Our Commonwealth’s implementation of a prescription drug monitoring program was an important first step in heavily restricting the flow of opioids, but we can do more.
In 2013, the Veterans Health Administration implemented a new “dashboard” system allowing clinical leaders to systematically track opioid prescription rates and average MEQ (“morphine equivalents,” a measure of drug potency) per dose, compare those numbers to the national average, and then provide prescribing physicians feedback. Over the course of two years and through the implementation of this program, high dose prescribing dropped 16%, very high dose prescribing dropped 24%, and the number of patients receiving sedatives in conjunction with opioids (which can be lethal) dropped 21%. As governor, I will push for stronger opioid prescription auditing practices with regard to the number of prescriptions written in our hospitals and the average potency of each dose.
Discourage Over-Prescription of Opioids, Particularly in High Doses
Prescription opioids are often the cheapest form of pain management available, leading doctors and insurance companies to heavily rely on opioids despite the availability of other, non-addictive pain treatment options. Though prescription opioids are necessary in a small number of cases to treat chronic or extreme pain, they are too dangerously addictive to be used as anything but a last resort.
Opioid addiction often begins with short-term pain management, according to the U.S. Centers for Disease Control and Prevention (CDC). In 2016, the CDC issued opioid prescription guidelines that include recommendations on: when to initiate, continue, or discontinue opioids for pain management, what dose level and duration is appropriate for given conditions, and how to assess risk and potential harm of opioid use. For example, the guidelines note that most patients should only need a 3-day prescription of opioids to deal with acute pain, while a 7-day prescription should “rarely” be needed. I will support legislation requiring that doctors follow the CDC’s guidelines for opioid prescription.
3. Support Family and Community Programs
Expand Access to Resources for Kinship Care Families
Under current Virginia law, grandparents or other non-parent family members raising children (called kinship families) are only eligible to receive foster care reimbursements — payments to help families provide for foster children — if they become certified foster parents. However, many current kinship care living situations are structured informally and thus do not benefit from the law. Without legal custody of the child, kinship care providers also have a hard time getting kids enrolled in schools and vaccinated.
With a foster care system stressed by opioid addiction and related deaths, kinship care needs to be prioritized as a first resort. We must act to help family members navigate the bureaucratic red tape surrounding taking custody of a child in emergency situations and expand access to funding for kinship families.
Direct State and Federal Funds to Provide Rehabilitation Services to Expectant and New Moms and Their Children
Newborns and young children are the most vulnerable victims of the opioid epidemic. In 2015, a baby was born addicted to opioids every 19 minutes, and children whose parents are substance-dependent are three times more likely to be abused and four times more likely to be neglected than the children of non-substance-dependent parents.
We need to do more to support newly-sober moms and prevent them from relapsing. New Hampshire, a state particularly hard-hit by the opioid epidemic, last year opened a new living facility dedicated to providing support for recently-sober, expectant or new moms and their young children. These women receive comprehensive substance abuse treatment services along with a stable, safe living environment for themselves and their children. Ending the opioid epidemic means ending the multigenerational cycle of addiction, and as governor, I will direct federal and state funds towards providing rehabilitation services to expectant and new moms and their children.
4. Treat Addiction As a Public Health Issue by Reforming our Criminal Justice System
Work with Local Officials to Prioritize Expanding Drug Courts, Diversion Programs, and Treatment Facilities
It is clear that solving the problem of drug addiction in Virginia requires reforming our criminal justice system. Every adult participant accepted into a Virginia drug treatment court docket saves the Commonwealth $19,234, compared to traditional case processing.
We need to better-fund existing drug courts and expand the use of drug courts to more jurisdictions, to provide more effective treatment while reducing the fiscal burden on the corrections system. This move should be accompanied by an expansion of treatment facilities, the creation of more robust support services for those leaving rehabilitation treatment who are still part of the court system, and the implementation of diversion programs like Law Enforcement Assisted Diversion (“LEAD”). LEAD allows police officers to exercise their discretion to divert offenders to community-based harm reduction programs where appropriate, instead of our criminal justice system. The Roanoke Valley Hope initiative is a great example; addicts can voluntarily turn in their drugs and seek help at a clinic or the local police department — without fear of arrest. We need to ensure that those who seek help for the disease of addiction have access to the resources they need to get clean.
Fully Implement a Statewide Needle Exchange Program Accessible to all of Virginia’s Communities
Syringe exchange programs provide free sterile syringes and collect used syringes from injection-drug users. These exchange programs are proven to reduce transmission rates of diseases like HIV/AIDS and hepatitis C. Successful syringe exchange programs are already operating in Maryland, D.C., West Virginia and North Carolina, many of which also provide a range of public health services including referrals for substance abuse treatment and prevention education for STIs, as well as HIV testing and counseling.
In 2017, the General Assembly passed a bill that allows the Commissioner of Health to establish and operate a syringe exchange program during a public health emergency in communities designated at-risk by the Department of Health. I will work with the Department of Health to fully implement a statewide needle exchange program and make sure any local law enforcement or community health department can participate.
5. Increase Access to Quality Health Care in Our Communities
Fight to Expand Medicaid and Continue Holding Insurance Companies Accountable to the Essential Benefits Package, Including Mental Health and Addiction Treatment Services
Treating those already suffering from addiction in our Commonwealth is essential, but stopping the spread of opioid dependence requires universal access to mental health and other basic healthcare services. I will work to expand Medicaid, so an additional 400,000 Virginians will have access to care. Despite Governor McAuliffe’s efforts, Republican obstructionism in the General Assembly has already cost our Commonwealth $10 billion from the federal government that could be used to expand access to healthcare, including mental health and addiction treatment services. Until every single Virginian has access to healthcare, we will never eradicate this epidemic.
Support Increased Funding for our Community Service Boards
The front line responders to many of Virginia’s overdose and addiction patients are Community Service Boards (CSBs). Any Virginian needing services related to mental health, disabilities, or substance abuse problems can walk into a CSB and receive on-site counseling or a referral to a professional. My administration will increase funding for CSBs in order to build resources for addiction and mental health services and increase the number of beds in our inpatient detox facilities. One third of patients treated at CSBs would be newly-covered if Virginia expanded Medicaid, helping reduce the projected cost of funding these programs.
Make Education and Training Programs More Affordable for Students who Commit to Filling our Commonwealth’s Community Service-Related Need Gaps
We need to train enough qualified health care staff so treatment is available in every corner of the Commonwealth. To motivate a new generation of mental health workers, substance abuse counselors, and other community service providers, I will push for Virginia to offer partial loan forgiveness through a re-established Virginia Educational Loan Authority as well as expand support for existing state matching grant programs in exchange for a commitment to live and work for two years in the communities that need it most. I will also expand the Virginia Transfer Grant — which provides financial assistance to former community college students who return to school and complete a four year degree — to Virginians who never completed their degrees but want to re-enroll in school or a training program.
