State Net Capitol Journal: States Embracing Efforts to Combat Rise in Heroin Deaths

State Net Capitol Journal: States Embracing Efforts to Combat Rise in Heroin Deaths

By Rich Ehisen

For years, America's "war on drugs" has inspired police and lawmakers to take a very tough minded, arrest-and-incarcerate approach to dealing with illicit drug use. But an alarming increase in heroin overdose deaths nationwide has a growing number of states turning away from solely punitive measures in favor of so-called "harm reduction" laws that instead prioritize saving an overdose victim's life. 

Although there are far fewer heroin users than users of drugs like marijuana or even cocaine, their numbers have risen dramatically over the last decade. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Dept. of Health and Human Services, the number of people who use heroin has almost doubled since 2007, as has the number of people who are addicted to the drug. Much of that spike has been driven by young adults, whose use has also come close to doubling in that time. Overall, SAMHSA says approximately 669,000 people — 366,000 adults over age 25, 272,000 aged 18 to 25 and 31,000 kids under the age of 18 — used heroin at least once in 2012. 
Some Northeastern states have been hit particularly hard. Vermont Gov. Pete Shumlin (D) dedicated his entire State of the State address in January to what he called the state's "full-blown heroin crisis," citing a 770 percent increase in heroin addiction since 2000. In Boston, Mayor Martin Walsh said his city has seen a 76 percent increase in heroin overdose deaths since 2010. In Maine, heroin overdose deaths quadrupled from 2011 to 2012. In January, the Providence Journal reports, Rhode Island experienced 22 heroin overdose deaths in just 13 days. 
Ironically, this rise in heroin use is due at least in part to the success states and federal agencies have had in making it harder to get prescription opiates like OxyContin and Percodan. As supply has fallen, prices have predictably gone higher. OxyContin pills, for example, that in many places used to go for around $10 a pill on the street have climbed to as high as $100 each. That, experts say, makes a $10 dose of heroin much more attractive. 
"The lack of supply has made heroin much more intriguing to entrepreneurial dealers, who are offering really high strength heroin at low cost to bring in this new market of customers," says Dr. Steve Grinstead, a nationally-recognized addiction therapist located in Sacramento, California. "There's some real good marketing going on out there." 
The data backs him up. According the Center for Behavioral Health Statistics, people who have previously used painkillers to get high are 19 times more likely to use heroin than someone who has not done so. 
Regardless of the reason, the surge in use has led to a subsequent surge in overdose deaths. SAMHSA reports that almost 3,100 people died from heroin overdoses in 2010, the latest year for which data is available, up 55 percent from 2000. 
Law enforcement and other emergency responders say that many of these deaths could have been prevented if someone with the overdose victim would have simply got that person help. Usually that means calling 911 or taking the overdosed person to medical attention. But it could also come in the form of giving that person the anti-overdose drug naloxone, which works to block opiates from the brain's receptor cells. A 2012 report from the Centers for Disease Control says naloxone — usually sold under the brand name Narcan and which can be injected or applied via a nasal spray — has reversed over 10,000 opiate overdoses since its introduction in 1996. 
But many overdose victims never get that chance because fear of being arrested often supersedes a drug user's willingness to call 911. And in many states, there is no assurance that even emergency responders will be carrying naloxone when they arrive. 
Wisconsin Rep. John Nygren (R) knows those scenarios from firsthand experience. His 24-year-old daughter, Cassie, has been battling heroin addiction since her teens. 
"I remember the day meeting with her for dinner at a local pizza place," he says on a YouTube video he made for the Wisconsin Department of Justice for use in an anti-heroin campaign. "She looked terrible. When she told me she was using heroin I almost got sick to my stomach." 
It only got worse from there. She came very close to dying from an overdose in 2009 after the people she was with left her unconscious on their family's bathroom floor, a needle hanging out of her arm. She survived, but has been in an out of both jail and rehab ever since. 
Nygren responded to his daughter's travails by authoring a half dozen heroin-related bills this session. Among them: AB 447, which would grant limited criminal immunity to someone who gets help for an overdose victim and AB 446, which would increase the number of people who can legally administer naloxone and grant civil and criminal immunity to those that do. 
The Wisconsin Assembly and Senate have each overwhelmingly endorsed those proposals as well as two others in Nygren's suite of bills: AB 445, which would require someone to show ID when picking up an opiate prescription medicine and AB 448, which encourages communities to establish drug disposal programs. They are now on their way to Gov. Scott Walker (R), who has said he will sign them. 
If and when Walker signs them, Wisconsin will join a growing number of states with similar laws. According to the Council of State Governments, at least 17 states and the District of Columbia have already adopted so-called "Good Samaritan" laws in recent years that grant limited criminal immunity to someone who gets help for a person who has overdosed. While all 50 states already allow doctors and other trained hospital personnel to give an overdose victim naloxone, 18 states and D.C. also have adopted measures granting emergency responders and, in some cases, specially trained non-medical personnel to do so as well (See Bird's eye view in this issue). 
More are on the way. Similar naloxone measures have also gained approval in recent weeks in the Tennessee Senate (SB 1631), the Ohio Senate (HB 170) and the Utah Senate (HB 11). The Tennessee measure is now in the House, while the Utah bill is on its way to Gov. Gary Herbert (R). The Ohio legislation has returned to the House but is expected to quickly gain concurrence and be sent on to Gov. John Kasich (R). Both are expected to sign them into law. 
According to LexisNexis State Net, Good Samaritan bills are also pending in at least seven states, while bills to approve or expand the use of Naloxone, either to police, additional emergency personnel or others, are pending in at least a dozen. And in Boston, Mayor Walsh announced that his city would copy a successful program being used in Quincy that requires all city police to carry naloxone in their vehicles. All Rhode Island police are now doing the same. And while it does not specifically address Good Samaritan laws or naloxone, the Affordable Care Act does require health insurers to include addiction care as part of the 10 essential health benefits all health policies must cover. 
Not everyone, however, is on board with such plans. Maine lawmakers endorsed a Good Samaritan bill (HB 735) and a naloxone measure (HB 737) last year, but Gov. Paul LePage (R) vetoed both of them. In his veto message, LePage said increasing the availability of naloxone would give heroin users a "false sense of security" that encouraged them to "push themselves to the edge, and beyond." He claimed the Good Samaritan measure would impede drug enforcement. Veto override attempts failed. Rep. Sara Gideon (D) has introduced another naloxone measure this year (HB 1209), although LePage has indicated he would veto that one as well. 
That mystifies observers like Grinstead. 
"Some people still have the mindset that it is a will power issue, a moral issue and, ultimately a criminal issue," he says. "That's disappointing because we've been going about it with the same old supply-side 'war on drugs' approach for years, and so far it has been a total failure." 
Rep. Nygren voiced the same sentiment last month when the Assembly endorsed his two remaining heroin bills: AB 701, which creates regional comprehensive opiate treatment programs; and AB 702, which would set up short-term sanctions for drug offenders who violate conditions of their release. 
"We also need to change the way we view addiction," Nygren said in a statement. "It's not just criminal behavior — it's a mental health issue." 
Those bills are now in the Senate, where they are expected to be approved later this month.

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