The committee last met just as fentanyl was emerging and before COVID-19. It now faces a transformed overdose crisis.
By Seth Klamann (July 5, 2023)
The legislative committee tasked with helping to guide Colorado’s response to substance use has reconvened for the first time in four years to face a drastically changed drug landscape, a worsened overdose crisis and a series of worrisome data points about the state’s patchwork treatment system.
The Opioid and Other Substance Use Disorders Study Committee — featuring six Democrats and four Republicans from the state legislature — met for the first time Thursday and will meet again over the coming months with the goal of forwarding potential bills to the full General Assembly when it reconvenes in January.
The group had met for three straight years through 2019, but COVID-19’s emergence derailed its schedule. The committee returns now not only near the peak of the state’s drug crisis, but also amid internal divisions within the legislature about how to address the issue.
In what amounted to a state of the state’s drug use, the committee’s 10 members were presented at a meeting last week with the enormous and complex problem facing them: Just under 1,800 people fatally overdosed in Colorado last year, a still-too-high plateau after three years of marked increases.
Fentanyl, the deadly synthetic opioid, has strengthened its grip on the broader drug supply, making other substances — like methamphetamine and cocaine — far riskier for users. As a result, fatal overdoses involving fentanyl have quadrupled in the past four years, spiking from 222 in 2019 to 920 last year, according to state data.
More young people and people of color are dying, and data presented at Thursday’s meeting showed significant gaps in treatment for both populations.
“We are making progress,” Rob Valuck, a University of Colorado pharmacy professor and the executive director of the Colorado Consortium for Prescription Drug Abuse Prevention, told lawmakers. “People think, ‘Well it’s just getting worse and there is no progress.’ Not true. But the ground is moving under us. Potency of substances is growing. COVID certainly didn’t help — it didn’t help anything. … So we’re fighting all these things, but we still have to do a lot more.”
The good news, Valuck and others said, is that a large group of Colorado agencies, nonprofits and officials are collaborating to find solutions. Representatives from four state agencies testified about their role in combating the crisis: the state departments for public health and health care policy and financing, along with the Colorado Attorney General’s Office and the new Behavioral Health Administration. Public health officials have become increasingly involved in pushing a harm-reduction approach, too, which the state has begun to embrace — to a point.
Lawmakers, meanwhile, have not coalesced around a path forward. While legislators in 2019 de-felonized low-level possession of several drugs, including fentanyl, a sweeping bill passed last year tightened penalties for fentanyl and led to bitter fights about the state’s approach. A bill this year to study the costs of the drug war passed, only to be vetoed by Gov. Jared Polis. The House advanced another bill that would’ve allowed safe drug-use sites to open in willing Colorado cities. The state Senate then narrowly approved a different measure that would’ve tightened penalties for drug dealers. Each chamber then killed the other’s bill.
The consortium also showed lawmakers the results of surveys it had sent to health care providers, people in recovery from substance use, policymakers and government officials. Those responses showed support for harm reduction, prevention and treatment approaches. But there was far less satisfaction with the steps the state has taken with criminal justice and recovery policies. Criminal justice in particular scored the lowest (law enforcement officials are not listed as having participated in the survey).
The debate around approach — should the state lead with public health or criminal justice — is likely to continue. Rep. Chris deGruy Kennedy, a Lakewood Democrat and the committee’s chair, has said one of his priorities is to further study safe-use sites with an eye toward bringing another bill next year. The agendas for future committee meetings have yet to be set.
Sen. Kevin Priola and Rep. Elisabeth Epps, both Democrats, sponsored the safe-use site bill and serve on the committee. So, too, does Sen. Kyle Mullica, a Thornton Democrat who voted against the safe-use bill and backed the criminal penalty measure. Rep. Mike Lynch, the top Republican in the House and another supporter of the penalty measure, also sits on the committee.
Safe-use sites will not be the only issue the lawmakers sift through this summer and fall. New resources have become available for the state and the committee to leverage that weren’t available when the committee last met in 2019. Hundreds of millions of dollars’ worth of settlement funding, gained from lawsuits against opioid makers and pharmacies, is rolling into the state. The newly launched Behavioral Health Administration is tasked with helping to address substance use here. Data collection, a key part of understanding the crisis, has improved, and more details will emerge as legislative-directed reports are issued in the coming years.
Much of the settlement money is being dispersed to individual regions and counties. Some will be spent on various forms of treatment, though the sums are still too small to stand up new facilities or permanent programs. Valuck said that treatment options in Colorado have improved in recent years. But they still fall short.
“It used to be that… 80% to 85% of people who needed treatment could not get it, 10 years ago when we started this work,” he said. “That number is much lower now — maybe 60%. But still — that’s better than most states, but still more than half of people who have a use disorder and need treatment cannot access that treatment. It’s still a long way to go.”
That’s particularly true for people of color and young people, as well as those living in rural areas. Valuck and the consortium’s director, Jose Esquibel, showed lawmakers data that just one out of five opioid treatment facilities in Colorado accepts patients under 18. Fewer — if any — options are available to young patients who need more intensive care, especially those without financial resources.
One map, showing the parts of the metro area with opioid treatment offerings, showed just one facility in southeast Adams County, which has a high proportion of Black residents. Similarly diverse parts of north Denver, eastern Arapahoe County and Aurora also lacked options.
Meanwhile, overdose rates among communities of color have risen amid fentanyl’s emergence, a shift from the previous two waves of the opioid crisis — driven first by prescription drugs then heroin — that impacted white Americans more heavily. Data presented last week showed that Native American and Black Medicaid beneficiaries in Colorado died from opioids at far higher rates than their white peers.
“There’s something not right that, in those communities, there is not easy access to opioid-use-disorder treatment,” Esquibel said. “Now, we are working with the state departments and others to figure out how to respond. But we’re going to continue to see these deaths and high impacts in these communities if we don’t help them access treatment as well.”
Read more at DenverPost.com
For further reading, check out this piece at ColoradoTimesRecorder.com