The centers, also called harm-reduction or safe-use sites, are where people can use illegal drugs and, if necessary, be revived from an overdose by trained staff

By Elliott Wenzler (September 20, 2023) 

Colorado lawmakers plan to use an untested policy from Rhode Island as the model for a 2024 bill they are drafting that would pave the way for so-called overdose prevention centers in the state. 

The centers, sometimes called harm-reduction or safe-use sites, are intended to be a place where people can use illegal drugs and, if necessary, be revived from an overdose by trained staff. The sites are also meant to provide counseling and access to substance-abuse treatment services.

Earlier this year, the Colorado legislature, which is controlled by Democrats, rejected a bill that would have let local governments authorize the centers to operate in their community. In August, some of the same lawmakers who supported that measure — several of whom sit on the legislature’s Opioid and Other Substance Abuse Disorders Study Committee — voted to try again in 2024 by drafting a new bill for next year’s lawmaking session, which begins in January and lasts 120 days. 

This time, they say they will tweak the legislation to require more state control.

Colorado state Rep. Chris deGruy Kennedy, chair of the interim opioid committee and a supporter of the policy, said during a virtual forum last week he wants the new bill to focus on the Rhode Island policy in order to address some of the concerns of people who opposed this year’s Colorado effort. 

Rhode Island’s legislature passed a bill in 2021 to create a two-year pilot program testing out the sites, also called “harm reduction centers.” But the first site won’t open until sometime next year.

“I think that the main reason we were gravitating a little bit towards the Rhode Island model is just because it has more robust state oversight to pair with the local control,” the Lakewood Democrat said last week during a virtual public meeting with Rep. Elisabeth Epps, D-Denver, and Sen. Kevin Priola, D-Henderson, two members of the committee who are helping him with the draft. 

DeGruy Kennedy highlighted how Rhode Island’s model created a nine-person advisory committee to help draft regulations around overdose prevention centers.

The committee in Rhode Island consists of:

• the state attorney general or their designee 
• three medical representatives, with one specializing in addiction 
• A current or former law enforcement officer
• a person with a substance use disorder
• someone working in overdose prevention
• someone who has suffered from an overdose or a family member of someone who died from an overdose
• a representative from the state’s league of cities and towns

DeGruy Kennedy said he also likes that Rhode Island’s legislation was endorsed by the American Medical Association. The Rhode Island centers will be required to provide “necessary health care professionals to prevent overdose” and will have referrals for counseling and medical treatments, according to the bill.

With the help of the advisory committee, the director of the Rhode Island public health department creates the regulations for the program. The sites must be approved by the city they are located in. 

Colorado’s draft bill would also create a pilot program, but likely for longer than two years, Kennedy said. 

“We have heard concerns from committee members about making sure that whatever we do is harmonious with the work that law enforcement is doing on distribution crimes in the city at large,” deGruy Kennedy said at the forum. “That voice on an advisory committee was something that we thought was a smart way to include law enforcement voices and cover the concerns that there could be unintended consequences with regards to crime and drug distribution in surrounding areas.”

Law enforcement members gave their perspective to the committee in early August during a three-hour discussion on the topic — the first indicator that the bill may be coming back. 

During that meeting, Epps, who has said she supports working toward abolishing police, said she could support policing of drug distribution and dealing.

“I see a role — don’t tell anybody I said this — I see a role for law enforcement in dealing with … this crisis,” she said.

Epps was a prime sponsor of the bill that failed this year.

While Epps and other lawmakers who supported that bill seem to be in favor of the new effort, proponents would have to persuade skeptics in their own party — likely including the governor — to come on board. Another prominent skeptic is state Sen. Kyle Mullica, a Thornton Democrat who sits on the Opioid and Other Substance Abuse Disorders Study Committee. 

Mullica cast one of the deciding votes shelving the 2023 overdose prevention centers bill, but then in August, on the interim committee, he also cast the deciding vote to allow the 2024 version to be drafted. 

“I’ll be honest with you and transparent: I’m not convinced that this policy is the most effective policy for us to do,” he said during a committee hearing. “But I do believe that it’s a conversation that we should be having and I’m not afraid of that conversation — even if I do have concerns.”

Mullica said he wanted to join Epps, Priola and deGruy Kennedy in drafting the measure. 

While Mullica said he’s not sure he will ever be able to support a bill allowing overdose-prevention centers, he said being part of the bill-drafting process will mean he can try to get some of his concerns addressed. That includes what he feels is a lack of data around overdose prevention centers, the fact that they’ve been used in cities with much denser populations than Denver and how to police around the sites.

The Opioid and Other Substance Use Disorders Study Committee will hear public comment on the 2024 draft on Sept. 27. Nonpartisan legislative staff will then have a week to make any changes and create a fiscal note before the full committee votes on whether to advance the bill to the Legislative Services Committee for further consideration. 

If the Legislative Services Committee advances the bill, it would be introduced in January and go through the legislative process. If the Legislative Services Committee votes against advancing the measure, it could still be brought during next year’s lawmaking term.

The Democratic proponents of the proposal are unlikely to get any support from Republicans, who have been universally opposed to the idea in recent years.

Rep. Ryan Armagost, a Berthoud Republican on the  Opioid and Other Substance Use Disorders Study Committee, said during the August committee hearing that he still thinks authorizing overdose prevention centers is a bad idea. “What might work in one city isn’t (necessarily) going to work throughout Colorado,” he told the committee before a vote to draft the 2024 bill was taken.

The overdose prevention centers measure was one of five drafts the interim committee decided to pursue in August. Support for drafting the other four measures — which would deal with opioid abuse prevention, harm reduction, treatment and recovery — was unanimous.

Read more at ColoradoSun.com

For additional reading, check out this article by ColoradoPolitics.

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

BY: SARA WILSON – MARCH 3, 2023
Colorado Gov. Jared Polis and a group of Democratic lawmakers introduced a slate of new bills Thursday they say are meant to reduce health care costs in the state.

The bills would reduce premiums for Colorado Option plans, lower prescription drug costs and work to increase transparency for hospital profits.

“Saving people money on healthcare has been a top priority for me since Day One, and it’s a big challenge,” Polis, a Democrat, said. “We want to pound away on it every year, to find every cost driver and address it to make sure Coloradans stop having to overpay for prescription drugs, hospital care and the health care that they need.”

House Bill 23-1224 would work to improve the Colorado Option, the state-regulated plan offered by private insurers that passed last year. The bill would lower premiums by making it easier for consumers to shop for plans, requiring the development of a method for displaying the standardized plans.

“The Colorado Option is a marquee piece of legislation and a marquee law in our healthcare platform and I’m incredibly pleased with the progress we’ve made on it,” bill sponsor Sen. Dylan Roberts of Avon said. The bill is also backed by Democratic Reps. Iman Jodeh of Aurora and Kyle Brown of Louisville.

The bill also empowers the state’s insurance commissioner to hold carriers accountable for the cost reduction requirements within Colorado Option standardized plans.

Another bill, House Bill 23-1225, addresses the state’s prescription drug affordability board. It would allow the board to review any number of expensive prescription drugs instead of only a dozen as outlined in the legislation that created the board.

The board, which has not yet reviewed the costs of any drugs, has the authority to set an upper payment limit if it determines that a certain drug is unaffordable for Coloradans.

“There are thousands of medications on the market. Limiting it to 12 makes no sense,” bill sponsor state Sen. Sonya Jaquez Lewis of Longmont said. The bill is also sponsored by Reps. Chris deGruy Kennedy of Lakewood and Ruby Dickson of Greenwood Village.

A third bill, House Bill 23-1227, would give more oversight power to the state’s Division of Insurance over pharmacy benefit managers. It would require PBMs to register with the state and require health insurers to pay a fee when filing a list with the insurance commissioner of the PBMs they use.

The bill specifies that the division has the power to enforce certain requirements over PBMs. PBMs are prohibited from, among other things, requiring patients to get medications through the mail, modifying a drug formulary during the plan year and not allowing pharmacists to tell patients about more affordable drug options. It is sponsored by Jodeh, Rep. David Ortiz of Centennial and Republican Sen. Perry Will of New Castle.

“In some cases, PBMs are coming between consumers, health insurance plans, pharmacies and manufacturers while making very, very large profits. PBMs can be a part of the plan to save Coloradans money on prescription drugs, but they have to follow the rules,” Jodeh, one of the bill sponsors, said.

Lawmakers highlighted other pieces of health care cost saving legislation:

• HB23-1226 would enhance current hospital financial transparency reporting in an effort to highlight what is driving up hospital costs in the state. It is sponsored by Republican Rep. Matt Soper of Delta, deGruy Kennedy, Roberts and Will.
• A yet to be introduced bill from Democratic Rep. Judy Amabile would require a minimum level of community investment by nonprofit hospitals.

Read more at ColoradoNewsLine.com

By Marianne Goodland (February 21, 2023)

The first of three bills attempting to deal once again with fentanyl won approval from a House panel on Tuesday.

House Bill 1167, which applies to the state’s Good Samaritan law, attempts to fix problems that the sponsor said came out of last year’s omnibus legislation on the deadly drug.

As amended by last year’s House Bill 1326, the law now says individuals are immune from arrest and prosecution if they report an overdose to law enforcement or first responders, stay on the scene and cooperate. 

But fentanyl was not included in the right place in the Good Samaritan law, and supporters of HB1167 say that could create felony charges for someone possessing drugs who are trying to do the right thing.

Right now, “people are very afraid to call” for fear of those charges, according to Lisa Raville of the Harm Reduction Action Center.

“We broke the Good Samaritan” law, bill sponsor Rep. Chris deGruy Kennedy told Colorado Politics. “We created a new felony fentanyl possession law.”

That, he said, wasn’t intended.

Fentanyl, used legitimately as a medical anesthetic, is a synthetic opioid that has become a dominant player in the illicit market, and it’s increasingly being mixed into other substances. It’s cheaper and produces a stronger, more fleeting “high,” according to experts. But its potency in small quantities makes it unlike any other substance that preceded it in the drug supply, spurring heated debate about how to address it.

On the one hand, advocates like Raville argue that further criminalization won’t improve the situation. On the other hand stands law enforcers and their allies, who say policymakers should treat fentanyl like “the deadly” substance it is.   

No one testified against deGruy Kennedy’s bill in the House Judiciary Committee.

Raville told the committee that people who use drugs are the “true first responders” in an overdose crisis if they have access to naloxone. They’re also the primary witnesses to overdoses but they have a lot of good reasons to not engage with 911 — and the biggest is fear of law enforcement, Raville said, adding last year’s bill eroded the Good Samaritan law.

“We need people to stay” on hand and cooperate, she said.

To highlight the fear people have about calling 911, Aubrey Wild with the Colorado Coalition for the Homeless told the story of a man who was recently released from jail and overdosed. Someone called 911 with directions on where to find the man, who was passed out in an alley. He survived, but Wild said it shows the fear that people have of sticking around to wait for law enforcers or first responders or even taking life-saving action during an overdose related medical emergency.

Had the caller stayed with the man, the 911 dispatcher could have walked the caller through emergency assistance, Wild said.

Others haven’t been so lucky, she said.

Tessa Torgesen, who works with people who use drugs by distributing sterile syringes, safe injection supplies, fentanyl test strips and Narcan, said she is seeing firsthand how the weakening of the Good Samaritan law has harmed the progress made in overdose prevention — occurring at a time when overdose deaths are on the rise nationwide.

She recounted the story of a woman whose husband overdosed but didn’t call 911 for fear of being arrested because she possessed fentanyl and her husband was on probation for felony drug charges.

It’s more important now than ever for people who use drugs to feel safe calling 911, said Torgesen, whose own life was saved with Narcan.

The harm reduction community — whose members advocate for intervention programs and oppose tougher penalties for crimes — raised immediate concerns once the legislature adopted the fentanyl legislation last year, said Jose Esquibel, who is with the Colorado Consortium for Prescription Drug Abuse Prevention.

The law did not link the call Good Sam law to the new penalties for possession, he said, adding his group had to put out an alert to its coalition that the Good Sam law did not apply to fentanyl.

One group that stayed away from the hearing was the Colorado District Attorneys’ Council, which is divided on the bill, according to Tim Lane.

However, Denver District Attorney Beth McCann spoke in favor of the measure and affirmative defense, the section that has caused some heartburn for district attorneys. 

Under HB 1167, a person who is charged with distribution of less than four grams of fentanyl but stays on the scene of an overdose has an affirmative defense that can be used if the dealer is prosecuted.

McCann said prosecutors don’t want drug dealers to avoid prosecution but that the intent is really around sharing drugs, not dealing them.

The bill focuses “on situations where people are providing drugs to a friend or a girlfriend, boyfriend, and they are using them together with the intention of consuming the drugs,” and then someone overdoses, she said.

In those kinds of situations, McCann said it’s unlikely a person would be prosecuted.

“It’s more important to come down on the side of saving lives, given the immediacy of an overdose situation,” McCann said. “Although I know there are some in the DA community who are not particularly enamored with this bill, I believe that it’s more important to allow us to save lives in these very difficult” and sad situations.

McCann added they still intend to prosecute those who are involved in widespread distribution.

Broadly speaking, advocates of tougher penalties to crime, particularly the distribution of fentanyl, argue that the state’s lenient approach is contributing to Colorado’s grim overdoses.

Last year, Deputy Chief Adrian Vasquez of the Colorado Springs police department told a House panel that any possession of fentanyl should be a felony, that there is no “relatively safe amount of fentanyl” and public policy should demonstrate its seriousness.

In pushing for the 2022 legislation, supporters of tougher penalties said even one pill can kill and argued there’s no middle ground when dealing with a substance as deadly as fentanyl. 

They said users often don’t know what they’re taking and fentanyl also puts first responders at risk.

Monday marked the one-year anniversary of the deaths of five people in a Commerce City apartment.

Police Chief Gregory Sadar, who also represents the state’s chiefs of police association, asked for an amendment to exempt manufacturers and dealers from the Good Samaritan law.

“Expanding the immunity to those who manufacture and distribute the drug is problematic for us,” Sadar said.

“We continue in Colorado to take a more and more permissive position towards drug use,” said Sadar, who added that it leads to the overdose crisis. “We want to make sure we take a position that incentivize people to call.”

“But it’s also a sad commentary,” he added, that people have to be incentivized to save their neighbors.

HB 1167 was amended at deGruy Kennedy’s behest to exempt the manufacturers, although that drew opposition from two committee Democrats. The bill passed on a 10-2 vote and now heads to the full House.

A second bill on fentanyl that intends to address the issue of “knowingly” possessing fentanyl, sponsored by House Minority Leader Mike Lynch, R-Wellington, was pulled from the committee’s schedule.

The third bill dealing with fentanyl is in the state Senate.

Sponsored by Sens. Kyle Mullica, D-Thornton and Byron Pelton, R-Sterling, Senate Bill 109 seeks to create a level 1 drug felony, along with mandatory sentencing, for controlled substance distribution that results in death. It’s similar to a provision in HB 1326, but SB 109 applies to more than just fentanyl.

The measure, which is supported by the Colorado District Attorney’s Council, is scheduled for the Senate Judiciary Committee hearing on March 6.

Read more at ColoradoPolitics.com

New bill would cover fentanyl users, drug sharers who try to stop an overdose

By Seth Klamann (Feb 3, 2023) 

A bill introduced in the Colorado House late Thursday would expand a state law that provides immunity to drug users who try to save someone from overdosing, after those same protections were inadvertently undermined by lawmakers during last year’s fight over fentanyl legislation.

The bill would fix that apparent oversight, made when legislators tightened penalties for fentanyl possession in 2022. But it would also expand those immunity protections, available under the state’s Good Samaritan law, to users who report an overdose of other illicit substances but were found to have shared drugs, and the measure would also provide an additional legal defense to some accused low-level dealers.

Supporters, like bill sponsor Rep. Chris deGruy Kennedy, cast the changes as common-sense solutions intended to save lives and work within the realities of drug use: At low levels, the lines between user and seller are often blurred, and calling for help should be encouraged whenever possible.

But law enforcement and district attorneys indicated they’re leery of some of the changes deGruy Kennedy, a Lakewood Democrat, is proposing.

Though representatives for those groups told The Denver Post late Thursday that they’re still examining the bill’s impact, law enforcement spent much of the last legislative session calling for tight penalties for anyone convicted of dealing fentanyl and other drugs, citing the state’s ongoing overdose crisis.

The diverging views of substance use and how to structure state laws to address it echo that bruising legislative fight, which pit public health experts against law enforcement groups and stretched across two contentious months. Ultimately, lawmakers last year lowered the threshold to charge users with felony, rather than misdemeanor, fentanyl possession.

Through that work, lawmakers essentially made a special carveout for fentanyl possession, distinct from Colorado’s broader felony drug framework. In turn, that cut some users out of the state’s Good Samaritan law, which deGruy Kennedy said was the result of lawmakers working on a large piece of legislation at the 11th hour last May.

The top Republican in the House, Minority Leader Mike Lynch, who was a vocal supporter of increasing penalties last year, was unavailable for comment Thursday.

“The bill will make sure that people that are calling in an overdose event to try to save a life, who stay on scene and fully cooperate with law enforcement, are not going to face harsh penalties for choosing to do the right thing,” deGruy Kennedy said.

That cleanup is largely noncontroversial for the constellation of law enforcement, district attorneys and harm-reduction advocates monitoring the bill. There’s more disagreement with how the measure would apply to drug sharing and to certain low-level drug dealers.

The bill would extend the Good Samaritan law to a person who reports an overdose to 911 and cooperates, but was subsequently found to have shared drugs with others. It wouldn’t give immunity to any drug dealers, but if someone who called 911 is suspected of selling small quantities of drugs, they could use that cooperation with first responders as a defense at any subsequent trial.

“What we’re really talking about, in the vast majority of cases, are going to be buddies getting together to share drugs, which may involve splitting the cost of drugs that one of them purchased, which would trigger a distribution crime,” deGruy Kennedy said. “To be clear, they are culpable of a crime in that case, but what I want to assert is that they need to prioritize saving the life of the person overdosing as opposed to running from the police.”

A coalition of Colorado law enforcement groups is still examining the bill but has concerns about the distribution and sharing provisions, a representative said Thursday. Tom Raynes, the executive director of the Colorado District Attorneys Council, said prosecutors are in a similar position.

District attorneys for Denver, Adams and Broomfield counties — with whom deGruy Kennedy said he consulted in crafting the bill — were unavailable for comment late Thursday afternoon.

Experts in substance use, like the Harm Reduction Action Center’s Lisa Raville, have long maintained that sharing drugs and pooling money are common among substance users and don’t fit neatly into drug laws. Raville, whose Denver facility provides clean needles and smoking kits to substance users, praised the bill on Thursday.

She said the new fentanyl penalties enacted last year had discouraged many substance users from calling 911.

“It was very clear that folks were very concerned,” she said. “There was no good message, no one could feel confident in calling 911, so they simply weren’t. As the largest provider of harm reduction services in the state, I could not feel confident for them to call 911 either.”

Read more at DenverPost.com