The Illinois Legislature recently overrode Gov. Bruce Rauner's veto of Medicaid funding for heroin-addiction treatment. The vote against the state's new fiscally conservative leader reflects a new way of thinking about substance abuse disorders.
Illinois and almost every other state is taking public health action on heroin, including facilitating the wider availability of the anti-overdose drug Narcan (or Naloxone).
“When you have prosecutors coming to (the Illinois state capitol in) Springfield to advocate for overriding the governor's veto on funding heroin treatment, you're talking about a game changer in how people perceive this issue,” said Kathleen Kane-Willis, director of the Illinois Consortium on Drug Policy at Roosevelt University in Chicago.
“It's reframing it as a public health issue rather than a criminal justice issue."
From 2006 to 2013, the number of heroin-related deaths quadrupled, according to the Centers for Disease Control and Prevention. The numbers have compelled states to take measures to lower the number of deaths by encouraging people to seek treatment.
Kentucky made headlines this year for passing what some experts say is the most comprehensive approach to combating the scourge.
The new law toughens penalties for those who bring heroin into the state with the intent to sell or distribute. The penalties for selling heroin are even tougher.
The law also calls for $24 million annually for treatment. It allows needle-exchange programs and increases availability of Narcan. A “Good Samaritan” clause gives immunity to people who call 911 to help someone experiencing an overdose.
Although the number of heroin-overdose deaths in Kentucky has climbed from 22 in 2011 to 233 in 2014, support for the measure was not universal.
State Sen. Paul Hornback, a Republican from the town of Shelbyville, voted against the bill, arguing that programs like needle exchanges merely enable addicts.
“We've always had drugs around,” Hornback said in a news release. “We are not going to eliminate heroin. A lot of my constituents are tired of paying for people's bad choices. That is what this does.”
Kent Runyon, executive director of Novus Medical Detox Center, a private company in Palm Harbor, Fla. says it's important to understand that heroin addiction has crossed color, class and geographic lines. “Heroin has shifted into middle-class America and it's affecting a different segment of our population,” he said.
Other states appear to be heeding the warning.
According to the National Conference on State Legislatures, states have enacted 99 statutes that facilitate use and distribution of Narcan. Kane-Willis said 40 states and the District of Columbia now have laws on the books allowing its wider use. She adds that more than 150,000 people had received training in how to administer the drug, which has led to he reversal of more than 26,000 overdoses.
Some states are also allowing Narcan to be dispensed through a standing order with a pharmacist.
“That's really important in making it more accessible—especially in rural areas,” Kane-Willis said. “As we see the opioid epidemic spread into rural areas, it's important to ensure access through Medicaid and pharmacists.”
More than 30 states and the District of Columbia have enacted “Good Samaritan” laws. Many states have added provisions to ensure the laws do not protect anyone involved in more serious crimes like manufacturing, trafficking or distribution of controlled substances.
The laws appear to help. Washington state was among the first to offer immunity to those calling 911 for help with an overdose. The University of Washington Alcohol and Drug Abuse Institute found that 88% of those who knew about the law were more likely to call 911 in an overdose emergency.
“The decriminalization of drug use is something we need to address as part of removing barriers to treatment,” Runyon said. “We cannot allow only the wealthy and those with quality insurance to have access to help.”
To help ease some of the political concerns surrounding Good Samaritan laws, many states have imposed restrictions on immunity. For example, looking at criminal history to determine whether or not the Samaritans are eligible. Florida covers only possession-related offenses, and a Delaware law offers immunity from drug-related offenses that are not Class A, B, or C felonies.
Katrina Gay, spokeswoman for the National Alliance for Mental Illness says her organization is encouraged by the states' movement to address substance abuse as a public health issue.
“We believe the mental health crisis is both a social crisis for communities, families and individuals, but it's also a public health crisis,” Gay said. “The lack of understanding is also a social disgrace.”
Dr. Georges Benjamin, executive director of the American Public Health Association, said the federal government should be playing a significant role in the efforts, particularly by modifying the way the CMS pays for substance-abuse treatment and in ensuring there is reimbursement parity between medical and behavioral health services.
“It's a leadership issue at the federal level,” he said. “There are things that happen locally that the feds can influence.”