Statewide Substance Abuse and Overdose Crisis Policy Proposal

The Attorney General’s Role in Combating the Drug Abuse and Overdose Epidemic

The Virginia Attorney General serves as counsel to Virginia’s agencies, boards, commissions, and colleges. The Attorney General also works closely with law enforcement to prosecute enforcement actions in a range of areas impacting our citizens, including elder abuse, financial crimes, healthcare fraud, organized crime, and other specialized prosecutions.  These authorities place the Virginia Attorney General in a critical leadership position in fighting the drug overdose crisis in our communities.  In the last year alone, we have lost over 1,400 lives to drug overdoses in Virginia, outpacing deaths caused by motor vehicle accidents and gun-related incidents.  Well over half of those overdoses are due to the opioids and heroin epidemic.  Currently, there are several agencies, localities, and community-based programs working hard to fight this epidemic.  Virginia’s Attorney General, however, needs to do much, much more to leverage state resources and enhance those efforts across the Commonwealth. 

Three Elements for a Successful Strategy

No single individual, agency, or program can turn the tide on the overdose epidemic.  Rather, coordinating efforts and resources is essential for combating the opioid and heroin epidemic plaguing the Commonwealth, as well as other drug problems confronting our communities. It is essential to gather a robust team of business, community, faith-based, law enforcement, prevention, public health, treatment, and other leaders around the same table, to address the current crisis and the other drug abuse problems before us.  The Attorney General has the ability to leverage the office’s authority and resources to deploy a strategy coordinating those efforts in the following areas:

  1. Prevention and Education
  2. Treatment
  3. Enforcement

Accountability in each of these areas is critical for future success.  Although many groups discuss grand plans on the drug effort, they lack the accountability components ensuring they deliver promised results.  Ongoing self-assessment of strategic efforts is key for making sure we are gaining ground in our efforts, or retooling our approach as necessary in areas where we are falling short.  That accountability must apply at each level, from the Attorney General to each of the community, local, state, and federal partners at the table.  As part of that effort, the Attorney General, in coordination with the Governor, should implement the following accountability measures among others:

  • Periodic (quarterly and yearly) reporting to the public – A substantive public report to show both:
    • Progress – publicly identifying the localities and programs making progress and providing a statewide platform to share best practices.
    • Failures – publicly identifying the areas and programs where we are failing to meet our goals, along with a commitment to look for ways to improve our efforts.
    • Attach accountability/progress strings to funding (grants/gifts); people (staff and prosecutor); and other resources (access to educational materials, first in line to treatment options, and others).

1. Prevention and Education

Educating our youth and changing attitudes empowers families, communities, teachers, and others on the front lines of our efforts to establish a lasting strategy for our future. In addition to existing efforts, the following strategies should be deployed:

  • Establish the Attorney General’s Virginia Substance Abuse Coordination Center (VSAC) to engage all available resources for community efforts.  The Attorney General is uniquely positioned to bring state, federal, and local resources to the table and coordinate efforts for attacking the drug epidemic. The Attorney General must embrace an “All Hands on Deck” approach and establish the VSAC to proactively engage with all available partners tasked with identifying their unique drug problems and coordinating resources for addressing those problems from all angles.
  • Mobilize law enforcement, community, and other resources for the effort.  Aside from caregivers and teachers, some of the most effective tools for identifying innovative strategies and relaying the ills of drug abuse are law enforcement officers, recovered addicts, peers, and those who have lost loved ones to the epidemic.  Through the VSAC, the Attorney General must provide a platform for mobilizing these resources, developing fresh ideas for combatting evolving drug threats and spreading the word about the deadly drugs that are impacting our children’s future. The Attorney General would work with the Governor and Secretary of Public Safety and Homeland Security to coordinate the law enforcement response.
  • Facilitate access to funding and grants.  Every program costs money. Fortunately, the Attorney General is a public figure with access to opportunities not readily available to every locality.  As part of the prevention program, the Attorney General should implement the following additional components to help our communities access additional funding:
    • Dedicate staff for grant-writing. The Attorney General can establish a Grant Supervisor and dedicate office resources to solicit, receive, and distribute funding to appropriate treatment and prevention programs across the Commonwealth.
    • Act as central clearinghouse for substance abuse program funding and grant management.  Utilizing office staff, the Attorney General will act as a facilitator and central clearinghouse to vet applications, programs, and individuals for receipt of grant funds.  The office must also help hold those applicants accountable for any resources they receive.  The clearinghouse will proactively research and recommend new funding sources and worthy recipients for innovative prevention and treatment programs. Those decisions should be based on real-world experience and emulate the most successful programs in existence.
    • Partner with early-childhood education and prevention efforts. Recent studies have concluded that effective anti-drug abuse education must start before the roots begin to take hold, long before the adolescent years when the abuse is most likely to first occur. This means starting these efforts at the elementary school level.  The Attorney General should collaborate with drug education and prevention experts to enhance and develop programs geared for pre-adolescent children.
    • Provide guidance and expertise for community and legislative efforts.  To help Virginia stay on the cutting edge in anti-drug abuse efforts, the Attorney General should establish a dedicated policy team of attorneys and subject matter experts devoted to working with the General Assembly and communities to identify non-partisan, common-sense changes to Virginia law for maximizing treatment, prevention, and enforcement efforts. These experts will also be responsible for educating relevant stakeholders, testifying before legislative committees, reviewing bills and draft legislation, and meeting with legislators and policy-makers to provide ongoing education and accurate information.
    • Support Public and Private Health efforts that make sense.  Partner with the state and federal agencies, treatment experts, community groups, and others to identify and support programs that make sense for maximizing our efforts and supporting prevention and public health programs that help our communities. Continue outreach and partnership efforts with physicians and healthcare providers on the front lines, working together to identify problems and develop effective response strategies.

 2. Treatment

Effective treatment and recovery geared toward helping others to break the deadly drug abuse cycle requires a concerted effort by key community players. Through the coordination of treatment and recovery programs by state agencies, private providers, and industry experts, Virginia can fight the opioids crisis and other drug problems on all fronts. The following steps should be employed in addition to existing efforts:

  • Create a culture of compassion.  Society tends to view those suffering from addiction as weak and consciously making the decision to continue their drug use and their downward spiral.  This stigma perpetuates the drug abuse problems facing Virginia, holding those suffering from addiction back from seeking treatment and damaging their ability to reconnect with loved ones and society.  The Attorney General must work with other leaders to break this cycle and help the public to understand that implementing an effective, lasting treatment methodology starts with the recognition that addiction is a powerful chronic disease that requires long-term disease management.
  • Coordinate treatment and recovery options with other state agencies, including the Department of Behavioral Health and Developmental Services, the Department of Medical Assistance Services, and the Virginia Department of Health. As counsel to state agencies, the Attorney General has access to state resources responsible for regulating prescribers and funding treatment programs.  The Attorney General must take a proactive leadership role in providing these state agencies consistent counsel and advice to coordinate regulation efforts, enhance treatment and recovery options, and, critically, to standardize practices across the Commonwealth. Through the VSAC, the Attorney General should form a state agency task force dedicated to effectively coordinating the Commonwealth’s regulation and treatment efforts across the state.
  • View treatment as an effective law enforcement tool for demand reduction.  Law enforcement officials are on the front-lines of this epidemic and are in a unique position to touch at-risk populations, track emerging drug abuse trends, administer naloxone to save lives, and refer individuals for treatment before and after enforcement activities. The Attorney General should coordinate specialized training in each of these areas to ensure that every at-need jurisdiction has access to the resources needed for successful implementation of these and other strategies.  Further, in coordination with local law enforcement leaders, the Attorney General must help spearhead efforts to expand community treatment and recovery options, provide treatment alternatives for appropriate low level, non-violent substance abusers and serve as a resource for establishing new treatment and recovery programs that make sense for our communities.
  • Allocate Attorney General settlement funds to expanding treatment and recovery options. Through state and federal enforcement operations, the Attorney General’s office often receives asset forfeiture funds seized from criminals under federal equitable sharing guidelines. The Attorney General should dedicate seized funds for distribution to eligible law enforcement agencies and programs for improving treatment and prevention efforts.
  • Help community-based organizations and first-responders to identify available treatment resources. When a person suffering from a drug addiction needs help, immediate access to treatment resources is critical.  Delay is often deadly. First responders and others on the front lines often encounter situations where they can help put people on track for treatment, but they need to know about available options. The Attorney General can dedicate community-based staff with access to a database of treatment and legal resources providing planning support, both before and during time sensitive situations.
  • Provide support for people with the disease of addiction.  Making treatment resources available is only half the battle in establishing long-term success.  If a recovering addict cannot remove himself from the environment that led him down the path to addiction, the battle is lost from the start.  The Attorney General must work with state, federal, and local partners to help people with the disease of addiction to rebuild their self-worth through access to treatment and recovery programs, support meetings, and employment opportunities.  That includes assisting recovering addicts in their reintegration into the community, including providing information and resources dedicated to transition housing and developing recommended incentives for employers willing to hire them.

3. Enforcement

Although it is often said “we cannot arrest our way out of this problem,” and that is certainly true, law enforcement and the criminal justice system still play a central role in combating this epidemic.  While many law enforcement officials are making great strides in their local efforts to develop innovative solutions (such as the Chesterfield County Sheriff’s Heroin Addiction Recovery Program (HARP)), the Attorney General has the unique opportunity to coordinate law enforcement efforts between multiple jurisdictions and state agencies.  Efforts in this arena should include:

  • Tackle the most significant drug trafficking problems that are plaguing our communities.  Virginia’s state and local law enforcement resources should be devoted to tackling the organizations and individuals responsible for bringing these poisons into our communities.  The Attorney General can help coordinate and leverage state, federal, and local resources to focus on dismantling the most significant trafficking threats facing our communities.  For that effort, the Attorney General must work hand-in-hand with state police and local law enforcement authorities to identify and develop the best strategies for combatting the unique trafficking threats facing their communities.
  • Support legislative efforts to enhance Virginia’s laws for holding traffickers tied to drug overdoses accountable.  Directly in line with current federal strategies, the Attorney General must support strengthening Virginia’s laws for prosecuting drug traffickers tied to drug overdoses and imposing significant sentences.  Holding traffickers responsible for overdoses accountable falls directly in line with community expectations and sends a powerful deterrence message to drug dealers. Dealers who kill our fellow citizens must be dealt with accordingly.     
  • Develop a Multi-Jurisdiction Grand Jury (“MJGJ”) Drug Task Force.  The Attorney General is responsible for approval of MJGJ applications prior to submission to the Supreme Court of Virginia. The Attorney General should partner with jurisdictions interested in adding a MJGJ component and focus on cultivating areas and jurisdictions that would benefit the most from this system.  The MJGJ approach allows localities to reach across jurisdictional lines and provide a coordinated regional approach to targeting and dismantling the traffickers involved in the illicit distribution of opioids and other illegal drugs.
  • Coordinate the creation of Multi-Jurisdiction Drug Treatment Courts. Drug treatment courts have been authorized by the General Assembly to reduce the incidence of drug use, drug addiction, family separation due to parental substance abuse, and drug-related crimes. Localities that choose to create drug treatment courts are given limited latitude regarding the kinds of offenders that can be included in the program.  Within the enabling legislation, however, is the option for distinct jurisdictions to form a collaborative drug treatment court program that crosses jurisdictional lines, expanding the scope and reach of the program. The Attorney General can help establish regional drug treatment courts, facilitate the sharing of best practices, and help implement common sense changes to existing laws to expand access to these programs.
  • Implement and enhance public health data collection and analysis. On-the-ground data is critical for understanding what is going on in our communities and quickly responding to a deadly drug outbreak (such as fentanyl) before it claims several lives.  In this area, the Attorney General should execute the following steps along with other ongoing efforts:
    • Coordinate with the Virginia Department of Health and local public health professionals to enhance our data collection and analysis efforts.  Early warnings from this effort will enable law enforcement to quickly engage and effectively target the sources of particularly deadly drugs before scores of lives are lost in our communities. 
    • Partner with the Department of Medical Assistance Services, contracted Managed Care Organizations, and the Prescription Monitoring Program to utilize data analysis to identify high-risk practitioners and users for targeted enforcement and intervention actions.
    • Use these same sources to provide law enforcement, public health, prevention, and treatment professionals with access to up-to-date trend analysis, helping our communities to stay ahead of emerging trends and take steps before the crises escalates.
    • Provide experienced prosecution resources for state and federal efforts. The Attorney General frequently partners with Commonwealth’s Attorneys and United States Attorneys in Virginia to provide resources for the prosecution of specific offenses. To aid in the fight against the opioids epidemic and other drug problems, the Attorney General should employ a team of experienced prosecutors with subject-matter expertise to be on call for state and federal prosecution authorities dealing with particularly pressing drug trafficking and overdose problems.
    • Employ a coordinated approach to combatting drug diversion.  The General Assembly and state regulatory bodies have made significant strides in addressing the opioids addiction crisis. These efforts must continue, including partnering with medical practitioners and others to further improve prescribing practices, raising awareness about the dangers of opioids abuse, and identifying patients who are on the path to addiction and need help.  The Attorney General must also work with all available state, federal, and local partners to effectively investigate and pursue cases against practitioners who are prescribing outside the law.  All partners must also continue to support drug takeback programs, providing full access for citizens to safely dispose of unwanted prescription medications.