2019 Report to the Colorado General Assembly Opioid and Other Substance Use Disorders Interim Study Committee Prepared by Legislative Council Staff Research Publication No. 730 December 2019 Opioid and Other Substance Use Disorders Interim Study Committee Members of the Committee Senator Brittany Pettersen, Chair Representative Chris Kennedy, Vice-Chair Senator Dominick Moreno Representative Perry Buck Senator Kevin Priola Representative Bri Buentello Senator Jack Tate Representative Leslie Herod Senator Faith Winter Representative Jim Wilson Legislative Council Staff Anne Wallace, Research Analyst Elizabeth Haskell, Senior Research Analyst Ariel Hammerquist, Fiscal Analyst Office of Legislative Legal Services Yelana Love, Staff Attorney Kristen Forrestal, Senior Attorney Brita Darling, Senior Attorney Shelby Ross, Staff Attorney December 2019 COLORADO GENERAL ASSEMBLY EXECUTIVE COMMITTEE COMMITTEE Sen. Leroy Garcia, Chair Sen. John Cooke Rep. KC Becker, Vice Chair Sen. Lois Court Sen. Stephen Fenberg Rep. Monica Duran Rep. Alec Garnett Rep. Dominique Jackson Sen. Chris Holbert Rep. Susan Lontine Rep. Patrick Neville Sen. Vicki Marble Sen. Dominick Moreno STAFF Rep. Kyle Mullica Natalie Mullis, Director Rep. Lori Saine Elizabeth Burger, Deputy Director Sen. Ray Scott Manish Jani, Deputy Director Rep. Kevin Van Winkle Sen. Angela Williams LEGISLATIVE COUNCIL ROOM 029 STATE CAPITOL DENVER, COLORADO 80203-1784 E-mail: [email protected] 303-866-3521 FAX: 303-866-3855 TDD: 303-866-3472 December 2019 To Members of the Seventy-second General Assembly: Submitted herewith is the final report of the Opioid and Other Substance Use Disorders Interim Study Committee. This committee was created pursuant to Article 22.3 of Title 10, Colorado Revised Statutes. The purpose of this committee is to study issues relating to opioid and substance use disorders in Colorado and examine potential solutions concerning prevention, intervention, harm reduction, treatment, and recovery from opioid and other substance use disorders. At its meeting on November 15, 2019, the Legislative Council reviewed the report of this committee. A motion to forward this report and the bills therein for consideration in the 2020 session was approved. Sincerely, /s/ Senator Leroy Garcia Chair Table of Contents Committee Charge..................................................................................................................... 1 Committee Activities................................................................................................................... 1 Substance Use Disorder Prevention .......................................................................................... 2 Substance Use Disorder Harm Reduction.................................................................................. 3 Substance Use Disorder and the Criminal Justice System......................................................... 4 Substance Use Disorder Treatment ........................................................................................... 4 Substance Use Disorder Recovery ............................................................................................ 5 Families Affected by Substance Use Disorder............................................................................ 6 Stakeholder Recommendations ................................................................................................. 7 Summary of Recommendations.............................................................................................. 9 Bill A — Concerning Prevention of Substance Use Disorders................................................ 9 Bill B — Concerning Measures to Reduce the Harm Caused by Substance Use Disorders..10 Bill C — Concerning Substance Use Disorder Treatment in the Criminal Justice System.....11 Bill D — Concerning Treatment for Substance Use Disorders..............................................11 Bill E — Concerning Substance Use Disorder Recovery ......................................................13 Committee Letter 1 —Letter to the Joint Budget Committee.................................................14 Committee Letter 2 —Letter to the Colorado Congressional Delegation...............................14 Resource Materials .................................................................................................................15 The text of each bill and letters are included as Attachments A through G after the resource materials page(s). This report is also available online at: https://leg.colorado.gov/committees/opioid-and-other-substance-use-disorders-study- committee/2019-regular-session Committee Charge The Opioid and Other Substance Use Disorders Interim Study Committee was created pursuant to Interim Committee Request Letter 2017-02 and met six times in the 2017 interim. House Bill 18-1003 continued the committee for two additional legislative interims in 2018 and 2019. The committee met five times in the 2018 interim and six times in the 2019 interim. The committee is charged with the following: studying data, data analytics, and statistics on the scope of the substance use disorder problem in Colorado; studying the current prevention, intervention, harm reduction, treatment, and recovery resources; reviewing the availability of medication-assisted treatment and whether pharmacists can prescribe those medications through the development of collaborative pharmacy practice agreements with physicians; examining what other states and countries are doing to address substance use disorders; identifying the gaps in prevention, intervention, harm reduction, treatment, and recovery resources available to Coloradans and hurdles to accessing those resources; identifying possible legislative options to address gaps and hurdles to accessing prevention, intervention, harm reduction, treatment, and recovery resources; and examining law enforcement and criminal justice measures addressing penalties for trafficking illegal drugs, and jail-based and prison-based treatment and harm reduction programs and technologies. Committee Activities The committee held six meetings during the 2019 interim. Briefings and presentations were made by the following organizations and stakeholders: state agencies, including the Department of Human Services (DHS), the Department of Public Health and Environment (CDPHE), the Department of Health Care Policy and Financing (HCPF), the Department of Regulatory Agencies (DORA), and the Department of Corrections (DOC); the Colorado Consortium for Prescription Drug Abuse Prevention (consortium); the Colorado Medical Society and the Colorado Pain Society; representatives from acupuncture, chiropractic, physical therapy, and occupational therapy practices; Colorado State University and the University of Denver; local public health agencies; Rise Above Colorado; local law enforcement agencies; the Colorado District Attorneys’ Council, and the Colorado Criminal Justice Reform Coalition; the Colorado Jail Association; the Colorado Syringe Access Providers Coalition; the American Heart Association; Opiod and Other Substance Use Disorders Interim Study Committee 1 Denver Health, Signal Behavioral Health, and the Colorado Behavioral Healthcare Council; the Colorado Providers Association; Mental Health Colorado; the Colorado Health Institute; the Colorado Coalition for Parity and the Stout Street Foundation; Illuminate Colorado; and the Colorado Cross-Disability Coalition. Key topics addressed by the committee include: safe opioid prescribing and access to alternatives to opioids; access to opioid antagonists and clean syringes; criminal justice diversion programs and substance use disorder services provided in jails and prisons; various substance use disorder treatment models and their funding sources; increasing the behavioral health care workforce; and the availability of recovery support services in the state. The following sections discuss the committee’s activities during the 2019 interim. Substance Use Disorder Prevention Safe opioid prescribing. Representatives from the Colorado Medical Society discussed the reduction in provider prescribing rates for opioids in Colorado. Representatives from DORA and the consortium described development of a new continuing education requirement for licensed opioid prescribers regarding substance use disorder prevention and safe prescribing. Alternatives to opioids. Representatives from the Colorado Pain Society, American Physical Therapy Association, the Occupational Therapy Association of Colorado, the Acupuncture Association of Colorado, and the Colorado Chiropractic Association presented on the use of nonpharmalogical options to treat pain and described barriers to accessing these opioid alternatives. Specifically, they discussed the lack of insurance coverage for alternative pain treatments; burdensome referral or prior authorization requirements by insurers; the need to identify more evidence-based treatments for pain management; and systemic improvements to referral and treatment services for patients with substance use disorder. Statewide prevention strategies. Representatives from Colorado State University and the University of Denver who study substance use and misuse prevention practice, policy, and science presented on the history of drug prevention strategies, and pointed out that programs such as “Just Say No” were not effective in decreasing drug use or delinquency. They discussed applying prevention science to create effective