Opium and its derivatives have been part of human society for thousands of years. From ancient Mediterranean civilizations, through Mesopotamia and South Asia, to China and beyond, recorded human history has from time to time intersected with the addictive, body- and mind-altering plant.
In the United States today, we live in one of those times of intersection. The modern reemergence of opioids in many synthetic forms is one of the deeply concerning public health and law enforcement stories of the second decade of the 21st Century.
The legal marketplace for opioid medications sometimes enables addiction, intentional or careless diversion, or other misuse. At the same time, the illicit opioid marketplace for diverted medications or for heroin is large and growing. The human cost is high: The Centers for Disease Control and Prevention estimates opioid overdoses kill 91 Americans every single day. Prescription opioid misuse is estimated to cost more than $78 billion per year in health-care costs, lost productivity, addiction treatment and criminal justice costs.
The problem is widespread but not uniform. In some parts of the country, opioid abuse and dependence is the top local public health and safety concern. In others, different illicit drugs remain the top worry – in my state of Kansas, for instance, the serious problem of opioid abuse remains second to the ongoing scourge of methamphetamine - but opioids are trending noticeably upward.
So while national attention and assistance is vital, it is critical to allow for state and local responses tailored to unique local needs. The modern-day opioid epidemic is particularly ill-suited to one-size-fits-all solutions.
That is why state attorneys general are important players in addressing this crisis. As a group that regularly works together to address interstate problems, state attorneys general have a national reach. But at the same time they are diverse state officials closely connected to local leaders – particularly law enforcement leaders.
In short, state attorneys general are one of the natural bridges between the national dynamics of this crisis and its varied local realities. Individual attorneys general are tailoring local responses to emphasize the local aspects of the nationwide opioid crisis.
Some have focused on the illegal diversion of opioids from the legitimate supply chain to the illicit market. The Florida and Kentucky attorneys general, for example, coordinated crackdowns on “pill mills” and other illegal diversions of controlled opioids. The Massachusetts attorney general has worked with law enforcement to disrupt prescription opioid trafficking networks. State attorneys general also have prosecuted health-care professionals, including doctors, who have illegally diverted opioid medications.
Others have emphasized public awareness as a prevention strategy. The Arkansas attorney general launched a “Prescription for Life” initiative to discourage prescription drug misuse and abuse among high school students. The Wisconsin attorney general initiated the “Dose of Reality” public-awareness campaign that other states have adapted. The West Virginia attorney general introduced “Combating Addiction with Grace” to connect faith leaders with law enforcement and treatment professionals.
Still other state attorneys general have elevated the importance of safe disposal of unwanted prescription drugs to reduce post-consumer diversions. The Pennsylvania attorney general provides drug deactivation and disposal pouches to promote safe disposal of unwanted and unused prescriptions. Almost every state attorney general promotes or participates in the National Drug Take Back Day, and many also work with pharmacies, law enforcement and others to help make convenient take-back locations available year-round.
Treatment of addiction or exposure is a top priority for some attorneys general. The Arizona attorney general has partnered with CVS drugstores, which will begin selling Naloxone without a prescription. The Illinois attorney general has directed civil lawsuit settlement proceeds to community-based drug treatment. To promote officer safety, the Wisconsin attorney general has directed the state crime laboratory to allow officers to bring unknown powders to the laboratory for field tests rather than handling them at a crime scene.
Attorneys general also are using civil investigations and lawsuits to identify, penalize and stop illegal conduct in the marketing of opioid medications. The Ohio attorney general recently sued several drug manufacturers, and several other states have followed. A multi-state investigation of the practices of companies that marketed prescription opioids is underway.
The Oklahoma attorney general has convened key players in the newly created, multi-disciplinary Oklahoma Commission on Opioid Abuse.
To ensure good ideas do not stop at the state border, all of these state-level efforts – and more as they develop -- are continually shared nationwide through the Substance Abuse Committee of the National Association of Attorneys General. State attorneys general can work at the junction of law enforcement and policy. So at this point in human history, state attorneys general are important contributors to society’s overall response to opioid addiction and its many associated ills.
Derek Schmidt is president of the National Association of Attorneys General and the Kansas state Attorney General.