Ralph Northam's plan for

Solving the commonwealth’s opioid and heroin crisis

The prescription pain reliever and heroin epidemic is killing more Virginians every year than motor vehicle crashes or gun deaths. In 2016 alone, 1,133 Virginians died as a result of an overdose of prescription pain medication, heroin, or other illicit opioids.

As a doctor, Lieutenant Governor Northam knows how to stop the opioid epidemic that is ravaging the Commonwealth. We must:

  • Provide treatment and recovery resources for all Virginians who need them;
  • Ensure progress, transparency, and accountability;
  • Support law enforcement as they encounter the effects of addiction on the front lines;
  • Eliminate interstate opioid “shopping” and promote non-opioid pain treatment;
  • Provide support and training to Virginia’s on-the-ground workforce;
  • Support Virginians in recovery and recognize that addiction is a disease; and
  • Empower communities to build resilience and work together to address addiction.

Provide treatment and recovery resources for all Virginians who need them

  • In his first month in office, Dr. Northam will re-institute the emergency declaration in response to the opioid crisis. This will make special authorities and resources available to the Northam Administration to enhance access to treatment and recovery services, procure supplies and/or medications, institute training, obtain near real time data reporting, and otherwise equip public health and law enforcement officials to effectively address opioid addiction using evidence-based strategies.
  • Prior to the Affordable Care Act (ACA), over a third of Americans purchasing health insurance did not have access to substance use treatment services. That changed with passage of the ACA – plans must include access to mental health and substance use treatment services, deemed “essential health benefits.” Dr. Northam will fight to make sure essential health benefits remain the law of the land, and oppose efforts that could eliminate them.
  • Work with leaders in both parties from the General Assembly and the federal government to identify and implement sustainable, innovative, and cost-effective solutions to the opioid crisis, including providing treatment services to those who need them. Virginia Medicaid has a comprehensive Addiction and Recovery Treatment Services (ARTS) program that can serve as a model. Additionally, we should bring back all available federal funds, including expansion of Medicaid, to ensure that all Virginians, especially in the hardest hit regions such as the Far Southwest, have access to affordable health care.  An important first step will be resubmitting the state’s Delivery System Reform Incentive Program (DSRIP) waiver as a more robust research and demonstration waiver (1115).
  • Partner with the General Assembly to fund supportive housing for people with addiction with a focus on pregnant and parenting women. Homelessness and unstable housing are major barriers to recovery. Securing safe and secure housing in sober living homes is critical to reuniting families and supporting ongoing recovery.
  • Develop a nurse home visiting program for pregnant women with addiction and substance-exposed infants including babies with neonatal abstinence syndrome. As a pediatric neurologist, Dr. Northam has cared for children with lifelong physical and behavioral problems due to their mother’s substance use. Home visits by nurses and social workers during pregnancy and the first two years of life can provide critical support to new mothers and significantly improve outcomes for mothers and their babies.
  • Ensure that all women struggling with opioid use have access to Long-Acting Reversible Contraception (LARC) so they can focus on recovery and choose when to become pregnant. LARCs should be available immediately after delivery to all women who choose this option, which will help prevent future cases of neonatal abstinence syndrome.
  • Create a provider warm line so that front line providers can access addiction experts and ensure they are using the latest evidence-based treatment for those with addiction.
  • Partner with emergency rooms (ERs), primary care clinics, schools, and law enforcement to ensure all people at risk are screened and offered treatment. If a person is seen in the ER for heroin or opioid addiction or overdose, they should be offered evidence-based treatment such as buprenorphine that can be initiated in the ER. They should be connected to ongoing treatment by Peer Recovery Specialists who have lived experience of addiction and are embedded in ERs.
  • Provide evidence-based addiction treatment services including residential, partial hospitalization, intensive outpatient, peer recovery supports, and Medication Assisted Treatment – the combination of medication (buprenorphine, methadone, naltrexone) and counseling that results in recovery rates of 40-60% from opioid addiction. Medicaid members already receive these services under the ARTS program. We will work to ensure that commercial and Medicare Advantage health plans offer the same benefits. The uninsured could also receive these life-saving services if Medicaid is expanded.

Ensure progress, transparency, and accountability

  • We have been talking about the opioid crisis for a long time and yet Virginians are still dying in greater numbers every year. We must act with urgency and focus in responding to this crisis. To do this, we must be able to see the problem clearly and respond quickly.
  • Dr. Northam will create a public dashboard with data on opioid overdose metrics that will be updated in as close to real-time as possible and posted online. The dashboard may include de-identified information such as overdose deaths, admissions for treatment, number of opioid prescriptions, naloxone reversals, and opioid-related arrests. Being able to track trends in real-time will enable state and local officials to focus on Virginia communities with the greatest need and address problems early.
  • To ensure accountability that the Commonwealth is making progress, Dr. Northam will appoint a point person to coordinate opioid efforts and lead comprehensive efforts across agencies and departments to end the epidemic.

Support law enforcement as they encounter the effects of addiction on the front lines

  • Local law enforcement officers are on the front lines of this crisis, and they see the effects of addiction every day – from overdose calls to the crimes committed by people with addiction as well as the violence and chaos caused by drug trafficking. Many local law enforcement officers and sheriffs have noted that because we cannot arrest our way out of this epidemic, we must use different tools to stop the flow of people with addiction in and out of jails and prisons.
  • Every police officer should carry Naloxone. No one should die from an opioid overdose, as there is a safe and effective antidote—Naloxone—that anyone can safely use to reverse an overdose. Dr. Northam has worked hard as Lieutenant Governor, with the Department of Health, to increase community access to Naloxone. A Northam Administration would build on this important work and ensure that not only first responders, but friends and family, know how to administer this life-saving drug.
  • Dr. Northam is a strong advocate for jail diversion programs and innovative treatment approaches rather than furthering the costly cycle of incarceration. Several localities have begun programs that will help people who are ready for recovery enter treatment with the help of their law enforcement communities, and as Governor, Dr. Northam will continue to support these programs across the Commonwealth.
  • Support jail-based addiction programs and partnerships that provide evidence-based treatment. Virginia’s local and regional jails have been inundated with people with addiction, but jails are not treatment facilities and are not resourced to do this work.
  • Provide transitional treatment programming and recovery-based services for people re-entering the community post-incarceration. People leaving a jail or prison are at high of risk of overdose upon re-entry. Working with the Department of Corrections to support treatment inside the facility and subsequently connecting these people to ongoing services in the community is key to ongoing recovery and preventing overdose deaths.

Eliminate interstate opioid “shopping” and promote non-opioid pain treatment

  • As a physician, Dr. Northam understands how important it is for providers to self-regulate their profession and take proactive measures to address prescription abuse and prescribe non-opioid pain relievers. As Governor, Dr. Northam will partner with key stakeholders to continue to educate providers and to ensure that current and future providers know when and how to prescribe opioids safely and when to prescribe alternatives.
  • Virginia already has important prescribing data through the Prescription Monitoring Program (PMP). However, the only way to end the opioid crisis is to prevent Virginians from getting addicted to opioids in the first place. The vast majority of providers are responsible prescribers, but the few bad apples practicing at opioid pill mills are recklessly endangering Virginians and fueling this crisis.
  • While Virginia’s PMP links with other states’ systems, we don’t have the legal authority to search it proactively. Dr. Northam will work with the General Assembly and stakeholders to seek additional authority to fully leverage Virginia’s PMP. Our Board of Medicine and law enforcement would then be able to work with neighboring state boards to identify and stop inappropriate prescribing and shut down opioid pill mills.
  • In addition to our Board of Medicine’s work with neighboring states, Dr. Northam will convene regional summits with physicians from surrounding states to ensure we are coordinating bests practices and that our provider community, and the professional organizations representing them, are working together. Dr. Northam has visited recovery clinics, volunteered at free medical clinics, and held multiple roundtables throughout the state, and a consistent theme and cause for concern is the interstate doctor shopping for opioids that occurs.
  • Dr. Northam understands that physicians often prescribe opioids because the administrative burdens placed by insurance companies make very difficult to prescribe alternative non-opioid pain relievers that are less addictive. Virginia’s Medicaid program already requires all Medicaid health plans to remove the Prior Authorization barriers for all evidence-based, non-opioid pain relievers. Dr. Northam will work with commercial and Medicare Advantage health plans to ensure that they also remove these barriers so all insured Virginians have access to alternative non-opioid pain relievers.
  • The root causes of the opioid crisis are chronic pain and mental illness – half of the people taking prescription opioids have a mental illness diagnosis. As a physician who treated children with chronic pain, Dr. Northam understands how important it is to cover non-pharmacologic treatment and ensure that evidence-based treatments such as behavioral health and physical therapy are available. Dr. Northam will support integrated behavioral health counselors and physical therapists in primary care physician’s offices and chronic pain treatment centers to treat people with pain where they seek care.

Provide support and training to Virginia’s on-the-ground workforce

  • Work with social services, as well as health and behavioral health care providers, to train incoming and existing staff on the role of trauma in addiction as well as evidence-based screening and treatment for opioid addiction.
  • Engage with higher education programs to train our students on how to treat addiction and chronic pain when they enter the workforce. In addition to the Department of Health Profession’s work with Virginia’s medical schools to ensure appropriate curricula are used, Virginia should support college and university social work, rehabilitation counseling, psychology, and allied health professional programs in teaching students about addiction and treatment.

Support Virginians in recovery and recognize that addiction is a disease

  • People in recovery, with lived experience of addiction, can provide a unique source of support for individuals and families dealing with addiction as Peer Recovery Specialists and in other health professions. We must address barrier crimes that keep people with certain criminal records, often as a result of a long-ago period of active addiction, from being able to work in helping professions where they are needed the most.
  • Virginia should help fund and support student recovery communities on Virginia’s college campuses. Student recovery communities are imperative in providing sober spaces. Recovery services can ensure that students know that they have a place to talk with other people in recovery without having to disclose that they have substance use disorder which helps foster inclusion.
  • Recognize that addiction is a disease, and it is indeed treatable and manageable. The prevalence of this disease means that no individual or family has to experience it alone. People can and do recover and become productive members of their communities.
  • One of the best ways to stop this epidemic is to disrupt the first step in the cycle and prevent people from becoming addicted. Invest in school-based health centers that will increase addiction screening and treatment for students and provide prevention and awareness campaigns for students and adults.

Empower communities to build resilience and work together to address addiction

  • The opioid crisis will only be solved by a 360 approach with leaders in each community from health care, law enforcement, schools, corrections, housing, churches, and recovery organizations coming together in coalitions to address their communities’ needs and create a roadmap with a pathway forward. Dr. Northam will provide resources to support each community’s existing coalition or form a new coalition if none exists. Successful coalitions such as One Care of Southwest Virginia can support and mentor other regions in developing their roadmaps.
  • The Northam Administration will provide near real-time data to inform these community efforts and convene community leaders in regional meetings to share best practices and lessons learned from fighting the epidemic.
  • Regions such as Southwest Virginia and Roanoke have been the hardest hit by the opioid epidemic but have the most experience fighting the epidemic. These communities can serve as the training ground for the new workforce of Peer Recovery Specialists who have lived experience of addiction and can provide invaluable support to help people recover. Peer Recovery Specialists for addiction and mental health are reimbursed by Virginia Medicaid and are a viable career pathway. Dr. Northam’s administration will ensure that Peer Recovery Specialist trainings are offered in the areas with the greatest need.
  • Empower communities to build the addiction treatment workforce to address their needs. Dr. Northam will support new training programs for health professionals such as substance abuse counselors and social workers at community colleges with a focus on the areas hardest hit by the opioid epidemic.
  • Training and deploying an addiction treatment workforce is critical to rebuilding the economy in Southwest Virginia and other struggling areas. Companies are unable to hire workers to fill existing jobs because they can’t find people who can pass a drug test. In addition to creating new jobs, Dr. Northam’s comprehensive approach to ensuring addiction treatment is available to all who need it will ensure that companies have the workforce they need today and empower communities to thrive.
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