RD71 - Substance Abuse Services Council Annual Report 2012-2013

Executive Summary:

The Substance Abuse Services Council is established in the Code of Virginia [§ 2.2-2696] to advise the Governor, the General Assembly and the Board of the Department of Behavioral Health and Developmental Services (DBHDS) in matters pertaining to substance abuse. Its members are representatives of state agencies, senators, delegates and representatives of provider agencies and advocacy organizations who are appointed by the Governor. The Code requires DBHDS to provide staff and funding to support the operation of the council. The council met its requirement to meet four times each year. Notices of meetings, minutes and the membership are posted on the council’s website at http://www.dbhds.virginia.gov/SASC/. The council did not file a report last year; therefore, this document summarizes the council’s activities for 2012 and 2013.

Extent of the Substance Abuse Problem in Virginia

The extent of the substance abuse problem in Virginia has been documented by several sources. The National Household Survey on Drug Use and Health (NSDUH) indicates that, in the year prior to the surveys on which the estimates are based (2008-2010), 23.7 percent of Virginians age 12 and older participated in an episode of binge drinking, and that nearly 5 percent used pain relievers for a nonmedical use. More than 7 percent needed but did not receive treatment for alcohol use and 2.45 percent needed, but did not receive, treatment for illicit drug use. Data from the Virginia Department of Health’s Office of the Chief Medical Examiner (OCME) indicate that the number of deaths caused by drugs increased 45.3 percent between 2003 and 2011, with 61.7 percent due to prescription drugs in 2011.

Enacted Legislation Related to Substance Abuse

Although many bills were introduced that related to substance abuse in the 2012 and 2013 sessions, the following enacted bills were the most relevant to the work of the council.

• House Bill 1291 (2012) transferred responsibility for the administration of the Governor’s Office for Substance Abuse Prevention from the Secretary of Public Safety to the Department of Alcoholic Beverage Control, where it was renamed the Virginia Office for Substance Abuse Prevention.

• House Bill 507 (2012) addressed several issues related to prenatal exposure to illegal drugs or alcohol. It extends the time (from seven days to six weeks) that an infant can be determined to be substance exposed, increases the time that a child can be diagnosed with fetal alcohol spectrum disorder to anytime after birth, and allows a petition to be filed at anytime alleging child abuse or neglect related to substance-exposed infants.

• House Bill 1672 (2013) designates DBHDS, with support from the Virginia Department of Health (VDH) and the Department of Health Professions (DHP), as the lead agency with responsibility for developing a pilot program to use naloxone to prevent opioid overdoses (via nasal administration). The statute allows prescribers to prescribe naloxone to lay rescuers for use with individuals not known to the prescriber. DBHDS must report on the results of the pilot to the General Assembly by December 1, 2014.

• The General Assembly approved an act that permits funding for the Virginia Foundation for Healthy Youth (VFHY) to be held in escrow, pending resolution of a dispute with tobacco manufacturers participating in the Master Settlement Agreement. This allows the foundation to retain about $500,000, with the rest of the funds (about $4 million) redirected to cancer research and the General Fund.

• House Bill 1941 expands the list of prohibited chemicals to address the surge in synthetic marijuana and “bath salts.”

• The 2013 Appropriation Act permits localities to establish drug courts without the review of the General Assembly, as long as no state funds are requested, the application is approved by the Drug Treatment Court Advisory Committee, and the court meets certain other standards established in the language of the act.

Major Presentations

Critical Issues Related to Tobacco Use in Virginia

The council heard several presentations concerning tobacco use and dependence, treatment resources, and monitoring of sales to minors. Staff from the Institute for Drug and Alcohol Studies at Virginia Commonwealth University presented research conducted on community services board staff attitudes about treating tobacco use among individuals in treatment for mental illness or substance use disorders. The study found that the more highly trained the behavioral health professional, the more likely he was to provide treatment for tobacco use to individuals already receiving services. Very few staff are providing services, however.

Staff from the Alliance for the Prevention and Treatment of Nicotine Addiction provided information about resources available to help individuals stop tobacco use. Demonstrated compliance with laws prohibiting sales of tobacco products to minors is a requirement of the federal Substance Abuse Prevention and Treatment Block Grant (SAPTBG). The noncompliance rate for 2012 was about 13 percent, well within the allowed range of 20 percent. Failure to adequately demonstrate compliance could cost the state as much as $16 million. Staff from the Department of Alcoholic Beverage Control (ABC) and DBHDS discussed the two agencies’ collaborative efforts to monitor retail sales of tobacco to minors, the penalties to the retail staff, and the potential costs to the state.

High Intensity Drug Trafficking Area (HIDTA) Program

HIDTA is a federal initiative that coordinates federal, state, and local efforts to reduce drug trafficking. Virginia has three designated HIDTA areas: northern Virginia (included in metropolitan Washington, D.C. HIDTA), metropolitan Richmond, and the far southwestern part of the state that is included in the Appalachian HIDTA. Staff who oversee the metropolitan Washington, D.C. and Richmond area HIDTAs provided information on the program’s activities, which involves 18 agencies sharing information. The major focus is on trafficking heroin, cocaine (including “crack”), prescription narcotics, PCP, and marijuana. Outcome measures include the wholesale value of drugs seized, amount and number of cash seizures, numbers of fugitives apprehended, and numbers of leads referred to other HIDTAs and other law enforcement agencies. Some of the intelligence strategies involve tracking gang members, learning the organizational networks of the gangs involved in drug trafficking, and tracking social networks of the gang members. The project also utilizes mapping technology. The information collected from many different sources by the participating law enforcement agencies is analyzed by a special unit of HIDTA that houses and shares the information. HIDTA also helps local law enforcement agencies coordinate logistics and targeted activities, such as surveillance and execution of search and seizure warrants with maximum public safety and security in mind.

In addition, these two HIDTA regions are unique in that they also fund treatment initiatives, both in the community and in jails and prisons, as well as drug courts. They also fund two prevention initiatives.

National Governors Association Policy Academy to Reduce Prescription Drug Abuse

In the fall of 2012, Virginia was competitively selected to participate, with seven other states, in the National Governors Association (NGA) Policy Academy to Reduce Prescription Drug Abuse. This was the first policy academy on this topic sponsored by the NGA. Led by the Director of the Department of Health Professions, Virginia’s team included the Secretary of Health and Human Resources, the Secretary of Public Safety; the Superintendent of Virginia State Police, and the Commissioner of DBHDS. The team participated in two national meetings and hosted a statewide meeting where a draft plan was shared with the public. The plan was the result of intensive work by four subcommittees that included a variety of stakeholders from other state agencies, local agencies, industry professionals, community advocates, and legislators. The four subcommittees, which focused on specific strategies, were: Monitoring, Training and Education, Enforcement, and Drug Disposal. Although the framework of the NGA policy academy did not include a specific emphasis on improved access to addiction treatment services, the Virginia NGA policy team believed that this strategy is an important component in addressing abuse of prescription drugs, and included a recommendation that the issue be specifically addressed as an interagency initiative, to be led by DBHDS.

The Department of Corrections’ Virginia Adult Re-Entry Initiative (VARI)

As a result of the creation of the Virginia Prisoner and Juvenile Offender Re-Entry Council, established under Executive Order 11, the Department of Corrections (DOC) has instituted a significant focus on programs within correctional institutions and during the transition period from institution to the community for offenders in its custody. Staff from DOC shared how the department had responded to this challenge through the Virginia Adult Re-Entry Initiative (VARI). Ninety percent of offenders in custody eventually return to the community and DOC releases 11,000 offenders each year. To reduce the recidivism rate, DOC is focusing its resources on providing services that corrections research has demonstrated can effectively assist the offender in learning how to successfully live in the community. As a result, DOC has moved from the sixth best to the second best recidivism rate in the nation. These programs include intensive cognitive behavioral therapies specifically designed for this correctional population, as well as a focus on intensive substance abuse treatment services, using therapeutic models based on research, as 70 percent of offenders have a need for substance abuse treatment.

Prior to release, offenders are moved into correctional facilities closer to their home communities where they participate in these programs. Implementing these services has required extensive re-training of correctional staff, as well as the addition of new roles. Some of these new roles include: probation officers who specialize in serving as a liaison between the correctional institution and the community, forming partnerships with employers, helping to locate housing, and locating services that the offender will need once they return to the community. Implementing this program in a relatively short period of time presented a number of challenges to DOC, and the initiative remains somewhat hampered by the need for additional resources.

Patient Protection and Affordable Care Act (PPACA)

Staff from the State Associations of Addiction Services (SAAS) presented implications of the Patient Protection and Affordable Care Act (PPACA) for providers of substance abuse treatment. Virginia was one of six states competitively selected to receive technical assistance in this area from SAAS.