Prepared Remarks: Opioid Safety Summit (Feb. 11, 2020)

Thank you for inviting me to speak here at the 3^rd Annual Opioid Safety Summit. As Attorney General, I have often talked about the opioid epidemic gripping our state, and my commitment to address this crisis. I know that many of you have seen up close the horrendous harm caused by the opioid crisis—every day it affects lives, families, and communities across our state. I want to begin by thanking the Colorado Hospital Association for its efforts to address this crisis, including by encouraging responsible reductions in opioid prescriptions, something I witnessed firsthand in a visit to Banner Health’s Brush Hospital.

Background on the Opioid Crisis

As I have traveled around the state over the past three years, I have heard many stories of individuals and loved ones affected by opioid addiction, opioid overdose deaths, the lack of funding for treatment in areas hard hit by the crisis, and the absence of infrastructure in many of our rural areas to provide assistance to people affected by opioid addiction. In Alamosa County, for example, 90% of the inmates in the county jail are addicted to opiates, and Sheriff Robert Jackson has bemoaned the difficulty his community confronts because of insufficient capability to provide needed treatment. Making this matter more painful, when inmates are released—after going through withdrawal—they are 100 times more likely to overdose. In Alamosa, like many other counties, there are insufficient resources to provide Medication-Assisted Treatment (MAT) opportunities—let alone effective recovery programs. Dr. Robert Valuck, Director of the Colorado Center for Prescription Drug Abuse Prevention, and Marc Condojani, Director of Adult Treatment and Recovery for CDHS, report that Colorado provides only 30% of the needed level of treatment for opioid addiction; the picture nationally is even more dire, with as little as 10% of the needed level of treatment available in areas. We need to do better—for our families, for our communities, and for all the individuals searching for a path out of addiction.

You have all heard the harrowing statistics from this crisis. In 2017, for example, more people in the United States died from drug overdoses—mostly opioids—than in the Iraq War and Vietnam War combined. On average, according to the Centers for Disease Control, an estimated 130 Americans die every day from an opioid overdose.  From 1999 to 2019, over 4,600 Coloradans died from a prescription opioid overdose; including fentanyl, this number rises to over 5,300. But, the sense of urgency does not come from mere numbers; these are all people’s lives—and their deaths create untold amounts of trauma for families, friends, and communities.

The path to opioid addiction comes in many forms. For some, it is a prescription for opioids to treat an injury or chronic back pain or the like that leads to dependency on the drug. For others, it is the use of mom or dad’s opioid prescription that sits unused in a medicine cabinet. We also must not forget the unfortunate role of bad actors in the evolution of this crisis. Just last month, our office finalized the summary suspension of the licenses of a pharmacist and her pharmacy in Del Norte, Colorado, where the pharmacist had illegally used the DEA’s semi-annual “Prescription Drug Take Back Day” to collect opioid medications being returned by conscientious residents, and then turned around and diverted those medications for unauthorized use to others. That case is just one of too many where our office has had to take action against illegal conduct by opioid prescribers.

In too many cases—namely, 80% of heroin users— their addiction begins with the use of prescription opioids. Given these alarming numbers, I appreciate your commitment to education, awareness, and vigilance against the overprescribing of opioids.

The opioid epidemic is creating not only the demand for drug treatment, but also strains our health care system in a number of ways, such as requiring hospitals to provide for babies born addicted to opioids. To protect access to health care, including for the 700,000 Coloradans with pre-existing conditions and the 400,000 Coloradans who are depending on the Medicaid expansion for health care, we are defending the Affordable Care Act against the challenge brought by the U.S. Justice Department and some States. This case is now before the U.S. Supreme Court. We are working hard to make sure that we defend the rule of law and access to affordable health care. For some rural hospitals, the threat of losing access to Medicaid funding for people impacted by opioids could be a fatal blow.

Litigation Against Culpable Pharma Companies

As you may know, the opioid crisis is a top priority for the AG’s Office. Our office is committed to using all of the tools we can to address this epidemic, including taking action against doctors who have overprescribed opioids, providing guidance and training to law enforcement facing the crisis (including supporting Narcan distribution), coordinating education and prevention efforts through the Substance Abuse Trend and Response Task Force we lead, supporting Illuminate Colorado and many hospitals’ work on substance-exposed newborns, and supporting drug interdiction efforts. The most significant tool, however, is our ongoing litigation against the pharmaceutical companies that irresponsibly and deceptively marketed, distributed, and dispensed opioids. With respect to that litigation, as I have repeatedly explained, I am committed to ensuring that all funds obtained from such litigation—whether from settlements or litigated judgments—are directed towards addressing this crisis, including education/prevention, drug treatment, and recovery.

The State of Colorado is all in on litigation, investigations, and settlement negotiations with the pharmaceutical industry. In September of 2018, our office sued Purdue Pharma, which is the poster child for deceptive and wrongful conduct. Last summer, we amended this complaint to add as defendants a number of current and former owners and executives of the closely held company, including members of the Sackler family. Following that action, Purdue Pharma declared bankruptcy and the Sackler family sought protection of their assets in the bankruptcy court. We concluded that the proposed settlement was inadequate and unfair, and we are now challenging the Sackler family’s effort to cram it down on Colorado and other states.

Over the last couple of years, a number of states, local governments, and Tribes have filed actions against a range of pharmaceutical companies, including manufacturers, distributors and pharmacies. To join forces, state Attorneys General offices from around the country have formed a multistate coalition to investigate the manufacturers and distributors and other actors who contributed to the crisis. This coalition is currently evaluating courses of litigation as well as negotiating with companies interested in reaching a settlement. It is still premature to know when we might first see funds from any settlement or litigated judgment. As the litigation goes forward, I can pledge to you all that we are not going to accept a bad deal settlement just to get funds quickly—and that’s exactly why we are now fighting the Sacklers in court.

Our Plan for Settlement Funds

Because we expect that we will, at some point, receive funds from a settlement and/or litigation, we are now making plans for how we can best address this crisis. The first part of our plans center around the hiring of a Director of Opioid Response, Heidi Williams in January of this year. Heidi comes to our office after serving as the Mayor of Thornton, and she is here with us today. She has already started her listening tour to connect with communities across our state, all of whom have differing needs. We are well aware, for example, that the needs of Montezuma County will differ greatly from Moffat County. In addition to listening to communities around the state and consulting with relevant experts and advisors, Heidi will collaborate with stakeholders across the state—including many in this room—as we continue to learn about the practices that provide the best outcomes in opioid prevention, education, treatment, and recovery.

Heidi well appreciates that she is coming to the work of leading our opioid crisis response as part of a team. As noted above, our office chairs the Substance Abuse Trend and Response Task Force, which is familiar to some of you in the audience. The task force, in the spirit of Colorado problem solving, takes a team-oriented and multi-disciplinary approach towards the opioid crisis.  The task force is comprised of a number of professionals from public health, law enforcement, and community leadership.  It also draws upon the important work of the Consortium—both Rob Valuck and José Esquibel are valuable members—along with our partnership with the Department of Human Services’ Office of Behavioral Health and the Department of Public Health and Environment, along with many others. As we continue to evaluate best practices and the needs of communities across Colorado, we will benefit from the task force’s experience and judgment.

In addition to establishing the task force and appointing our office as its chair, the General Assembly also empowered us to convene an advisory committee (created by HB19-1009) as a consultative body. This body reflects our broader commitment to far-and-wide consultation, recognizing that we need to manage a range of priorities that fits within the imperative that the funds are used to address this crisis. And, unfortunately, conversations with this committee and others will have to grapple with the reality that the funds we are likely to recover will not come close to addressing all of our state’s needs to increase our levels of education/prevention, treatment, and recovery programs.

At this point, it is still premature to plan around the outlines of what a recovery of funds by settlement or judgment would look like. We do know, however, that for Colorado to maximize its share of a settlement we will need buy-in of the State as well as buy-in of all our local governments. If our State cannot develop strong local government support for a settlement, it is very likely that defendants will pay significantly less to Colorado and our local governments. To that end, one proposed settlement framework reported publicly provides that the largest share of settlement funds—that will vary based on local buy-in—will be distributed through the state AG’s Office to fund opioid addiction, treatment, education, and other abatement programming in local communities. Additional, separate, settlement amounts may be paid to the State and to local governments directly for abatement. In short, we know that funds recovered from opioid settlements will need to be managed in a way that works for our whole state, appreciating the different needs of different communities, and distributed with the utmost transparency so that we can all ensure the funds are going to addressing this crisis.

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When the history of the opioid epidemic is written, there will be a reckoning with the events and forces that resulted in such pain and loss. After all, no other country has suffered anywhere near the devastating consequences seen here in the United States. In Colorado, we are fortunate to have a community of professionals committed to working together to address this crisis. At the Attorney General’s Office, we are looking forward to working with you all and doing our best to ensure that funds received from any settlements or litigated judgments in the opioid litigation are used to facilitate and support sustainable solutions for education/prevention, treatment, and recovery. We are most fortunate to have Heidi Williams aboard to lead these efforts, and to live in a state where our ethos is one of being in this together and looking out for one another. Thanks for your leadership and engagement as we do our part to address this crisis.