OVERVIEW OF STATE OPIOID POLICY AND LEGISLATION AMBER WIDGERY & ALISON LAWRENCE JUNE 2018

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1 OVERVIEW OF STATE OPIOID POLICY AND LEGISLATION AMBER WIDGERY & ALISON LAWRENCE JUNE 2018

2 CRIMINAL JUSTICE SYSTEM: EARLY INTERVENTIONS

3 Naloxone Access Laws Immunity For: Authorizes: Prescribers Dispensers Lay Administrators Distribution by Lay Persons Possession Without a Prescription 3 rd Party Prescriptions Prescription by Standing Order Distribution by Community Organization Administration by First Responders etc.

enforcement for purposes of intervention when called to the scene of

4 Naloxone All 50 states have a naloxone access law. These provisions have often included access to naloxone for law enforcement for purposes of intervention when called to the scene of an overdose. Naloxone can also be a tool for an officer s personal safety. Source: DEA Report

5 Good Samaritan/911 Overdose Immunity Laws 40 States and D.C. have a Good Samaritan Law Updated June 2017

6 Deflection Definition: Stopping a citizen from entering the criminal justice system who is at immediate risk of or is at likely future risk of entering the criminal justice system due to behavioral health challenges, and instead deflecting (moving) them into the community human services system. Sources: Jac Charlier, TASC Overdose Response QRT Quick Response Team DART Drug Abuse Response Team PORT Post Overdose Response Team Police Referral LEAD Law Enforcement Assisted Diversion STEER Stop, Triage, Engage, Educate, Rehabilitate Self-Referral Types of Programs Angel Program

7 Recent Deflection Enactments California SB 843 (2016) LEAD pilot program and made a $15 million appropriation. Colorado 2017 Budget LEAD pilot program and co-responder programs. Appropriated $5.2 million. Kentucky SB 120 (2017) Authorized Angel Initiative programs. New Jersey AB 3744 (2016) Authorized law enforcement assisted addiction and recovery program. New Mexico HB 2 (2017) Authorized funding for the study of LEAD in Santa Fe.

8 CRIMINAL JUSTICE SYSTEM: TREATMENT FOR THE JUSTICE INVOLVED

9 According to Substance Abuse and Mental Health Services Administration (SAMHSA), the criminal justice system is the single largest source of referral to substance abuse treatment. Sources: SAMHSA Report

10 States have expanded access to Medication Assisted Treatment (MAT) throughout the criminal justice system. MAT has been authorized: During pretrial release As part of diversion As part of a probation/parole In prisons & jails As part of reentry

11 Recent MAT Diversion Enactments In recent years, at least 12 states have enacted new laws addressing the use of medication assisted treatment in treatment courts and diversion programs. Florida HB 5001 (2016) Illinois HB 5594 (2016) Indiana SB 464; HB 1304; HB 1448 (2015) Michigan HB 5294 (2016) Missouri HB 2012 (2016) New Jersey SB 2381 (2015) New York AB 6255 (2015) Ohio HB 59 (2013) Tennessee SB 2653 (2016) Virginia HB 30 (2016) Wisconsin AB 657 (2016) West Virginia HB 2880 (2015)

12 Increasing Treatment for Incarcerated & Supervised Individuals The majority of justice-involved referrals to treatment come from probation and parole. Sources: SAMHSA Report

13 Recent MAT Enactments Affecting Incarcerated & Supervised Individuals In recent years, at least 10 states have enacted new laws addressing the use of medication assisted treatment correctional facilities and by supervision agencies. California SB 843 (2016) Florida HB 5001 (2016) Indiana SB 464; HB 1304; HB 1448 (2015) Kentucky SB 192 (2015) Michigan HB 5294 (2016) Missouri HB 10 (2015); HB 10 (2013) New Jersey SB 2381 (2015) Pennsylvania HB 1589 (2016); SB 524 (2015) Tennessee HB 1374 (2015) West Virginia HB 2880 (2015)

14 Medication Assisted Treatment: States with Recent Enactments Updated August 2017

15 CRIMINAL JUSTICE SYSTEM: ALTERNATIVES, SENTENCING AND PENALTIES

16 Deflection and Diversion Deflection is an emerging legislative trend that reroutes individuals with behavioral health needs before arrest or before contact with the justice system. Statutory pretrial diversion is well established in 48 states and the District of Columbia and reroutes defendants after arrest, but prior to adjudication or final entry of judgment.

17 Statutory Pretrial Drug Courts and Diversion Programs States with drug courts States with drug diversion program States that have both Updated February 2017

18 Statutory Pretrial Diversion Database Statutory Pretrial Diversion Database

19 Scheduling Synthetic Opioids Updated June 2017

20 Redefined Offense Elements Drug Thresholds Weight/ Amount Drug User VS. Drug Dealer Arkansas -> separated manufacture, deliver & possess with intent Kentucky -> added quantity thresholds for trafficking

21 Reclassified (Categorized) Offenses Felony Misdemeanor Drug Possession (excluding marijuana) Alaska California Delaware Indiana Maryland Minnesota Mississippi South Dakota Utah

22 Added Penalty Categories: Colorado Previous New Felony Class Sentence Range 1 Life / Death years years years years 6 1 year 18 months Drug Felony Class DF1 DF2 DF3 DF4 DF2 DF3 DF4 Sentence Range 8 32 years 4-8 years 2-4 years 6 months 1 year Aggravated Range 8 16 years 4 6 years 1 2 years

23 Other Offenses of Note Drug Delivery Resulting in Death a.k.a. Drug Induced Homicide Just under half the states have a homicide provision specific to overdose Rising overdoses = increasing prosecution under these provisions and other reckless homicide/manslaughter laws Trafficking/Distribution Increasing penalties and new offenses for trafficking in opioids or specified opioids like fentanyl

24 CRIMINAL JUSTICE SYSTEM: FUNDING

25 Funding Reform Reallocate Real or Projected Savings Treatment Programs Performance Incentive Funding Training and risk/needs assessments Justice Reinvestment

26 Funding for Treatment Courts State/Local Court Fees Program Fees Treatment Funding via State Agencies Federal Drug Court Discretionary Grant Program Justice Assistance Grant (JAG) Formula Funding HUD, ONDCP, SAMHSA

27 CHILD WELFARE & HUMAN SERVICES

28 # of Children In FY2016, there were approximately 437,000 children in foster care in the U.S., the highest caseload since In the same year, more than 270,000 children entered care, the highest number since pre , , , , , , , , ,000 50,000 0 Number of Children in Foster Care and Number of Children Entering Foster Care 423, , , , , , , , , ,539 Children in Foster Care During FY Children Entering Foster Care During FY AFCARS Measure Source: AFCARS

29 # of Children The number of children under the age of 1 entering foster care is increasing, the highest percentage, by age group, of children entering foster care 60,000 # of Children Under Age 1 Entering Foster Care during FY 50,000 40,000 39,697 41,235 43,085 45,535 47,219 49,234 30,000 20,000 10, Fiscal Year Source: AFCARS

30 # of Children In 2015, for the first time, AFCARS provided specific data showing removals due to parental drug and other co-occurring reasons for removal such as neglect, caretaker inability to cope, alcohol abuse of a parent and parent death 180, , ,679 Reason for Removal Related to Parental Substance Use in FY , , ,000 92,107 80,000 60,000 40,000 20, ,857 15,143 2,212 Neglect Drug Abuse Parent Caretaker Inability to Cope Alcohol Abuse Parent Parent Death Reason for Removal Source: AFCARS

31 State Legislation Generally Compliance with CAPTA through changes to plans of safe care legislation Amending the definition of child abuse and neglect to include substance exposure Cross-system collaboration and communication, including the creation of task forces Addressing the needs of expectant mothers and babies to reduce or prevent substance exposure Creating criminal penalties for child endangerment if the child is born substance exposed Establishment and support of specialty courts Testing/reporting/assessing/investigating substance exposed newborns

32 2017 State Legislation 27 states considered 59 bills in 2017 Plans of Safe Care (8 bills from 6 states) Including substance exposure in definition of child abuse and neglect or as child in need of services (15 bills from 8 states) Addressing the needs of expectant mothers and babies (3 bills from 3 states) Testing/Reporting/Assessment/Investigation of substance exposed newborns (11 bills from 5 states) Criminal penalties for child endangerment (9 bills from 7 states) Establishment/Support of Specialty Courts (7 bills from 5 states) Awareness education (1 bill from PA) Source: Child Welfare Information Gateway, Parental Drug Use as Child Abuse, 50-state Statutory Survey (2015); found at: NCSL Research using StateNet, a services of Lexis Nexis

33 State and Local Programs Strong States, Strong Nation Court-Based Programs Family Drug Treatment Courts Zero to Three Safe Baby Court Teams Treatment Programs for Mothers and Babies Child and Recovering Mothers (CHARM) Collaborative Lily s Place, West Virginia Handle with Care State legislatures have created special committees or task forces Lots of local programs, few, if any, statewide/to scale programs

34 Safe Baby Court Teams Strong States, Strong Nation Bring stakeholders together with child, birth parents, foster parents etc. to help move towards reunification. (e.g., child welfare agencies, treatment providers, other community supports) Viewed with a traumainformed/aces lens Sometimes called early childhood courts because of focus on child development. 12 states or localities currently have safe baby court teams. During the 2017 and 2018 legislative sessions, several states have introduced legislation to create, expand, or support specialty courts.

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Medication Assisted Treatment in the Justice System. NCSL Law, Criminal Justice and Public Safety Committee Breakfast

Medication Assisted Treatment in the Justice System NCSL Law, Criminal Justice and Public Safety Committee Breakfast Quick Facts About Addiction for Justice-Involved Individuals: More than half of state