LOUISVILLE, Ky. — Experts encouraged state lawmakers to look at new ways to fight fentanyl at this year’s National Conference of State Legislatures annual summit.

Keith Humphreys, a professor at Stanford University, and Tisha Wiley, assistant director for criminal justice at the National Institute on Drug Abuse, delivered presentations Tuesday on combating the opioid crisis.

Humphreys, who worked on drug policy under Presidents George W. Bush and Barack Obama, presented the findings of the 2020-2022 Stanford-Lancet Commission on the North American Opioid Crisis.

The commission found three distinct waves of opioids, beginning with a rise in prescription opioids beginning in the 1990s.

The crisis was initiated by opioid manufacturers and distributors that “behaved in ways that were not consistent with the public law,” Humphreys said, and were enabled by numerous regulatory and policy failures. He called for more separation between regulators and the pharmaceutical industry. 

“There is absolutely a role for painkillers,” Humphreys said. “But we do want the conduct of the people who make them to be in the public interest.”

The legal market stimulated an illicit market that has continued to grow, including a wave of heroin overdose deaths beginning in 2010. After that, around 2014-2017, synthetic opioid overdose deaths skyrocketed.

Opioid overdoses in the early years of the crisis killed disproportionately higher levels of white people, but now Black people are dying at higher rates. Mortality rates in the Native American population have been extremely high throughout the crisis.

Since 2018, the National Institute of Health’s Helping to End Addiction Long-term Initiative, or HEAL Initiative, has provided $3 billion in funding for research on how best to address the problem, Wiley said. Many of the studies funded through the program will likely release results in the next year or two.

“We are sort of standing at the precipice of a tsunami of data,” Wiley said.

But she said existing effective treatments are underused. According to a 2021 study, only 36% of people with opioid use disorder received treatment and only 22% received medications specifically for the disorder.

“The country lacks an infrastructure to support delivering prevention services,” Wiley said.

She said there are key touchpoints where resources can be most effectively targeted, including through emergency services, behavioral health treatment and the criminal justice system.

Both experts spoke about the importance of support for people who were recently released from prison.

In that situation, people are at significantly higher risk of overdosing, Humphreys said. He encouraged states to apply for a CMS (Centers for Medicare & Medicaid Services) waiver to help inmates re-enroll in Medicaid.

Humphreys emphasized the importance of prevention, particularly at younger ages.

“In the end, we have to stop people from entering this very challenging state,” he said.

Opioid settlement funds will give states more flexibility, Humphreys said. He suggested lawmakers use the extra millions to help in areas that wouldn’t already receive funding.

Instead of jumping straight to technocratic questions, states must have conversations about what exactly they’re trying to achieve. Humphreys said the funding influx can help states start a conversation about opioid use disorder and identify priorities for funding.

“Those things are all important,” he said. “But you can’t do all of them.”

Brett Stover is a Statehouse reporter at State Affairs Pro Kansas/Hawver’s Capitol Report. Reach him at [email protected] or on X @BrettStoverKS.