Task Force resumes look at Missouri’s response to substance abuse

      A Task Force that hopes to advance Missouri’s response to substance abuse has resumed work. 

Representative John Black (Photo: Tim Bommel, Missouri House Communications)

      The Substance Abuse Treatment and Prevention Task Force met in the 2023 interim and developed recommendations for the legislature, some of which were enacted.  One of those was that it be continued this year, and its chairman, Representative John Black (R-Marshfield), is glad that was passed.

      “I think we’ll do more or less the same thing we did last year.  We’ll look at some of the issues that we’ve identified for review this year and then hopefully the Task Force will continue to refine those and come up with more issues.  The budget, of course, is a big deal,” Black said after the Task Force met Monday.

      Representative Del Taylor (D-St. Louis) is glad to be a part of the group.

Representative Del Taylor (Photo: Tim Bommel, Missouri House Communications)

      “Missouri, as our counterpart 49 other states, as well as most countries in the world, are really struggling with getting our arms around substance abuse disorder.”  He said the group heard from experts Monday that, “[Substance abuse] is kind of how we respond to our own different mental illnesses.”

      The Department of Mental Health’s Chief Medical Director, Dr. Angeline Stanislaus, opened the session with a discussion of the neurobiology of addiction.  She said much has been learned in the last three decades that can guide the state’s programs. 

      It was believed in the medical field some 20 or 30 years ago that when a substance was out of a person’s system and they resumed using it, it was by choice and they had an issue with discipline or willpower.

      “That was the mindset in which we were trained as physicians in the 1990s,” Stanislaus said.  “There’s been more research now to show that just because a substance is out of the system … but all the neurotransmitter changes the substance did before it got out, they’re still lingering and the body’s still working on them.  This is the new understanding over the last couple of decades, it took us this long to understand that.”

Dr. Angeline Stanislaus and Director Valerie Huhn with the Department of Mental Health (Photo: Tim Bommel, Missouri House Communications)

      Stanislaus said many people who abuse substances like alcohol, cocaine, and heroin do so because they were victims of childhood abuse or neglect that altered their brain chemistry.

      “The brain wasn’t connected the way to produce a natural level of dopamine and neurotransmitters that a brain needs for us to lead healthy lives … same thing with violence.  Witnessing a lot of violence changes the brain chemistry.  There’s a lot of fear.  The neurotransmitters that are impacted by fear will go up, so when you have so many fear neurotransmitters going on in your brain you may seek a substance to decrease that fear.”

      A brain disrupted by substance abuse will never return to what it was before, but it can heal.

      “The brain is such a wonderful organ.  It’s very neuroplastic, that can produce itself more neurotransmitters given enough time, given treatment, this is how treatment works.  Give them enough time for the brain to recreate all this dopamine and all those other neurotransmitters, either through medications, combination of therapy, combination of whatever needs to be put together … that’s the true potential of what the brain can possibly do and that’s what we try to do as treatment providers.”

      Former Missouri House Speaker Todd Richardson has been the Director of MO HealthNet since 2018.  Much of what the Task Force discussed with him was its recommendation from last year that a new state executive be created – what members have tentatively referred to as a “czar” – to oversee substance abuse issues across the various state departments that deal with those. 

      He said while the idea has merit and could work, giving one figure authority over three, four, and even five departments and asking that person to understand and take on all that is involved in substance abuse issues, could prove too much to ask.

      He thinks the effort the Task Force has set in motion should be given time to work.

      “I think it is incredibly important that the departments continue to collaborate in this space and make sure that our policies are complimentary of each other … I think that collaboration is better than it has ever been before.  While I think the idea behind having somebody to oversee this is the right thinking, I really think the best way to accomplish what you’re trying to accomplish is by trying to continue to encourage that collaboration between those departments.”

      To the Task Force’s credit, Richardson said, “I do think the focus that this task force has put on it has already led to more collaboration and coordination and discussion about this subject than I’ve seen in the 15 years I’ve been coming to Jefferson City.”

Representative Todd Richardson (Photo: Tim Bommel, Missouri House Communications)

      Taylor appreciates the different backgrounds brought to the group.  A budget-minded legislator himself, Taylor hopes to get more data about Missouri’s substance abuse response.  

      “Consistently I want to know:  what are the programs and how do we measure effectiveness?  Is the program actually working?  How much have we appropriated for that program and are we spending the money that we appropriate?  Let’s at least be honest and up front about how much of that is actually going to get used, how many people are you going to actually hire, and how much of that is going to lapse?”

      Some members weren’t present at Monday’s hearing due to technological or medical issues.  Black hopes more members will be able to attend in subsequent hearings.

      “The more people we have, the more involvement, the more good questions.  That would be beneficial, but I’m very happy that the Senate, the House, and the governor’s office are supportive of the continuing work of the task force.”

      The Task Force will meet again in July.

Second House bill sent to Senate would increase penalties for trafficking fentanyl

The second bill the Missouri House has sent to the Senate would increase penalties for trafficking a dangerous drug, the use of which can easily result in overdoses.  Opponents worry the change will cast too broad a net, putting more users in prison for long terms.

Representative Nick Schroer (Photo: Tim Bommel, Missouri House Communications)

The House voted to making it a class-B felony to knowingly distribute, make, or attempt to distribute or make, more than 10 milligrams of fentanyl or its derivatives.  This would carry a penalty of five to 15 years in prison.  Making or distributing 20 or more milligrams would be a class-A felony, carrying a sentence of 10 to 30 years in prison.

Law enforcement advocates have told lawmakers that fentanyl is 50 to 100 times more potent than morphine.  It is being trafficked frequently in Missouri – particularly illegally made – and is often mixed with other drugs like heroin or cocaine, often resulting very easily in overdose deaths.

The sponsor of House Bill 1450, O’Fallon representative Nick Schroer (R), said fentanyl trafficking has continued to increase exponentially in the past year.  He believes increased penalties will help law enforcement get to those who are making and selling fentanyl.

“Right now law enforcement and the prosecutors only have the ability to charge drug traffickers with possession, or possession with an intent [to distribute.]  We are seeing a trend across the United States from attorneys general, prosecutors, and law enforcement working with the federal government adding this to their criminal trafficking statutes, giving them a new tool in the toolbox to get to the criminal enterprises,” said Schroer.

Representative Peter Merideth (D-St. Louis City) agrees that fentanyl is dangerous and efforts should be made to get it off the streets, but he does not believe the way to do that is by increasing penalties.

“For the last many decades now we’ve been pursuing a drug war where we try and lock people up for longer times thinking that’s going to help us deal with our drug problem, and it hasn’t.  It hasn’t at all,” said Merideth.  “What we’re really doing is also pulling people out of their communities, out of their families and putting them in prison for extremely long sentences for drugs.”

Representative Peter Merideth (Photo: Tim Bommel, Missouri House Communications)

Florissant representative Alan Green (D) said the longer sentences HB 1450 proposes fly in the face of recent years’ efforts toward criminal justice reform.

“We already got one prison shutting down, we’re looking at shutting down a second prison, and we’re talking about alternative sentencing and all that wonderful stuff now for the last two years, but you’re saying you want to give more to the prosecutors to give them ammunition to go after more cases, but we’re trying to close prisons, so I’m getting mixed messages here.  What are we really trying to do with criminal justice reform here?”  Green asked Schroer.

Schroer argues that criminal justice reform does not mean being “weak on crime, it means being smart on crime.”  He said fentanyl has not been addressed in Missouri and his proposal would do that.

“I agree with the governor … when he indicated that only the most violent of offenders, only society’s most harmful, need to be in our prisons, and I think anybody who’s going to bring these deadly drugs – that even [an amount the size of] a granule of salt will kill several people – those people need to be addressed,” said Schroer.  “If we lock that person up, if they just take a plea deal and are locked away we can’t get to the actual manufacturers, this will continue.  We’re not fixing the issue.  This is a tool which we have seen across this nation is starting to work.”

HB 1450 would also increase the penalties for trafficking one gram or more of Rohypnol or any amount of GHB, both of which are often used in sex crimes.

The House voted 122-33 to send the bill to the Senate for its consideration.

House endorses adding fentanyl, ‘date rape’ drugs to trafficking laws

The Missouri House has proposed strengthening the state’s trafficking laws to include the potent pain reliever fentanyl and its derivatives, as well as Rohypnol or GHB – both commonly known as “date rape” drugs.

Representative Nick Schroer (photo; Tim Bommel, Missouri House Communications)

House Bill 239 would make possession or trafficking of those drugs a felony.  Penalties range from three years to life in prison, depending on the amount of the drug involved.  Missouri laws against trafficking do not include any of those substances.

Lawmakers heard that the abuse of fentanyl steadily increased between 2013 and 2017, and doctors said many people are being treated in emergency rooms because they took heroin mixed with fentanyl.

Bill sponsor Nick Schroer (R-O’Fallon) said there is a hole in Missouri’s trafficking law, so prosecutors often must charge for whatever drug fentanyl is laced with.  He said more and more it’s being trafficked by itself, as it’s becoming more popular to abuse.

“I have two beautiful, amazing daughters that I kind of want to ensure … that they are not going to be exposed to these things such as fentanyl and carfentanyl and these other drugs of choice that are so dangerous that being prescribed in a micro-milligram fashion can actually kill you,” said Schroer.

Fentanyl is 50 to 100 times more potent than morphine and is legally used to manage pain, especially after surgery.

“We saw right before the hearing [on HB 239] that there was a record bust in the United States – 260 pounds was busted at the [U.S.] border … but in years past we’ve had many different seizures on Highway 44, Highway 70, where it was 30, 40 pounds, which was enough to kill not only everybody who’s in this Capitol right now, and this Capitol is full, it could kill many Missourians,” said Schroer.

As a criminal defense attorney Schroer represented a number of people who had battled heroin addiction.  That’s how he became aware of the rise of fentanyl.

“The majority of those people said, ‘Once fentanyl came into the picture a lot of my friends either died or a lot of my friends became so hooked that we thought it was a lost cause,’” said Schroer.

Representative Gina Mitten (photo; Tim Bommel, Missouri House Communications)

Representative Gina Mitten (D-St. Louis) sponsored the amendment that would make possessing or trafficking Rohypnol or GHB punishable by the same penalties as those for other controlled substances.

“If you’ve got somebody at a party that’s got 37 grams of marijuana, why would they have received a greater sentence than somebody that has less than a gram of Rohypnol or GHB?” asked Mitten.  “My amendment … ensured that there was parity between those substances, because personally I believe that the ‘date rape’ drugs are apt to do a heck of a lot more damage than a large amount of marijuana or even heroin.”

Schroer and Mitten both acknowledged that Rohypnol and GHB are also used extensively in sex trafficking.

“If we’re going to take a hard stance on human trafficking it needs to include these substances,” said Mitten.

Schroer anticipates some in the Senate might try to make additions to HB 239 and then send the bill back to the House.  He is optimistic that Governor Mike Parson (R) would sign the bill if it gets to him.