In the face of one of the worst opioid crises in the country, Alabama lawmakers are considering everything from syringe exchanges to criminal justice reform as they seek to address an epidemic that claimed more than 5,000 lives across the state between 2006 and 2014 and has put thousands at risk for HIV and hepatitis C virus (HCV) infection, reports.

Alabama leads the nation in the number of opioid prescriptions per capita. The state also does not have any legal syringe exchange programs or training programs for state doctors to learn how to treat the epidemic. In response, Alabama Governor Kay Ivey’s Opioid Overdose and Addiction Council has made several recommendations to state leaders seeking new ways to curb the impact of the crisis.

The council, which includes local prosecutors, medical professionals, treatment providers and patients in recovery, proposed increased penalties for the trafficking of fentanyl (a deadly injectable opioid known for its overdose-causing potential), improving access to the drug naloxone, which can reverse these overdoses, and improving state databases designed to track the region’s opioid and addiction epidemics.

The council also wants to improve access to addiction treatment and proposes that the government build a website to help reduce the stigma of substance abuse and provide education for Alabama drug court judges, many of whom do not allow defendants to use methadone or other medication-assisted treatments under the supervision of their doctors. Another recommendation includes adding two addiction medicine fellowship programs in the state for doctors-in-training. 

Lawmakers also reintroduced two bills that failed to pass in 2017 that would authorize syringe exchange programs in areas at high risk for HIV and hepatitis C outbreaks from injection drug use. Recently, the Centers for Disease Control and Prevention identified four rural Alabama counties as prone to potential epidemics, heightening the urgency of that conversation.