Colorado Lawmakers move forward with Fentanyl Accountability Bill
According to a recent report, a rising number of deaths in the US continue to come from overdoses involving fentanyl. This alarming trend is particularly concerning for vulnerable populations such as those with co-occurring mental health and substance abuse disorders.

Fentanyl Deaths on the Rise

According to recent data from the Centers for Disease Control and Prevention, US deaths involving synthetic opioids, largely fentanyl, rose to approximately 71,000 in 2021 from 58,000 in 2020.

Fentanyl is a white powder, making it easy to combine with other drugs, including opioids like heroin. The drug can also be added to substances like methamphetamines and cocaine and made into counterfeit pills for anti-anxiety drugs like Xanax. Such combinations can be deadly if a user is unaware that they are taking fentanyl or are unsure of the dose.

Dually Diagnosed Individuals at Increased Risk of Fentanyl Overdose

Dual diagnosis is a term used to describe a person diagnosed with a mental illness and substance use or abuse and disorder. Over 50% of persons with serious mental illness also have a substance use or abuse disorder. Dual diagnosis is sometimes referred to as co-occurring disorders or comorbidity. According to the National Survey on Drug Use and Health, in 2020, 17 million US adults simultaneously had a mental illness and substance abuse disorder.

Recent research has revealed that “those with mental disorders appear to be at increased risk of intentional and unintentional fatal and non-fatal opioid overdose, with both prescription and non-prescription opioids.” These overdoses have been found to exist in a wide variety of subpopulations.

Depending on the individual’s diagnosis, symptoms, and course of treatment, dually diagnosed individuals using illegal substances may not be in a state of mind to assess risk, thereby inhibiting their ability to protect themselves from a fentanyl-related overdose. Additionally, research indicates that individuals struggling concurrently with mental disorder and opioid use experience higher levels of complexity in symptoms, face more pronounced exclusion, require more integrated treatment, have poorer outcomes, and incur higher costs.

Colorado’s “Fentanyl Accountability Bill”

After months of debate between Colorado lawmakers, harm reduction advocates, and law enforcement groups, Colorado Governor Jared Polis signed the “fentanyl accountability bill (HB22-1326) into law. The new law creates tougher penalties for fentanyl possession. However, it also provides some funding for drug treatment, harm reduction, and other related services.

In effect, HB22-1326 lowered the threshold amount for felony possession of fentanyl or drugs that have been combined with fentanyl. The new law will make it a felony to possess more than one gram of fentanyl compound/mixture.

Further, first-time offenders could get up to six months in jail and two years' probation. However, unlike other felonies, those convicted for the first time of this offense would not be sent to prison. In addition, if a convicted person completes their probation and court-ordered substance abuse treatment, their charge can be reduced to a misdemeanor on their record.

Treatment Options and Prosecutorial and Judicial Discretion

Although ordering a fentanyl offender to attend substance treatment is an option, according to a recent report, treatment is not equally available across the state. Further, individual prosecutors and judges will have discretion over how to apply the felony. Consequently, people in different communities may face vastly different consequences for fentanyl possession. It is also unclear how this disparity will impact dually diagnosed individuals.
Harm Reduction

Although the new law provides harsher penalties for those in possession, it also requires that county jails offer medication-assisted treatment by July 2023. Jails will also have to assess those arrested for substance abuse disorder and may have to prescribe those individuals medications like buprenorphine or methadone. Cities and counties must also work with managed care organizations to provide detox and stabilization services. The state is also required to study fentanyl and several related topics. However, the new law does not mention how local governments and these entities will incorporate mental health initiatives for those who are dually diagnosed.
Addiction and Mental Health
When an individual is dually diagnosed, they can suffer from symptoms that interfere with their ability to function, cope with stressors, and assess risk. Further, mental health and substance abuse disorders impact one another. When a mental illness goes untreated, individuals with substance abuse disorders often increase their use of drugs or alcohol. As substance abuse increases, mental health issues usually increase as well. For those who are using drugs such as heroin, cocaine, and methamphetamines to self-medicate for mental health symptoms, the risk of encountering fentanyl is likely to increase.
The Criminal Justice System and Dual Diagnosis
According to recent research, dually diagnosed patients perpetrate crime more often than healthy individuals. Further, those with serious mental illnesses such as schizophrenia, anxiety disorders, major depression, and bipolar disorder have a high comorbidity with substance abuse disorders. Consequently, “the legal corepercussions and destabilizing effects of drug and alcohol use on the course and treatment of psychiatric illness, many individuals with a dual diagnosis become involved in the criminal justice system.”
Increased penalties for fentanyl possession, such as those in the new Colorado law, could adversely impact this group and lead to more arrests and convictions. Once incarcerated, these individuals often become more symptomatic and have less favorable outcomes due to a lack of mental health and substance abuse treatment in jails and prisons. 
If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental disabilities. To schedule a consultation, contact us or call (509) 991-7058.
Additional Resources
‘You Ain’t No Big Man’: Videos Show Disparities in Cleveland Police Response to Kids in Crisis

An ambulance was already outside the East Side Cleveland home, its lights flashing, when the police officer arrived one evening in December 2020. According to body camera footage from the incident, the aunt of an 8-year-old with attention-deficit/hyperactivity disorder said the boy was “acting crazy.” At one point, she said he had climbed out a window onto the house’s roof.
Addressing College Mental Health With Compassion And Common Sense

In discussions about college mental health, the focus has almost always been on what resources schools are providing on campus and how those can and should be expanded. Are there enough therapists? Peer counselors? Training for RAs?

These are all fair and urgent concerns, especially as rates of anxiety, depression, self-harm, and suicide soar among teens and young adults. But if colleges are serious about their commitment to mental health, they must also start addressing a barrier to care that’s easily overlooked: their leave of absence policies, which have long stigmatized mental illness and too often penalize students who are forthright about their conditions.
Are White-Collar Criminals Sociopaths?
Having studied over a hundred white-collar criminals with an insider’s view for over eight years, I am often asked if those who commit these crimes are sociopaths or psychopaths. Interestingly, this question is most often posed to me directly by the spouses of the perp. I am not a clinician so that question, although valid, would require the professional evaluation of a specialist in a clinical setting.

Neither sociopathy or psychopathy are considered clinical terms or disorders, but both are included in the Cluster B category of personality disorders that include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. Regardless of any formal diagnoses it has been established by criminologists that those who commit white-collar crimes have attributes associated with Cluster B disorders, particularly, antisocial personality disorder and narcissistic personality disorder.  
How could a mother allegedly kill her children? Experts say mental health can distort thinking.

It seems beyond comprehension: A Duxbury woman has been charged with murdering two of her children, ages 3 and 5, and her third, a 7-month-old, has been hospitalized with traumatic injuries.

Neighbors said they never noticed anything unusual about the home with weathered shingles and a swing set in the backyard. And indeed little is known about what preceded the horrible occurrences of Tuesday evening. Authorities said the mother, Lindsay Clancy, jumped out of a second-story window in what may have been a suicide attempt, and remains hospitalized.

What would prompt a mother to do such a thing?
NY students ‘deliberately inappropriately’ restrained 214 times in recent years, state says

ALBANY — State investigators found staff at New York schools serving children with disabilities intentionally misused physical restraints on students dozens of times annually in recent years, records obtained by the Times Union show.

The Justice Center for the Protection of People with Special Needs, a state agency that investigates allegations of mistreatment, substantiated 214 such cases between 2016 and 2021. The center classifies these encounters as a form of abuse.
A better Rx for mental health crisis

This winter has seen a renewed focus on severe mental illness and discussion of how New York can best address the health and safety of these residents. As an emergency room psychiatrist, I began my career on the front line of addressing mental health crises in NYC and saw firsthand the limitations that short-term interventions have on bringing long-term health and stability to residents living with these health concerns.

In a city where an estimated 1 in 25 residents have a severe mental illness, involuntary commitment and a revolving door of emergency department visits have become a permanent stopgap for those with acute needs yet do little to alleviate the root of these residents’ troubles.
Representing People with Mental Disabilities: A Criminal Defense Lawyer's Best Practice Manual

Published by the American Bar Association. Topics include:

  • Competency
  • Sanity
  • Malingering
  • Neuroscience
  • Jail and Prison Conditions
Representing People with Autism Spectrum Disorder: A Practical Guide for Criminal Defense Lawyers

Published by the American Bar Association. Topics include:

  • Co-Occurring Disorders
  • Testing
  • Competency
  • Risk of Violence
  • Mitigation
Suicide and its Impact on the Criminal Justice System

Published by the American Bar Association. Topics include:

  • Co-Occurring Disorders
  • Testing
  • Competency
  • Risk of Violence
  • Mitigation.
Families' Guide to Working with a Criminal Defense Lawyer
Representing People with Dementia: A Practical Guide for Criminal Defense Lawyers
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